Nowhere else to turn

The British Red Cross recently published their new health inequalities report, Nowhere Else to Turn, which explores the complex and often non-clinical reasons for high intensity use at A&E, listening to those with lived experience.

People who frequently attend Accident and
Emergency (A&E) are few in number, but
their impact on health systems is significant.
They make up less than one per cent of
the population, but account for a significant
proportion of all A&E attendances, ambulance
journeys and hospital admissions. They cost
the NHS at least £2.5bn per year.

This report draws on in-depth analysis of health data from North West London, undertaken in 2020 by Imperial College Health Partners – we analysed frequent attendance among a cohort of 2.2 million patients.

This research aimed to explore comprehensively the high intensity use at A&E in England. It aimed to answer the following questions, including:
– What are the demographic characteristics of people attending A&E regularly?
– What triggers high intensity use of A&E services?
– What patterns can we observe in people’s patient journeys?
– How could people attending A&E regularly be supported better?

In order to answer these questions a mixed-method approach was used, including:
– a literature review
– a quantitative analysis of a novel 6-year longitudinal nationwide dataset covering 367,000 people frequently attending A&E
– a quantitative analysis of emergency department diagnosis data from 3 major acute trusts
– 14 semi-structured interviews with people who were frequently attending A&E
– 17 expert interviews with health and care professionals supporting people who were frequently attending A&E services
– Imperial College Health Partners Research in North-West London analysed frequent attendance among a cohort of 2.2 million patients

• While only 0.67% of the English population attend A&E frequently, as a group they are significantly over represented in emergency care, accounting for 16% of all A&E attendances, 29% of all ambulance journeys and 26% of all hospital admissions in England.
• Our research estimates the cost to the NHS of the high intensity use of A&E to be £2.5bn per year.
• 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.
• Supporting people who frequently attend A&E would have a wide range of benefits, including improving people’s life expectancy, quality of life and experience of care as well as reducing pressures on the healthcare system.
• Mortality rates are higher among people who frequently attend A&E than among the overall population of A&E attenders.
• The risk of mortality is highest among the younger members of this group. Those attending very frequently and with especially high levels of self-harm and suicidality are also especially vulnerable.

The data enabled British Red Cross to make a series of recommendations:

NHS England and Improvement and the Department of Health and Social Care should:
– Update guidance on the development of High Intensity Use services to reflect new NHS structures, including ensuring that Integrated Care Systems develop strategies for high intensity use across their areas
– Incentivise improved recording of patient data and information-sharing regimes between emergency departments, community health and non-clinical services
– Agree a consistent set of national measures to evaluate the impact of High Intensity Use services and to build the evidence to support investment.