Nurses may have grudgingly voted to accept the pay award, but the government has its work cut out if the profession is to get 'on-message'. Pat Healy caught the mood at the RCN congress

Health secretary Frank Dobson may have had better things to do than address the Royal College of Nursing's annual congress in Harrogate last week, but the government has clearly not stopped courting nurses.

It sent one Cabinet minister - the immensely popular Northern Ireland secretary Mo Mowlam - and two parliamentary private secretaries, including Mr Dobson's own, former nurse and nurse educator Ann Keen.

There was no hiding the fact that nurses are disillusioned with the government over a range of issues, including pay, nurse education, and its muted response to the Royal Commission on Long-Term Care (see box, top right).

This was clear both in the formal conference sessions and on the fringe. By the time Ms Keen arrived for an all-party 'parliamentary question time', delegates had already voted to accept 'with reservations' this year's pay deal, after a debate in which Nottingham nurse Nick Lawton said he had met no one who was happy with it.

Unhappiness with the deal was already clear from the RCN's consultation with members, with 67 branches voting to accept, and 45 to reject the award. The margin at the congress was higher - nearly 80 per cent in favour - although even RCN council chair Debbie Murdock admitted that she was angry at the award.

'It is divisive and doesn't recognise the issue of retention,' Ms Murdock told delegates. 'But it has given a huge boost for newly qualified nurses, increased leads and allowances and it gives us a strong position from which we can ask for more.'

General secretary Christine Hancock caught the mood in her conference address. She said the government's drive to improve patient care would be delivered only if all nurses - not just the newly qualified - received a further pay boost.

And she welcomed Dr Mowlam's comments earlier in the week that improving nurses' salaries was the same as investing in patient care.

Despite having missed all this, Ms Keen had no trouble in mounting a robust defence of the government position on pay.

It was the first time in years that the pay award had been paid in full, she said, although she candidly acknowledged that 'sadly' her own government had had to obey 'the rules of the Treasury' in phasing last year's award.

But trade unions now had an open door and a dialogue had begun on 'how we will function in the future on pay', she said. And she emphasised the government's commitment to ensuring that nurses should be able to advance without having to abandon clinical practice.

'We should not have been turned into business managers and turned into non-nurses and told not to think like nurses,' she said.

Nurses were not convinced. One said she felt 'sad and let down' because she was not being rewarded at the same level as D-grade nurses. Another described it as 'another way of staging', forecasting: 'It's D-grade this year, someone else next year.'

Another said the pay award was divisive - and added that nurses who were fully involved in primary care groups should get the same rewards as GPs.

Liberal Democrat health spokesman Simon Hughes asserted that nurses were still not being treated fairly, despite the government's acceptance of the pay review body recommendations in full.

They had not been compensated for previous phasing of pay awards, he said, which meant that most nurses getting the 4.7 per cent next month would be£50 a year worse off this year. He said the chancellor should have given more to the public sector instead of cutting 1p from income tax 'which a lot of people don't need'.

Shadow health spokesman Alan Duncan supported the 'significant pay rise' for newly qualified nurses, but said the award should be fully funded.

'It is,' retorted former nurse-turned-manager Professor Ray Rowden, quoting an analysis by the Association of Chartered Certified Accountants which found that 'there is more than enough to pay for it'.

'Tell that to some of the trusts I've been talking to,' said Mr Duncan, who had already endeared himself to the audience by admitting that clinical grading, introduced by a Conservative government in 1988, had 'clearly misfired'.

Ms Keen was obviously acting as Mr Dobson's representative in Harrogate. Part-time lecturer Sue Howarth told her that she should not underestimate 'how offensive' Mr Dobson's remarks about nursing education becoming too academic were. The evidence showed quite the contrary because degree courses were practice-based, Ms Howarth said.

Ms Keen said her boss had been misquoted. He didn't want to remove nurses from higher education, but he believed there was something wrong with the way nurse students were managed and treated. He wanted the NHS to 'own them again'. We need 'well educated, well-researched nurses and they need to be valued by the NHS', Ms Keen said.

Similar remarks have been made by prime minister Tony Blair, who came under fire during a debate on the use of recreational drugs by young people. 'The government does not appreciate that we have to give factual, non- judgmental information,' Mersey delegate Rod Thompson said.

Mr Blair and his colleagues should 'support nurses if we are to put our heads on the line to help young people understand all the effects of drugs and help them avoid it'.

Home secretary Jack Straw also came in for flak for his proposals to detain 'dangerous people' - about which Simon Hughes said it was important not to over-react when only 300-600 people could fall into the category.

But nurses voted overwhelmingly for an emergency resolution demanding they should not be placed in the role of jailer if the proposals are implemented.

Frank Doran, PPS to trade and industry minister Ian McCartney, launched a trade union recognition toolkit at a fringe meeting.

It is aimed at the 75,000 nurses - a quarter of the RCN membership - who work in the independent sector where some employers have a written policy of not employing union labour.

But if they were at the meeting, they were keeping quiet about the possible implications for them.