Case study:

20 November 2009

Community Matron for Supportive and Palliative Care for Oxfordshire

Key points

A community matron dedicated to coordinating supportive and palliative care for patients in Oxfordshire has helped cut admissions to hospital and enable more people to die at home.

The post, jointly funded by Sue Ryder Care and Oxfordshire PCT, is believed to be the first of its kind in England and is estimated to have saved £60,000 in a single year.

The key aims of the three-year pilot are to coordinate care, identify bottlenecks in the pathway, unite existing services and drive strategic change and place the patient at the centre of care by the use of case management and encouraging self-care strategies.

Early evaluation shows the role is already having an impact. The service is now at full capacity with the matron managing a case load of 60 patients. Initial reports indicate it has reduced hospital bed days and helped speed up the discharge of patients from hospital to enable them to die at home. It also seems that patient choice around end of life is more likely to be achieved through this role.

Referrals come from all areas including community and acute hospitals, social care, nursing homes, members of the primary health care team and relatives.

Evaluation of the pilot supports the need for the post to be continued.