High Intensity Use programme

The High Intensity Use (HIU) Service has been designed and developed with people who have lived experience of accessing healthcare regularly. The services are commissioned and delivered at local level, regionally led and supported at national level.

Research has shown a clear link between high intensity use of emergency services and wider inequalities. HIU services can support urgent and emergency care (UEC) pathway pressures whilst at the same time addressing health inequalities, helping to free up front line resources to see other patients and reduce costs. High intensity use of UEC is associated with focussing help for non-medical factors including age, housing instability, social isolation, loneliness, deprivation, and as well as poor physical and mental health. Outcomes include reducing health inequalities and a reduction in avoidable emergency department attendances and non-elective admissions.

The service comprises a high intensity use lead that proactively makes contact with the most frequent attenders of the local A&E to find out how the local health and social care system could better meet their needs. ICBs can fund HIU leads through the system allocated health inequalities funding 2022/23

I feel safe. Someone who understands me, someone who listens to me, and knows to help me by heart. Client

HIU is a core objective in NHS England Winter Plan 2022 “Next steps in increasing capacity and operational resilience in urgent and emergency care ahead of winter” and HIU features in the integrated care board assurance framework. In the 2023 planning guidance on embedding measures to improve health and reduce inequalities:

“Continue to deliver against the five strategic priorities for tackling health in equalities and establish high intensity use services to support demand management in UEC.”

NHS England HIU service principles

  • identifies the top 50 people who make most high intensity use of A&E identified utilising A&E data systems
  • personalised and direct contact from a HIU lead focusing on the individual’s issues, identifying, de-medicalising, de-criminalising and humanising their needs to uncover the ‘real’ reason for attending A&E or an admission
  • De-escalates the issue as many individuals use health care frequently due to an escalation in their social, emotional, financial, or family issues, an unmet need
  • Discharge from the project to community or voluntary support services. Community or voluntary support services are available when the individual needs on-going support but not at the intensity or level of the HIU Lead. Many are reconnected to their community with renewed friends and purpose.
  • Manages relapse occurring when individuals begin to feel isolated again or can no longer cope with a change in situation. They may begin attending A&E again, individuals contact the HIU lead directly who picks up their issue and helps them, rather than feeling the only option is to reattend A&E.
  • Quality of intervention. Higher quality more personalised and effective interventions create positive outcomes for individuals and deliver financial savings to the system with increased pace.

Resource pack and supporting documents

This resource pack provides support for systems on setting up a HIU service.

These resource pack supporting documents provide systems with guidance on setting up a HIU service

  • setting up a high intensity use service
  • HIU service specifications
  • HIU Information Sharing Agreement
  • implementation timescales
  • HIU person specification
  • HIU job description
  • HIU consent form
  • equality impact assessment
  • privacy impact assessment
  • HIU evaluation
  • a bespoke business case is available upon request.


The HIU service has received the following awards:

  • 2019 Healthcare Transformation Award for ‘Innovation in reducing variation and improving outcomes’
  • 2018 Kate Granger Compassionate care organisation award

For queries please email england.prehospital-iuec@nhs.net