Frequent callers to UK ambulance services in the COVID-19 pandemic: managing mental health, social isolation and loneliness

Objectives:
Patients who frequently call ambulance services are a vulnerable yet heterogeneous population with unmet multiple and complex physical health, mental health and/or social care needs. In this paper, we report the challenges that the COVID-19 pandemic has introduced for ambulance services across the UK when managing frequent callers, and reflect on how existing systems and practices are adapting to support changing patient needs.

Methods:
Data reported in this article comprise reflections from the frequent caller leads in each ambulance service in the UK. All data were provided between 23rd April 2020 and 1st May 2020, shortly after the peak of the outbreak in the UK. A single anonymised case study is also reported to illustrate how the pandemic is affecting people’s circumstances and contributing to frequent caller behaviour.

Results:
Ambulance services are observing changes to the frequent caller population, with many new frequent callers due to health anxiety caused or exacerbated by the pandemic. Management of frequent callers is also changing, with multidisciplinary and multi-agency working becoming more challenging due to decreased access to external services, whether in social care or the community and voluntary sector, and the redeployment of ambulance service staff. There is also decreased face-to-face contact with frequent callers, meaning that opportunities to deliver person-centred care are reduced. However, the introduction or increased use of tele/video conferencing with other organisations has mitigated some of these challenges, and in some cases has improved engagement amongst external organisations.

Conclusions:
Health anxieties, lack of access to other health, social and community and voluntary sector services, and exacerbations of social isolation and/or loneliness have reportedly contributed to changing behaviour amongst frequent callers. The COVID-19 pandemic has also affected how ambulance services have been able to manage frequent callers. Ambulance services should continue to engage with external organisations to aid the delivery of person-centred care, particularly organisations with experience in multiple complex needs such as mental health, social isolation and/or loneliness. Future research should examine the consequences of the pandemic for frequent users of ambulance services, and how this impacts on the wider health and care community.