Case study:

04 December 2008

Community matron in care homes - providing access to appropriate care in Nottinghamshire Community Health PCT

Key points

For the past two and a half years a community matron has been working with staff and residents in care homes in parts of the Nottinghamshire Community Health PCT area to help improve standards of care.

Much of the work has focused on end of life care which was felt to be most problematic. In particular there was growing concern about the number of care home residents who were being admitted inappropriately to hospital. In addition residents with long-term conditions tended to receive less anticipatory care than those with cancer.

Another area identified as needing extra input was mental health, which has led to the funding of a CPN and two health care assistants to work with residents experiencing acute mental health problems.

To begin with the community matron and a team of facilitators focused on nine care homes, helping staff to introduce the LCP and backing this up with training and support and close auditing of the pathway as it was being used. They also encouraged a degree of networking between homes by organising support meetings, each home taking a turn to host the meeting.

The result has been not only better end of life care but a significant reduction in both number of bed days and emergency admissions – although so far this is based on anecdotal evidence rather than hard figures.

Feedback from care homes and residents’ families has also been almost universally positive.

It has taken patience and time to persuade some of the homes to use this service, though others have embraced it from the beginning. But using them as an example has helped persuade less enthusiastic homes to refer residents. The biggest challenge now is to manage an increasing service with no increase in staff.

The service is currently being reviewed and it is hoped it might eventually be expanded to the whole of the county.