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Exploring the high intensity use of Accident and Emergency services

Nowhere else to turn

In this report, we evidence that high intensity use of A&E is fundamentally a health inequalities issue.

Our new report, Nowhere else to turn: exploring high intensity use of accident and emergency services, shows that people from the most deprived areas of the UK are more likely to be in poor health and most likely to attend A&E most frequently.

We believe that high intensity use of A&E is fundamentally a health inequalities issue.

'High intensity use' applies to a patient who attends A&E more than five times a year. Some people have gone to A&E more than 300 times in one year and estimate that this has cost the NHS £2.5bn per year.

People who are rushed repeatedly to hospital have a real impact on emergency services, representing 16% of attendances, 29% of ambulance journeys and 26% of admissions.

We believe that there are ways that we can better support people who frequently attend A&E so that they don’t feel they have nowhere else to turn. 

The British Red Cross provides High Intensity Use services across all seven NHS regions which can reduce A&E attendance and non-elective admissions amongst people who frequently attend by up to 84%.

These non-clinical services work with people to understand the reasons behind repeat visits to A&E and provide personalised support. But we know that more is needed to address this issue and support people better frequently going into A&E services.

Key findings

  • People who frequently attend A&E make up less than 1% of England’s population but more than 16% of A&E attendances, 29% of ambulance journeys, and 26% of hospital admissions.
  • Some people end up at A&E more than 300 times a year. Our research estimates this costs the NHS an estimated £2.5bn per year.
  • Deprivation and inequalities are driving repeat A&E visits. People in deprived areas often have physical symptoms that warrant a visit to A&E. However, they are often dealing with sudden life changes such as job loss, relationship breakdown, or grief combined with social and economic challenges.
  • Housing insecurity, homelessness, loneliness, and mental health issues are other common factors.
  • People who attend A&E frequently often make use of other health services too – for example frequent use of GP services can be an ‘early warning sign’ of high intensity use at A&E.
  • Gaps in support in the community, and restrictive eligibility criteria, can lead to people starting to attend A&E frequently.

Our recommendations

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%.

These non-clinical services work with people to understand the reasons behind repeat visits to A&E and provide personalised support. The British Red Cross is calling for action in the following key areas.

1. Putting in place more dedicated ‘High Intensity Use’ services across the country

We are calling for Integrated Care Systems to develop strategies for addressing high intensity use across their areas, ensuring that there is adequate provision to meet need across acute settings, with a particular focus on areas of deprivation.

2. Improving access to community-based support, to prevent people reaching crisis point

We are calling for investment in VCSE provision linked to social prescribing and other key services, such as community mental health as well as increased training and support for GPs and other health professionals to identify and respond to those at risk of high intensity use.

3. Taking action to address health inequalities and wider determinants that affect people’s health

We are calling on the Prime Minister to commission a national cross-government strategy to reduce health inequalities.

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