Somerset NHS Foundation Trust has successfully reduced emergency department attendances by 58% among frequent users, thanks to its High Intensity Use (HIU) service.
Launched in August 2023, the HIU service aims to provide targeted support to patients who regularly visit A&E, ensuring they receive the right care in the right place.
The HIU service has made a remarkable impact in its first year. A total of 141 individuals, who previously accounted for 1,963 A&E visits, saw their attendances drop to 1,189 – a 48% reduction across all age groups. This achievement far exceeds the national standard set by NHS Right Care, which targets a 20-40% reduction.
Commenting on the service, Somerset NHS Foundation Trust’s High Intensity Use Service Lead , Neil Thomas, said:
“Research shows that there’s a clear link between a high intensity use of emergency services and wider health inequalities, such as age, housing instability, social isolation, loneliness, deprivation, as well as poor physical and mental health.
“This is why we’ve taken care to ensure that our high intensity use service has been designed and developed alongside people who have lived experience of accessing healthcare regularly.
“A very small percentage of patients account for 16% of all emergency department attendances in Somerset, as well as 26% of hospital admissions, and 29% of those brought to hospital by ambulance.
“Our service is helping us to identify those people who are our top attenders, so we can find out about their unmet needs in the community, and what we’re not getting right for them.”
The success of the HIU service is attributed to the collaborative efforts of clinicians from Somerset NHS Foundation Trust’s psychiatric liaison teams and emergency departments. By working closely with patients who have a history of high intensity use, the team has been able to identify unmet needs and provide appropriate support.
One of the key strengths of the HIU service is its ability to quickly spot trends. For instance, the team can identify spikes in under-18s with a history of self-injury, allowing for timely interventions. This proactive approach ensures that emerging issues are addressed promptly, further reducing the strain on emergency services.
Neil added:
“We worked closely with our colleagues at the NHS Somerset Integrated Care Board to set up three separate high intensity use committees.”
“These are in the east and west of Somerset to represent the emergency departments at Musgrove Park and Yeovil hospitals, as well as the first ever high intensity use service for under 18s in the country.
“We set up a full data reading system across both emergency departments, so anyone identified as attending at least 10 times in three months, are now discussed at our committee meetings, which are attended by a range of clinicians and non-clinicians from different agencies.
“Depending on the patient’s needs, we may then ask our colleagues at Ubuntu, which is run by the Community Council for Somerset to find non-healthcare alternatives for people, to create a non-clinical approach at pace, pulling together services and thinking differently around the individual’s needs.
“Ultimately this digs deeper into the unknown needs for the individual in the community, and it ideally brings them a better quality of life, as well as reducing pressures on our frontline services.”
Image credit: Somerset NHS Foundation Trust
