High Intensity Use programme
Overview
The High Intensity Use (HIU) programme typically supports individuals aged 18 and over who attend an Emergency Department (ED) more than expected. We define this as attending ED more than five times a month, or more than 20 times a year. HIU services also help to reduce frequent use of urgent and emergency care (UEC) services where a person’s needs could be better met elsewhere, such as in community health services or social care.
HIU services are locally funded and are largely delivered in the community via voluntary, community and social enterprise (VCSE) organisations. The services are regionally led and supported at a national level.
Link with health inequalities
Research from the British Red Cross (including their reports Nowhere else to turn: exploring high intensity use of accident and emergency services and Seen and heard: Understanding frequent attendance at A&E) has shown a clear link between high intensity use of UEC services and wider health inequalities and deprivation. HIU services can support UEC pathway pressures whilst at the same time addressing health inequalities, helping to free up frontline resources to see other patients and reduce costs. High intensity use of UEC is associated with focussing help for primarily non-medical factors including housing instability, social isolation, loneliness and deprivation as well as poor physical and mental health. Benefits for clients after engagement with a HIU service include feeling more confident to look after their health; having improved wellbeing; and feeling less lonely.
HIU services are referenced in the Urgent and emergency care recovery plan year 2: building on learning from 2023/24 and the Priorities and operational planning guidance 2024/25, where systems are asked to expand coverage of HIU services as a cost-effective intervention to both manage ED demand and address health inequalities.
Link with productivity and efficiency
HIU services also support the overall productivity and efficiency drive in the NHS, with a range of between 38 and 84 percent reductions in A&E attendances and between 24 and 84 percent reductions in non-elective admissions (Source: Nowhere else to turn: exploring high intensity use of accident and emergency services). For 2023, HIU services supported by the British Red Cross reported a return on investment of 351%, with a 54 percent reduction in A&E attendance, a 50 percent reduction in ambulance conveyances, and a 40 percent reduction in non-elective hospital admissions among service users (Source: Seen and heard: Understanding frequent attendance at A&E).
NHS England HIU service principles
- Identification – The top 250 people who attend ED most frequently are identified utilising ED data systems. A HIU lead will then prioritise clients and provide support for up to 50 clients per year.
- Assertive outreach from a HIU lead – A HIU lead gets in direct contact with a potential client and offers support.
- Personalised approach and coaching – The HIU lead focuses on the individual’s issues, identifying, de-medicalising, de-criminalising and humanising their needs to uncover any underlying reasons for attending ED. The HIU lead visits clients in their usual place of residence or in the community and provides one-to-one coaching.
- De-escalates the issue – Many individuals use healthcare frequently due to an escalation in their social, emotional, financial, or family issues, or an unmet need. The HIU lead works with clients to identify underlying causes of ED attendance and provide more appropriate support or signpost to alternative services.
- Discharge from the HIU service to community, voluntary or statutory support services – Community or voluntary support services are available for ongoing support when a client is ‘discharged’ from the HIU service. Many individuals are reconnected to their community with renewed purpose.
- Manages relapse – HIU services can provide support when individuals begin to feel isolated again or can no longer cope due to a change in personal circumstances. Instead of attending ED, individuals can contact their previous HIU lead directly who can support them.
- Quality of intervention – The intervention provided by the HIU lead is holistic and effective, which in turn creates positive outcomes for clients and delivers financial savings to the wider UEC system.
Resource pack and supporting documents
The HIU service resource pack: supporting documents provides support for systems on setting up a HIU service and includes the following topics:
- Setting up a HIU 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 (available upon request)
Case study
Information on the HIU services within South Tees Hospitals NHS Foundation Trust, Wolverhampton and at Norfolk Community Health and Care NHS Trust can be found on our website here: NHS England » NHS artificial intelligence (AI) giving patients better care and support.
Awards
The HIU programme 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 related to the HIU programme, please email england.prehospital-iuec@nhs.net