Perspectives in NHS management. Issues in nursing management.

What does nursing management mean to the average hospital doctor? The chances are that it means "Salmon," and my experiences of addressing doctors prompts me to say with confidence that the word tends to provoke a brisk reaction, especially among elder members of the medical profession, who remember with nostalgia the days of matrons and all powerful ward sisters. I propose to put the nursing management structure in perspective by providing some background to and facts about the Salmon reforms. In 1963 Brian Salmon was commissioned to lead a study into the organisation of the nursing services.' At that time these services were headed by a matron, who reported to the hospital management committee through the group secretary. Mr Salmon's team concluded that someone who shouldered the responsibility for such a large share of the group's expenditure-nurses cost about 400° of a hospital's budget-should report directly to the hospital management committee. In retrospect it was, perhaps, a mistake to have assigned numbers to the new post holders, but the idea of appointing a nursing officer (No 7) to be responsible for the nursing service provided in, say, four wards of a hospital was cogently argued. There was logic in introducing a nurse manager at this level, as it facilitated the monitoring of ward nursing activities and standards. Two unforeseen consequences of this arrangement affected the medical staff. Firstly, many had become accustomed