There are some classic clichés of British (and I think I really mean English) life. A lot of it involves a wistful nostalgia for a life that historians might – spoilsports that they are – point out wasn’t like that when we were allegedly living it. Among the tricks memory plays is the vanquishing of rickets, chilblains and rural poverty. The would-be evocative speechmaker that looms largest in recent memory was John Major, whose 1993 speech to the Conservative Group for Europe included a sentence since widely quoted:

Fifty years from now Britain will still be the country of long shadows on county grounds, warm beer, invincible green suburbs, dog lovers and pools fillers and – as George Orwell said – “old maids bicycling to holy communion through the morning mist” and if we get our way – Shakespeare still read even in school.”

It wasn’t until I searched for the original source of the quote that I noticed its original audience – a political party divided over European issues – or the sentence that followed: “Britain will survive unamendable in all essentials.” I can’t trace details of the venue for the speech, but if it had a gallery the speaker was certainly playing to it. But there was one thing missing from the gallery of nostalgic charms that I thought was conspicuously absent – until it popped up on the news a few days ago. Yes: matron.

Matron is an archetypal figure that, in popular British culture, seems to press several buttons: a nostalgia for ‘how things used to be done (in the good old days)’, an appeal to those who see strict discipline as the best answer to most problems, and (what strikes me as a distinctively English theme) a stern woman in uniform that creates a certain frisson in a certain sector of the public. The mere mention of the word is, for some English men, mentally accompanied by a twang of suspender belt and, for some English women, by a rustle of starched aprons. (Sorry for the stereotyping, but matrons seem to come with a plethora of them, tucked neatly into an apron pocket.) “In olden days a glimpse of stocking” and all that …

Though it might surprise some of the latter-day Sid James and Colonel Blimps, ‘Bring Back Matron!’ is, in reality, a rallying call that’s already been answered: Modern Matrons were introduced in 2001. The Government’s target of achieving 5000 of them was met in 2008, yet outcries about patient care and infection control continue. A human resources solution – creating matron posts – has been implemented, but in response to a process problem (elderly patients going unfed and uncleaned, MRSA, and all the unfortunately familiar horror stories from the media). Stepping out of the sphere of the mainstream media, it’s interesting to look at the medical and nursing press for commentary. In an article from Nursing Times in June 2008, the following quote from Jane Cummings, NHS North West’s director of performance, nursing and quality, was illuminating in terms of driving factors:

The SHA provided funding for additional staff, such as ward sisters, to free up existing senior nursing staff to be promoted to matrons. Ms Cummings says that the driving factor in employing matrons was to increase public confidence.

‘It was about being seen to do it and do things differently – having modern matrons gives patients and the public more confidence,’ she said.

But although the role of matron may have increased public confidence, has it had any impact on infection control as the government promised?

Ms Cummings is unsure. ‘There is a real need now to test the evidence base for having modern matrons over the next couple of months and assess their impact,’ she said.”

In the same article, RCN’s head of policy, Howard Catton, makes a further interesting comment: “The modern matron can help to reduce infection rates as part of a range of factors that are put in place.”

Now I have no medical training, but I do have an elderly relative with advanced dementia who was admitted to hospital to deal with a fracture some months ago. The experience – for patient and carer alike – was horrendous, but I was forewarned about the nature of the underlying problem by her regular carers. Those providing professional care to dementia patients have specialist training to understand the symptoms of sufferers and the behaviours that arise: they know that delivering food doesn’t mean it will be eaten – the patient may forget it’s arrived or assume it is someone else’s.

They will be confused, bewildered or scared by any number of activities, and may not even realise they are in hospital. (And attempting to persuade them otherwise will do you no good: their delusion is their reality.) A nurse with sound clinical training but no experience of dementia’s symptoms will not be best equipped to deal with this: neither, unless they have the training, will a matron. A matron might provide firm line management, but – in a society with an ageing population and a concomitant increase in numbers of dementia sufferers – they will be managing without knowledge and managing those without necessary skills.

The first issue here is training, and no amount of wishing things were as they were – which seems bitterly ironic given one of the behavioural patterns of dementia – will deliver it. I was comforted by a limited extent to have a figure on the ward I could take issues to, but I can’t say I got any confidence from doing so. It was easier to short-circuit all the processes and deliver what was needed – tea, sandwiches, dry shampoo, and time to make sure they were used – myself, and to try to explain my relative’s needs in more detail to the nurses (which did improve things a little).

The issue of ‘matron’ blew up in the last few days because of a report by The Patient’s Association, reported by Nursing Times in an article called “Patients Association claims bringing back matron has failed”. The comments posted in response to the article (which it’s probably safe to say are mostly by those actually ‘at the coalface’) are highly illuminating reading, not least because of the range of responses and reasons for failings that they report. No training is required to take the nurses’ temperature on the topic: hot with anger. If one role of modern matrons was to provide leadership in nursing, some of the nurses feel either un-lead or lead in unhelpful directions.

The final words of the article come from Royal College of Nursing general secretary and chief executive, Peter Carter:

Now is it a question that the individual nurse is poor or is it a question that there are systemic failings in some hospitals.”

Logic would imply the latter – as it would in any scenario where the performance of the core function (in a hospital’s case, patient care) is being called into question. In the situation, whatever the purpose of the organisation, performance management needs to be re-examined: if performance is failing, it’s not monitoring that’s required, it’s remedial action. But reasons for under-performance need to be flushed out too: if processes are being followed, they need to be reviewed if they are not delivering their intended purposes. If structures are standing in the way, they need to be reconfigured.

Nostalgia, however, is not a solution. Even if she were still with us, Hattie Jacques (the no-nonsense matron of five Carry On films) would not provide a role model: a chain smoker who battled obesity and was obliged to work on stage when her health meant insurance for film work was no longer possible, she died of a heart-attack at the age of 58. (A sad end to the life of a great comedienne.) Creating new posts within organisations does not solve all their problems, and old solutions do not necessarily solve new problems, as the BBC appeared to realise when it took a retired old-school Matron to visit Addenbrooke’s hospital:

So should we bring back the old style Matron? Would it make any difference? Hazel isn’t sure.

“I don’t think you can bring back Matron in the way it was in my day. But I think personally seeing those girls this morning I thought they were doing a very good job.” “

Matron’s fob watch, like anyone’s, should always keep accurate time: turning back the hands is not the answer.

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