Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, will make sure you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce. Contact me in confidence

“It did get pretty bumpy for a while, didn’t it? A rumour even said that Theresa May was beginning to feel sorry for the RCN.”

New Royal College of Nursing chief executive Dame Donna Kinnair didn’t waste much time in acknowledging the past year has been one of the most challenging in the trade union’s history. But, for some members, “pretty bumpy” was an understatement.

Although it didn’t quite reach the level of chaos presided over by Mrs May’s government, Dame Donna used her maiden speech to remind this year’s congress that the past year has seen “contentious votes and departures from the top team”.

This was in reference to the revelation the union promised NHS nursing staff they would get an uplift of 3 per cent following the Agenda for Change pay deal. In reality, the RCN miscommunicated the deal and what it would mean for members – they actually saw an uplift of 1.5 per cent.

In the months that followed, former chief executive Janet Davies stepped down and the RCN council lost a vote of no confidence from its members, amid comments from the leadership at the emergency general meeting that a political faction was trying to infiltrate the organisation.

Dame Donna said there were “weaknesses in how the RCN carried out its trade union function in particular” and pledged to act on recommendations that were made – “the college is changing,” she told the room.

The annual general meeting on the first morning of congress, according to Dame Donna, involved a “full and frank discussion”, where RCN members asked the “toughest of questions”.

HSJ has heard from those attending that members held the union leadership to account and Dame Donna apologised for comments made about political infiltrators.

However, others told me her apology didn’t go anywhere near far enough as thousands of members voted for a deal that has left them out of pocket. It was made clear there is further to go to regain members’ trust, with one telling me they wouldn’t be surprised if something similar to the pay deal debacle happened again.

Another member told delegates during a debate there has been no formal apology made to all members and little reflection on progress and lessons learned over the last year. “Now might be an opportunity,” they said.

Dame Donna also reminded congress the next time it meets it will be time for the union and NHS staff side to enter into the next round of discussions with the government and NHS Employers, to negotiate NHS pay levels. The RCN has another year to stabilise before these negotiations begin, where all eyes will be on its leadership and the messaging to members.

Safe staffing campaign

The RCN leader told congress her “number one priority” for the top job is to get “meaningful legislation and investment in every part of the UK.” A big part of this will be the RCN’s campaign to enshrine safe staffing levels in law, as already done in Wales, and as of two weeks ago, Scotland.

“Those with power, money and authority to change this are too often found unwilling; all too happy to let the individual take the blame for failings that are genuinely systemic,” she said.

RCN president Anne Marie Rafferty reiterated the need to safely staff hospitals while speaking at the congress. 

“The odds of death are more than 25 per cent greater in the worst staffed hospitals compared to the best,” professor Rafferty said. 

“Though each country is on a different journey, all of our work is underpinned by five clear principles,” she said. “These principles outline the need for an adequate supply of nursing staff, with enough students coming through the system, and development of the existing workforce. And importantly, they demand responsibility and accountability for ensuring there are enough nursing staff to meet the changing needs of the population.” 

Alison Leary, professor of healthcare and workforce modelling at London South Bank University, gave another perspective on the way forward for safe staffing. 

“It is very welcome that RCN are pursuing safe staffing legislation in England but I’m not sure it will work with the same success it has had in Wales or Scotland,” Professor Leary told HSJ. “The Parliamentary process is very different and the relationships are very different.”

Professor Leary suggested another option is to introduce “wider safety legislation” and “leverage safety legislation we already have”, such as employment, and health and safety laws. 

“My preference would be to go for overarching safety legislation, the way other safety critical industries have, that gives a really robust legislative framework and gives people freedom but holds them to account to both their staff and patients,” she added.