She's making a comeback - but how will the new-look matron differ from her former incarnation, and how loved and respected was she really first time round, asks Janet Snell

Some people just never got over it when they did away with matron in the late 1960s. Calls to bring her back have rumbled on ever since, though, mainly, it seemed, among Conservative MPs and elderly members of the public.

So it came as something of a surprise that it was New Labour, rather than old Tory, who finally chose to do something about it.

By April next year matron will be back - by popular demand, the government tells us.

According to the NHS plan the public consultation exercise on the health service provoked a strong call for a 'modern matron' figure - 'a strong clinical leader with clear authority at ward level'.

For certain sections of the public the notion of matron conjures up an era in which wards were spotless, uniforms were starched and you knew who was in charge. But did those halcyon days really exist? And even if they did, could a 'modern matron' bring them back? And what exactly is a 'modern matron' anyway? Is it just a glorified ward sister or a new name for a director of nursing? A publicity stunt or a genuine attempt to raise standards?

The nursing profession seems willing to allow the government the benefit of the doubt and give the new scheme a try, though there is widespread dismay at the revival of the title matron - with all its Hattie Jacques connotations.

The Royal College of Nursing is in talks with the Department of Health over the practical details of how the new role will operate, but at the moment these remain sketchy, and trusts in different parts of the country seem to be interpreting the scheme in various ways.

Howard Catton of the RCN's policy unit says the college broadly welcomes the proposal. 'We are very supportive of any idea acknowledging that the ward environment is an integral part of delivering high-quality patient care and you can' t do it all with hands-on nursing.

'And the other welcome aspect of this is that nurses are seen as having a pivotal role in achieving the ideal of holistic care. '

He wonders what the exact ramifications will be of health secretary Alan Milburn's recent pledge that ward sisters will control ward budgets. Mr Milburn said this would give them 'the power to stop payments to privately run cleaning firms which are failing to keep our hospitals clean'.

Mr Catton says: 'We are concerned that a distinction is drawn between having the authority to deal with issues such as the cleaning and finding yourself held accountable for it being done well. It is important the new role has teeth, because unless the modern matron is given real authority to see these things through, the public will think It is her fault if It is not done. '

It is still not clear just how big a role the modern matron will have. Will she oversee just one or two wards or will it be more? Discussions are also underway over the relationship she will have with other staff and how her role will relate to the general management structure and other tiers.

Another question yet to be answered is how much Continued from page 29 will she be paid? And will her name badge say 'modern matron'?

Louise Boden, chief nurse/director of quality at University College Hospital, London, thinks not.

Her trust plans to extend the remit of ward sisters to make them modern matrons, but she doesn't envisage them adopting the title.

'When I go round the hospital and say hello to the patients I always introduce myself as matron because it doesn't mean much to the public if you say you're director of quality. But I do not think the ward sisters need to use the title matron as people are already pretty clear about what they do.

'At UCH, the modern matron will probably be in charge of a group of small wards. The Department of Health is giving everyone the outcome targets and It is up to individual trusts to deliver, so I think a lot of changes will be site-specific, ' says Ms Boden, who believes the new idea can do 'nothing but good'.

'It shows we are being proactive about issues like ward cleanliness, which patients and relatives are quite rightly very concerned about. '

But David Rye, vice-chair of Bournewood Community and Mental Health trust, is more sceptical. 'The politicians do not really know what they are talking about. It is a populist thing to say bring back matron and let's get back to the good old days. Well, I remember those old days and they were not all that good.

'When I trained as a nurse everything was terribly regimented. When matron did her rounds it was more important that you pulled the beds out than you made the patient comfortable. There was very little that went on then that you would refer to as good practice now apart from the routine ensuring that the ward was clean. '

He concedes that matron helped to ingrain in staff the principles of infection control, but he argues that she did little else.

'I recall as a second-year student on nights being put in charge of a 52-bed ward with one other junior student and an auxiliary. There were patients in oxygen tents and I would never even seen an oxygen tent. The levels of risk in those days were a hundred times what they are today. But of course the public's perception is quite the reverse. '

Health policy analyst and qualified nurse Ray Rowden agrees. 'They are trying to hark back to a golden era that never existed. With a few notable exceptions, matron exercised little real power and she used to sit in her office most of the time. It is all very well focusing on issues like cleanliness, but why choose a crass title like matron? For one thing It is sexist and it seems to have been born of muddled thinking. To make it work, this new role must fall to someone at a fairly senior level who has real power and authority. If they have it at ward sister level It is just going to lead to a lack of clarity. '

Although some trusts are identifying senior nursing staff as would-be modern matrons, others are sticking more closely to the NHS plan, which suggests ward sisters and charge nurses for the role.

The rationale is that it is a more sensible arrangement to make use of those staff who are closer to the patient.

As for the title, perhaps 'modern matron' really does strike a chord with the public and maybe the government is being shrewd in recognising that.

However, nurses may take a while to win over and they are unlikely to embrace the term matron while it retains its old-fashioned Carry On film image.