Integrated referral scheme helps reduce accident and emergency visits by 60 per cent

Case study summary

A new project run by partner organisations in Devon has helped regular users of accident and emergency (A&E) and other emergency services to tackle issues such as housing and finance. Consequently this has improved the lives of these service users, reduced their A&E visits by 60%, and saved taxpayers £200,000.


One Northern Devon – part of Devon Integrated Care System (ICS).

What was the aim?

Police, social care, the NHS and other partners in Devon formed the One Northern Devon programme. In turn, this group set up the ‘High Flow project’ to identify and provide support to individuals with highly complex, multiple needs who frequently access services – but not necessarily those services most appropriate for their needs.

Andrea Beacham, One Northern Devon Programme Manager: “Medical treatment is just one aspect [of regular attendees’ needs] and may not be the most pressing issue. The NHS alone cannot offer solutions to those people attending A&E regularly; but working with other organisations, we can make the most of our relationships with our local authority partners, our ‘One Community’ groups, and all those who have a role in supporting people.”

What was the solution?

The project adopted a ‘team around the person’ approach, aiming to tackle holistically all issues people have, which can contribute to them reaching a crisis point that often results in an ambulance callout.

The High Flow project identified the top 15 users of A&E with complex needs. It helped them attend medical and counselling appointments, find housing or suitable alternatives, and gave advice and guidance on budgeting and form-filling.

High Flow caseworkers provide intensive, personalised support for individuals. They discuss the issues facing each person and produce bespoke plans to co-ordinate multi-agency support. This prevents a cycle of referrals on to other services, allowing support to ‘flow’ around a person.

What were the challenges?

Andrea Beacham: “We’re very committed to this approach, working with these individuals and getting to know them and recognising how the trauma they have experienced in their past has affected them and their ability to cope with the circumstances they find themselves in.

“The ‘Flow’ approach is not about just dealing with the presenting issue, but recognising other factors at play and working together as a team, with the individual, to address what’s going on in their life and what matters to them.”

What were the results?

This group of service users now attends A&E 60% less than previously, and spends 9% fewer days in hospital. Evaluation has shown improved housing stability, financial status, family relationships, living conditions and reduced homelessness.

Feedback from High Flow clients suggests individuals feel more in control and have an improved experience of the system. Professionals are better able to provide holistic support; and the stigma associated with frequent attendance has been reduced.

What were the learning points?

Andrea Beacham: “It’s so important to have all of our partners around the table, from police to housing, addiction services and primary care, working in a consent-led environment where we can share key information about individuals, in a spirit of trust and optimism that with the right amount of support, people can achieve their potential.”

One Northern Devon includes the NHS, social care, local councils, police, fire service, local businesses and voluntary and community groups working together to address issues in health, housing, employment and social isolation. It has a network of ‘One Communities’ who have developed a ‘community around the person’ approach to supporting vulnerable residents.