Is is time to revive the iron ladies of nurses?

Susan Holmes remembers the days of Matron I remember Matron well. She wore a dark crimplene dress and a frilly little hat made from starched white cotton lace. It was the lace that set her apart. Deputy Matrons had less of it while Sisters' caps had a mere edging of lace.

At dinnertime, maids brought food and Matron served. Plates were passed, vegetables spooned, then, self-conscious of their manners, staff ate. The performance was repeated with the pudding.

The Scottish Conservatives' commitment to the introduction of a "modern" Matron, who would be a "visible leader" on the wards, has started tabloid talk of a return to the starched authoritarian figure of old. Matron is a peculiarly Tory image, but the Scottish Conservatives believe she can still play to the gallery.

They may say they advocate a more modern version, but is it a return to such a pecking-order the Tories seek? Matron's behaviour set her above the other staff, using an elaborate range of symbols and rituals drawn from a fantasy world of some aristocratic lady in her stately home. This might appeal to stereotypical old buffer Tories yearning for discipline and segregation of the classes, but can it really be sought in the 21st century?

The ostensible reason for "modern matrons" is to have a visible leader, one who will care for the "hotel services" that have fallen so badly below standard since the same Conservative party saw these as easy targets for cuts in the later 1970s and 1980s. But Matron was never truly concerned with cleanliness. In larger hospitals she delegated oversight of the ward-maids to a "Housekeeping Sister", but whether Sister or Matron, the focus was on discipline, Maids came from a class of society who by definition were untrustworthy. Matron's concern was firstly that maids did not steal the mops. A new one was only issued if the old one was produced.

The Royal College of Nursing is eager to gain pay and standing for its members. Another call is for more professionalism and better training - the technical knowledge for cleaning hospitals would add two years to nurse training. Sadly, nurses are sometimes too "professional" to concern themselves with areas perceived as lower value. The hospital corner is a ladylike achievement still serving to differentiate low-grade nurses from maids. Such attitudes linger. In this culture, a career option as "modern matron" becomes unattractive.

Why do Tory policy-makers believe this will appeal to voters? Sadly, too many people have visited a relative in hospital and heard from the patient that the nurses, and Sister, are too busy for human contact. Some of us suspect this springs from time spent in too many meetings called to discuss change and progress. Not to make changes and achieve progress, but discuss it. Nurses could help themselves immensely by abandoning all meetings having no objective, or where no decision or action is to emerge. Too often, nurses' research projects generate data about problems, but omit plans to solve them.

There are already people caring about patients. They are these same nurses and other staff who would love to improve customer care. The remedy is largely in their own hands. There are already people who care about the food and the cleaning. Domestic and Catering Managers can be found by reading the signs at the hospital entrance, unless they were replaced by a contractor during Mrs Thatcher's years.

Hospitals have a chief executive whom patients and relatives can contact, and often this person is a nurse. They might not look like a nurse, in a smart suit and with a mobile phone, but does this matter? If we seek the person in charge in a hotel, a shop, or a business, they will not be wearing a frilly lace hat and intoning grace before meals.

Everyone, patient and nurse alike, but especially the Conservative party, should question this odd suggestion and ask why the "modern matron" appeals. Why, in this new millennium, does a woman in fancy dress hold such iconic attraction, and what could she achieve that cannot already be achieved - if we challenge Matron's legacy?

Susan Holmes formerly worked in the Scottish health service

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