Vulnerable people make repeat A&E visits, says charity

·4-min read

Vulnerable people repeatedly go to A&E because they feel they have nowhere else to turn, according to a new study.

The analysis, by the British Red Cross, found that some people attend A&E more than 300 times every year.

The charity analysed data from 376,000 people who frequently go to emergency departments in England across a period of six years, and also interviewed GPs and hospital staff.

The full reasons for attendance were varied but people who regularly go to A&E are more likely to live in the most deprived regions and have physical symptoms that require admission to hospital.

They are also more likely to be experiencing sudden life changes such as job loss, relationship breakdown or grief, combined with social and economic issues.

Housing insecurity, loneliness, and mental health issues are other common factors, according to the study.

High-intensity use of A&E is defined as five or more visits in a year and is estimated to cost the NHS at least £2.5 billion annually.

The analysis found that less than 1% (0.67%) of the population attend A&E frequently, but as a group these people account for 16% of all A&E attendances, 29% of all ambulance journeys and 26% of all hospital admissions in England.

People who frequently go to A&E move home 25% more often than the general population, the data found.

The report also noted that the death rate among people aged between 30 and 49 who frequently attend A&E is 7.5 times higher than among this age group in the general population.

People who frequently attend A&E told researchers they often feel unheard.

The British Red Cross said High Intensity Use services, which are run by the NHS and voluntary sector, can have a positive impact on reducing admissions among vulnerable people.

Currently there are around 100 High Intensity Use services in England covering mental health, A&Es, primary and secondary care, but not all hospitals have access to a dedicated service.

Mike Adamson, chief executive of the British Red Cross, said: “High intensity use of A&E is closely associated with deprivation and inequalities – if you overlay a map of frequent A&E use and a map of deprivation, they’re essentially the same.

“When multiple patients are making repeat visits to an A&E, that should flag the need to tackle other issues like barriers to accessing services, or societal inequalities that affect people’s health.

“For example, housing insecurity is a common challenge – people who frequently come to A&E move home more often than the general population.

“This has a knock-on effect on people’s finances, mental health, social networks and access to services.”

Julia Munro, British Red Cross lead on High Intensity Use services, said: “When someone is repeatedly coming to A&E, it often indicates they are facing wider problems.

“We work with people who face all kinds of challenges, from poor housing to grief to childhood trauma, or who are struggling to cope with ongoing health issues.

“Getting the right help for people reduces ambulance and A&E use and hospital bed days, but most importantly it brings positive change to people’s lives. We’d like this support to be available to everyone who needs it.

“One gentleman we worked with had an undiagnosed health issue, but he also had no heating or hot water, and was going without food due to confusion over his benefit support. By listening and building trust we were able to get his finances sorted, the boiler fixed, and connect him to a local community group for support.

“In the last six months of working with him, he only visited A&E once, and now has a diagnosis for a developmental disability which helps healthcare staff better understand his needs.”

Dr Sam Royston, director of policy and research at Marie Curie, said a significant number of people with a terminal illness end up in A&E and have repeat visits.

“When people are experiencing pain or need their symptoms managing, having good care planning and community care in place can avoid the need for emergency admissions,” he said.

“However, these services are inadequate across the country and people are suffering because they have no other option than to go to A&E.

“Our own data shows there were over 1.6 million emergency admissions for those in the last year of their life, costing the NHS £2.5 billion.

“This week, the Government’s new Health and Care Bill is being discussed in the House of Commons.

“In its current form the Bill makes no mention of support for dying people. Unless the Government amends the Bill to ensure adequate end-of-life care services are provided in communities across England, the most vulnerable will continue going into A&E because they have nowhere else to turn.”

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