Seen and heard: Understanding frequent attendance at A&E. An analysis of frequent attendance data at A&E in Dorset (November 2024)

Summary

Frequent attendance at A&E—when a person goes to A&E five times or more in a year—is often because someone desperately needs help and care yet they have nowhere else to turn. Unmet social, emotional and practical needs can drive their physical and mental ill health to crisis point.  

A&E too often serves as a last resort when someone has not received, or cannot access, appropriate care and support earlier. Supporting people to get the help they need before this point improves their health and wellbeing, and reduces pressures on A&E and ambulance services.

This research from the British Red Cross aims to deepen understanding of the needs of people who frequently attended A&E in Dorset. The findings and recommendations set out in this report reflect the importance of addressing health inequalities and highlight areas for national and local focus to better support people who frequently attend A&E. 

Content

Key findings

• People who frequently attend A&E constitute a small and vulnerable minority of people in Dorset who struggled to get the support they needed for their clinical and non-clinical care needs. They made up a significant proportion of A&E attendances, 1.7 per cent of Dorset’s population account for 13.8 per cent of the county’s A&E attendances. 
• There is a clear relationship between socio-economic deprivation and frequent A&E attendance. People who frequently attended A&E were 72 per cent more likely to live in Dorset’s most deprived areas. 
• Hospital visits among people frequently attending in Dorset were more likely to be classed as urgent cases and have an emergency admission. 
• Two groups made up around 70 per cent people frequently attending in the county: people over 70, most of who had multiple long-term conditions and people aged 20-49, particularly women aged 20-29 with high levels of mental ill health and a significant link with deprivation.
• More than a third (36 per cent) of frequent attendance periods by people in this second group required a new mental health referral. 70.2 per cent of these were closed within seven days. This does not include ‘did not attends’.
• There were increased rates of frequent A&E attendance, primary care use and mental health referrals among children and young people aged 19 and under following the height of Covid-19. 

Recommendations  

• Continue to roll out and expand HIU services.
• Increase the breadth and availability of accessible, linked data, and harness it to identify people at risk of frequent attendance and opportunities for targeted support. 
• Improve availability of, and access to, mental health support, with a particular focus on community services. 
• Further develop multidisciplinary proactive care in primary care for people with long-term conditions, prioritising people most at risk of experiencing poor health outcomes due to other risk factors. 
• Ensure that funding and performance measures support a preventative community-based approach which addresses nonclinical drivers of frequent attendance at A&E. 
• Align targets and funding to support sustainable action on health inequalities.