Published: 24/02/2005, Volume II5, No. 5944 Page 12
Meeting the pledge to recruit 3,000 community matrons by 2008 will be the toughest part of policies to cut emergency bed days, the Department of Health's head of primary care has warned.
Gary Belfield told a conference last week that achieving the 'secretary of state's unofficial target' for 3,000 community matrons was the biggest challenge in the government's policy to improve care of people with long-term conditions and cut emergency bed days by 2008.
He said the solution could be to entice emergency ward staff from the secondary sector to become community matrons, if they were told they would otherwise be 'working empty wards' as the number of emergency bed days fell.
Mr Belfield said the government's management framework on supporting people with long-term conditions, published in January, was 'about 80 per cent right' and that primary care professionals should 'just get on and implement' it.
But the head of primary care was disappointed that the public sector agreement target on emergency beds - signed off before he joined the DoH - was not a joint one for health and social care.
He told the conference in London: 'We need to engage properly with social care and the voluntary sector as well as working across secondary and primary care, because if we do not we will fail to deliver the target. Let's not have hundreds of pilots. We know what works, so let's just get on with it, ' he added.
Mr Belfield also said the DoH 'might over the next few months think with strategic health authorities' about what 'disease groups' may be appropriate to set as national priorities for case management.
These could include areas like diabetes and coronary heart disease.
But Mr Belfied said the policy was moving on from its emphasis on 'case management' and patients at high risk of admission and promised guidance on self-care within two-three months.
Primary care czar David ColinThomé told the conference that practices could use practice-based commissioning to commission social care services and improve joint working.
'Since [the health service] have got the funding growth and have a common agenda with social services, we need to be liberal about joint funding, ' he said. 'Practices might want to develop joint services at a local level, because I know our experience at my practice was we were most efficient at lessening patients need for hospital treatment when working in partnership with social care, ' he added.
'We need networks that engage all players'
Emergency care networks look set to get central funding for at least one accountable manager to ensure partnership -working gets off the ground.
Primary care czar Dr David Colin-Thomé told HSJ he had joined forces with emergency care czar Professor Sir George Alberti in an effort to persuade the Department of Health to inject resources into the networks.
The networks are supposed to ensure joint-working between primary and secondary care, the ambulance service, mental health services and social care.
But they have largely failed to get going because no-one is accountable for delivery.
Dr Colin-Thomé said the time was now right to mainstream the initiative that would support the government's policy on long-term conditions.
'Our thinking is we need to have networks that engage all players across the system, and that it needs to be professionally managed, ' he added.
Sir George has been keen to give the networks more clout since they were first mooted as part of the policy on reforming emergency care launched in 2003.