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.”

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