Clifton suspension bridge

Winter Pressures Pilot

During the winter of 2017-18, Golden Key began working intensively with high-impact users of Accident and Emergency (A&E) services who also have complex needs

The A&E environment can provide challenges for people with complex needs, which can in turn impact upon hospital staff and other service users. The Winter Pressures pilot was launched in order to address some of these challenges, changing systems where necessary and providing support to enable all those involved to have a better experience. 

This was a short-term project, designed to support hospital services during the winter months when already stretched. 


For clients:

  • Decrease their incidences of self-harm
  • Decrease their risk of suicide
  • Increase their resilience

For services:

  • Reduce the amount of A&E admissions
  • Facilitate earlier discharge following admission
  • Reduce inappropriate presentations at A&E
  • Reduce challenging behaviour in A&E
  • Strengthen links between A&E and individual agencies

In addition to the human benefits of reducing the number of A&E visits for people with complex needs, a further reason for the pilot was the financial savings resulting from this.  In 2015/ 16, the Department for Health estimated that the average cost of a visit to A&E was £138.  However, this figure does not take into account the ‘knock on effect’ in terms of in-patient services.  Moreover, some patients visit A&E up to 50 times in a year, so providing targeted help for some of these people would be beneficial all round.

Supporting clients

The pilot worked flexibly with people with complex needs who met the Golden Key eligibility criteria, helping them to engage with their communities, make connections and build sustainable relationships. Clients were also helped to navigate services and work with appropriate agencies to access the support they need.  This overall approach aimed to be preventive, helping clients to avoid crisis situations which are distressing, dangerous and could result in visits to A&E.

The Winter Pressures Service Coordinators worked alongside existing teams to help identify and resolve barriers for clients - rather than replacing existing services, the Service Coordinators aimed to facilitate a more joined-up and systemic approach.

Additional support

In addition to the above, the pilot also offered a brief intervention to selected high-impact users of A&E, who did not meet the Golden Key eligibility criteria. 

Brief Intervention workers offered these clients 3 to 6 support sessions where, through motivational interviews, they helped individuals to access services and make choices to prevent future crisis situations arising.


An evaluation of the pilot is currently underway and a summary of the finding will be added to this page in the near future. Watch this space.