Hospitals, hygiene and the return of the matron

Another day, another initiative advanced by one party to trump an earlier initiative of the other. A few months ago, Labour told us they would bring matrons back into hospitals to take responsibility for hygiene. Now we have the Tory leader, Michael Howard, also pledging the return of matrons. These, however, would be matrons with power - the power to close dirty wards even against the orders of those new-fangled managers and bean-counters.

Another day, another initiative advanced by one party to trump an earlier initiative of the other. A few months ago, Labour told us they would bring matrons back into hospitals to take responsibility for hygiene. Now we have the Tory leader, Michael Howard, also pledging the return of matrons. These, however, would be matrons with power - the power to close dirty wards even against the orders of those new-fangled managers and bean-counters.

The image of the hospital matron, all starched cap and apron and military-style discipline, has clearly left a deep impression on the British psyche. The Carry On... films have much to answer for. What we slack British hanker after, it seems, is a figure of authority to keep our hospitals shipshape.

In part, this is pure nostalgia for a bygone age. But the very fact that the return of the hospital matron is seen as a vote-winner suggests that the new structures of hospital management are felt to lack something important. That something is what matrons used to provide: the reassurance of a uniformed figure-head, the evidence that someone is in charge, the presence of someone with the practical knowledge and authority to get things done.

There can be little doubt that the financial discipline and record-keeping introduced to NHS hospitals in recent years were necessary and long overdue. It is also clear, however, that the privatisation of ancillary services and the preoccupation with targets have brought distortions and shortcomings in their wake. The spiralling incidence of MRSA infections may not be a direct result of privatised cleaning services, but it does reflect unacceptable hygiene standards and inadequate supervision.

Hospital managers cannot be expected to run their finger along every bed-frame of every ward. They cannot be expected to ensure that each bedpan is emptied or notice when a nurse's uniform is not freshly laundered. But these are the very basics of hospital hygiene and someone must be responsible for them. Today's hospitals may not need old-style matrons, but they could certainly do with more people at the sharp end of ward management who know what cleanliness looks like and have the authority to make it happen.