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Patients Association claims bringing back matron has failed


Matrons should be able to concentrate on basic nursing care standards rather than meeting performance targets, the Patients Association has said.

The patient advocacy charity said the government’s attempts to bring back the post had failed because commitments to patient care were being sidelined by bureaucracy.

It has today published a report highlighting what it describes as “serious failings in standards of nursing care, poor communication with relatives and an ineffective complaints handling system”.

The report Listen to patients, Speak up for change includes 17 firsthand accounts of hospital care of older patients from across the NHS.

It is a follow up to a similar report published last year called Patients not numbers, People not statistics.

Patient Association chief executive Katherine Murphy said: “It is clear from the stories we hear on our helpline that too many patients are being badly let down. It’s a scandal and it’s outrageous that has been persisting for years. Families are left with a life sentence of grief, with no lessons learnt and the same failings continuing.”

She added: “The NHS has tried to bring back matron, but is hasn’t worked. That absolute commitment to patient care seems to get sidelined by targets, finances and bureaucracy.

“What we need is a matron who can ignore all of that. They can tell trust managers, ‘forget your strategic framework and middle manager initiatives, it is meaningless if patients are not getting the vital nursing care they are entitled to.”

Ms Murphy also called for the NHS complaints system to be “reviewed urgently”.

“Patients and carers need to be able to call on a real advocate when they complain, someone to fight their corner,” she said.

Speaking about the report on BBC 4’s Today programme today, Kieran Mullan, also of the Patients Association, said: “We’ve put forward the idea that there should be a senior matron type figure who could really be a patient champion.

“They would be independent of the hospital in some way, whether that’s with the regulator or the local authority. Someone who focuses on these essential care needs.

“There is something there about the old school matron who would not take no for an answer on patient care,” he added in response to a suggestion that a “Hattie Jacques” figure was needed. 

Royal College of Nursing general secretary and chief executive Peter Carter said the report’s findings did not come as a surprise.

He said: “We commend the Patients Association. They are absolutely right to keep standing up for patients’ rights and highlighting poor care.

“We have real concerns about the care in some of our hospitals. Now is it a question that the individual nurse is poor or is it a question that there are systemic failings in some hospitals.”


Readers' comments (26)

  • Its the system that is failing both patients and nurses. Nurses concerns about their inability to deliver the care they have been trained to provide have been ignored by managers for years. Low staffing levels, high workloads and lack of real support from senior nurses has taken its toll and nurses are worn out by fighting.

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  • Oh please, not more matron stuff, bring back Matron and rely on some tired old myth that she (exclude all men as this title literally means unmarried woman) will somehow make everyone snap to it and all will be well. How about not making impossible promises to patients, raising their expectations and sense of entitlement yet imposing endless restrictions financially. Better still make it illegal for governments to impose National Health Service reviews and grand gestures to enhance their political profiles.

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  • This really is no surprise. The development of the Modern Matron was an ideal opportunity to get things right, instead what we've seen is ward sisters/charge nurses stripped of their autonomy, the implementation of yet another tier of "yes men", and an increase in the cost of care as more money is syphoned-off to pay "target checkers".

    I don't want to see more "Hattie's"; what I want to see is nurses taking responsibility for their actions, setting and maintaining patient care standards and standing up for their patients rather than just bleeting on about how hard done by they are.

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  • As an RGN and NHS patient I can identify with the issues raised about failure of the role of modern matron and general poor standards of nursing care, however the situation within hospital psychiatric nursing is far worse. This is an area of national concern that has received some attention over the past few years in that the CNO was concerned enough to commission a report on the failing role of RMN's,the report was written, recommendations made, followed by yet another review of the impact of the recommendations and then? - nothing has changed! Despite an abundance of patient opinion research making the point that the quality and quantity of nursing care is inadequet, only a few centres of excellence have made any efforts to instigate change. Sadly my local hospital is not one of them. The RCN question whether failure is with individual nurses or the system? My observations would suggest that it is both. RMN's neglect their patient care role (which is the most important requirement of the NMC Code of Conduct) in favour of office work to the detriment of patients in their care. Yes perhaps some are burnt out by a punitive system but have they formally advised their managers of their inability to carry out direct patient care due to admin duties, ie. in writing? And what about the matrons - conspicuous by their absense on the ward? As a previous nurse consultant I know of the organisational pressure to fall in with management activity thus finding very little time for the core activity of direct patient care, and along with matrons actually having no direct authority to do anything about poor care. When I left at my exit interview I asked why they had employed me to be a champion of patient care and implement changes that the nurses and organisation itself clearly did not want? The reply - "We had to tick a box for the SHA" Matrons beware you also may have been a box to tick!

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  • Once upon a time there were state enrolled nurses whos primary role was to concentrate upon patent care. These nurses were qualified to take responsibility for clinical duties and were not distracted by all the administrative nonsense and too posh to wash mentality of some. Sadly they were deemed no longer relevant and got rid of. But never mind the Matron was invited back but soon became a toothless office bunny and nothing changed.

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  • Teamwork is essential and without appropriate communication and taking on board suggestions and even pleas from those below them is it any wonder that the system is failing. Get back on the ward and open your eyes to whats really going on.

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  • EN's were taken out of the equation because of agenda for change.

    Many trusts will not have any more than one trained nurse for a large group of patients.

    This meant that EN's were having to take charge of the ward and do the exact same job as an RN when they were on duty. And they were doing it for much less pay.

    It was considered unfair and this is why they were "disposed" of.

    When I first started in the NHS 8 years ago I can remember EN's being the only qualified member of staff on the ward. The only other staff were auxilliaries. This meant that the EN was lumbered with all the paperwork, doctors rounds etc, with very little time for patient contact.....just like an RN. The difference was the EN was on a lot less money.

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  • Well, my career goes back 34 years and I have differing memories/experiences, the EN role was additional to the RN and yes they did occasionally take on temporary extra duties but mostly they were used as they were intended, as a nurse with clinical skill who was not concerned with the administration, paperwork, governance etc which is now the expectation of RNs. Indeed, in my day, student nurses worked on the wards in the capacity of a member of staff, earning a wage (no loans) and gaining the much needed experience they required when they qualified, this was eventually stopped as they were deemed as not to be regarded as an extra pair of hands. Abandoning the role because Trusts have restrictive practice has created problems for the RN in that they take on an increasing responsibility in the face of financial cuts. The upshot is down banding nurses (yes, it’s happening now in my trust) on pain of unemployment if they do not accept the new terms, whist taking on an ever increasing burden of accountability and responsibility. My point is, looking to the past can be very selective, if we are to do this how about considering those at the coalface who need boosting in numbers and mixed skills, not a misty eyed distorted idea that "Matron" will deal with it all. It has all the potential of creating another layer of management. How about getting rid of the “modern matron” fantasy and using the spare finances to employ people who actually work directly with the patients.

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  • .Anonymous, You are correct about what the EN's used to be. The problems is what they became when hospitals started trying to save money in the 1990s by cutting trained staff from the wards. Once that happened, EN's got screwed. They often found themselves as charge nurses for the shift with only auxilliaries to help them. They were tied up in paperwork and forced to give IVs because they were the only trained person on their team that shift. They had to do all that for much less pay than an RN.

    The hospitals' legal people warned admin that the EN's would win a lawsuit if they sued over it. So instead of staffing the wards with both RNs and ENs, the hospitals got rid of the EN and began staffing wards with one RN and some unregistered care assistants for the shift. This is what destroyed nursing care.

    If they brought EN's back now the exact same thing would happen. The trust would staff a ward with one EN and some unregistered assistants rather than one RN and some unregistered assistants.

    The current Nursing students are still working shifts on the wards. They are an extra pair of hands. They are not supernumery really. When the nursing students are on the wards the bed managers send our care assistants off to help out on other wards that are even more short staffed.

    This means that the students have to jump right in and take over the role of care assistant. This means that their placements are crap because they don't learn all the RN stuff. Really, they should be doing meds with the RN and learning how to assess and pull information together. But this never happens as the student (yes degree students too) is just running around answering bellls and toileting. The lone RN is getting killed managing all the IVs and orders. It is a bad way to train a student nurse.

    Liability these days means that Nursing students (no matter what year) cannot not just go off and do things like drug rounds and dressings etc WITHOUT supervision. It isn't the nurse training that is the problem, it is the threat of lawsuits. Even if we went back to hospital training nothing would change. THR RN mentor is usually too swamped to mentor properly. So the students are just glorified hca's until they qualify. Then they findthemselves as the only RN on a ward only knowing how to work as a health care assistant.

    It isn't good.

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  • So Matron will resolve all this then ? Again, my point is, looking to the past cannot be the solution. That’s my primary objection to the resurrection of "matron". It’s based on a nostalgic nonsense. The very title "matron" is truly irritating; it brings thoughts of "angels" and Drs Handmaidens. It keeps the nursing profession stuck in the minds of people as a bunch of characters from a carry on movie.

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