"Is this change for changes sake or just cost cutting?"

About: Central Lancashire PCT / Community nursing North West Ambulance Service NHS Trust

(as the patient),

I have been a COPD patient for over 15 years. Mature onslaught of asthma, which led to emphysema and later the development of bronchiectaisis. I can only say that the treatment received from the chest team, ward 24 staff, emergency staff (ambulance, paramedics plus A&E) has been second to none and continues to be an inspiration and a reassuring facility.

However, the newest initiative, the community matron service has to be the best, most valuable resource to be tried out for many years. But, sadly it appears that the tide of change is sweeping over the service and unfortunately the signs of self destruction are plainly visible. Initially, the direct contact approach by telephone to your delegated matron was a rapid response system, which created an ideal source for information, reassurance and advice. If a visit was deemed necessary then a visit would be arranged, ASAP, usually that day if deemed urgent. Not only was it a safety net, but a rapport could be developed in both directions and the matrons could form a mental picture to attach to any conversation which took place via telephone. This must have proved invaluable in forming a judgment as to whether the patient required a visit, a doctors appointment or simply just reassurance and a kindly word.

However, it has come to light that the working practices within the community matron service have been changed beyond all recognition. It is now the accepted and advertised practice that on each day of the extended hours worked, any one of the matrons would be on the switchboard to answer all calls, only till 1600 hrs when another matron takes over for the remaining 2 hours of each week day. Therefore continuity must be extremely difficult to maintain and creates a situation where the patient might not speak to the same person for many many months. By consequence, the matron can in effect spend a whole day talking to complete strangers, trying to make decisions on information relayed by a sometimes, poorly, confused in some cases and shy or reluctant patient to once more relate all the history of their own medical background to a stranger. Continuity surely must be the most important ingredient in the mixture.

Alas it appears that managerial interference and meddling, whatever the reasoning, could be ringing the death knoll of an invaluable service. I do hope that a fresh evaluation of the c/m service will be considered a priority and a return to sanity and common sense becomes a matter of importance and urgency.

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

Dear Smithies

Thank you for posting your experience about the Community Matron Service provided by NHS Central Lancashire.

In order to answer your comments from the service's perspective, I have passed your posting to the manager. A more in-depth response will be posted on the Patient Opinion website within the next 2 weeks.

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Response from Susan Bellmon

Dear Smithies

I am pleased to hear that you appreciate the Community Matron Service and see it as a valuable resource. It is also pleasing to hear that you have received a rapid response when you have contacted your named Matron, especially when you have had an urgent need. Sometimes for the Matron to respond in this way another patient has had their more routine appointment cancelled at short notice.

The service provided has not changed but an attempt has been made to improve the way in which it is delivered to make it more responsive. The Duty Desk system has been set up to provide a single point of access as sometimes when the named Matron is on annual leave or training, patients have not received the speedy response that you have received and we are keen to provide an equitable service to all our patients.

I understand your concerns around continuity, and would like to reassure you that a standard procedure is in place to triage calls and to take a comprehensive medical history to inform our clinical decision making. Only this week we received an urgent call from a patient who's named Matron was on annual leave. Within 30 mins of receiving this call the Duty Desk Matron had arrived at that patient's home. When something changes that we have become used to it can sometimes not always seem to be for the best. I would like to set your mind at rest that you will continue to be monitored by your named Matron in accordance with your level of need through visits or over the telephone as before. The Duty Desk is available for any unplanned contact when you need help urgently.

We have reviewed the Duty Desk function for the month of February and of the contacts made, 93 resulted in a routine or urgent visit being performed by the patient's named Matron, indicating that continuity is still maintained wherever possible.

The Duty Desk has provided the opportunity to extend the service operational hours to cover 8.00-18.00hrs Monday-Friday (excluding Bank Holidays at present). Calls have been received during these times which may indicate that patients welcome the extended hours.

We will continue to evaluate this function and the outcomes for patients. Our aim is to provide an efficient, quality driven service to support those on our caseload to self-manage their condition. I hope this provides you with some reassurance. You are most welcome to contact the Operational Lead through the Duty Desk if you wish to discuss any concerns in the future, as service experience is important to us when considering further service developments.

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