The NHS met its target of employing 5,000 modern matrons last week. Helen Mooney analyses whether they have been a success.
Modern matrons first came on the scene in 2001 when a public consultation on developing The NHS Plan provoked a call for a ‘matron figure, a strong clinical leader with clear authority at ward level’.
The government wanted this figure to be easily identifiable and accessible, with an aim of ensuring the ‘basics of care’ were right and that the patient’s experience was improved.
Last week the Department of Health said it had a met its target to double the number of matrons by May 2008 from a 2007 baseline. The last NHS Workforce Census showed there were 2,153 in post in September 2007. The DH said this figure is now 5,538 (NT News, 10 June, p2).
However, an overview of strategic health authorities suggests a mixed picture when it comes to implementation of the role, as the numbers in post differ greatly by SHA. While the North West employs 844, the North East has only 350.
The DH said each SHA was set a realistic target from its 2007 baseline and that all exceeded the numbers of matrons they were told to employ. But the disparity remains. Does the North West really need nearly 500 more modern matrons than the North East, for example?
The RCN’s head of policy Howard Catton says that it is ‘legitimate’ to question this disparity and remains adamant about the need for the role. ‘Just because the target has been met nationally, the NHS must not now forget about modern matrons – there is still work to be done,’ he said.
There had been concerns that modern matrons would not be new recruits but would simply be ‘rebranded’ by organisations from their current staffing pool.
‘For the modern matron role, some organisations have just given ward sisters the title,’ said Lib Jones, a modern matron at Doncaster and Bassetlaw Hospitals NHS Foundation Trust in Yorkshire and chairperson of the Matrons National Network.
But Mr Catton disagreed. ‘We feel that by and large the modern matrons are new, although they are coming from the ward sister talent pool,’ he said.
In 2007 the DH instructed NHS North West to recruit 796 modern matrons by May 2008. The SHA has far exceeded this and is currently employing 844 with a further 19 due to start before September.
Jane Cummings, NHS North West’s director of performance, nursing and quality, explains that the SHA asked each of its 63 organisations to review their senior nursing cover to see how they could increase modern matron numbers.
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.
Mr Catton agreed. ‘In principle modern matrons are a good thing but it is important to recognise the degree of patient power in play here. Somebody needs to be visible on the wards with the power and authority to make sure that the environment is clean and tidy, and that there are provisions for food, cleaning, equipment and supplies, and the matron does this,’ he said.
However, he warned against assuming the role is the ‘silver bullet’ in tackling infection. ‘The modern matron can help to reduce infection rates as part of a range of factors that are put in place,’ he said.
Ms Jones said matrons were important as a ‘custodian of the patient experience and environment’ but she questioned whether there was a direct link between increasing the number of modern matrons and a reduction in infection rates. ‘The modern matron gives patients confidence and is heavily involved in nursing staff education, training and auditing,’ she said.
Her trust has increased the number of matrons from 13 to 22 as a result of the government’s target and Ms Jones thinks this has had an impact on senior nursing staff development.
‘Within our organisations we have promoted senior staff and done a lot of work on developing nursing leadership,’ she said.
Mr Catton also said the role had helped to build a strong nursing career structure.
‘Previously there was a great big space between ward sister and director of nursing. What we have seen is that the creation of the modern matron, as well as consultant and specialist nurses, is providing a career structure and hierarchy enabling senior nurses to stay in leadership roles in a clinical setting,’ he added.
Even where they have not been heavily implemented, there are strong advocates for the role. Although NHS South Central employs only 315 matrons at present – the lowest number of any SHA – deputy chief nurse Cathy Geddes said there were plans to increase numbers and ‘ensure the development of the role’ across the patch.
‘Matrons are strong clinical leaders, given the power to make things better for patients and families, with distinctive uniforms to ensure that they are highly visible on the ward,’ she said.
Ms Geddes is in no doubt that they have a clear role to play in the NHS. ‘They have an essential role in monitoring and improving standards of care, [they ensure] dignity and respect of patients is maintained, wards are clean and that patients are properly fed,’ she said. ‘They help set and monitor the standards for cleanliness, dignity and respect and catering and have authority to take action where the highest standards are not met.’
While the jury is still out on whether modern matrons can be credited directly with reducing infection rates, their role in boosting patient and public confidence is clear. Announcing the government had met its modern matron target earlier this month, health secretary Alan Johnson suggested the role was here to stay.
‘Additional matrons have been recruited and given greater powers,’ he said.
‘If cleanliness is not up to scratch we expect matron to order additional cleaning and ensure the highest standards are met or that the cleaning contract is changed,’ he said.