Thousands of extra deaths and billions of pounds are being wasted because of NHS weekend slowdowns, emergency doctors are warning the new Health Secretary, James Murray, as ministers prepare long-term reforms for the health service.
The Royal College of Emergency Medicine (RCEM) has calculated that 15,860 excess deaths in England last year were associated with long A&E waits – the equivalent of around 305 deaths every week. Numerous studies have also shown an 11% increase in deaths at weekends, regardless of whether a patient is in the emergency department or awaiting planned surgery. Research from 2015 indicated that patients admitted on a Sunday had a 16% greater risk of death within 30 days compared with those admitted on a Wednesday, while Saturday admissions carried an 11% higher risk. Another study found a 7% higher risk for emergency weekend admissions. However, some researchers have questioned whether the so-called “weekend effect” is a direct result of reduced services or a statistical artefact caused by hospitals admitting sicker patients at weekends because of a higher severity threshold for admission.
RCEM president Dr Ian Higginson, a consultant in emergency medicine, said the fundamental problem is that the NHS tries to cope with seven-day demand using systems built around a traditional Monday-to-Friday working week. “Hospitals go full tilt from 9 to 5 but they drop to an on-call level at evenings and weekends and long bank holidays,” he explained. “The nurses are there, the porters are there, the catering staff are there and the cleaners are there. But most services operate on a five-day week with on-call provision at other times.” The mismatch creates dangerous bottlenecks throughout the NHS, he said, and the college is preparing to raise the issue directly with Mr Murray and Department of Health and Social Care officials.
The bottleneck of discharge
The RCEM argues that one of the biggest causes of overcrowding is the difficulty in discharging patients once they have been admitted. Many patients can receive emergency scans and treatment when they arrive, but then face delays accessing the tests, therapists, social care assessments and community services needed to get them safely home. “Most hospital emergency patients can get a CT scan, an X-ray and often an MRI and get admitted to a ward, but experience longer hospital stays if these are not available once they are on the ward and they’re not an emergency,” Dr Higginson said.
Services that are often reduced outside weekday hours include GP practices, physiotherapy, occupational therapy, social care support, community nursing and mental health teams. As a result, patients come to hospital when they do not need to, and hospitals fill up with patients who are medically fit to leave but have nowhere to go when support services are shut. “The busiest can be weekends and over long bank holidays because people are out and about and all services are not available,” Dr Higginson added. “People go where the lights are on.”
The consequence is severe overcrowding at the start of every week. Mondays and Tuesdays become the worst days “because we are dealing with the backlogs rather than with what is happening and the patients coming in,” he said. “It is even worse after long bank holidays.” In December 2022, an average of 13,440 patients per day remained in hospital despite being ready to leave, according to NHS data. Capacity issues were the leading cause of hospital delays in 2025, affecting nearly 3,700 patients a week who stayed in hospital for seven days or more. Delayed discharges are driven by waits for social care assessments, funding challenges, and a lack of available residential, nursing or domiciliary care places. Dr Higginson noted that internal hospital processes and coordination problems between health and social care services also contribute.
The impact on patients is severe: longer hospital stays can lead to poorer outcomes, loss of independence, increased risk of hospital-acquired infections, and a negative effect on mental well-being due to social isolation. At the same time, the whole system fails to flow. One NHS advisor, who preferred not to be named, said: “No hospital in the UK will ever flow, unload the wards efficiently or clear the emergency corridor care until we have a full seven day service.”
The price of inefficiency
Long waits are not only dangerous but expensive. Research has shown that patients admitted after lengthy waits in emergency departments often stay in hospital significantly longer than those admitted promptly. This creates a vicious circle, with fewer beds available for incoming patients and worsening delays throughout the system. Dr Higginson said: “One recent study showed that when patients are admitted from the emergency department following a long wait they stay a lot longer. This is costing the Health Service and the taxpayer £1.2 billion a year and is linked to 2 million extra bed days. This is wasted money doing things badly and inefficiently.”
The scale of the crisis is reflected in the latest NHS performance figures. The waiting list for hospital treatment crept up to 7.22 million in April, remaining almost three million higher than before the Covid pandemic. Cancer waiting times have worsened, with performance falling to its lowest level for eight months – in March, 72.8% of patients were treated within 62 days of referral under the new standard. A&E waiting times have missed the four-hour target every month since July 2015; in March, 36.2% of patients waited more than four hours in hospital A&E. Nearly 1.74 million patients waited at least 12 hours in A&E last year, while almost half a million waited more than 24 hours. In May, over 50,000 A&E patients waited more than 12 hours from the decision to admit to actual admission. Ambulance response times for Category 2 emergencies such as strokes averaged 29 minutes and 13 seconds in May, well above the target, while 24.3% of ambulance handovers exceeded 30 minutes. The number of patients treated in A&E corridors, cupboards, offices, car parks and lavatories has reached almost 3,000 a day – 2,241 in corridors and a further 669 in makeshift spaces.
The proposed solution
The RCEM wants a fully seven-day service built into the Government’s long-term NHS reforms. This would require more hospital doctors to cover the extra days, greater access to diagnostics, therapists, discharge teams and community services throughout the week. “We need a mission to do this,” Dr Higginson said. “If the NHS worked as a fully seven day operation we could get people assessed and treated from home or in other healthcare settings. This is about doing today’s work today and not building up queues for later.”
The push for seven-day services is not new. Some trusts have piloted extended services: Chesterfield Royal Hospital NHS Foundation Trust introduced seven-day services in A&E and general medicine, which they estimated paid for itself through reduced admissions and lengths of stay. However, the concept has faced challenges. Critics argue that the definition of “seven-day services” has been unclear, making implementation and measurement difficult. Some studies have found little difference in clinical outcomes between trusts that introduced weekend services and those that did not. Concerns exist that diverting resources to weekends could harm weekday care, and significant gaps in consultant rotas already exist in many A&E and acute medical units – even on weekdays. The £10 billion increase in the NHS budget between 2015 and 2020 was noted as not covering the cost of expanding Saturday and Sunday services, and some experts suggest it could take 20 years to achieve a fully operational seven-day NHS within current funding.
A Department of Health and Social Care spokesperson said: “It is unacceptable for patients to face long waits for emergency care, and hospitals should ensure that key services are available every day of the week, not just Monday to Friday, so that healthy patients can be discharged safely and promptly while creating space for others that need it. To reduce pressure on A&E, this government is investing more than £215 million in 40 new and expanded same-day emergency care and urgent treatment centres across England, and while deploying specialist teams to trusts with the highest levels of corridor care. Despite record demand, the NHS delivered a stronger performance this winter but, with record investment, we are going even further to modernise urgent and emergency care and make sure every patient gets the treatment they need, when they need it.”