Matrons carry on case management role

Last year, the government announced its intention to recruit 3,000 community matrons by 2007 to care for people with long-term conditions.

There is no doubt that patients with long-term conditions such as diabetes, asthma, arthritis, depression and heart failure are potentially being offered much improved care as community matrons start to develop their case loads.

Essentially, community matrons are senior nurses who are trained to provide case management services to patients with long-term conditions.

They assess needs and develop personal care plans, provide active care on a regular basis - at home or via the telephone, and work in partnership with patients' GPs and social services, sharing information and planning together. In addition, they can diagnose, treat and prescribe certain medications in patients' homes.

There are more than 17.5 million people living with chronic conditions in the UK. The care of these people accounts for around 80% of GP consultations.

Currently, the Department of Health says 10% of chronically ill patients who stay in hospital for their care account for 55% of hospital stays, and many of these patients have multiple chronic long-term conditions.

So you can see why the government is so keen to introduce community matrons who will help to improve a patient's quality of life, reduce unplanned emergency hospital admissions and the length of hospital stays.

But what effect, if any, is the community matron initiative having on the insurance sector?

As the initiative is in its early stages, the effects on the insurance industry are currently minimal. At the moment we are seeing some private companies providing case management training to nurses, while others are providing consultancy support - so the public and private sectors are starting to work together.

In the next couple of years, however, we should see a number of changes which will definitely have a positive impact on the insurance sector.

Community matrons have a similar role to medical case managers so there will be a greater awareness of the role case management can play in improving people's lives.

And this can only be good news for the insurance sector as the change in the public sector may encourage more insurers to embrace rehabilitation and case management. Currently only a small proportion of insurers use rehabilitation/case management services on a regular and consistent basis.

Raising awareness of case management in the NHS will bring other benefits too. Case managers in the private sector, for example, should start to see a positive effect on the outcomes of their cases as the NHS begins to have a greater appreciation of what they do.

The lack of case management knowledge within the NHS has, at times, hindered the progress of many cases. An increased awareness of the role may help reduce the lifecycle of cases and, ultimately, claims.

No doubt too, in the medium term, there will be a larger, more credible and professional case management resource available to insurers.

Some community matrons may choose to move from the public to the private sector, replicating the transfer of skills that has taken place between some public and private healthcare providers. In addition, we may find a small number of community matrons seeking to supplement their incomes by providing freelance case management services to the private sector.

The advent of so many new case managers in the public sector may drive the development of accreditation/certification of case management and the development of professional standards. Again, this is good news for those insurers who have been put off using case managers due to lack of professional credentials.

The community matron initiative has certainly driven rehabilitation and case management up the political agenda. There is now more awareness then ever before of the role case management can play in improving people's lives. We can only hope that the insurance industry will start to embrace rehabilitation and case management wholeheartedly. IT

' Deborah Edwards is a director at case management company, RTW Plus