HEALTHCARE in the community is filling the gap between the hospital and the home.

The work of the community matron, a role only started in January 2006, lets people decide how they want to be nursed.

Helen Rollings, a nurse for over 10 years and now community matron for the north west Swindon team, is responsible for long term care.

She said: "As community matrons we do improve people's quality of life because for the patients that's what matters to them."

The community team includes an occupational therapist, social worker, district nurses and administrative staff.

Helen's job is to assess and treat the needs of patients with a variety of long-term illnesses including chronic obstructive pulmonary diseases (COPD) like emphysema or chronic bronchitis, heart failure, diabetes and Parkinson's.

The team is linked with a rehabilitation centre run by the PCT where their patients can be taken if necessary.

The idea is that each patient has a care plan so that if they do go into hospital the staff will know exactly what to do.

Helen says more people want their care provided at home.

"They can have a cup of tea if they want to," she said.

"They feel comfortable in their own bed and they may not be visited in hospital by friends."

Helen says the matrons are seeing increasing numbers of older people with debilitating illnesses because people are living longer.

Patients are normally referred if they have been in and out of hospital or if their doctor feels they would benefit from a care plan.

They also work in partnership with district nurses and palliative care specialists at Prospect Hospice, so that if someone is coming out of hospital they receive suitable care and social workers at home to ensure people's needs are not forgotten.

Helen admits sometimes this can be difficult to manage.

"Some people shout loud, but a lot of people don't," she explained.

"They think people are too busy and we don't get time, but we have time and we need to know."

They also go into nursing homes to give advice to staff.

While the district nurse deals with the day-to-day needs of patients, a community matron will support and manage the care for those with long-term conditions.

"As a human being you want to keep people well, but as a nurse you have to accept that their condition is progressive and it's hard to watch someone deteriorating," said Helen. "But it's also rewarding to be able to work with the person to help them to have the choice about where they want to be cared for and to provide that care."

She believes healthcare will continue to change and adapt as people' s expectations rise and that in future more will be done in the community to try and prevent life style problems, such as smoking, obesity, drug abuse and nutrition.

"It's the lifestyle changes that none of us find easy, but would make the difference," she said.

I'm in charge of my health'

COMMUNITY care certainly seems to have worked wonders for Peter Horwood.

From installing a seat in his shower to constant monitoring, he believes it is the little things the community matrons do that make such a difference.

Peter, 67, of Anderson Close, has suffered from chronic obstructive pulmonary disease (COPD), mainly emphysema, for 10 years, and says without community care he would probably end up in casualty at least once a year.

He used to rely on wife Margaret to tell him he was not right then he would have to book a doctor's appointment, which he would put off until the condition worsened.

Thanks to the community matrons and a home telehealth machine he is not allowed to reach that point.

He was referred by his GP in June last year for the treatment and now only sees a community matron once a month.

On meeting with the nurse his blood pressure and pulse rate were found to be high and a further test blood test showed his blood sugar levels were too high.

Since then Peter has lost two and a half stone and changed his diet, which has lowered his blood sugar.

This has also improved his blood oxygen levels from 89-92 per cent to 92-94 per cent within a year (a normal person's would be 98 per cent).

He said: "You are in charge of it yourself and managing your own condition.

"It's going to keep people out of hospital, which is going to save the NHS money and improve the lives of patients."

Giving patients confidence

ADVANCES in technology are making it easier for home patients to manage their own care.

The telehealth machine started came to Swindon in July 2007 and 11 monitors were given out to patients in the town who rely on home visits.

A probe on the patient's finger can measure blood pressure, pulse and oxygen saturation levels.

Other tests are done on weight and the patients must ask four questions about their condition.

This test is performed daily and results are fed back to a nurse at a walk-in centre at the hospital with on-call doctors.

If the levels are higher or lower than those set by the community matrons this could indicate the start of an infection.

The nurses will therefore call the patient or ask them to redo the test.

Helen Rollings, community matron of the north west Swindon team, said the equipment was very expensive, but following its recent success 50 households would soon have access to one.

"Patients are not having so many episodes of illness," she said.

"They understand it better and have more confidence in managing their condition."