Extra Support Service (ESS)

Our High Intensity User or Extra Support Service supports those people who use health services most to address their underlying issues thus reducing scarce A&E and GP resources. Typically, we support patients who have attended A&E more than 6 times in one month through medical and pastoral care from GPs, nurses and health coaches. We support multi-disciplinary team approaches and work around the clock and are grateful for the support of ‘You First’ in our work with patients who experience homelessness and drug / alcohol dependencies. As a measure of the impact of our work we have reduced A&E attendances by our patients by over 60%.


A Patient’s Story – Extra Support Service: Miss B

Miss B patient is a 23 year old single mother of a 6 month old baby. She has problems with acid reflux causing vomiting, which means she ends up in A&E quite a lot. She feels this is brought on by stress and anxiety. Due to problems with local housing, she had been reluctantly moved from Lewisham to temporary accommodation in East London. She feels this is the big cause of her stress as she has no family support in that part of London and says her current accommodation is unsuitable for a mother and young baby.

The Extended Support Service – ESS – nurse contacted Miss B and learned the underlying reasons for her frequent attendances to A&E. The nurse provided her with an emergency contact number for the ESS nurses so that in a crisis she could contact them, rather than attending A&E inappropriately.

Her case was subsequently discussed at the ESS Multi-Disciplinary Team with other professionals, including the Fulfi lling Lives Team who, after the ESS nurse explained the patient’s situation, were able to liaise with the housing team on behalf of the patient to try and get her and her young baby moved to more suitable local accommodation.
Miss B moved back into Lewisham into a hostel following the actions made by the MDT and her situation has improved markedly.

The ESS nurse’s intervention has ensured that Miss B has:
• Addressed the underlying issues leading to improved healthcare and better health outcomes
for her and her baby;
• Reduced the stress she was under making her and her baby happier and more independent;
• Been able to re-establish contact with her circle of support meaning she is less socially isolated.

Resource impact
Miss B felt greatly helped by the ESS service as the move to local accommodation improved her mental state, and, by enabling her to reconnect with her support network, the life of her young baby. An intervention such as this has helped prevent this patient developing post-natal depression which is common in single mothers, especially those lacking support.

Miss B says about the ESS service:
“Thank you, the housing got back to me and I have now been moved to a hostel in Lewisham which is a lot better because I have support here. Thank you”
Miss B’s A&E attendances and interaction with primary care are significantly reduced.