Providing 'somewhere to turn' 

In the years since the report’s publication, the HIU programme run by the British Red Cross has already begun transforming outcomes for people who previously felt they had nowhere else to turn. High Intensity Use services work one-to-one with individuals to understand the reasons behind repeat A&E visits and provide personalised support. To date the services have supported thousands of individuals - helping them regain stability, connection and confidence in the support available to them. 

Tackling the 'right drift'

In 2024, the British Red Cross worked with 1058 new clients – reducing A&E attendances and ambulance conveyances amongst this cohort by over 40%, and hospital admissions by 59%. With 16 services up and running across England, the programme generated savings of over £3m in 2024, with one site delivering a 500% return on investment. Scaling this further across the country would deliver further savings – money that could go into providing more community care.  

At a time when the health system is experiencing continued ‘right drift’ into acute services - with rising spend, increased pressure on hospital beds and comparatively less investment in community-based support - attendance and admission avoidance programmes are more vital than ever. The UK Government too has made shifting care leftwards towards a ‘Neighbourhood Health System’ a priority. Therefore, scaling programmes that have already demonstrated their success - such as the HIU programme – is a good place to start. 

So, what's next?

Looking, then, to what needs to change in the next 20 months for the 'left shift' from hospital to community to actually happen, it is clear that commissioning HIU services is a necessary step for many health systems across England in the near term. Not only does this enable more individuals in different areas to be reached and supported by the services, but it also increases the positive impact that HIU services have on the NHS & hospital care, and embeds the 'community-first' attitude further in the system - something we hope to see be the norm in 20 years time. In this respect, Lisa Hollins, Executive Director (UK) of the British Red Cross, said:

Find out more

The British Red Cross provides High Intensity Use services across all 7 NHS regions in England, providing personalised support and understanding the reasons behind repeat reasons to A&E so they don't feel like they have nowhere else to turn. You can find out more about the 'Nowhere else to turn' report, the HIU services, and watch videos from service users on the British Red Cross website. 

The PSC has been delivering lasting public impact since 2006. We are passionate about realising the 'left shift' from hospital to community care - improving in-hospital flow and care, and support available to individuals out of hospital. If you'd like to find out how we can support your system to achieve just this, please get in touch with us at hello@thepsc.co.uk. You can also take a look at some of our case studies.