My caution about 'modern matrons' came across as rather understated ('Eyebrows raised as matron returns', news, page 8, 12 April). The proposals have all of the problems you list. I was, however, trying to look on the bright side amid the gloom at new levels of detailed prescription.

At least we have some recognition, at last, that middle managers make a real and important difference to the NHS. It is a shame that to get this support we have to call them by an old-fashioned name that dictates their gender, dress them in a 'distinctive uniform' and confine them to wards, where only a minority of patients receive their treatment.

We need to recognise the contribution of all staff in middle-management jobs, and support them in providing leadership to their teams.

If we did this rather than singling out one group, the implementation of the NHS plan would be easier, require less paper and be less reliant on hit squads, traffic lights and some of the less attractive apparatus of implementation.

Nigel Edwards Policy director NHS Confederation