Neighbourhood health in practice

Lessons from reducing frequent attendance at A&E

Using in-depth interviews with people who have frequently attended A&E, and professionals working to support them in the community, this report identifies five key lessons for policymakers when designing and delivering neighbourhood health services.

Neighbourhood health is a key vehicle for the UK government to move care closer to people’s homes while delivering the shifts towards a more preventative and community-based health system, as set out in the NHS 10 Year Health Plan for England.

Our report, Neighbourhood health in practice: lessons from reducing frequent attendance at A&E, draws on research conducted with two British Red Cross HIU services: in the East Riding and in Brighton and Hove. High Intensity Use of A&E (HIU) services support people who have attended A&E or used ambulance services at a high frequency, often as a result of unmet clinical and non-clinical needs. These services are run by the NHS or by VCSE organisations, with the British Red Cross being a leading provider in England.

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An illustration showing the cover of the Neighbourhood Health report as a drawing of four jigsaw pieces being put together by a diverse group of people. Each piece is around the size of a person. — (Credit: British Red Cross)

HIU services offer an example of how neighbourhood working can look in practice, providing a person-centred model of care that improves health outcomes while also reducing avoidable demand on urgent and emergency care.

Through in-depth interviews with nine people, including people supported by a British Red Cross HIU service, HIU service staff, and professionals who work with the service, we have identified five key lessons for local systems and national policymakers to consider when designing and delivering neighbourhood health:

1: The importance of person-centred care in meeting complex needs

A strength of the HIU service is that flexible support is centred around the individual, their needs and what matters to them, giving people a greater sense of agency in their own health. For those with multiple and complex needs, low health literacy, a lack of confidence, or who are socially isolated, the health and care system can feel siloed and difficult to navigate. A person-centred approach should be at the heart of neighbourhood health to effectively meet the needs of people most at risk of falling between gaps.

2: Utilising partnerships and cross-sector coordination to connect people with the right support

The HIU service supports people with multiple needs by working with partners to coordinate care across different parts of the system and connect people to services in their community. However, strain on services, barriers to data sharing, short-term contracts and system reorganisation make it hard to build the cross-sector relationships this work relies on. Addressing these challenges will be important if neighbourhood health is to deliver in an integrated, joined-up way.

3: Investing time to build relationships and break down barriers to care

The HIU service does not limit the length of time that someone can receive support. This enables caseworkers to build trusting relationships and develop a full understanding of someone’s clinical and non-clinical needs. While it is not always required, for people with complex needs or those who distrust services, longer-term support and continuity of care can break down barriers to engagement. Neighbourhood health is an opportunity to provide greater continuity of care and personalised support that can rebuild trust.

4: The value of the non-clinical workforce in addressing the wider determinants of health

HIU caseworkers are specially trained non-clinical staff who offer support to people with wider social needs, which often have a knock-on effect on clinical needs. Neighbourhood health offers an opportunity for clinical and non-clinical professionals to work together to provide holistic and complementary care, while maximising the skills and capacity of different staff groups.

5: The role of funding and commissioning levers in incentivising neighbourhood working

We heard from health and care professionals that the NHS and wider services are under significant financial strain, and the pressure to reduce costs can mean that community services are deprioritised. Misaligned incentives can result in spending in one area leading to financial savings in another, which discourages working across organisational boundaries. Contracting, payment and oversight mechanisms that encourage whole-system working will best enable neighbourhood health to deliver improved population health outcomes and provide joined-up care.

To read more about our work on frequent attendance at A&E please see our previous reports Nowhere else to turn and Seen and heard.

For more information, please email advocacy@redcross.org.uk