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.