"My matron is nice but not quite joined-up"

About: Central Lancashire PCT / Community nursing

(as the patient),

My matron has a pleasant pesonality with rather a 'butterfly' mind - often jumping from one thing to another. It's because she comes without a plan and forgets to look at people as a whole: some of us at eighty are more 'with it' than others at sixty!

Matron monitors my blood pressure, oxygen levels and weight. Somehow, she is not joined up to other parts of the NHS and had no idea I was being assessed for oxygen at home, now installed, or was awaiting a nasty lump to be removed from my leg, (all gone successfully) or noticed both cataracts (one gone now) or taken in that I have the dreaded osteoporosis.

Maybe she doesn't come often enough but more likely I don't have the energy to explain, or the breath. Can nobody read all the recent medical notes or are they all kept in different files / buildings / computer systems? If only the NHS would join up its departments.

Meanwhile, there has been an occasion when I was so distressed and down - it happens. Dutifully, Matron wrote up her kind offered drugs / referral to psychiatry and said she'd be back in a month. Not even a follow up phone call!

Matron is great on discussions about the end of life - hospitals are full, hospices are very full and so nursing homes are a possibility. Perhaps also specialist nursing at home. It was helpful to make us have the discussion as a family. The second time Matron wanted it all discussed (she hadn't written it down several months ago and now the doctor wants to know) I found it very upsetting. I don't want to keep planning the end - just want to enjoy what's left now.

Last points - Matron has not been able to organise a pressure bed / accessible bathroon / stairlift / extra hand rails etc. All useful things which I have had to adapt to mentally, and now realise help me to stay in my own home. Thank goodness for my daughters who have persisted with Social Services to find out about these aids and how to apply and find funding etc.

Matron is a great idea but cannot seem to yet do the whole job. The boxes are ticked but I often feel like a client in a caseload not a lady to be respected and cared for in her own home after a lifetime of service to our great nation!

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Response from Julie-Ann Bowden, Clinical Quality and Assurance Manager, NHS Central Lancashire

Dear Speedway Queen

Thank you for taking the time to provide your feedback about the Community Matron Service provided by NHS Central Lancashire. It is disappointing to hear that your experience has not lived up to your expectations.

In order to provide a comprehensive response to your posting, I have passed your comments to a senior manager within the Community Matron team for consideration.

A further, more detailed response will be made within the next 2 weeks. In the meantime, if you wanted to speak to someone further about your issues then you could consider contacting the Patient Advice and Liaison Service on 0800 032 24 24.

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Response from Julie-Ann Bowden, Clinical Quality and Assurance Manager, NHS Central Lancashire

Dear Speedway Queen

I have now received a more detailed response to your posting from the Community Matron Team.

Firstly, I thought it might be helpful to outline the aims and objectives of the service. Community Matrons use the Single Assessment Process to ensure that a holistic approach is used to assess the person as a whole. The aim is to provide coordinated personalised care so that you can remain safe and healthy in your home or chosen environment as long as possible. This assessment period can be difficult at times as it is realised there are many questions to be asked, plus the assessment can be spread over several visits.

The Community Matron Service has identified that communication across services, professionals, secondary and primary care could be improved, as you identify, so that we all 'join up' a bit more. The service has, in some areas, introduced the patient held single assessment process. The person receiving the service holds this in a red folder in their home. As the focus of the Community Matron Service is to support and empower people to self manage their condition, patients are encouraged to take this file with them when going to appointments with other services. This provides a meaningful way of communicating between healthcare professionals and helps reduce duplication. Your comments regarding communication do further support the service's view that as a whole, communication pathways do need to be improved further.

With reference to the period of time you refer to as 'being down', the Matron's role is to offer advice on possible solutions to an individual's identified needs. It is then the patient who makes the choice around future care. As the service offers an open door policy to patients, their carers and relatives, you are able to contact the service if you feel you need additional advice or support prior to your next planned visit. This reflects the self-care/self-management model as described above.

Discussing end of life issues is always difficult for all those involved and you clearly highlight this. It is pleasing to hear that as a result of the Matron's intervention, you and your family were able to have these discussions to enable your preferences to be known.

You make reference to a number of items of equipment that you have been waiting for. NHS Central Lancashire (the primary care trust) provides the specialist assessment which identifies what adaptations and equipment a patient may require. This assessment is then passed to Social Services who are responsible then for provision of the identified aids. Your daughters were right to contact Social Services as you stated. I am sorry to hear that you found this to be a difficult and drawn out process.

Throughout your posting, you have raised a number of issues that have made you feel that the service provided by the Community Matrons could have supported you more completely. I will ensure that your comments are discussed at the next Community Matron Service Meeting to ensure that the Matrons are aware of your views. This will help to identify where the service can be improved and where lessons can be learned.

Should you wish to discuss your concerns further or require any support or advice about any aspect of your healthcare, then please consider contacting the Patient Advice and Liaison Service and NHS Central Lancashire on 0800 032 24 24.

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