Health coaching and support for high intensity service users
A Quality Improvement Project designed to provide health coaching and non-judgemental support to service users who have frequent contact with A&E and unplanned admissions and may also be calling West Midlands Ambulance Service (WMAS) 999 more often than expected. The service uses A&E case finding to proactively engage individuals that are using the department on more than 12 occasions over a rolling 12 months to offer support.
Why change was needed
In 2019/20, NHS Operational Planning and Contracting Guidance set out that all health systems in England must implement a High Intensity Use (HIU) service. The approach had originated from NHS Blackpool CCG, which was then followed by an evaluation of effectiveness across four CCGs with the conclusion that these services offered a robust way to reduce frequent user activity to 999, NHS 111, A&E, GP contacts and hospital admissions.
A&E departments have also drawn upon the learning gained from the 2017/18 – 2018/19 mental health CQUIN (Improving services for people with mental health needs who present to A&E: Indicator 4) for case finding and care planning purposes.
What we did
Initially the GEH A&E HIU service ran three days a week from Tuesday to Thursday (7:30 a.m. to 3:30 p.m.) and then from April 2021 the service was extended to four days (Monday to Thursday) across both GEH and Warwick Hospital A&E.
The service aims to deliver the following outcomes using the NHS Rightcare HIU principles of non-judgmental support and personalised care planning:
- George Eliot Hospital (GEH) A&E case finding using health care professional led clinical review
- Improved experience of care for individuals through proactive phone contact to offer support
- Improved quality of care by developing personalised care plans and an integrated approach
- Reduced usage of unscheduled care by supporting individuals to engage with alternative services through proactive support
From June 2020 to October 2021, of the 81 cases identified, 50 were monitored and 31 received significant input. The impact tracking for those who received individual input demonstrated indicative savings of over £67,000.
A common theme in case studies has been that these users feel supported through the alternative services they are now accessing, including social prescribers, high intensity case managers, ‘Change, Grow, Live’ Drug and Alcohol Recovery services and mental health services. The case studies demonstrate how personalised care plans, developed in partnership with these people, enable them to manage their needs without attending A&E.
There are some potential service development opportunities which include:
- HIU manager to meet with the WN PCN Lead for Anticipatory Care and Personalisation to discuss joint working
- Explore the potential for co-production with individuals who have lived experience of high intensity use of A&E to inform future service design - linking in with CWPT Mental Health transformation leads.
- Expansion into Paediatrics with the support of safeguarding team.