High Intensity User (HIU) Programme - Outcomes Partnership (Market Engagement)

NHS North East London Integrated Care Board (NEL ICB) is exploring the market ahead of seeking to commission an ICB-wide High Intensity User (HIU) Outcomes Partnership. The provider must have proven experience in delivering preventative health Social Outcomes Partnerships, be willing to undertake co-design with NEL ICB at risk, and have access to at least £1.0m of approved social investment risk capital available for drawdown upon contract award. Health and care systems face a growing, structural challenge: a small number of people experiencing the deepest deprivation and complexity account for a disproportionate share of urgent and emergency care demand. This is not a marginal issue; it is a material driver of pressure, cost and inequality across the NHS. High Intensity Use is predictable, persistent, and concentrated. It is driven by unmet social need, trauma, poor access to community-based support and fragmented systems. Left unaddressed, it results in repeated crisis presentations, poor outcomes for individuals and escalating system cost. High Intensity Use of urgent and emergency care represents a significant and growing challenge across UK health systems. National evaluation evidence shows that fewer than one per cent of people account for approximately:

• 16% of A&E attendances.
• 29% of ambulance arrivals.
• 26% of emergency admissions.

This activity is estimated to cost the NHS at least £2.5 billion per year. Individuals with repeated attendances are highly likely to continue using emergency care unless targeted intervention occurs. By a person's eighth emergency attendance within a year, there is a greater than 50% likelihood that they will continue to attend frequently for at least two years, rising to over 80% by the fifteenth attendance. This creates a clearly identifiable cohort for targeted preventative intervention. There are proven delivery models addressing these challenges, with a track record of reducing secondary care usage for high intensity users. However, despite the potential to improve outcomes for these individuals and reduce demand on the system, funding for these interventions has traditionally been both small compared to the need, and short-term. An outcomes approach offers a potential solution to this. Outcomes partnerships are services where 100% of the funding is linked to evidenced outcomes achieved by individuals on the Programme. They add value in issue areas which require a change in policy focus (i.e., from sickness to prevention) through creating an environment to test ideas, build and develop new services, or continue to improve existing ones. The work is proposed to consist of two phases: 1. A Co-design phase working with NEL to develop the delivery model and outcomes framework, and;

2. the delivery of the intervention

The co-design phase will include analysis of existing services, gaps in provisions, and local priorities to identify the target cohort, geography, and total contract value for the service. This would be followed by co-design of the delivery model, facilitating input from all key stakeholders (including Hospital MDT leads and patients), and joint development of an outcomes framework. A key feature of an outcomes partnership is the flexibility of the delivery model, which can be improved over time as the Programme learns what works. The typical duration of support is expected to be between 9 to 12 weeks, but this will vary depending on the cohort to ensure sustained improvement and positive health outcomes. The outcomes the service would be targeting include:

• Improved wellbeing and patient activation.
• Improvement in wider social determinants of health including housing, financial situation, and loneliness.
• Reduce use of secondary care services including; A&E attendances, Emergency admissions, and Ambulance conveyances.