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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."