Paramedic’s brainwave eases A&E pressures by keeping “frequent callers’ away

A senior paramedic’s light-bulb moment that has cut A&Es visits from “frequent callers” by up to 90 per cent is being rolled out across the country.

The High Intensity User programme was the brainchild of Rhian Monteith, who was working as an advanced paramedic in Blackpool when she noticed that a very small group of people took up a great deal of NHS resources and staff time.

Working with other NHS teams, Rhian drew up a list of 23 patients, many suffering from mental health problems or loneliness, who had visited A&E 703 times in the previous three months, mostly by ambulance.

Rhian decided to tackle their problems by meeting for coffee and a chat. Through personal mentoring and one-to-one coaching, as well as getting them involved with community activities, and encouraging them to phone her rather than call 999, Rhian helped A&E attendances, 999 calls and hospital admissions drop by about 90 per cent among the group. Eventually the patients were able to cope for themselves and came to call Rhian less often.

The scheme was then scaled up to cover about 300 patients in Blackpool over the following three years, saving the NHS more than £2million. It has now been rolled out to around a fifth of the country with 36 local heath teams adopting the scheme.

NHS England now wants the remaining clinical commissioning groups to take on the idea through its RightCare programme, which aims to improve care for patients while making the NHS more efficient.

Nationally, around 5,000 people attend major A&E units more than 20 times each year. In 2016 they accounted for 0.05 per centof A&E visitors, but about 3 per cent of spending, or £53 million so the potential to improve care while saving NHS money is huge.

Rhian Monteith, who now works as the High Intensity User lead with the RightCare programme, said: “This scheme is about making sure people are not left behind in society and not medicalised or criminalised. Every individual is put in contact with a person in their lives who cares about them, and stands with them in their time of need

“I’m incredibly proud to see how my idea has grown and it shows how, if you are armed with a phone and a high level of emotional intelligence, and ask people ‘what matters to them’ instead of ‘what’s the matter’, the difference you can have to people who need a hand up in life.”

Tessa Walton, Director of NHS Delivery, said: “The High Intensity User programme is a fantastic example of what we are trying to achieve – improving patient care while reducing some of the pressure on NHS services through new ways of working. We really want to see all local NHS areas using this idea to benefit their patients and services.”

“The fact that it was an advanced paramedic working on the front line of patient care that spotted the potential demonstrates that, regardless of where in the health service someone works, a good idea can have a huge impact across the whole NHS.”