Overview
High Flow emerged out of a desire to support individuals within our system who have complex needs. Currently High Flow is focused on supporting our patients who for many reasons regularly attend our Emergency Department in NDDH. It also ensures we meet the requirement from NHSE to have a High Intensity Use Service in every area.
In North Devon District Hospital in the three months to November 2023 there were 1008 attendances to the Emergency Department. 48 people attended the Emergency Department more than 5 times in that period….
Individuals who make regular use of the Emergency Department at North Devon District Hospital. Freeing up resources to meet the demands, more efficient use of clinical Emergency Department resources….
Firstly and foremostly, better outcomes for our patients – helping them in both clinical and non clinical aspects of their life. We will measure this, through feedback from those we support and by looking for corresponding reductions….
By combining our ‘flow’ approach to working with individuals with complex needs to the NHSE HIU model to provide a service which supports these individuals in a far better way. The programme will work in partnership with….
Currently we have funding to provide this programme until 31st March 2024. We are exploring all options for sustainable funding – with a view to the programme….
Our most recent quarterly report can be found on this page alongside an evaluation of our previous High Flow Service. These documents can also be downloaded through this website….
Operational team led by Encompass South West, programme managed by Royal Devon University Healthcare NHS Foundation Trust….
The problem we are addressing
In North Devon District Hospital in the three months to November 2023 there were 1008 attendances to the Emergency Department. 48 people attended the Emergency Department more than 5 times in that period. The highest number of attendances in that three-month period was 22.
A significant proportion of those people attending the Emergency Department had unmet health and social care need. It follows that their attendances to the Emergency Department may have been avoided if those needs were better identified and the most appropriate support offered earlier. This would improve care for those individuals, reduce cost and enable better deployment of resources to meet the population health needs of Northern Devon.
Attendances to ED cost the healthcare system. In 2024/2025 we supported 57 people.
- In the 12 months prior to High Flow engagement, these 57 people had:
- Attended ED 484 times
- With 145 subsequent non-elective admissions
- And 244 ambulance conveys
At an estimated cost to the NHS of £786,641
The intended beneficiaries
- Individuals who make regular use of the Emergency Department at North Devon District Hospital – sometimes known as High Intensity Users.
- North Devon District Hospital services. Freeing up resources to meet the demands, more efficient use of clinical Emergency Department resources, and reduced hospital admissions.
- Wider system partners due to reduction in demands on their services enabling them to provide more effective services to those who need them
What we want to achieve
Firstly and foremostly, better outcomes for our patients – helping them in both clinical and non-clinical aspects of their life.
We measure this through feedback from those we support – and by looking for corresponding reductions in attendances to Emergency Departments, unplanned admissions to hospital and reductions in ambulance conveyances.
We also measure the positive outcomes patients have achieved as a result of their work with us, across all aspects of their lives.
Finally, working with our system partners, we will also see how they benefit from by reductions in demand, to ensure that we are successfully helping patients to achieve the things they want to – and not simply rediverting their needs elsewhere in the system.
The Key Performance Indicators for the programme are in line with NHS England requirements and are as follows:
How we want to achieve it
By combining our ‘flow’ approach to working with individuals with complex needs to the NHS England High Intensity Use model, to provide a service which supports these individuals in a better way. The programme will work in partnership with the Voluntary, Community and Social Enterprise Sector to provide workers who offer support to patients over a period of time, to work together on the things that matter to that individual. What matters becomes the focus and we will help to put all other support the individual might receive from partner services in that context – and where needed, ensure all involved are all joined up as a ‘Team Around the Person’ (TAP).
We will provide
- A data driven approach, prioritising resources towards people who attend A&E multiple times, starting with the top 100 and incrementally towards the top 250, per LCP (Focus on attendances and non-elective admissions in terms of data and identification of cohort).
- An assertive outreach approach, connecting with people where they are comfortable with professionals they want to relate to, in a person-centred way. This a creative, contextual, and holistic approach, which provides positive outcomes for people, services, and systems.
- Person centred care: A primary focus on what is important to that person – goals/wishes rather than ‘needs’. A move from ‘what’s the matter with you? – to what matters to you?’
- A strengths-based and trauma informed approach. The model of personalised care will be used as an enabler to drive forward culture change and embed shared decision making, ‘What matters to you, personalised care and support planning, enabling choice, including legal rights to choice and integrated personal budgets (PHBs), social prescribing and community based support, supported self-management through the offer of the HOPE programme
- Full-time, ring fenced, dedicated HIU services supporting each locality and connected into the wider network and community landscape
- A sustainable workforce with health and wellbeing built into their day to day work lives to minimise the risk of so avoids staff burn out and potential poor recruitment programmes to enable a “bring your whole self to work and live our values” ethos .
Timescales & Funding
High Flow is funded by the One Northern Devon Local Care Partnership through the One Devon Integrated Care Board’s population health budget. Part of this budget is devolved to the local Local Care Partnerships s to deliver programmes of work which tackle health inequalities – and High Flow is one of these programmes.
We currently have funding until 31st March 2026 for 2 Full Time High Flow Caseworkers
Evaluations & Results
The 2024/2025 annual report can be found here:
The most recent quarterly report can be found here (need to upload document and then link)
An evaluation of our previous High Flow Service can be found here (need to upload document and then link)
Who has been involved?
The service is provided by the RDUH in partnership with Encompass Southwest who employ and manage the two High Flow caseworkers. Encompass also work in partnership with Colab Exeter to deliver High Flow in Eastern Devon
There is a High Flow Steering Group which covers both the Northern and Eastern Service. The Terms of Reference for this group can be found here:
The One Northern Devon LCP provide the funding for the project and High Flow is part of their health inequalities programme of work for 2025/2026.