Royal College of Nursing is the union for most nurses in the North’s National Health Service. We visited pickets across region on their first of two planned days of strike action 15 December. This interview was conducted in East Belfast’s largest hospital in Dundonald just east of Stormont: Ulster Hospital. The strike continues today Tuesday 20 December.People Before Profit (PBP)
Yes. So this is Ulster Hospital and today is December 15th Thursday. And who are we speaking with?
Simon Higgs
I’m Simon Higgs. I’m an RCN steward.
PBP
Do you work here at the hospital?
Simon Higgs
I do indeed. I work in the pain service. I’m the pain services manager.
PBP
All right, good. What’s your name?
Gail Young
My name is Gail Young and I’m one of the RCN Learning and Development Reps.
PBP
All right. And you’re working here?
Gail Young
Yeah, I work with the Gastro team in hospital supporting patients in clinical trials, drug therapies.
PBP
Okay, all right. Okay. Yeah. What’s your name?
Ruth Thompson
I’m Ruth Thompson. And I’m an RCN Board member and clinical manager of cancer services here.
PBP
Very good. All right, great. So how long have you been working in the hospital here?
Ruth Thompson
I’ve been here for two years.
PBP
Okay. Yourself, Simon?
Simon Higgs
I’ve been here 16 years.
PBP
16 years! All right!
Gail Young
I’ve been here seven years.
PBP
Seven years? Okay… And I’m here about seven minutes!
What’s the main issue that RCN is out about? Is it any different to say last time you guys were out, I think it was 2019 or something like that? What’s changed?
Simon Higgs
Last time when we it was more along the lines of both safe staffing, which are out for now, but also about pay parity.
So before Northern Ireland, because of the devolved government, we were out of Pay Parity with the rest of England and Scotland and Wales, which then meant that our nurses here were getting paid far less than the other three countries. That then meant that our nurses that we were training here were obviously going to find somewhere to work where they could get better pay for doing exactly the same job.
So they were leaving Northern Ireland and that meant then that we were getting depleted numbers. Now we’re out again because we’re still out of Pay Parity. We’ve literally just got the 3% introduced in Northern Ireland and we haven’t got that in our pay packets yet, but hopefully that will come in the new year that then will bring…
PBP
Will that be backdated? Do you know?
Simon Higgs
Backdated to April is what we’re being told
PBP
It was a bit of a conflict when I heard it over at City (Hospital) the other day: they were saying there was going to be pay parity, but some people said that hadn’t been established…
Simon Higgs
…yet! So hopefully then that will come in.
PBP
That’s just down to the problems with Stormont.
Simon Higgs
Yes.
PBP
Okay.
Simon Higgs
So that was all to do with Stormont. And they told us that they couldn’t give us the pay award because there was no functioning government and nobody there to make those decisions.
So once we’re back into Pay Parity, we’re still in the same situation where in real terms, we are 20% worse off than we were in 2010 because of the withholding of pay awards, below inflation pay awards.
PBP
So their strategy is working just fine…
Simon Higgs
Yes. So we are then still losing nurses hand over fist. We are the lowest country really in all of Europe for nursing pay.
PBP
Really!
Simon Higgs
Yes. So all the rest of the countries are paid far more than us. Nurses are not paid as if they are professionals, which we are a professional organisation. We are a degree (at least degree), if not, a lot of nurses now are coming out and going on and doing their masters as well and still getting paid the lowest in Europe for that.
Our biggest issue that we have now is because we have recruitment and retention issues, because nurses want, obviously, to be able to put food on their families’ tables. Majority of nurses are women, so again, they have children and things like that to look at. Maybe they’re having to work part-time and having to work several jobs, work in bank or agency to try and top up their salary. So again, it causes huge problems there as well.
And because we don’t have enough staff, skill mixes on the wards get the dangerous levels. And it’s hard then to make sure that the best care – that all nurses want to give (the whole nursing family, both registered nurses as well as the healthcare support workers and nursing auxiliaries)… We all want to provide the best care that we can to patients.
And because of the lack of staffing, it makes it very difficult to do that.
Nurses are in tears.
Nurses are at their wits end.
Nurses are psychologically affected by what they’re having to go in and see us every day, because they know that the next morning when they get up to go to work, they’re going to be short staffed.
They’re going to have to try and spread themselves so thin to be able to try and give whatever best amount of care that they can with their patients.
And it gets to the stage where they have to ration themselves because they can’t spread themselves across everybody. And we just feel that enough is enough. We can’t let our patients potentially get to that stage where there could be harm. We do our best and that’s one thing that we want to do, is avoid any harm coming to any patient or any client in our care. And because of the staffing issues that we face and the lack of a proper pay, that is becoming a real issue.
PBP
(to Ruth Thompson) Your bib here says ‘The Voice of Nursing’ on it. ‘Royal College of Surgeons’. Right? One of the things that came up at another one of the hospitals that I visited was that it’s not that we just need to get back and get back up to the right levels, but we actually need to build up the NHS further.
Ruth Thompson
Absolutely.
PBP
Can you talk about why people are saying that and what’s brought that on?
Ruth Thompson
I think there’s a big change. You asked us earlier about what’s different this time.
I think we’re in a very, very different place than where we were the last time (please note: RCN were on strike last time in 2019), with waiting lists and under resourcing and that’s just getting worse and worse.
But we also have an aging population.
In Northern Ireland we have the highest rate of aging in our society. So that means you’re more and more people needing care, more and more people who live in with comorbidities – so needing more help, more advances in technology, and advances in treatment, which are great, but again, that adds to the demand on our hospitals.
So because of that, our staff levels aren’t keeping pace with the demand always increasing. So you might hear people say, oh, well, we’ve increased our number of student nurses and things like that, but not at the pace that is needed to match demand.
PBP
That’s important.
PBP
(to Gail Young) What about how people are feeling about getting what about the basics of kind of organizing this strike today? How did it come about? Was it difficult? Is it difficult to motivate people, arranging care for people who are still in the hospital, who don’t have a choice around this thing. How does that all work? How do you manage a hospital strike?
Gail Young
It’s not really that difficult. We’ve been very much supported, by management, by the chief executive of the hospital, by the public themselves because they understand. They get it. They’re on this journey with us, so they are.
And let’s be clear, none of us want to be standing outside the hospital today. We want to be inside the hospital doing what we do best, and that’s looking after our patients. And that’s just reiterating what Ruth and Simon have just said: We’re here for our patients. We’re the voice of nursing. We’re the voice of our patients. We’re advocates for our patients.
And that’s why we’re standing here today: for safe levels of staffing.
More often than not, there’s very unsafe levels of staffing and we’re just a breaking point. And for anyone who says we’re being greedy, shame on them.
PBP
Absolutely.
Gail Young
Because the maths simply don’t add up, so they don’t. Because, as Ruth and Simon both have said*, we are 20% worse off than what we were ten years ago*!
And any offer falls very short of the rate of inflation.
And we have members who have come to us as representatives and they’re asking to be pointed in the right direction towards food banks. Now. That’s very sad.
PBP
I was down with it was Unison strikers down at City Hospital. And I met a young nurse named Natalie. Young, but she’s been working at it for ten years. And she said, this year is the first year that I’ve seen people talking about the fact that they’ve gone to food banks and talking about their experiences at those food banks and comparing those experiences. It’s not something that they’re doing alone, it’s something that they’re doing with each other and they’re trying to find a better food bank and things like that. It’s ridiculous.
Gail Young
How can nurses care and look after patients, that they can’t look after themselves and their own families?
PBP
How did it get to this level?
Simon Higgs
It’s the continual underfunding of the NHS and the lack of recognition for the work that the nursing family gives to providing that care. With the chronic underfunding and the inability for government to make the hard decisions in terms of centralizing specialist services and things like that, it makes it very difficult to provide care over what is relatively a small country that we have.
But we have so many hospitals that things are spread out. Things have improved. Things are being centralized now. I think from a health care point of view, we’ve done a lot of the stuff that we can and nurses have led a lot of that change and a lot of those developments to be able to work within the resources that we have. But a chronically underfunded system cannot provide the level of care that is needed.
And as Ruth says, with the aging population, more people at higher risk of need and needing more care. And obviously in Northern Ireland we have health and social care linked together. In a joined up system that requires proper funding.
And when you have chronic shortages, primary care community services are in a dire state of affairs.
We can then not get patients out of hospital, back into their home, into a level getting care delivered in the person’s home where they need it, therefore they’re blocking beds in the hospital…
PBP
And that cascade effect…
Simon Higgs
It does. It knocks on. Then you have EDs (emergency departments) And every day on the news, on social media, ED departments are putting on ‘We are a breaking point. Please don’t come unless it’s absolutely necessary.’
And a lot of that is because people are blocking beds in the hospital because they can’t get into the community where they need to actually get back to.
You were asking about what we’re doing here in terms of looking after the patients. We have strike committees which are staffed by professionals from the RCN. The Royal College of Nursing obviously is a professional body for nurses and we do not want to see any patients come to harm. And we are doing everything to make sure that the picketing and the striking that we’re doing make sure that all patients are kept safe within our system and within our health care service.
And that strike committee is on standby should anything happen, to make sure that we can then talk to our members and if necessary, get staff to cover if there was an emergency.
But we are making sure at all times that there is an open line of communication between right away from the Chief Executive of the Trust to our picket line and vice versa. And people can just contact them if they need support and assistance. So that’s all the things that we’re trying to do to mitigate any risks as well.
PBP
I’m down from People Before Profit, up from Dublin today, and we’ve been around at a lot of different hospitals. We’re actually over at the Royal Mail centres as well, and we’re talking to people.
Obviously, our position is, you’re absolutely right to be looking for fair pay and you’re in a hole. You’re not looking for something over and above. You deserve over and above, though. You deserve above inflation. There’s a bit of a worry about settling for less than that 7.5 that was offered and accepted over there in Scotland. And we think that can’t really be accepted here. And you shouldn’t absolutely should not be demonized by the media or have anybody take that on board. So I’m really glad to hear folks, you know, knocking that right on the head and saying NO. But the other thing that one of the one of the, one of the big questions is kind of how do you win this? What is what does winning this look like? And how do you unite all the fights? I mean, the guys who were out on Monday and yourselves, obviously, should all be out at the same time. How can that be done? How will that be dealt with?
Simon Higgs
To pick up on Scotland? Except in their day in Scotland, we’re already getting paid higher than the rest of the other three countries anyway, so they were ready on a slightly higher level than us. What we are I forgot your question there.
PBP
The main thing is how do you unite the different structures? How do you unite the fights and how’s that going to happen?
Simon Higgs
I think really what we need first of all, first and foremost, is government to actually take this seriously and actually meet with Pat Cullen from the RCN and actually have those discussions and actually join the negotiating table. And that would be the first step in all of this process.
Obviously, Scotland (the Scottish devolved government) have been sensible. They have met. They have negotiated, and we are still in that situation in England or England, Wales and Northern Ireland. Northern Ireland. We have no government to actually meet with anybody on England and Scotland. They are refusing to meet with the unions and have open negotiations. We obviously, as RCN members, are open to negotiation. We do have a red line that we have there that we agreed to whenever we went out to ballot with our members, but we are open to negotiations.
But the first stage is this whole thing of them just doing this (refusing any meeting at the negotiating table). It’s nearly like bully boy tactics- ‘No, we’re not going to meet with you! We’re not going to meet with you!’ And standing off and see what happens.
That’s not right.
The last time we did the strike as well, we had no functioning government here.
Simon Higgs
And one of the main things that we got as an outcome of the strike is: Stormont was up and running again!
They had to come back.
They had to come back- to make the decisions that needed to be made in Northern Ireland!
PBP
Well, what we’d like to see is we’d like to see those fights united. We’d like to see everybody striking together and we think that you guys certainly have the power to do that and we’ll be backing you 100% and all the way.
Ruth Thompson
Absolutely. And you were saying covered saying about us being ‘The Voice of Nursing’, but we’re also the voice of the public as well!
There is nobody that doesn’t need the health service.
Every single person, including all the assembly members and the executives, you know, they all need this service.
PBP
Yeah, folks are still coming in here.
Ruth Thompson
Because it’s absolutely you can see it’s still really busy. People coming in, night, all-day services,
PBP
It’s the National Health Service. People need it.
Ruth Thompson
Someone said a few weeks ago how nurses were ‘too important to strike- but not important enough to pay fairly’. So that’s certainly something to think about.
We’re doing it for our patients, most importantly, but we’re doing it for the whole public and there’s nobody who doesn’t need a high quality service. And at the minute, what the things we see every day aren’t high quality, unfortunately, it’s actually quite heart-breaking. And that’s what really affects nurses. And what does push nurses to come out here is to stand up for patients because they want to come at the end of the day knowing they have done a good job and they’ve given really high quality care and some days they can’t do that, which is really, really unfortunate.
Simon Higgs
And I think that it’s a very salient point as well in that to get the voice of nursing and to get the membership behind us, we had to remind our members: What are you facing on a day in, day out basis when you go into work? What are you facing in terms of patient care? Are you happy and acceptable of the standards that you are going in, the working conditions that you’re faced with? And the resounding voice, unanimously, more or less within Northern Ireland especially, was ‘No- We are not happy.’
We are doing that for our patients. This may have pay in there and the government will do smoke screens, they will say, ‘Oh, they’re just being greedy,’ as Gail has mentioned there. People are saying that, but that’s not the point.
The point is we need a nursing profession and a nursing family that can care for the patients to run the NHS. We have, what is it, 500,000 members in the RCN across the four countries. And that family provides and is the backbone of the NHS. Research, development: all of those things do not happen within the health service. Without nurses at the forefront of that, leading those projects, those changes, they are the ones that are there.
And without us, the NHS will not function. And we see that from our patients as well. We do this for our patients and that was the way that we were able to motivate our members is reminding our members if we do nothing. Yes, we went out on strike three years ago, but in England and Scotland and Wales is the first time the RCNs ever went out, and it’s 110-year history. The reason for that is nurses do not want to put extra strain on the system in any way. But we know, I know, that there’s no other option.
PBP
No. What you guys are doing today is caring– just as much as being in there.
Simon Higgs
They have to listen. We cannot have an NHS without a proper funded service.
Ruth Thompson
The other thing, the important point to make that we haven’t really made very much is we are a very specialized, highly skilled workforce. That has evolved constantly over the years. And nurses always stepped up to the mark. There’s no nurse here you’ll be who hasn’t done postgrad education. So not only are we a graduate profession, but people are constantly doing courses and they could be going and doing courses, they’ll do degrees, they’ll do specialist courses, they’ll do masters and maybe never go another grade above what they’re working on. I don’t know any other profession where that would happen, where you wouldn’t be rewarded for continuing your education. But nurses have always embraced that. They’ve always continued to take on specialist, advanced roles, taken on roles that other professions did. But it’s just a breaking point now.
Gail Young
In Northern Ireland we have the highest number of nurses who retire at a Band 5. They want us to be professional, but they don’t pay us as professionals.
PBP
That affects your entire retirement as well.
Gail Young
It does indeed.
PBP
I just want to say thank you very much for the interview and best of luck with this.
RCN strikers and reps Gail Young (left), Simon Higgs (centre), Ruth Thompson (right).
Some of the striking picketers at Ulster Hospital.
The strike picket at Dundonald with People Before Profit supporting.
RCN Strikers at Belfast City Hospital