Enter and View: High Intensity Users Team at Stafford County Hospital

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Summary of report content

In September Healthwatch Staffordshire carried out an announced Enter and View visit at the High Intensity Users (HIU) Team at County Hospital, Stafford on 22 September 2025. The team assists individuals with one or more complex health conditions that require various health and social care services.

Any individual with three or more hospital admissions or who has spent a total of forty days as an inpatient over the past twelve months can be included in this service.

This service was implemented in response to the rising number of emergency admissions among the ageing population. It is recognised that hospitalisations can be distressing not only for physical health but also for emotional and mental well-being.

Through multi-agency collaboration, the service seeks to address the root causes of high service utilisation, reduce unnecessary hospital admissions, shorten the length of stays, and ultimately improve individual outcomes while easing pressure on the healthcare system.

From a patient point of view & from the data provided by MySense, it indicates that the service effectively supports individuals in staying at home and maintaining their independence. The service takes a proactive approach by considering the whole person and the various factors that affect their well-being. 

It is evident that many health issues arise from social challenges and deprivation, and it is encouraging to see these aspects being addressed holistically with patients. Additionally, the staff clearly enjoy their roles and take pride in their achievements for both their colleagues and the care of their patients. The service has also addressed certain health inequalities while reducing costs and the duplication of services within the NHS and emergency services, which is commendable. 

 

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General details

Local Healthwatch
Healthwatch Staffordshire
Publication date
Date evidence capture began
Date evidence capture finished
Key themes
Caring, kindness, respect and dignity
Communication with patients; treatment explanation; verbal advice
Consent, choice, user involvement and being listened to
Follow-on treatment and continuity of care
Cost and funding of services
Discharge
Integration of services and communication between professionals
Lifestyle and wellbeing; wider determinants of health
Referrals
Remote appointments and digital services
Service organisation, delivery, change and closure

Methodology and approach

Was the work undertaken in partnership with another organisation?
No
Primary research method used
Observation (eg Enter and View)
If an Enter and View methodology was applied, was the visit announced or unannounced?
Announced

Details of health and care services included in the report

Details of health and care services included in the report
Adult social care, including care packages and social workers
Ambulances and paramedics
Discharge lounge/ discharge team/ discharge to assess
Inpatient care/General inpatients
Name of service provider
University Hospitals of North Midlands

Details of people who shared their views

Number of people who shared their views
3
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