The first of many

    By spring 2007 there should be 3,000 community matrons in
    England and Wales working across health and social care. They will
    take on the case management of people with long-term conditions in
    a move that some social workers have taken as a snub. Despite
    social workers’ wealth of experience in case management only nurses
    will be eligible for the role.

    But the government has made its position clear, and so in
    February, Selby and York Primary Care Trust began a three-month
    pilot scheme in February with Julie Rae, a trained district nurse
    who has more than 20 years’ nursing experience, becoming the first
    community matron. The pilot was so well received that the posts
    have become permanent. Three more community matrons will soon
    complete the six-week induction process and by the government’s
    target date of March 2007 the PCT expects to have 10 community
    matrons in place.
    To find out what they do, Community Care spent a day with
    Rae.

    8.30am

    Rae arrives at her first floor office in Selby War Memorial
    Hospital. The hospital was opened in 1942 and her office –
    according to its door label – should be occupied by the cashier.
    “When they create these new posts they put you where they can,” Rae
    says. The office has been painted light green and overlooks the
    hospital’s well-maintained back garden. A card on a filing cabinet
    says “Congratulations!” and a poster of a white yorkie dog with the
    slogan: “I’ve misplaced my place in life” hangs on the wall. Rae
    quickly explains that the picture was there before her arrival.

    First on her to-do list is to check her e-mails and voicemail.
    Then she calls the equipment loans service, which provides
    adaptation equipment for patients with mobility problems. A patient
    has died and Rae arranges for the service to collect the equipment
    it had lent her.

    Next is a quick phone call to Jim Lennon, care manager for North
    Yorkshire Council’s social services, to ensure he can attend a
    multi-disciplinary case management meeting about a client called
    Ella Smith (not her real name) in the afternoon. Rae then goes
    downstairs to visit Brian Teskey-King, a senior occupational
    therapist and specialist in palliative care to see whether he can
    come too. He can and so the meeting is scheduled for 2pm.

    In the meantime Rae heads to her next meeting, about assistive
    technology.

    9.30am

    Selby fire station is playing host to a meeting of the telecare
    project group. Under discussion is how assistive technology, such
    as sensors that record when someone gets out of bed or opens their
    fridge, can enable patients to stay in their own homes longer.

    Rae is one of the first arrivals, but soon gathered around a
    table are 13 people from North Yorkshire Council’s social services,
    housing support and occupational therapy teams and three
    representatives from Tunstall Group, a private provider of
    assistive technology products.

    Jane Lockley, the council’s social services area manager for
    Selby and Sherburn, leads the meeting. First is a discussion of a
    visit made by members of the council’s occupational therapy team to
    a manufacturer of assistive technology products. Over 90 minutes
    the group debates how criteria need to be established which set out
    the circumstances in which patients qualify for the technology to
    be installed at home.

    11.15am

    The meeting ends and Rae drives to visit her first patient of
    the day, Betty Vollans, 71, who has the chest condition chronic
    obstructive pulmonary disease. Vollans’s sitting room is full of
    family photos. A transparent tube connecting her to an oxygen
    cylinder snakes across the carpet. Vollans has had the condition
    for four years and has been seeing Rae since the matron service
    started. Before then she saw her GP, but only when he was called
    out to deal with a problem. Vollans appreciates seeing Rae every
    few weeks. She says: “I can discuss anything with Julie and she
    sorts it out for me.” In the six months that Rae has worked with
    Vollans she has got her a bath lift, changed her medication and
    monitored her progress. Rae takes Vollans’s blood pressure as they
    chat.

    11.50am

    It is back to Selby War Memorial Hospital and a visit to patient
    Ella Smith. Aged 70, Smith was admitted to the hospital at the
    beginning of August after her daughter, who visited her at home to
    care for her, told her GP it was too difficult to cope. The GP
    spoke to Rae who carried out a joint visit with social services and
    occupational therapy to Smith’s home. Over the years Smith has had
    several strokes and the professionals found her living in
    unsanitary conditions. In addition, she was not eating properly and
    was poorly.
    During a discussion involving Rae, Smith and her doctor, Smith
    demands to know when she can go home – a date Rae does not yet
    have. “It is nice to have Julie come and see me but I do give her a
    hard time!” Smith says. “We get on great and she is the only one I
    can trust.” On admission, Smith was unsteady on her feet, wary of
    accepting help and did not communicate. But now she is more mobile
    and happy to talk to other patients.

    12.10pm

    When Rae leaves the ward she visits staff nurse Jackie Broadbent
    to mention Smith’s eagerness to return home. Broadbent is impressed
    with the community matron’s role. She says: “It has opened up
    communication between hospital staff, district nursing staff and
    the matrons themselves. Things have improved since Julie has been
    in the role as now it is more formalised and less ad hoc than it
    was in the past.”

    While they are talking a confused patient walks into the office
    and thinks our photographer is her son, who has died. She is
    distressed and asks him to take his “mask” off so she can see his
    face. After she is taken back to her bed Rae comments on how
    difficult it can be when there are not enough mental health
    services for older patients.

    12.30pm

    Rae and staff nurse Margaret Dockrell have lunch in the hospital
    canteen and discuss whether home care workers should visit Smith on
    the ward so she is familiar with them before she is discharged.
    Another check of e-mails follows and then comes a further phone
    call to the equipment loans service to request that a patient’s
    nebuliser is replaced while it is being serviced. She phones the
    patient to tell them this will happen next week.

    2pm

    It is Rae’s case meeting with Teskey-King and Lennon about
    Smith. They agree that Smith will only be able to live at home
    again if she receives visits from home care workers four times a
    day. Rae says: “She will have to accept support but the issue with
    her is that she doesn’t trust other people.” Rae adds that she has
    discussed with the staff nurses that home care workers visit Smith
    on the ward and Teskey-King and Lennon agree this is the way
    forward.

    Rae and Lennon then discuss the continuing care funding of
    another patient, John Hannah (not his real name), 70. Rae and
    Lennon visited him together the previous week. The pair go through
    a continuing care assessment and threshold form discussing issues
    including Hannah’s mobility and breathing. They conclude he is not
    eligible for funding for his nursing care, as he has no nursing
    needs.

    3pm

    After the meetings, two trainee community matrons, both based in
    York, arrive for a catch-up with Rae. The three are due to give a
    five-minute presentation to a group of local district nurses about
    the role of the community matrons and they need to prepare for it.
    On a flip chart Rae writes “what we are” and “what we are not” as
    the two trainees, Jan CondŽ and Emma Cummings, make
    suggestions.

    Conde is a trained health visitor and was prompted to become a
    community matron after her own mother received poor care in her own
    home in another area. She is “passionate about case management” and
    is keen for district nurses to develop proactive rather then
    reactive practice, something she hopes the community matrons can
    assist them in achieving.

    Cummings is a district nurse and swapped roles because it seemed
    a natural progression. She found one part of the community matron
    induction process particularly useful – the shadowing of other
    professionals with whom community matrons work, such as social
    services. “Now we know when we place a call to them what they do
    afterwards and the system that they follow, and how we can
    influence this,” she says.

    5pm

    Rae’s working day is ending and she heads back to her office to
    check her messages one last time. At 5.15pm she leaves, eager to
    spend the evening horse riding.

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