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Wednesday, December 1, 2021

Study finds some patients attend A&E hundreds of times a year

Patients are turning to Accident & Emergency units hundreds of times a year, because they feel they have nowhere else to go, research by the British Red Cross suggests.

The study found less than 1 per cent of the population is responsible for a sixth of A&E attendances, almost one third of ambulance journeys, and one quarter of hospital admissions.

One patient was found to have attended A&E on 364 occasions in one year, with hundreds more patients visiting at least twice weekly.

In the study, patients said they had turned to A&E units after GPs dismissed symptoms, including chest pains and trouble swallowing. Experts said the associated £2.5bn bill for the NHS could be vastly reduced by action to tackle the social problems of the most vulnerable.

The analysis of NHS data identifies 367,000 people who attend A&Es in England at least five times a year. They include 16,000 people who visited at least 20 times annually and around 370 attending at least twice a week.

All patients interviewed for the study said they had initially contacted a GP about their health problems, with many becoming dissatisfied with their response, or feeling they had been “fobbed off”.

The report said: “Some people we interviewed said they’d gone to A&E on occasions where they couldn’t get a GP appointment. Healthwatch England report that since the outbreak of Covid-19 75 per cent of people … said they had faced challenges with GP access, leaving them feeling negative about their ability to access primary health care.”

Several patients interviewed for the study said their GP was not listening to them, or fully understanding their problems, and went to casualty units to seek a second opinion or reassurance about their health.

Latest NHS figures show A&Es and ambulance services are the busiest on record, with heart attack victims waiting almost an hour for ambulances in October. Last week research by the Royal College of Emergency Medicine found more than 4,500 patients died after waiting 12 hours on trolleys in crowded A&E departments last year.

Today the Red Cross calls for an expansion in “high intensity use” services, aimed at frequent users of A&E departments, which attempt to establish the reasons behind attendance, and provide help and support to get people back on their feet.

Such teams attempt to uncover the underlying reasons for reliance on A&E, and provide support and help to get people back on their feet.  

Studies have found such schemes, already in use in about about 100 parts of the country, can cut A&E attendance and emergency admissions by frequent attenders by as much as 84 per cent.

Experts said those suffering from loneliness, relationship breakdowns and mental health problems were repeatedly turning to A&E, because they had reached “crisis point” and could not find help elsewhere.

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.”

The findings are a result of analysis of six years’ data, including 367,000 patients who attended A&E in England at least five times in the year 2015, as well as interviews with GPs, hospital staff and patients.  

Researchers found that 0.67 per cent of the English population attend A&E at least five times a year.  As a group they accounted for 16 per cent of all A&E attendances, 29 per cent of all ambulance journeys and 26 per cent of all hospital admissions in England.

The study found such attenders often had physical symptoms that required NHS help, but were also dealing with sudden life changes such as job loss, relationship breakdown, grief, loneliness and mental health problems. They were also more likely to live in deprived areas and to live alone.

Researchers said too often frequent attendance was stereotyped as “inappropriate” use of A&E or a “cry for help” when in fact many of the repeat attenders had conditions, such as dementia, heart failure, epilepsy or a mental health diagnosis, which required medical help.    

Frequent attenders of A&E had mortality rates seven times as high as the rest of the population, analysis of those aged between 30 and 49 found. The most common age groups to attend A&E frequently are those aged 20 to 29 and those aged over 70, the analysis found.  And lonely individuals over the age of 65 were 50 per cent more likely than others of the same age to end up being hospitalised after admission to A&E.

While much of the data in the analysis pre-dates the pandemic, researchers said they feared that repeated lockdowns had exacerbated such problems.

“Interviewees who regularly visited A&E commonly spoke of lockdown limiting social contact with loved ones,” the report said.

“Anecdotal reports have suggested that over the long term, the pandemic may lead to an increase in the number of people who attend A&E frequently, perhaps unsurprisingly when you consider the emotional and mental health impacts of isolation and lockdowns.”    

Professor Stephen Powis, NHS National Medical Director said: “The NHS is already experiencing record demand for emergency care, and we are only just heading into winter so the introduction of around 100 High Intensity Units across England will help to reduce unnecessary visits to A&E.

“The roll out is being accelerated by the NHS, meaning patients will be able to get a range of support in a more appropriate setting.”

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