South East Coast Ambulance Service NHS Foundation Trust

3. Ms H complains about South-East Coast Ambulance Service’s (the Trust’s) treatment of her in relation to calling 999/111. She complains since 2020 she has been inappropriately placed on a frequent caller plan.

4. Ms H says since this happened, she has been in a state of anxiety, and the stress has prevented her from sleeping or leaving the house. She says her consultant has told her to expect more frequent hospitalisation due to her medical condition. She says she has a life limiting illness that frequently develops into an emergency situation and she says not having support with this has become a terrifying and lonely experience.

5. As a result of bringing this complaint to us, Ms H is seeking financial remedy.

6. Ms H was diagnosed with complex post-traumatic stress disorder (PTSD) with disassociation in 2012. She was also diagnosed with sclerosis of the liver (permanent scarring and hardening of the liver that impairs its function and can lead to liver failure) in late 2021 and following this developed a linked condition called Ascites (a build-up of fluid which affects her brain).

7. Ms H complains since May 2020, the Trust inappropriately placed her on a frequent caller plan. A frequent caller plan is a structured approach to managing patients who frequently call emergency services. This is to ensure resources are allocated efficiently and that patients receive appropriate care.

8. The Trust wrote to Ms H in February 2021 to try to arrange an ‘acceptable behaviour agreement’ with her and gave her 14 days to respond. There were no restrictions to its service in place at this time. The Trust wrote to Ms H again in April 2022 to explain she had been restricted to one contact to 999/111 in any 24-hour period. It explained in instances where her calls became excessive, the Trust may decide to block her mobile number for 8 hours at a time and they would contact to let her know before deciding to do this.

9. The Trust wrote to Ms H again in January 2023 to let her know the frequent caller plan had been reinstated, and she had again been restricted to one contact to 999/111 in any 24-hour period. The Trust explained how it would review the plan at regular intervals.

10. Since May 2022, Ms H has complained to the Trust about this 9 times. The Trust sent its final response on 9 April 2025. The Trust also lifted the frequent caller plan in April 2026 when Ms H had had six months of lesser contact. There are currently no restrictions in place for her.

13. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any indications that something has gone wrong.

14. Ms H complains since 2020 she has been inappropriately placed on a frequent caller plan by the Trust. Ms H says say since the plan being put in place she has been in a state of anxiety and the stress has prevented her from sleeping or leaving the house. She says her consultant told her due to her condition to expect more frequent hospitalisation. She says she has a life limiting illness that frequently develops into an emergency situation and not having support with this has become a terrifying and lonely experience.

15. In its complaint response, the Trust says the frequent caller plan has been implemented safely for several years. It says the frequent caller plan has been implemented in line with its policy and procedure and the rest of the frequent caller cohort.

16. The Trust’s telephone call log record shows between May 2020 to May 2026, Ms H made consistent daily calls to 999 and 111, and often multiple calls in one day.

17. The records show that since 28 May 2020 the Trust has received approximately 1374 999 calls and 1739 111 calls from Ms H. The records also show that since May 2020, the Trust sent 210 ambulances where Ms H remained at home and sent 30 ambulances where she was transferred to the hospital’s emergency department. This resulted in over 434 hours of the Trust’s operational time being spent attending Ms H and over £90,000 of the Trusts budget spent, including call handling, dispatch and operational time.

18. The records show Ms H’s frequent caller plan was implemented with the support of the Trust’s system partners to help ensure Ms H received the right care at the right time, in the right place. The plan was reviewed every 3-6 months to ensure it remained safe and effective.

19. Since May 2020 the records show the Trust held more than 15 multi-disciplinary (MDT) meetings to review the situation and try to ensure she had appropriate support. Staff from Ms H’s GP surgeries, the local mental health trust, ‘Staying well, Changing futures’, NHS 111 mental health line, a trust care coordinator, and ‘Change Grow Live’ attended these MDT meetings.

20. The NHS England ‘Supporting High Frequency Users (HFU)’ guidelines say

‘One particular cohort of patients who may benefit from more proactive support, relates to those who use services more frequently than usual, and may be identified as being vulnerable, for example complex, patients with multiple long-term conditions. Through the offer of proactive, personalised care, they can be supported to uncover and address psychosocial support needs, improve their symptom and condition management and to access a broader range of support options in their communities, resulting in reduced unscheduled use of primary and emergency care’.

21. It also says MDT meetings should be used to review the identified list of patients to ensure the correct support is being provided. This should take into consideration the clinical and non-clinical risk factors for each individual.

22. The Trust’s frequent caller procedure says ‘a frequent caller is defined as someone aged 18 or over who makes 5 or more emergency calls related to individual episodes of care in a month’.

23. It says ‘frequent callers are restricted to one contact (ambulance response or clinical triage) within a defined period of time: 4/8/12/24 hours or 7 days. These plans are linked to the patients ‘usual presentation’. This type of plan is designed to assist the Clinical Support Desk in managing frequent callers who present multiple times a day.’

24. In relation to blocking calls it says;

‘BT 999 Stage 2 Block (available for landline and mobile phones) may be utilised to temporarily block a frequent caller from connecting to SECAmb via the 999 service. The maximum timeframe allowed for each request is 8-hours. This intervention may be utilised when patients are actively calling 999 excessively for non-emergency complaints, significantly impacting on Trust call answer performance.’

25. We can see from the Trust’s call logs that Ms H did make 5 or more emergency calls in a month during this period. Therefore, she met the Trust’s definition of a frequent caller as set out in its procedure. As such, we consider it was appropriate, and in line with its procedure, that the Trust restricted Ms H’s contact to its service.

26. The restrictions that the Trust put in place were to limit Ms H to one contact to 999/111 in any 24-hour period. This is in line with the example restrictions set out in its procedure. At no stage was Ms H’s access to emergency services stopped.

27. We have reviewed the letters sent to Ms H regarding the frequent caller plan and consider the Trust’s communication with Ms H at all stages was considerate and it fully explained the restrictions and the reasons for the plan having been implemented.

28. We have also seen that the Trust were holding MDT meetings and liaising with appropriate other services in line with the HFU guidelines, to try and support Ms H and manage the demand to its service.

29. The Trust has a duty not only to Ms H, but also to the wider community and it needed to ensure other patients would not be adversely affected by the demands Ms H was placing on their service. From the evidence we have seen the Trust were accommodating and reasonable in facilitating the requests of Ms H.

30. The demand placed upon the ambulance service by Ms H amounted to 18 calls to the service in one 24 hour period and 951 calls were made to the 999 service between January 2023 and August 2025.

31. There is no evidence which indicates any harm came to Ms H as a result of the individualised frequent caller plan, and on the occasions she was taken to hospital she was not admitted overnight and never in a life-threatening condition.

32. We consider the Trust followed its own procedure in implementing the frequent caller plan, and as such we will take no further action on this complaint.

33. We understand this may not be the outcome Ms H had hoped for, and it is not our intention to cause her any further distress. We hope our explanations go some way to reassure Ms H that her concerns have been taken seriously.

1. We have carefully considered Ms H’s complaint about the Trust’s decision to place her on a frequent caller plan. We were sorry to hear of the difficulties that Ms H was experiencing at this time and for the impact this decision had on Ms H.

2. We have not seen any indications of failings in relation to the Trust’s decision to place her on a frequent caller plan, as we have seen the Trust implemented the plan in line with guidance. Therefore, we will not consider this complaint any further.