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Addressing members at RCN Congress in Brighton, Pat’s speech covered six key themes: 

1. Strike action: ‘Something fundamental has shifted’ 

Pat talked of the moral and emotional dilemma nursing staff faced when going on strike. “I never once met a nurse or nursing support worker who wanted to be on a picket line. Standing outside our work became the only way to change what was happening inside,” she said.

“Many members I spoke to on picket lines were in tears at how far they’d been pushed and never thought striking would be a move that nursing would ever make.

“But the fact is, our health and care system, across the whole of the UK, is sailing dangerously close to the wind. It is brutally unfair on patients and the conditions feel intolerable for too many of you. Patients aren’t dying because nurses are striking, nurses are striking because patients are dying.”

Pat highlighted the courage and sheer determination nursing staff have shown, describing them as “an inspiration”.

“Something fundamental has shifted,” she said. “Nursing has always had a voice. But this last year we decided to use it in a way that astounded everybody. After years of feeling left behind or unheard; patronised and misunderstood; undervalued and out of sight, we had a message for every single politician in this country: never again dare to believe that you can keep nursing staff quiet.”

2. Next steps: ‘Nobody wants to see twice as many nurses take strike action’ 

In seven days from now (23 May), RCN members working for the NHS in England will receive fresh ballot papers asking whether they want to continue strike action for up to six more months in their fight for fair pay. “If you give the College another six-month mandate for strike action, across the whole of England’s NHS, then the UK government will be forced to act once more,” Pat said.

“Nobody wants to see twice as many nurses take strike action. Or twice as many hospitals affected by a strike. Prime Minister, you did the right thing to open negotiations with me in February. Before the 75th birthday of the NHS this July, let’s get this job finished.”

As the anti-strike bill reaches its final stage in the UK parliament, Pat assured members that the RCN will continue to fight it. She labelled the bill “draconian, unnecessary and vindictive” and added: “If it gets through, I will hold the Labour Party to their word on abolishing it”.

3. Safe nurse to patient ratios: ‘It isn’t too much to ask’ 

Speaking on safe staffing laws, Pat mentioned Wales’ success in this, and noted that “expansion is the key.” This pioneering legislation – the first of its kind in Europe – requires health boards to have sufficient numbers of registered nurses on duty at all times. And it gives nurses the power to raise concerns if they believe that staffing levels are unsafe.

Scotland followed in 2019 and at RCN Congress 2022 in Glasgow, members forced the government into announcing a timetable for the law’s implementation.

Returning to, and implementing, the staffing agreement in Northern Ireland will be our first ask of Stormont when the government reforms. “I know what you want, above all else, is for where you work to be safely staffed. It isn’t too much to ask, is it?” Pat asked.

"We all know it is England and Westminster where politicians have continued to strongly resist your campaigning on safe staffing,” she continued. “And when that general election comes, I want every party to have it clear in their manifesto that they value what nursing is, the people who provide it and know that for the sake of the patient there needs to be enough of us.”

On this, Pat announced that the RCN will firmly put its stake in the ground, campaigning for safe nurse to patient ratios under her leadership. We need staffing levels “that safeguard quality of nursing care and the wellbeing of our professionals,” she stressed.

Current vacancy rates are having a “devastating impact on you and patients when you have to care for more and more patients each shift,” she said. "It needs putting in law who is accountable for the planning, all the gaps and the harm to patients. It can never be the individual nurse when you are simply set up to fail.” 

4. Embracing diversity: ‘The way the government talks about migration sickens me’ 

Pat spoke passionately about diversity, and how it’s “one of our many strengths as a profession”, noting that Congress is a visible showcase of the many places where members are educated.

“Whether somebody comes to this country ready to work as a highly-skilled nurse; or they arrive as a political refugee fleeing war or persecution; or they simply want a new and prosperous life in the UK, they are beyond welcome,” she said.

“That should not need saying. But the way this government talks about migration sickens me. Our country deserves a better, more informed and celebratory national conversation. Especially in this anniversary year of Windrush.”

5. Education and career development: ‘Let’s push this great profession to new frontiers’

At last year’s Congress, Pat announced that the RCN Institute of Nursing Excellence would be reinstated and today (16 May) she gave an update on progress, outlining the ambition for it as “the home of the active professional as much as the professional activist”.

The institute will be a centre for nursing education, evidence-based nursing practice, activism, and policy. “It will be a driving force for change and will be central to supporting all levels of nursing through quality assured professional development, life-long learning opportunities, standards, and guidance,” Pat said.

The institute is made up of five academies on our biggest areas of work: nursing workforce, nursing practice, nursing leadership, international nursing and activism.

“If the last 12 months have been about raising nursing’s voice, the next 12 months will be about demonstrating our expertise and pushing this great profession to new frontiers,” said Pat.

6. Tackling internal challenges head on: ‘The future is ours to shape’

Following the publication of two independent external reports last year – one by KPMG and one by Bruce Carr KC – it was clear the RCN’s governance and culture, both closely connected, needed addressing.

“Along with our Council, I commissioned those reports to help me get to the heart of the problem,” Pat said. “We were found to be too narrow in our focus; unstrategic in our direction; unappreciative of our diversity; and too often the poor behaviours of a minority overshadowed the wisdom and expertise of a much greater number. I told you I would turn the page on those days, and I can confidently say that we have.”

She said that while there are a number of things that have been actioned as a result of the reports, “there are many pages still to be written”, and invited members to work with her and the RCN to help carve the future of the College and the profession as she launched the RCN’s new five-year strategic plan. “The nursing profession and this College have our best days ahead of us. The future is ours to shape,” she concluded.

Pat Cullen keynote speech Congress 2023

Images by Steve Baker

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