Moving beyond the symptoms

High intensity users of emergency care are often defined by how frequently they attend services. But as Diane explains, those numbers only tell part of the story.

Behind repeated attendance is usually a far more complex picture – a combination of health, social, emotional and practical challenges. Many individuals are navigating multiple overlapping needs, often without consistent or accessible support elsewhere in the system.

As a result, emergency departments become the default. Not because they are always the most appropriate setting, but because they are the place people know they will be seen, heard and responded to.

HIU services: working alongside people, not on them

HIU services take a fundamentally different approach.

Rather than focusing solely on reducing attendance, they begin with the individual – understanding what matters to them, what drives their behaviour, and what support might help them move forward. This is often described as a trauma-informed, person-centred approach, grounded in trust and relationship-building.

As Diane reflects, this is not about “fixing” people. It is about working alongside them – building confidence, connection and the ability to navigate support more effectively.

In practice, that can look very different from traditional service models. Sometimes it starts with something small or unexpected – a personal goal, a conversation, or a point of connection that builds trust. From there, broader support can follow.

From reactive to preventative systems

What emerges from this work is a clear shift in how we think about demand.

Rather than treating repeated attendance as a problem to manage, HIU services reframe it as a signal – an indicator that existing systems are not meeting people’s needs early or effectively enough.

By intervening earlier, building relationships and connecting individuals to the right support, these services reduce pressure on urgent and emergency care – not through restriction, but through better design.

This aligns with a broader ambition across public services: moving from reactive models, where systems respond to crisis, towards preventative, insight-led approaches that address need before it escalates.

The role of community and connection

A key part of this shift is the role of community-based support.

HIU services sit at the intersection between hospitals and communities, helping to bridge gaps that often exist between health, social care and voluntary sector provision. They recognise that sustainable change rarely happens within one organisation alone.

Instead, it depends on connecting people to the right support – locally, consistently and in a way that reflects their individual circumstances.

This also highlights a wider challenge for public service leaders: ensuring that community services are visible, accessible and capable of meeting diverse needs.

What this means for the future

Looking ahead, the lessons from HIU services are clear.

First, that demand in public services is often driven by unmet need rather than inappropriate behaviour. Second, that understanding people – their experiences, motivations and circumstances – is critical to designing effective responses. And third, that better outcomes come from systems that are connected, preventative and centred around individuals, not institutions.

As public services face increasing pressure, these insights become more important than ever.

HIU services offer a practical example of what it looks like to redesign around public value – improving outcomes for individuals while reducing pressure on the system as a whole.

Find out more

The British Red Cross provides 16 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 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 organisation, please get in touch with Chris at Chris.Bradley@thepsc.co.uk.