Personal View: I don't like Mondays (after bank holidays)
Authors: Peter Kirkbride
Journal: BMJ (2004)

Although everyone, to some extent, lives their life according to the days of the week, this phenomenon is perhaps most noticeable in the NHS. If it's Tuesday, it must be theatre/clinic/ward round. This is never so clear as in spring, when each hospital in the United Kingdom has to cancel a disproportionate number of activities scheduled for a Monday because of three bank holidays (Easter, May Day, Whitsun) occurring within a couple of months.​months.




Figure 1





We don't like Mondays either, sang punk band the Boomtown Rats

Credit: ANDRE CSILLAG/REX FEATURES




Anyone who has come into contact with the NHS Modernisation Agency recently will know that it has identified one of the biggest problems leading to prolonged waiting times as a mismatch of capacity and demand. Although this is usually applied to computed tomography, out-patient clinics, etc, it strikes me that there is a capacity and demand mismatch across the whole NHS, caused by the fact that bank holidays are unevenly distributed across the working week. The NHS is highly dependent on days of the week, and almost all hospitals, GP surgeries, and other clinical units are timetabled differently for each working day between Monday and Friday.


The NHS is highly dependent on days of the week


In 2004 there are five bank holiday Mondays, but only one holiday Friday (Good Friday), one holiday Thursday (New Year's Day), and one holiday Tuesday (Boxing Day). There are no bank holidays on a Wednesday this year. This means that the capacity of clinics and operating sessions scheduled on a Monday is almost 10% lower than those on other days of the week. The situation is even more acute in April and May when three out of eight Mondays are public holidays, which means a net loss in capacity of clinical activities of 37.5%, or, for someone like me who does fortnightly new patient clinics in peripheral hospitals, even as much as 50%.

Principles of capacity and demand planning would suggest that we need to minimise the mismatch. I wonder if it might be possible to improve the situation by designating a couple of midweek days in April or May as “NHS Mondays,” when the entire NHS would function as if it were a Monday, even though it is really a Tuesday or Wednesday. This would help alleviate the current imbalance.

This idea has been aired at various levels in the Department of Health, and although some people have responded by saying that perhaps we should not observe bank holidays in the NHS (ideal but unworkable, I think), I have had encouragement from others. However, it has been suggested that initially I should try to make this work as a pilot study at a local level.

Unfortunately trying to alter weekly timetables in one small part of the NHS is difficult. For example, in my specialty—oncology—although I work for one trust primarily, our cancer network is such that we also provide a service to four other different trusts. For this pilot to work in oncology, all five would need to sign up. However, the cancer network is different to all the other formal and/or informal networks that exist, and it seems to me that it would not be possible to enact this without the entire country signing up.

This may be almost as infeasible as asking everybody to work Easter Monday, and I am sure there would be practical difficulties involved, especially with on-call rotas and part time workers. Nevertheless it might have significant benefits. It might also abolish those “heartsink Mondays” that immediately follow a bank holiday, when everything is overbooked, and patients and staff become increasingly exasperated. Depressingly, in April and May, it is inevitable that the whole process will repeat itself a few weeks later.