Nursing union chief warns balloting for Northern Ireland's first ever strike is imminent
An unenviable in-tray faces the new chief of Northern's Ireland's biggest nursing trade union with members preparing for unprecedented strike action. She tells health correspondent Seanín Graham about her tumultuous first month in the post
FOR Pat Cullen, nursing is "in her blood".
The youngest of seven, the Co Tyrone woman's four sisters went into the profession and following her own training, she soon realised that mental health care was her "passion".
But 37 years after qualifying, the straight-talking Carrickmore woman is on the brink of leading thousands of hospital and community nurses into an all-out strike - in what will be the first in a union's 103-year history.
Since being appointed as the new director of the Royal College of Nursing (RCN), Ms Cullen has led 'roadshow' events informing the public about how they have arrived at this point - and to prepare them for what lies ahead.
Unsafe staffing levels and a pay dispute are the two "burning issues" that have sparked protracted negotiations with Department of Health civil servants and which are now entering their final stage.
If pay talks collapse, RCN members will be balloted over the next month and then take to the picket lines in September - as winter pressures begin.
With nurses making up over 40 per cent of the health service workforce, the action will be crippling.
'Nurses don't make idle threats'
"This strike is not a threat, it's really important to underline that," Ms Cullen told The Irish News.
"Nurses don’t make idle threats. It has been with lots of careful consideration and discussion with our nurse members that we've come to this decision - it's the members decision, not ours. Each and every one has not made this lightly. When was the last time we heard a nurse contemplating strike or industrial action? They don't do that easily.
"We have been in pay discussions with department since 2009/10. Even under an Assembly, nurses did very poorly in terms of their pay and the gap kept widening.
"We have constantly tried to work with the department and drive home the message that we are going to hit a crisis. The health service is now in a crisis, it’s not just nursing."
At almost 2,600 nurses short and waiting lists hitting a record high, Ms Cullen said the workforce is "haemorrhaging" due to difficult working conditions and the worst pay in the NHS.
The north's annual nursing wages are £3,000 less than those "doing exactly the same job in England or Wales" and up to £5,000 less than their Scottish colleagues.
"In the individual nurse's mind, getting their pay brought up to an acceptable level is further down the agenda than safe staffing - but the two are inextricably linked because we cannot retain nurses here. It is a serious problem," she explained.
The union chief referenced recent media comments made by Richard Pengelly, the most powerful civil servant in the health service, who described nurses as "miracle workers".
'Nurses feel exploited'
Mr Pengelly is both permanent secretary at the department and the chief executive of the north's health trusts - a "unique" dual role in which he ultimately "responsible and accountable" for the delivery of health services, according to Ms Cullen.
It is his civil servants who are conducting pay talks with the RCN and other trade unions representing healthcare workers.
"We are sent messages out that our nurses are miracle workers, that they are the most respected in the health service and that they prop up the health service - but what the nurses said back to us is: those are laudable words but being described as a miracle worker doesn’t wash it when you can't pay an electricity bill or you can't put food on table," she said.
"They might be able to perform miracles for their patients by going over and above the call of duty - but right now they feel exploited."
While the RCN director acknowledged Mr Pengelly has "a challenging and complex job on his hands", she said his calls for "transformation" must include the nursing workforce.
"Our members are totally up for transformation, but you cannot transform the health service without the backbone of the health service - and that is nurses," she said.
The union chief said it was "shameful" they'd been pushed to this position, for both staff and patients.
To "close the gap", the RCN say they will require £23 million to bring them into line with pay in England and Scotland.
"We're hopeful that people in the Department will see light at the end of the tunnel, but not optimistic," Ms Cullen said.
She added it was a "real disappointment" that Mr Pengelly had made "no attempt to engage with us directly" during pay talks and hopes to pursue better "partnership working".
In the past fortnight, Ms Cullen admitted she had "lengthy" private discussions with her trade union counterpart in the Republic, Phil Ní Sheaghdha of the Irish Nurses and Midwives Organisation (INMO), to discuss their strike strategy as the northern union prepares to "map out" its plan in coming days.
Earlier this year, 40,000 southern nurses staged a national strike over staffing and a pay dispute.
Cancer patients were among those who had planned operations cancelled in the Republic while dialysis was also withdrawn for some patients on the first day of action, but reinstated on the second.
Children's services and maternity care were "off the table".
More than 50,000 appointments and 2,000 operations were postponed.
When asked if the RCN in the north intended to follow the lead of the INMO in terms of withdrawal of similar services, Ms Cullen replied:
"I think we have a lot to learn from them and how they managed to make those very important, professional decisions.
"Their bottom line was they had to define emergency services...this is not for the faint hearted, nurses will struggle with this as it will not just impact on our members but will significantly impact on patient services."
'We must take a stand... services are already unsafe'
The new nursing chief said she accepted that their proposed action will be seen as "contributing further to waiting lists" but argued that they "can’t get much worse".
"Nurses are doing an exceptional job - but in terms of people waiting for surgeries and cancelled surgeries…it is as low as it possibly can get.
"Unless we take a stand, it’s going to continue. Services are already unsafe."
And she said she took "great solace" from her trade union colleagues in the south, as their strike campaign was also about "attracting nurses back" from other countries.
"You can only bring them back if you can pay them properly and we know there's a trickle back into the Republic," she added.
"They're still seeing the outworkings of their strike and there is a commitment from government to increase staffing levels".
She also revealed "anecdotal evidence" of northern nurses in border towns, such as Derry and Newry, making plans to move to better-paid jobs in the south, a development which could severely impact on an already depleted workforce.
"After nurses do their intern year in the Republic, there is a significant increase in earnings compared to what nurses earn here - in the region of a 10,000 euro increase after a year," Ms Cullen said.
"Our members are telling us that nurses are making preparations for moving. Those stories are anecdotal but it is something we will try to get a handle on.
"Whilst we don’t have evidence, it’s a very high risk and I hope something Mr Pengelly pays attention to."
But she said however she understood however why some members are contemplating leaving after hearing first-hand accounts at the recent roadshows.
"Some of the stories were heart-wrenching, especially those about not being able to spend quality time with patients in the last stages of life. But that's a reality," she said.
As the spending bill on agency nurses by health trusts continues to rocket, Ms Cullen said the impact was being felt on the hospital floor and led to mounting fears about patient safety:
"One sister also told us they have a 'dolly mixture bag' of staff every day, they don't know which colour of uniform they're going into due to the volume of nurses from different agencies.
"They have to work out 'have I ever seen this nurse before', wondering if they're on the register or had an induction - and doing all that while trying to get 28 patients ready for surgery or get elderly patients toileted."
When pressed on whether the north was veering towards a 'Mid Staffs' crisis - an English hospital scandal which exposed appalling care failings and led to a major inquiry in 2013 - the nursing chief responded:
"If we are looking at what contributed to the Mid-Staffordshire situation that led to the public inquiry - it was simply because the need to ensure safe and effective nursing levels were totally ignored. Am I saying that is the situation we find ourselves in here? Yes it is.
"Our members believe that their pleas to try to recruit and retain nursing staff to keep the health service running have been totally ignored.
"If we look at what's happening in some of our services such as learning disability services - could you equate that to the Inquiry that led to the recommendations of the Mid-Staff report. Yes, I think you could."
Concerns about protection of whistleblower nurses is something she is passionate about - with the roadshows revealing that many of their members are "terrified" to speak out.
"They tell us day and daily about that, they feel they are silenced. Some don't understand the protection they're afforded by the trade union," she said.
"But yet, they did speak out at those events.
"However, there is definitely a culture in the health service that leads to people being afraid to speak out...it's so sad".
As the deadline for the pay talks with the department loom, the RCN director said it had become an issue of "respect and value" for the workforce.
"It's was my life's desire to become a nurse, it's in my blood...but for anyone who can come out and work on the frontline the way things are, they are very courageous.
"Our members say they have this feeling of getting up every morning and feeling under-valued. Their esteem and self-worth is being lowered and it's very hard to demonstrate these values to patients. Many of them are telling us they've had enough".
The Irish News asked the Department of Health to state its position on the pay negotiations as a strike threat looms.
A spokeswoman said that discussions on pay and conditions are "ongoing" between trade unions, health and social care employers and department officials.
"The department is committed to securing a positive outcome, notwithstanding the well documented pressures on our budget and the many competing demands for funding," she said.