Matron !

I went to a boarding school and the word 'matron' brings back memories of being 'inspected' three times a week, to see that I was washing properly and had no obvious contagious skin condition. I also can't help thinking of Kenneth Williams making amorous advances on Hattie Jacques.

However, in a hospital environment someone is desperately needed to be in charge of ward activities, from my experience. By that I mean someone taking ownership of and prioritising everything to do with the patients' progress through 'the system': ward staff now seem to have defined roles and are either too busy, or not experienced enough, to push through the things that matter as quickly as the consultants, managers and patients would like.

Viv's been on a ward at The Lister now for a week. A transfer to Addenbrooke's was first proposed on the second day of her stay. By yesterday the teams at Cambridge and Stevenage were at least talking. But, in this age when bed blocking is considered such a problem, the Lister people seem to have no clarity on what the dependencies are at the Addenbrookes end, so have no clear vision of how much longer Viv is likely to be with them, and is 'blocking' a bed. (I have suggested that I could care for her at home while we wait for Addenbrooke's, thus freeing said bed, but that would take her out of 'the system' and therefore would not be helpful.) The ward doctors and nurses are very much many like new graduates I have encountered in business - enthusiastic, knowledegable and hardworking. Where they need support is in prioritisation, and management of 'pinch points' involving external teams (transport, other hospitals, etc). In business that support would come from an experienced manager; in the NHS the consultants help a little, but what's needed is someone closer to the ward with many years experience and contacts, who's not afraid to rattle a few cages sometimes.

Matron would also chase some of the maintenance issues - in Viv's ward the only wheelchair accessible loo was out of use for three days due to a light tube going (no, the hospital doesn't use LED lights!). There was an enormous hoo hah a year or so ago when a paralympian found the disabled loo on a train out of action, but no one cares enough about poor bloody hospital patients to get simple maintenance jobs on the ward done promptly. A ward matron would put the fear of god up the maintenance men and the job would be done in no time.

There was another maintenance issue - really bad draughts around the windows (solved with the aid of some sellotape, bought in the hospital shop) which nurses were aware of, but which hadn't been resolved, perhaps it was just too difficult to get through the bureaucracy; again, an experienced matron would make things happen. (Yes, all that was needed was some tape over the poorly fixed insulation strips...)

The Matron would support both nursing and medical staff on the ward (at present, doctors spend much of their time sorting out referrals and arranging transfers - is that what they spend all that time at medical school for?), identifying key activities and helping to make them happen to speed people through the system quicker. It would probably be a role filled by someone with 20 or so years of experience - not necessarily all nursing or medical (project management skills will be needed too, something very scarce in the NHS).

It's simple to say the NHS needs more money, but when money has been thrown at the problem in the past working practices and job roles stay the same and the unions (including the BMA) just take as much of it as they can. What's needed is a wholesale change of attitudes and job roles.