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Monday 03 September 2018

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Modern matrons are finding it difficult to exert the authority needed to run their wards. Harriet Sergeant reports

'There's so much anger among our patients'

Before drawing up the NHS Plan, the Government solicited views from 152,000 members of the public and 58,000 NHS staff on how to improve the service. The single most requested item was the return of matron - a strong clinical leader with clear authority at ward level. Someone in charge of getting the basics right.

Now, after an absence of 30 years, 2000 "modern matrons", with their own uniforms and a "modern, enhanced set of responsibilities", have been introduced into the NHS. In the private sector, however, matron has never gone away.

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The NHS's rejection of an authority figure in the Seventies articulated a more general social trend that continues to this day. Many nursing staff and unions still seem uncomfortable with the idea of the matron and perplexed by its popularity; to them, it raises a spectre of the days when hospitals were ruled by a rod of iron and matron checked for every speck of dust.

Nursing organisations have therefore refashioned the job into something softer and more acceptable. The authority figure becomes, according to Sarah Mullally, Chief Nursing Officer, "professionally and emotionally supportive of staff" while allowing nurses to "take control of the environment''.

Modern matrons, says the Royal College of Nursing website, must exude "a professional calm" while engaged in "emotional labour". Unfortunately, emotional labour is not quite what patients had in mind when they asked for the return of matron.

Thirty years ago, matron's role was undisputed: she ran her hospital and wards. She knew all her patients, her nurses, her cleaners and the porters - and had authority over every one of them. One porter recalled a matron coming across a broken chair in the corridor. "What's it doing here? Get a carpenter and get it fixed." Now, he went on, "the waste is awful. I see 200 new computers just go out of doors. As for a chair, a slight rip and it's out, too."

The old-style matron also saw herself as the patient's advocate, and her opinion was sought and valued by the consultant on his ward round. If something went wrong or was not done, she took responsibility; the blame stopped with her.

She would not recognise her old job now. For a start, matrons are responsible for budgets. "I spend hours in finance meetings," complained one. She has less and less time for the wards, checking patients and supervising junior nurses.

I met several newly appointed matrons and shadowed one - Daphne - for half a day in an inner-city London hospital. The extent of her contact with patients appeared to be a quick walk through the wards, with the occasional stop for a chat. Daphne did not know any of her patients or what they were in for; nor did they know her.

On the female ward, we stopped in front of an old lady in a blue bed-jacket. Her face was a horrific mass of bruises - I assumed she had been brutally mugged. Daphne looked embarrassed. A wrong prescription from the old lady's GP had left her dizzy, and she had tripped over and broken a hip. Her bruises, however, came from falling out of her hospital bed.

An old man in the next bed, who had found himself on a women's ward, piped up: "People are falling out of bed all night long. Thump, thump, thump. They do it so much, they wake me up.''

I asked Daphne why the beds lacked the cot sides available in private hospitals. "We believe physical restraint is inappropriate to our patients' dignity," said Daphne reprovingly.

The "big part" of her day, she admitted, was spent in meetings. She named 10 off the top of her head: a clinical board meeting every three months; a food and cleansing meeting; a Blue Team meeting; a Critical Care Delivery Group every six weeks; a meeting with the heads of surgical wards every month; a subsequent meeting with ward managers to pass on that information; an audit of Risk Assessment every six weeks to see what had gone wrong and how it could be improved; a glucose monitor review group; a Flexibility Group meeting to improve retention and recruitment of staff. "And that's not all," she added. She was clearly proud to be part of these meetings and rated them highly. "They are a big part of the day, but necessary. You do need to be involved.''

Modern matrons are supposed to have the authority to get the basics right for patients. But, in the emotionally supportive NHS culture, how easy is it to exercise authority on behalf of the patient?

A patient in one of Daphne's wards had been waiting all morning for a porter to take her for a scan. Then, Daphne bumped into the porter in the corridor. Commenting on the delay, she said: "It's stressful for the patient and frustrating for the nurses.''

The porter shrugged, unmoved. His workload had tripled that day and three men were off sick. There was nothing he could do, he said, and moved off.

The matron watched him go, anxious that her mild reproof might have been too forceful. Eventually, as if seeking confirmation, she said: "Well, I am glad I mentioned it. I do like to have a chat if there is a problem." When I asked Daphne if there was any occasion when she could sack a porter or, at least, issue a reprimand, she looked shocked. "Oh, no. We can't get rid of porters if they are no good. We send them on a training course." Meanwhile, the patient continued to wait.

It was the same when it came to food. An Indian patient had ordered a vegetarian meal. Twice, the wrong meal had been delivered. Finally, the patient had given up and stopped eating. Daphne took the problem up with the kitchen. "A lot of ward sisters would not have bothered, but I do." Her power, however, seemed limited to complaining. "Things might improve for a month, but then it all slips back again.''

Daphne was clear about her role, which she saw as being passive and sympathetic - "I am here as a listening ear for everyone." She believed she had power, "but you can't use it willy-nilly or you lose it. You can't just go and whine. You have to negotiate."

This view was echoed by other modern matrons. Back in the Fifties and Sixties, "it was much more hierarchical", explained one. "Now, it's more a case of working with people to achieve goals. You can't go around saying: 'Do this' or 'Go and do that now'. It doesn't work like that any more."

This meant that Daphne saw herself less as a champion for her patients and more as a pacifier.

Tote Shoulder Pink Women Sharplace Beach Casual Black Bag Purse Lady Straw Messenger Satchel Patients, she said with an air of surprise, still demanded to see matron when something had gone wrong. She found a "softly, softly," approach the most effective. "I am here to defuse anger because there is so much anger among our patients.''

Tell us your story

Do you work in an NHS hospital? If so, do the issues raised in Harriet Sergeant's series reflect your own observations and experiences? Please address any letters to: NHS Hospitals, Features Department, The Daily Telegraph, 1 Canada Square, Canary Wharf, London E14 5DT or email us on: nhshospitals@telegraph.co.uk

  • This article is an edited extract from Managing not to Manage – Management in the NHS, published today by the Centre for Policy Studies. To order the full pamphlet, send a cheque for £10 to the CPS, 57 Tufton Street, London SW1P 3QL
  • Olive M Boot Waterproof Dark Arrowood Men's Teva Hiking Mid Cfqw8845
  • The hospitals pictured in this article were not among those visited by Harriet Sergeant

For publishers wishing to reproduce photographs on this page please phone 44 (0) 207 538 7505 or email syndicat@telegraph.co.uk

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