One in seven A&E patients are repeat visitors with unmet medical needs who feel they have nowhere else to go, according to research that found most are over 70 with multiple conditions or under 50 with mental ill health.
Less than 2% of the population account for almost 14% of all A&E attendances, the British Red Cross study suggests. Across the UK, patients are turning to emergency departments five or more times a year due to “unresolved medical issues”, the charity said.
“Many of those frequently attending A&E had often tried to get other help but this had not met their needs,” its report says. “This meant that when they reached A&E, they were often in need of more urgent care.”
The research comes as NHS England’s top A&E doctor urged people to use 111 services this winter and suggested that as many as two in five people arriving at A&E could be better treated elsewhere.
Frontline emergency doctors have sounded the alarm over an approaching winter crisis that they say is already putting patients in overstretched A&E departments at risk.
For the new study, British Red Cross experts conducted a deep-dive review of repeat visitors in emergency departments and also examined five years of data on A&E attendances in Dorset.
Just 1.7% of Dorset’s population accounted for 13.8% of its A&E attendances, according to the review. The visits were more likely to be classed as urgent by doctors, the report found. Frequent visitors were also more likely to live in deprived neighbourhoods.
The majority of people attending A&E frequently fell into two main groups: people over 70, most of whom had multiple long-term conditions; and people aged 20 to 49, particularly younger women, with mental ill health.
Both groups were more likely to arrive at A&E via ambulance and both attended GPs more frequently in the month before their A&E attendance.
Béatrice Butsana-Sita, the chief executive of the British Red Cross, said: “Every year millions of people go to A&E when they have an accident or are in desperate need of care. But some people have to attend more than others. There are many reasons that can contribute to this and for those individuals it is very distressing. It is a situation any of us could find ourselves in.
“Our research found almost one in seven A&E attendances in Dorset were from less than 2% of the county’s population. Those people needed help and were far more likely to be classed as urgent cases or need hospital admission. Our Red Cross teams work with the NHS across the country and regularly see people facing a range of issues, from isolation to inadequate housing and other challenges that impact health and wellbeing.”
Ministers are developing a 10-year plan to transform the NHS, and Butsana-Sita said the research highlighted the need to tackle underlying causes of ill health and support community services.
Prof Julian Redhead, NHS England’s clinical director for urgent and emergency care, urged people to use 999 or A&E services only for life-threatening emergencies and serious injuries, and otherwise to call 111 or use 111 online or via the NHS app.
NHS England estimated up to two-fifths of A&E attendances were avoidable or could be better treated elsewhere. It said NHS 111 could assess and direct people to the most appropriate local service, including urgent treatment centres, GP practices, or consultations with a pharmacist.
If needed, NHS 111 could arrange a call back from a nurse, doctor or paramedic or provide self-treatment advice over the phone. The 111 service is available 24 hours a day, seven days a week.
Redhead said: “We know that up to two-fifths of A&E attendances could be better treated elsewhere, as well as one in six calls to 999 just needing advice over the phone. So I really want to encourage everyone to use our free, around-the-clock 111 service that can give millions of people this winter fast, safe and easy access to the advice or treatment they need.”
The health minister Karin Smyth said the government was supporting the NHS to cope with winter pressures, and added that its 10-year plan would “make the NHS fit for the future, all year round”.
