500 Derbyshire people went to A&E 10 times in one year

A&E departments are under strain.
A&E departments are under strain.

More than 500 people in Derbyshire went to A&E at least 10 times in just a year.

An analysis of NHS hospital data by the healthcare analysis company Dr Foster found that 31,492 people visited A&E in England 10 or more times between June 2017 and May last year.

One patient attended A&E more than 400 times within this period.

In total, 558 of these “high intensity users” are within Derbyshire.

It is not known specifically how many times these users visited A&E, just that they all exceeded 10 in a year.

Dr Magnus Harrison raised the issue in a meeting of the University Hospitals of Derby and Burton NHS Foundation Trust board today (Tuesday, January 15).

He said that “400 users generate 15 per cent of the cost for us”.

The latest high intensity user figures comes as NHS chiefs roll out trials to reduce the number of regular visitors by hiring staff specifically to liaise with them to offer reassurances and advice.

So far this scheme, called the RightCare High Intensity User Programme has been rolled out at 48 sites across England, with 10 more preparing business cases..

NHS England could not confirm whether any of the four Derbyshire Clinical Commissioning Groups were running the programme or if they were to start preparing business cases.

Of the A&E “frequent fliers” in the county, 51 were in the Erewash CCG area, 54 in the Hardwick CCG patch, 129 within North Derbyshire CCG and 324 in Southern Derbyshire CCG.

A report compiled by NHS digital says that high-intensity users can cause some real issues.

It states that although a small number of the population, these “users” can trigger healthcare costs in excess of £53 million per year, increase the risk of overcrowding emergency departments and impact the safety of other patients.

A spokesperson for the Derbyshire CCGs said: “There are a variety of reasons why patients may attend A&E multiple times, depending on their individual circumstances, but they will almost always have a complex set of needs.

“Some of these may be frail elderly patients with a few different long-term health conditions and it may be that they have to attend A&E for different reasons each time.

“This is quite different from, for example, a younger patient with complex mental health and social problems who therefore can find it difficult to access services via the systems and processes that serve the majority of people needing NHS help.

“All four Derbyshire CCGs have looked at how to tackle this issue and during the course of 2017/18, before county CCGs were working more closely together as we move towards merging, some commissioned some services specifically to find alternative ways of meeting these patients’ needs.

“Commissioners and providers are working closely together and work is currently under way to review services that support high intensity users to determine what approaches are proving most effective.

“Our aim is to roll out what has been found to be most successful in helping patients and maximise efficiency given the county’s financial position.”

Across the UK, high intensity users are more likely to live in more deprived areas, be aged 21 to 31 and to visit A&E at night.

The most common condition they are admitted to hospital with is chronic obstructive pulmonary disease, but also chest and abdominal pain, poisoning by drugs, medications and psychotropic agents and alcohol-related disorders.

Paul Wildgoose, clinical navigator for Derbyshire for East Midlands Ambulance Service NHS Trust, said: “As part of the Place Alliance, we work closely with the hospital, a wide range of healthcare providers, charities, the councils, fire service and police force to help patients access the care they need and reduce the number of unnecessary A&E attendance.

“This particularly applies to high volume service users who regularly access emergency services and attend A&E departments.

“The aim is to support the patient by ensuring they are able to access the most appropriate health (or social) care in the right place and at the right time.”

The programme lead for the High Intensity User Programme, Rhian Monteith, wrote in a report: “You’ll read a lot about High Intensity Users (HIUs). It’s the current accepted phrase but, while an improvement on ‘frequent fliers’ or other lazy pejoratives, it doesn’t evoke the feeling that a person is at the very heart of it.

“Our work with HIUs has shown, time and again, that when you put these people in a box and label them – regardless of the label – you miss the point about how best to help them.

“Our experience shows that the underlying personal reasons for HIU behaviours do not lend themselves to models, averages, or trend-lines.

“They cannot be generalised. They cannot be viewed usefully from the safety of an office, nor do they allow the luxury of a top-down view. And this is why solutions designed at a safe distance for an abstract ‘typical’ HIU tend to fail.”

As part of the HIU trials, an employee is given a list of the 50 patients who call and visit A&E the most.

This employee will then select 15 to work with at any one time, call them to talk through their issues and reasons for calling and visiting so much, to understand their situations.

Then each three months, this employee will work through another 15 high intensity users.

Ms Monteith stated in her report that “there will always be a top 50 HIU users”, but the aim is that these users, although frequent, do not attend quite as often as the previous “frequent fliers”.