What are we doing about frequent callers?

By Rhian Monteith

“Rhian, what are we doing about Frequent Callers?”

Four years ago I was asked that question and my only answer was “Nothing…yet.”  But as an Advanced Paramedic it’s my role to find new ways to improve patients’ lives. So I did some research.

What I found was that ‘frequent callers’- those who call 999 on a regular and sustained basis- have a bad name in the NHS.  I heard words like “manipulative” and phrases like “they get a kick out of what they’re doing.”  Most of all I picked up a sense of futility: if you ‘fix’ one frequent caller, I was told, they will only be replaced by another.

I understand the frustration.  Clinicians work hard to qualify in a medical role so that we can help those with genuine medical needs.  We’re sympathetic when we hear a patient’s sad story the first time, but with frequent callers the tale can lose impact.  At the second, third, or even tenth time of telling we can become numb to their tragedies.  The budgetary constraints we are all under only compound this feeling.  It’s easy to feel that these people are nothing but a drain on scarce resources.

And the current approach to frequent callers reflects this attitude: it’s focused on punishment, deterrence, and shaming.  Threats of prison or ASBOs, or official letters setting out how much a caller has cost the system and, by implication, how little they contribute to society, are the hallmarks of how we handle them.

While this approach gives vent to our frustration as medical professionals, it misses one important fact: frequent callers are people. They may be people in crisis, but they are people nonetheless.

So for the last three years I have been involved with a project dedicated to treating frequent callers, not as irritations, scroungers or drains on resources, but as people.

If that sounds soft, fluffy or indulgent, then let me offer you some hard statistics: over three years of developing this programme with Blackpool CCG and working with 350 known ‘frequent callers’, we have achieved an 89% reduction in 999 calls, a 92% reduction in A&E attendances, an 82% reduction in hospital admissions and a 98% reduction in self-harm incidences.  Patients have flourished during the process. Police calls for the same cohort were reduced by 52% as a natural by-product of the programme.

It sounds obvious, but frequent callers weren’t made that way.  Something has happened in their lives to leave them in a place where regularly dialling 999 seems attractive. These people were successful employees, positive contributors to society with a purpose, friends and a loving family. Something unexpected happened that changed them, perhaps forever. This could have been divorce, bereavement, unemployment or crippling anxiety. Left alone, they realise that a medical complaint attracts an immediate human response in a way that a social complaint does not. Dialling 999 may be the only time they feel that somebody is listening to them.   And thus their cycle of frequent calling is established.

People from our project who spring to mind include someone who worked in a mental health hospital for 22 years, another who brought up three wonderful children, and a teacher at a school for disabled people: all honest, hard-working human beings.  What stands out from their treatment as frequent callers is the labelling, the sense that ‘Frequent Caller’ is now who you are and who you will remain.  Nobody asks who you were before. You have become worthless.

This sense of worthlessness is exactly why the current, punitive, approach to frequent callers doesn’t work. What good will it do to write to a person, who already believes they have no value, telling them- in so many words- that what they believe is true?  What do we expect a person desperate for respite and attention to do when threatened with jail?  The attention granted by the criminal justice system may seem preferable to being ignored. These methods are neither deterrents nor long-term solutions; they are, in fact, part of the problem they seek to solve.

Our project has achieved its remarkable results with a different approach. We neither criminalise not medicalise our clients.  Instead, we humanise them.  Each patient is provided with a person in their lives who cares about them, accepts them, and loves them for who they are.  We stand with them in their time of need as both friend and advocate.

But who can do this job? It’s not a clinical role.  I happen to be a paramedic by training but it’s not a paramedic’s task.  The right person is emotionally intelligent, a skilled negotiator and a problem solver. It needs workers with a tonne of intuition and empathy.  And it carries the risk of burnout for those assigned. Management must pay close attention to the mental health of staff in this role.

It’s not about building a service with no boundaries, or failing to be tough where toughness is required. I’ve seen through our own project that the tough line is sometimes the correct line to take.  But the key thing is to listen hard to the patient before getting hard with responses. This is not easy.

If you scan the paper on our project to find a cost saving figure then you won’t find one.  This is deliberate.  It’s a strange paradox, but with this type of programme –innovative, human in outlook- you save more in the long run by not focusing on savings at outset. Focus instead on the commitment to help frequent callers flourish and the savings will come by consequence. Remember that a frequent caller is more than just a debit on a balance sheet. Treat them instead like a person and the balance sheet will, in time, benefit just as much as they will.

The project model has been completely transferable to 37 CCGs in the past 18 months, to GP practices, and to police forces.

If you think this is right for your organisation then please contact Rhian on rh************@nh*.net

Rhian Monteith