Harry de Quetteville
THE TELEGRAPH
Sun, 15 January 2023
Pat Cullen - Andrew Crowley
Next week, renewed Royal College of Nursing action will see a second round of nurses’ strikes, with thousands walking out again, on consecutive days, after the Prime Minister declined an offer of a 10 per cent deal on nurses’ pay.
But although Pat Cullen, the General Secretary of the RCN, has accused the Health Secretary Steve Barclay of being a “bully-boy”, and insists that current talks must alleviate an NHS crisis that is causing patients to die unnecessarily “every day”, she has dealt with far worse.
Having started her career in Belfast at the height of the Troubles, Cullen is no stranger to tough-nut men and negotiations on which lives hang. Indeed, back in Northern Ireland in the early 1980s, there were times, she says now, when as an agent of the state – though just a nurse – she was viewed with mistrust, possibly even as a spy.
“I was moving around the Shankill Road, dominated by the [Loyalist paramilitaries] UVF, then coming back into the [staunchly Catholic] Falls Road. Doing that multiple times a day raised suspicion. It was the time of the hunger strikes, very difficult.”
Were there moments of danger, when she felt she was suspected of being an informer? “Absolutely. Particularly when you were moved, new to the area.” To smooth her passage, talks were held to establish her bona fides – what Cullen delicately calls “informal interviews with significant community leaders”.
I think of other bullyboy men, this time with guns. In those days, of course, if negotiations didn’t work out it was her own life that was on the line. So Cullen is not new to playing for high stakes.
Nonetheless, many said she had set the stakes far too high when nurses demanded a 19 per cent pay rise ahead of two days’ strike action last December. Prime Minister Rishi Sunak dismissed the bid as “obviously unaffordable”. Ministers noted grimly that more than £9 billion would have to be spent if such a settlement was extended across the whole NHS. The Government was offering 4 per cent, a £1,400 annual bump – though Barclay has since conceded that will have to increase.
Cullen now seems more accommodating, with hints that 10 per cent might seal the deal. But that does not mean she is climbing down. The RCN, she says, will extend strikes well into the second half of the year if necessary. The pickets will stay, she insists, “for as long as it takes for this Government to do the right thing for nursing staff. If we have to reballot our members after six months [to secure a mandate for more strikes], then that’s what we will do.”
Not only that, Cullen also vows strikes will get bigger, saying that RCN members at trusts which narrowly voted against current strike action are now clamouring to be reballotted, because they want to join the industrial action. This second round of nurses’ strikes will affect 55 trusts across England, up from 44 before Christmas.
“We’re talking about very significant trusts,” Cullen notes. According to the Nuffield Trust that could double the size of strikes. And the last walkouts saw 15,000 appointments cancelled. “All options [for action] are on the table,” says Cullen.
Then there are nurses’ other demands. More pay, says Cullen, would be “a step in the right direction”, but it is by no means the end of the matter: “This is about much more than pay.”
First up, is a mass recruitment drive “to fill the 47,000 unfilled, vacant nursing posts” to relieve pressure on those already in the job (the Nuffield Trust says there are 17,000 unfilled posts on any given day).
Then, Cullen wants “a separate pay structure for nursing, because the current structure is not working.” That structure – known as agenda for change – splits NHS roles by seniority into nine bands. Nurses start in Band 5, on £27,055. The average nurse wage was £35,989 a year before the last pay settlement. That’s slightly above the average national salary, according to the ONS, which is £33,000.
“Nursing is not an average job,” says Cullen, who notes that in other countries nurses are paid one-and-a-half times or double the national average. By contrast here, she says, they start low and get stuck low, marooned in Band 5, without the chance to progress up the pay scale.
There’s more: travel expenses. “Our nurses are spending up to £500 a month travelling, simply because they cannot afford to live close to their place of work,” she points out. Beyond that, there is “the debt that our student nursing population joins our profession with, we need to find ways of addressing that as well”. A report by the House of Commons last year found that the average student debt for nursing – which since 2009 has required a degree – is £35,000.
Finally, Cullen wants legislation in place that absolves nurses of responsibility for ensuring safe levels of staffing. That, she says, is up to politicians in Westminster, “not with ward sisters battling every day to try and fill vacant posts”. Without such safer nursing laws, she insists, if something goes wrong it is the ward sister who gets clobbered. It is a bit rich, she argues, for the Government to push through anti-strike laws enforcing a minimum safe service, when nurses have long been calling for minimum safe staffing levels.
But therein lies the nub of the matter. The Government is focused on doing more with existing staff, on productivity and efficiency, and the RCN’s priority is numbers: numbers of staff, and the numbers on their pay packets. So far, it has led to a dialogue of the deaf.
Cullen has met Barclay twice, and each time the meetings proved fruitless. At the beginning of this week, Sunak appeared to signal a softening attitude – hopes for a settlement soared, only to be dashed again. The problem, says Cullen, was that unions were asked to “find efficiencies from within the NHS, so that [Barclay] can go to the Treasury. In other words: ‘You find the money and we’ll see if we can do a deal.’”
Cullen describes the proposal as “absurd”. “We’re not in a position to find the money from the system,” she says. “We don’t manage the system.”
She is, however, happy to consider productivity improvements. “We’re always looking for opportunities for efficiency. But it’s very, very difficult to look for efficiency savings when people are constantly trying to mitigate risk every day.”
Government talks with the nurses seem to have become a battleground between the sexes. Cullen’s “bullyboy” comments enraged Barclay and, in what soon becomes apparent is not an unusual tactic, she softens her tone without entirely withdrawing her claim. “I don’t want to personalise it because that will be wrong of me to do. Barclay and the PM have very difficult jobs,” she says.
“But they have to also understand that I’m leading a profession that’s 90 per cent female and sometimes their actions lead this profession to believe that there is a macho or bullyish approach to how they make decisions.” I ask for an example. She says that nurses are patronised by those who “devalue caring”, who dismiss it as “women’s work” which is not skilled, and “doesn’t need to be a graduate profession. Those sorts of things are not helpful when you’re in a period of negotiation where you’re trying to build up relationships and trust.”
By her account, Barclay – without wanting to personalise it – emerges as something of a boor. “It’s his job to listen to me. He has a responsibility. And when you feel constantly that he is turning his back on the profession, it leaves all of us feeling rather nervous about where we’re going.” A ministerial spokesperson has rejected that description, saying Barclay has “utmost respect for nurses”.
Talks have not become so bitter as to be called off, though. When we meet – on Wednesday – Cullen’s office is trying to firm up a meeting with Barclay for the following day. She strongly hints that a one-off, cost-of-living payment effectively bumping up the 2022 pay deal, as mooted last week, would – in tandem with a rise of around 10 per cent this year – be enough to call off strikes. “I’ll seriously consider that.” As yet, though, the “Government is just so far away from what our members are expecting and requiring.”
Yet what precisely is the dispute about: pay or conditions? In the past, Cullen’s principal complaint seems to be about a crumbling NHS preventing nurses caring for their patients and “doing their job properly”. But an extra £3,500 a year in nurses pockets would do nothing to change that. Better pay, she counters, would help with staff retention and recruitment. And that would improve conditions.
I wonder what those conditions will look like if she follows through on her threat to pursue strikes throughout the year. Will the public still be onside? “We haven’t abandoned our patients,” she claims, despite the cancelled treatments. “We’ve been very careful about our derogations. Every survey that comes out shows the trust the public have in our profession, that was certainly borne out on every picket line that I visited on the two days.”
It’s true. Public support is strong, though it is not limitless. When strikes were first announced last November, 59 per cent of Britons supported the nurses’ strikes. A month later, as action got underway, that fell to 50 per cent. There is now some evidence that support is rising once more. After more than a century strike-free, it’s quite the gamble.
Yet Cullen is adamant it is the right thing to do – “It is not about me,” she says. “This is not my strike.” It was the members – the RCN represents around 300,000 nurses, around two-thirds of the profession – who were “very, very clear”. That may be true, but the fact is that this is the second time she has defied tradition to call a strike, after leading a walkout in Northern Ireland in 2019 as the union’s chief there. In April 2021, she was appointed General Secretary of the whole RCN.
Sun, 15 January 2023
Pat Cullen - Andrew Crowley
Next week, renewed Royal College of Nursing action will see a second round of nurses’ strikes, with thousands walking out again, on consecutive days, after the Prime Minister declined an offer of a 10 per cent deal on nurses’ pay.
But although Pat Cullen, the General Secretary of the RCN, has accused the Health Secretary Steve Barclay of being a “bully-boy”, and insists that current talks must alleviate an NHS crisis that is causing patients to die unnecessarily “every day”, she has dealt with far worse.
Having started her career in Belfast at the height of the Troubles, Cullen is no stranger to tough-nut men and negotiations on which lives hang. Indeed, back in Northern Ireland in the early 1980s, there were times, she says now, when as an agent of the state – though just a nurse – she was viewed with mistrust, possibly even as a spy.
“I was moving around the Shankill Road, dominated by the [Loyalist paramilitaries] UVF, then coming back into the [staunchly Catholic] Falls Road. Doing that multiple times a day raised suspicion. It was the time of the hunger strikes, very difficult.”
Were there moments of danger, when she felt she was suspected of being an informer? “Absolutely. Particularly when you were moved, new to the area.” To smooth her passage, talks were held to establish her bona fides – what Cullen delicately calls “informal interviews with significant community leaders”.
I think of other bullyboy men, this time with guns. In those days, of course, if negotiations didn’t work out it was her own life that was on the line. So Cullen is not new to playing for high stakes.
Nonetheless, many said she had set the stakes far too high when nurses demanded a 19 per cent pay rise ahead of two days’ strike action last December. Prime Minister Rishi Sunak dismissed the bid as “obviously unaffordable”. Ministers noted grimly that more than £9 billion would have to be spent if such a settlement was extended across the whole NHS. The Government was offering 4 per cent, a £1,400 annual bump – though Barclay has since conceded that will have to increase.
Cullen now seems more accommodating, with hints that 10 per cent might seal the deal. But that does not mean she is climbing down. The RCN, she says, will extend strikes well into the second half of the year if necessary. The pickets will stay, she insists, “for as long as it takes for this Government to do the right thing for nursing staff. If we have to reballot our members after six months [to secure a mandate for more strikes], then that’s what we will do.”
Not only that, Cullen also vows strikes will get bigger, saying that RCN members at trusts which narrowly voted against current strike action are now clamouring to be reballotted, because they want to join the industrial action. This second round of nurses’ strikes will affect 55 trusts across England, up from 44 before Christmas.
“We’re talking about very significant trusts,” Cullen notes. According to the Nuffield Trust that could double the size of strikes. And the last walkouts saw 15,000 appointments cancelled. “All options [for action] are on the table,” says Cullen.
Then there are nurses’ other demands. More pay, says Cullen, would be “a step in the right direction”, but it is by no means the end of the matter: “This is about much more than pay.”
First up, is a mass recruitment drive “to fill the 47,000 unfilled, vacant nursing posts” to relieve pressure on those already in the job (the Nuffield Trust says there are 17,000 unfilled posts on any given day).
Then, Cullen wants “a separate pay structure for nursing, because the current structure is not working.” That structure – known as agenda for change – splits NHS roles by seniority into nine bands. Nurses start in Band 5, on £27,055. The average nurse wage was £35,989 a year before the last pay settlement. That’s slightly above the average national salary, according to the ONS, which is £33,000.
“Nursing is not an average job,” says Cullen, who notes that in other countries nurses are paid one-and-a-half times or double the national average. By contrast here, she says, they start low and get stuck low, marooned in Band 5, without the chance to progress up the pay scale.
There’s more: travel expenses. “Our nurses are spending up to £500 a month travelling, simply because they cannot afford to live close to their place of work,” she points out. Beyond that, there is “the debt that our student nursing population joins our profession with, we need to find ways of addressing that as well”. A report by the House of Commons last year found that the average student debt for nursing – which since 2009 has required a degree – is £35,000.
Finally, Cullen wants legislation in place that absolves nurses of responsibility for ensuring safe levels of staffing. That, she says, is up to politicians in Westminster, “not with ward sisters battling every day to try and fill vacant posts”. Without such safer nursing laws, she insists, if something goes wrong it is the ward sister who gets clobbered. It is a bit rich, she argues, for the Government to push through anti-strike laws enforcing a minimum safe service, when nurses have long been calling for minimum safe staffing levels.
But therein lies the nub of the matter. The Government is focused on doing more with existing staff, on productivity and efficiency, and the RCN’s priority is numbers: numbers of staff, and the numbers on their pay packets. So far, it has led to a dialogue of the deaf.
Cullen has met Barclay twice, and each time the meetings proved fruitless. At the beginning of this week, Sunak appeared to signal a softening attitude – hopes for a settlement soared, only to be dashed again. The problem, says Cullen, was that unions were asked to “find efficiencies from within the NHS, so that [Barclay] can go to the Treasury. In other words: ‘You find the money and we’ll see if we can do a deal.’”
Cullen describes the proposal as “absurd”. “We’re not in a position to find the money from the system,” she says. “We don’t manage the system.”
She is, however, happy to consider productivity improvements. “We’re always looking for opportunities for efficiency. But it’s very, very difficult to look for efficiency savings when people are constantly trying to mitigate risk every day.”
Government talks with the nurses seem to have become a battleground between the sexes. Cullen’s “bullyboy” comments enraged Barclay and, in what soon becomes apparent is not an unusual tactic, she softens her tone without entirely withdrawing her claim. “I don’t want to personalise it because that will be wrong of me to do. Barclay and the PM have very difficult jobs,” she says.
“But they have to also understand that I’m leading a profession that’s 90 per cent female and sometimes their actions lead this profession to believe that there is a macho or bullyish approach to how they make decisions.” I ask for an example. She says that nurses are patronised by those who “devalue caring”, who dismiss it as “women’s work” which is not skilled, and “doesn’t need to be a graduate profession. Those sorts of things are not helpful when you’re in a period of negotiation where you’re trying to build up relationships and trust.”
By her account, Barclay – without wanting to personalise it – emerges as something of a boor. “It’s his job to listen to me. He has a responsibility. And when you feel constantly that he is turning his back on the profession, it leaves all of us feeling rather nervous about where we’re going.” A ministerial spokesperson has rejected that description, saying Barclay has “utmost respect for nurses”.
Talks have not become so bitter as to be called off, though. When we meet – on Wednesday – Cullen’s office is trying to firm up a meeting with Barclay for the following day. She strongly hints that a one-off, cost-of-living payment effectively bumping up the 2022 pay deal, as mooted last week, would – in tandem with a rise of around 10 per cent this year – be enough to call off strikes. “I’ll seriously consider that.” As yet, though, the “Government is just so far away from what our members are expecting and requiring.”
Yet what precisely is the dispute about: pay or conditions? In the past, Cullen’s principal complaint seems to be about a crumbling NHS preventing nurses caring for their patients and “doing their job properly”. But an extra £3,500 a year in nurses pockets would do nothing to change that. Better pay, she counters, would help with staff retention and recruitment. And that would improve conditions.
I wonder what those conditions will look like if she follows through on her threat to pursue strikes throughout the year. Will the public still be onside? “We haven’t abandoned our patients,” she claims, despite the cancelled treatments. “We’ve been very careful about our derogations. Every survey that comes out shows the trust the public have in our profession, that was certainly borne out on every picket line that I visited on the two days.”
It’s true. Public support is strong, though it is not limitless. When strikes were first announced last November, 59 per cent of Britons supported the nurses’ strikes. A month later, as action got underway, that fell to 50 per cent. There is now some evidence that support is rising once more. After more than a century strike-free, it’s quite the gamble.
Yet Cullen is adamant it is the right thing to do – “It is not about me,” she says. “This is not my strike.” It was the members – the RCN represents around 300,000 nurses, around two-thirds of the profession – who were “very, very clear”. That may be true, but the fact is that this is the second time she has defied tradition to call a strike, after leading a walkout in Northern Ireland in 2019 as the union’s chief there. In April 2021, she was appointed General Secretary of the whole RCN.
Pat Cullen - Andrew Crowley
It is a sequence that makes her sound like a militant throwback. But in her blue suit, with her cautious, almost nervous manner, finding the precise words she needs, she seems anything but a firebrand. Instead, perhaps as a result of her upbringing, she comes across as committed, but modest.
She was born in 1965, the youngest of seven children, six of them girls. Her father, Paddy, was a farmer in County Tyrone, who died when she was 13. Still, she had “a really happy childhood” until, to her huge distress, Annie, her mother, died suddenly when she was 18.
The pain of that loss was somewhat softened by the comfort of her siblings, the oldest of whom – Bridie – is 20 years her senior. Five of the six girls became nurses working in Ireland, including Petra, just 18 months older than Pat, to whom she remains devoted (“She’s my best friend as well as a sister. There’s never a single day goes by that I don’t call her as I leave the office”).
It was Petra who helped Pat pass her 11-plus, a result that secured a place in Loreto Convent Grammar School in Omagh. But, by her own admission, she found the convent regime difficult, so she returned to college in her hometown of Carrickmore. From there, she became a trainee nurse. Degree-less, she would today, of course, be rejected by the profession.
She started in Holywell psychiatric hospital in Antrim, ending the practice in which patients were routinely punished by having precious personal items removed. Then she moved to West Belfast, beginning her delicate mission as a community nurse across the sectarian divide. Soon she was head of nursing at a local healthcare trust, and by her early 30s she had joined the Department of Health as Nursing Officer.
She only joined the RCN seven years ago. Three years in, she led her fellow members in Northern Ireland on strike. No one doubted the justice of their cause. Because Stormont had been so frequently suspended, pay deals had simply not been passed. Nurses found their pay far behind peers on the mainland. In the end – Barclay take note – the pickets and public pressure forced a deal, not just for pay but also safe staffing levels.
When she arrived at the top of the RCN, whose governing council was male-dominated, she was greeted by scandal. Tales of sexual misconduct were rife. Cullen commissioned a report whose findings, which were leaked last October, made grim reading: the RCN’s annual conference was damned for its booze-fuelled “sexual culture … in which the risk of exploitation is significant”. The council was accused of bullying and harassment. Allegations flew of “abuse, grooming, preying”.
“It was a very difficult time,” admits Cullen. “We let our members down, and I’ve apologised on a number of occasions to them for letting them down.” A new council is now in place, and Cullen says that if a follow-up report identifies “any reason to have a criminal investigation”, she will refer colleagues to the police.
There is scandal elsewhere in her purview too, though one she is keener to talk about. Nurses are being recruited, she says, from so-called “red list” countries which, often wracked by poverty, desperately need the healthcare workers themselves.
Officially, the Government has banned such hiring drives. Worse, Cullen says, she understands “these nurses are arriving… and having their passports confiscated by social care providers, and then told if they wish to leave and break their contract, they have to pay a penalty of as much as £14,000 to actually get out and return. I do believe that there’s modern slavery being operated in some parts of our healthcare system.”
Moreover, Cullen says she raised the matter last year with Jeremy Hunt, when he was chair of the Health and Social Care Select Committee: “He acknowledged very clearly that it was absolutely wrong.” But nothing was done. “Times move on,” says Cullen. “He found himself in a different post.” Such tales only underline how hard recruitment can be.
I stand up to leave. Cullen will soon be making her daily call to Petra, these days more emotional than ever. Five years ago, Petra was diagnosed with cancer. Despite what Cullen calls “a little bit of a setback”, she is now “brilliant, everything moving in the right direction.” It can’t be easy being unwell and in healthcare. Cullen smiles, telling of how her sister pestered Enda, Cullen’s husband, who is a GP, and her son, Shane, a doctor, for information after her diagnosis. You can’t pull the wool over a sick nurse’s eyes.
Inevitably, though, the community that surrounds the RCN General Secretary most powerfully is a community of women. And we drift back again to her time navigating the Shankill and Falls Roads, as tense and bloody as any hospital ward.
“There was internment, men were on the run. So the people who helped us through were the women of both communities. It was so hard but they were incredible. They were strong. It was the women who got us through. I’ve learned so much from them.”
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