22 November 2021

Press release - Deprivation driving repeat A and E visits

Press release
0:01am Monday 22 November 2021
For further information 
press@redcross.org.uk, 02078777299 / 07710 391 703
Interviews available on request.
Embargoed report available via https://www.redcross.org.uk/nowhere-to-turn . 
Spokespeople available

Deprivation driving repeat A&E visits, says Red Cross

Vulnerable people are turning to A&E because they feel they have nowhere else to turn, according to new research from the British Red Cross – which reveals some people attend A&E over 300 times a year. 

High intensity use of A&E is defined as five or more visits in a year. The report looks at the complex reasons behind repeat visits to A&E, and how interventions benefit both patients and the NHS. The findings are a result of analysis of existing evidence, data from 376,000 people who frequently attended A&E in England across six years, plus interviews with GPs, A&E staff and patients. 

Research undertaken by the charity found:
Less than one per cent [0.67 per cent] of the English population attend A&E frequently, but as a group they account for 16 per cent of all A&E attendances, 29 per cent of all ambulance journeys and 26 per cent of all hospital admissions in England
Reasons behind repeat A&E attendance vary. People in this group are more likely to live in the most deprived areas and have physical symptoms that require admission to hospital but are often dealing with sudden life changes such as job loss, relationship breakdown, or grief combined with social and economic challenges. Housing insecurity, loneliness, and mental health issues are other common factors. 
People who frequently come to A&E move home 25 per cent more often than the general population. 
The mortality rate among people aged between 30 and 49 who frequently attend A&E is 7.5 times higher than among this age group in the general population.
People who frequently attend A&E often feel unheard, leading to dissatisfaction and disengagement with health services more generally. 

The charity estimates the issue costs the NHS at least £2.5bn a year. 

The research points to the positive impact of High Intensity Use services which can reduce A&E attendance and non-elective admissions amongst people who frequently attend by up to 84 per cent. These services work with people to understand the reasons behind repeat visits to A&E and provide personalised support. 

Currently there are around 100 High Intensity Use services in England run by the NHS and voluntary sector, covering different health settings, including mental health, A&Es, primary and secondary care. However, not all hospitals have access to a dedicated service. 

The British Red Cross is calling for more services to help people who end up in A&E multiple times, including: 
More dedicated ‘High Intensity Use’ teams available across the country.
Improved access to community-based support, to prevent people reaching crisis point.
Action to address health inequalities and wider determinants that affect people’s health.

Mike Adamson, British Red Cross chief executive said: 

“High intensity use of A&E is closely associated with deprivation and inequalities - if you overlay a map of frequent A&E use and a map of deprivation, they're essentially the same. When multiple patients are making repeat visits to an A&E, that should flag the need to tackle other issues like barriers to accessing services, or societal inequalities that affect people’s health.

“For example housing insecurity is a common challenge - people who frequently come to A&E move home more often than the general population. This has a knock-on effect on people’s finances, mental health, social networks and access to services.”

Julia Munro, British Red Cross lead on High Intensity Use services said: 

“When someone is repeatedly coming to A&E, it often indicates they are facing wider problems. We work with people who face all kinds of challenges, from poor housing to grief to childhood trauma, or who are struggling to cope with ongoing health issues. 

“Getting the right help for people reduces ambulance and A&E use and hospital bed days, but most importantly it brings positive change to people’s lives. We’d like this support to be available to everyone who needs it.

“One gentleman we worked with had an undiagnosed health issue, but he also had no heating or hot water, and was going without food due to confusion over his benefit support. By listening and building trust we were able to get his finances sorted, the boiler fixed, and connect him to a local community group for support. In the last six months of working with him, he only visited A&E once, and now has a diagnosis for a developmental disability which helps healthcare staff better understand his needs.”

Case study

Zach*, a young father in his 30s, struggled to cope when his son became ill. A combination of his own difficult childhood, worries about his son’s health and heavy drinking meant he hit ‘rock bottom’ and he was often in A&E. He spent time in prison and worked to reduce his drinking and establish a better mental health regime. However, on release from prison, he lacked a support network and began attending A&E again. 

“I didn’t have the mental health support I’d had in prison. I was discharged and didn’t know what to do with myself. People in hospital did everything they could do; I was just all over the place and didn’t know what to do with myself. My mental health wasn’t in the best place. I saw these unwell people and I was sitting there feeling like I was in the wrong place. I should have said everything that was going on.”

Zach was put in touch with a High Intensity Use service. His service lead was someone he could talk to and has helped him sort out his benefits and directed him to a local foodbank. 

Zach is now in a better situation. He says he tries to keep himself busy and while he doesn’t have a plan, he intends to “make the best of what comes next”.
“For other people in situations like mine, I want them to have someone to talk to.”

*Zach’s name has been changed to protect his identity. 

Notes to editor:

The British Red Cross
For more than 150 years, the British Red Cross has helped people in crisis, whoever and wherever they are. We are part of a global voluntary network, responding to conflicts, natural disasters and individual emergencies. We enable vulnerable people in the UK and abroad to prepare for and withstand emergencies in their own communities. And when the crisis is over, we help them recover and move on with their lives. redcross.org.uk 

To download the full report go to: https://www.redcross.org.uk/nowhere-to-turn 

Research methods: 
The research, commissioned by British Red Cross, was undertaken by Public Service Consultants (PSC). 

From January to November 2020 a mixed methods research study was undertaken to generate insight on people who attend A&E frequently. We aimed to develop a more robust quantitative picture than was previously available, as well as explore the diverse human experiences sitting behind these numbers. We did this using: 
A literature review of over 50 associated papers 
Analysis of a novel 6-year longitudinal nationwide dataset covering 376,000 people frequently attending A&E 
14 in-depth semi-structured interviews with people who have frequently attended A&E 
17 expert interviews including GPs, A&E staff and high intensity use leads 
Analysis of A&E diagnosis and admission data for three major NHS Trusts.  

Estimation of £2.5bn impact to NHS

Based on ambulance journeys, A&E attendances, and inpatient stays2, we estimate that this issue costs the NHS £2.5 billion pounds per year.3 Providing better and more effective support to people who frequently attend at A&E, and enabling them to reduce their usage of acute care, will in turn reduce pressure on the system and create significant cost savings.   

For full analysis of costs, see appendix B of the full report. 
Explainer on ‘most deprived areas’ and high intensity use of A&E: 
Our national HES dataset shows that people who frequently attend A&E are more likely to live in areas with higher levels of deprivation (based on the standardised measure of deprivation, the Index of Multiple Deprivation or IMD) with 20 per cent living in the most deprived areas (IMD band 1 of 10).

Information on British Red Cross High Intensity Use services
We work in all seven English NHS regions providing services to help reduce high intensity use of A&E. British Red Cross currently run 35 High Intensity Use services, 17 with A&Es, and is recognised as a leading provider. 
Our approach is based on the NHS Right Care model, in which an agreed number of people who frequently attend A&E are identified by our practitioners for support, and asked if they would like to try something different. 
We work with people to understand what is causing the repeat visits, what’s happening in their lives, and where they need support. 
We listen. We help navigate the system, advocate for people, and build their strength and resilience so they can take control of their own wellbeing. 
Everyone who is supported by HIU services starts from a ‘clean sheet’, so that from the moment they accept support they can create a new narrative which no longer focusses on what is “wrong with them” but rather what is “right with them”.  
Our approach is personalised, de-medicalised and decriminalised. Support is not time-limited and is based on what the individual needs. 
The people we help have often hit rock bottom, and don’t know where else to turn 
Our model has expanded, we also have services working with people who frequently use Mental Health Services (Liaison Psychiatry Services and Admissions) and Primary Care. We are also developing services across the devolved nations.