Can community matrons bridge the social care and health divide?

Health secretary John Reid was making headlines for all the
wrong reasons last week. But while hundreds of column inches were
given over to his comments on working class mothers’ pleasure from
smoking, less was written about his plans to develop a network of
what he dubbed “community matrons”.

Although he was making the announcement wearing his Labour Party
hat rather than governmental one – the idea has been floated as a
result of the party’s “Big Conversation” consultation – Reid made
it clear that “distinctive policy” would be drawn up over the
summer and be unveiled at the party conference in the autumn.

He said his initial thoughts were to recruit 3,000 community
matrons who would act as “search engines” and provide case
management for the 250,000 people with the most chronic and complex
conditions. It has been reported that they would be recruited
mainly from the pool of district nurses by 2008.

Community matrons are likely to be a key initiative if Labour is
elected for a third term. But how do the handful of community
matron pilot schemes work, where do they interact with social
services and what could the impact be on social workers?

Reid says most of the 17.5 million people with a chronic illness
can manage their condition with enough support and information. But
those with the severest chronic conditions account for more than
half of hospital in-patient stays, he says. It is this group that
community matrons will be expected to help.

Chronic long-term illness covers conditions ranging from multiple
sclerosis to diabetes and dementia to asthma. Social care
professionals play an important part in the care management of
people with many of these conditions. But, as the term “matron”
suggests, Reid’s new group of professionals will be
health-based.

“It conjures up images of Hattie Jacques but we shouldn’t get too
hung up on the title,” says Jonathan Ellis, policy manager for
health and social care at Help the Aged. “It’s the role and
function that is important.”

David Pink, director at the Long Term Medical Conditions Alliance,
agrees that people will associate the title with a hospital ward,
but a more modern name may not be an improvement. “Calling them
community chronic disease managers would probably frighten the wits
out of people,” he says.

Confused thinking

But he does believe the title and initial description of community
matrons is indicative of some confused thinking by government over
their actual role.

“Reid talked about people needing a guide to the complexities of
the health and social care system. There is a need for that sort of
person but not restricted to people who are very sick and have
multiple conditions. Those at the other end of the spectrum –
people disabled after an accident – should also have access to
them.

“But he also talked about matrons providing case management for
those with complex health needs, whereas we have a system that
doesn’t necessarily correlate to the needs of people with chronic
illness.

“Are you particularly interested in being guided through the system
if you have a severe condition?”

The concept for community matrons came out of a 2002 Department of
Health document, Liberating the Talents: Helping Primary Care
Trusts and Nurses Deliver the NHS Plan. The 129 posts already
created by primary care trusts are largely based on a US model
called Evercare.

But Pink says this model is more health-focused than the role
outlined by Reid. “It’s about early intervention and support to
prevent deterioration. They focus on maintaining people’s lives and
support networks and keep in regular contact with them. I support
that role as well but I don’t think you can have both.”

Wendy Panting, community matron in chronic disease management at
Guildford and Waverley Primary Care Trust in Surrey, works
alongside two other community matrons who focus on the improvement
of public health and facilitating first contact, including acute
assessment, diagnosis, care treatment and referral of patients (see
panel).

She says: “Each of us has a particular remit but our roles are
interchangeable. We all get involved in many of the interventions
we work on. Without one or other of us I don’t think it would be
very successful – there’s a remit there that is too wide [doing
both chronic disease management and first contact].”

Like other recent government initiatives, Panting admits that the
ultimate aim of the scheme is to reduce the number of people
admitted to hospital. “If we prevent hospital admissions or
facilitate early discharge from hospital of a patient it’s going to
affect social services.”

Social services

Ellis says one of matron’s key functions should be to work
with social services. He says: “Day-to-day care and support is
predominantly delivered by social services and [the community
matron role] needs to play a key role in bringing services for
those with long-term conditions in primary care and social care
closer together.” It should feed into the single assessment process
for older people, he adds.

“Community matrons could span the whole health and care system and
act as the trusted friend that helps people through it. They’d
become the first port of call,” he says.

Ellis believes the role could also help the system increase
preventive work and enable it to anticipate problems among the
chronically ill.

Pink would also like the role to take a broader view of chronic
illness – one that works closer with social services. “What
confounds people is when parts of the system don’t talk to each
other,” he says.

Health will almost certainly take the lead on the initiative, but
all agree that social care’s involvement is key to its success. All
there is to decide now is whether community matrons take on the
signposting or case management brief.

Wendy Panting, matron in disease management at Guildford and
Waverley primary care trust, and colleagues Julie Dalton and Liz
Rogers are three of only 129 community matrons in England.

Appointed in February, they each have a primary care background,
Panting and Rogers being former district nurses and Dalton a former
health visitor.

Despite the job title, Panting’s is not a clinical role and she
does not see patients. But leadership is a major part of the job,
she says. “Hospital matrons are visible but we in the community are
different. We’re looking at the provision of services for the
chronically ill and making sure there is equity.

“We aim to shape services around the changing needs of the
population and make sure people are treated at the right place at
the right time,” she says.

Panting says she is focusing on patients who go into hospital most
often and is aiming to improve the ability of services to identify
the early signs of deterioration. To address this, there are plans
to integrate the out-of-hours GP service with a walk-in centre at
Guildford’s A&E department and perhaps link that with
palliative care.

Improving diagnosis and ensuring that staff have the right skills
to meet the needs of patients is paramount.

Panting works closely with community health professionals, the
voluntary sector and social care providers. But she admits they
need to form closer links with social services.

She says: “My vision is to have some form of case management role
that has social services on board. Even though we’re talking about
a health model of care we need social services’ input. Most older
people have social care needs and I would love to see an integrated
team across the whole system.”