Evaluation of community matron services in a large metropolitan city in England.

Investment in community matron service development is an important feature of health policy in the UK, and underpins a national strategy to improve care for people with long-term conditions. These new services are under pressure to demonstrate added value in terms of patient experience and a reduction in unplanned hospital bed usage. The focus of this article is an evaluation of community matron services in a large primary care trust. The results of this city-wide service evaluation demonstrated high levels of patient and general practitioner (GP) satisfaction with community matron services. The themes identified by patients and GPs included improved communications and co-ordination of services. In addition to this, patients and carers commented on increased levels of confidence as a result of responsive and accessible services, as well as a perception that there was a reduction in unnecessary hospital admissions.

Community matrons: patients' and carers' views of a new service.

This article presents the results of a survey of patients' and carers' views about a community matron service in England. Key themes identified by patients and carers included the reliability of the service, the confidence it gave to patients and carers, improved links with GP services, and anecdotal evidence that the service helped to avoid admission to hospital. The authors believe the survey demonstrates a positive view of the community matron service which justifies continued investment in the role.

Community matron implementation: meeting the challenge in Leeds.

The introduction of the community matron role is an important milestone in the national strategy for the management of long-term conditions (DH, 2005a). Community matrons are seen as key in delivering personalized, managed care to adults with complex long-term needs. The Department of Health requires there to be 3000 community matrons in posts across England by March 2007 (Beasley et al, 2005). Leeds North West PCT is required to have seven community matrons in 2005/2006 and 13 by March 2007. This article describes the process of the introduction of the first wave of community matrons in North West Leeds.

Becoming a community matron: the transition from acute to primary care.

Community matrons are an important part of the policy of community-based management of long-term conditions. In contrast to some early conceptions of the role, community matrons can come from all areas of nursing. This article draws together two personal accounts by nurses from one primary care trust who have made the transition from acute care to community matron, and highlights the learning process they and their colleagues have undergone.

Developing the community matron role in care homes.

Care homes in England deliver complex packages of care to people with long-term conditions. The current policy focus on improving care pathways, choice and self-determination for people with long-term conditions offers tremendous opportunities for partnership working between the private and the public sector. This article describes an initiative to introduce the role of the community matron into the care home setting.

Developing the nurse's role in the care of older people.

A new model of care is being introduced at Wharfedale Hospital, Leeds. The 'Whafedale model' allows suitably trained nurses to assess, diagnose and deliver care to older people hospitalised with a range of conditions. This article describes the model's development and the challenges encountered.

Ask the experts. Single assessment process.

Person-centred assessments must reduce duplication of effort, promote effective communication between professionals and organisations, and lead to optimum, timely interventions with better patient outcomes. Wilson et al (2005) say: 'Successful implementation of SAP requires local agencies to develop effective approaches to whole system working and the delivery of integrated care. Little new seems to have been learnt about what makes integrated care work best since studies reported in the late 80s. However, in the implementation of SAP, effective improvements in joint working arrangements have been observed in areas where high level strategic understanding, commitment, and strong project leadership are present.' The benefits of an electronic system to support information exchange and workflow management are obvious. Some areas have managed to implement small scale IT pilots, but electronic versions of SAP are only a reality in those areas that are already piloting SAP solutions with their local service provider as part of the NPflT (National Programme for IT in the NHS). Nurse consultants have expressed frustration that the speed of IT development is not keeping pace with the appetite for SAP implementation. Contributors demonstrate how those not in the forefront of IT developments can make good use of the interim time by promoting the principles of the single assessment process and ensuring a commitment to SAP is maintained.

Implementing the single assessment for older people.

The National Service Framework for Older People envisages that the single assessment process will act as a key driver in the improvement of services for older people. Leeds Teaching Hospitals NHS Trust implemented a form of contact assessment that works in both hospital and community settings.

Ask the experts.

There is 'no one size fits all' solution to giving control to older people at the end of life. We need to move away from traditional homogenous and paternalistic approaches that see death as an event rather than part of the ageing process towards ensuring that individual wishes are foremost in CPR /DNR discussions. To achieve this, training and peer support is required as many staff, particularly those just entering a profession, feel unprepared to deal with issues around death and dying. Only when we have staff confident and competent to openly discuss and answer questions around CPR /DNR decisions will we truly be able to offer older people the opportunity to articulate and retain control over decisions at the end of their lives.

Ask the experts.

Older people are the biggest consumers of health care and therefore almost all nurses, whatever their chosen setting and specialty, find themselves directly involved in addressing their needs. Older people often have multiple health and other issues. How can nurses of the future be prepared effectively to take up this role?

Older South Asian patient and carer perceptions of culturally sensitive care in a community hospital setting.

This study describes the application of grounded theory to establish older, south Asian patient and carer views of service delivery in the UK. The purpose of the study was to inform the development of culturally sensitive services by defining the concept of cultural sensitivity from a user/carer perspective. The study took place in two community hospitals providing nurse-led intermediate care to a culturally diverse inner city population. Fifty-five per cent of the inner city population is of south Asian origin. Admissions to intermediate care, however, do not reflect the demography. Recent reports commissioned by the Department of Health highlight the failure of the National Health Service in England to provide culturally sensitive services to black and Asian patients. The Department of Health is trying to redress this inequality providing policy guidance for improving access and cultural sensitivity in the British health care system. There is little existing empirical evidence, however, to clarify the concept of culturally sensitive care. Patients and carers in this study described culturally appropriate care as that which respects individuality, creates mutual understanding, caters for spiritual need and maintains dignity. Older south Asian patients and their carers identified respect, understanding, spirituality and dignity as central to their conceptualization of cultural sensitivity. Their focus was on the nature of human relationships and their ability to interact in a positive way with staff. The findings of this small piece of empirical research are limited by the sample size (four patients and three carers), but illustrate that cultural sensitivity, although complex, can be defined. This then provides a basis for developing appropriate care strategies. One universal principle explicit in this research was that to be sensitive to culture staff must challenge their own assumptions and develop an understanding of the many layers of culture and subculture with which they are dealing. The starting point for any service is to understand the expectations of its users and to seek out and manage areas of conflict between organizational values and individuals' cultural requirements.