THE NATION’S NURSE: Christine Hancock, general secretary of the Royal College of Nursing since 1989, talks of the crisis facing the profession and her aim to set a new agenda under a Labour Government

On 18 July, nurses at St Helier hospital in Carshalton in Surrey

threatened to take industrial action over poor standards of patient

care, due to overcrowding in casualty - the latest in a series of

stories highlighting the problems created by healthcare national

shortages. And as a potential winter crisis looms, the UK media will no

doubt abound with horror stories of accident and emergency departments

littered with patients on trolleys, a lack of beds and of nurses.

The latest Pay Review Body Report (1997) estimates that there are at

least 18,000 unfilled nursing vacancies in the UK and with fewer

qualified nurses to meet a rising demand, nursing shortages are an

urgent problem.

The solution to this crisis, according to Christine Hancock, general

secretary of the independent nursing union, the Royal College of Nursing

(RCN) is no less than a complete overhaul of the way in which nursing is

viewed by the public, the health executive and the media. As a result,

Hancock, who has been dubbed the ’The Nation’s Nurse’ , is currently

spearheading a battle to communicate the true value of nursing and to

push forward the frontiers of nursing practice.

The RCN is the UK’s largest specialist union and one of the few trade

unions in the country to have consistently been led by a female general

secretary. Its members include three quarters of all NHS nurses and a

quarter of those in the growing independent sector, including practice

nurses and those in private hospitals and nursing homes.

It takes a wider approach to looking after its members than many

unions.

In addition to representing its 300,000 plus membership on issues of pay

and conditions, it is also the largest provider of education for

registered nurses.

Hancock is probably the strongest weapon in the RCN’s formidable PR

armoury.

Her combination of humour and hard-headed lobbying experience making her

an extraordinarily effective communicator.

’We are the voice of nursing and we are a membership organisation for

nurses which provides them with a range of advice and support and

collective strength to do their job as well as possible - which I

believe passionately is the absolute cornerstone of good healthcare,’

says Hancock who is keen for the RCN to be seen as more than just a

union.

’I think people who don’t value nurses - and that includes too many

managers and a few doctors - don’t really understand the process of

looking after people properly. They don’t think about some of the issues

surrounding nursing and just see some awkward local steward not wanting

to settle on local pay.’

The biggest communication challenge for the RCN, according to Hancock,

is communicating the range and depth of specialist skilled care now

offered by highly trained nurses.

’The press have their view characterised by that warm, middle-aged man

idea of a nurse - the ’poor, hard up, lovely woman deserves better’

approach.

It is very easy to convey nurses as nice and kind and caring but

communicating the skills that nurses have, the way in which they really

make a difference is a different matter.’

Raising media interest in the emotive issue of nursing shortages and the

effects of such shortages on patient care has never been a hard task for

the RCN. The real challenge for Hancock is to ensure that the urgency of

such shortages are conveyed without being alarmist.

’When we are talking to the outside world, our challenge is not to

frighten people who are patients, or who are about to become patients.

But (if you deny there is a problem) then you immediately undermine your

case. It is a matter of getting the balance right.’

As well as communicating the value of nursing to the public, Hancock is

critically concerned with lobbying on key issues such as the provision

of children’s nursing services.

The RCN has an active parliamentary lobbying arm headed by director of

external affairs Joanne Rule, which provides written and oral briefings

to MPs, Peers and their researchers and Hancock regularly gives evidence

to the Health Select Committee. The RCN is represented on many European

Commonwealth and international bodies such as the International Council

of Nurses, and Hancock is currently president of the Standing Committee

of Nurses of the European Union (PCN).

As an independent union, without affiliation to any political party or

the TUC, the RCN has benefited in the past from good access to the

government of the day and Hancock is confident that she is being

listened to by the new ministerial team.

’They are very much at the ideas stage. It is important to remember that

you have to lobby from the back and make sure that the issues are

understood by a new team.

’But at the same time that new team is coming in with lots of its own

ideas, so there is a sense in which it is not so much lobbying as making

sure you are in with all the discussions, all the new ideas and running

with them.’

According to Hancock, the new Labour Government came to the table with

an acute awareness that they had inherited some very serious problems,

and a critical view of the internal market but without a formalised

agenda.

’In education they (the Government) came in with a much more formal, a

much harder clearer agenda. In health they didn’t come in with quite

such a fixed set of policies, they are still very much in a listening

mode.’

The RCN has already won one major victory with the abolition of local

pay deals. On 19 May, at the opening of the 1997 RCN Congress, Frank

Dobson announced that nurses would receive a national pay award in 1998,

ensuring that nurses across the country will receive the same rates of

pay. But it was a hard won battle which involved taking the difficult

decision to change the RCN’s rules in 1995 to allow industrial

action.

’We were very nervous (about changing Rule 12). One of the things that I

have learnt in this job is about the power of headlines. We have never,

and I can’t image we would ever, ’strike’ - it is deep in the psyche of

nurses and the RCN that we don’t harm patients. But of course, limited

industrial action doesn’t make a good headline, while a strike does.

’One of the things I was unaware of until I went into this was how the

Thatcher years had nailed trade unions. The definition of industrial

action now is that anything that is called collectively - like refusing

to work unpaid overtime - is industrial action, whereas prior to the

Thatcher Government it was considered that the only real industrial

action were walk outs - real strikes.’

Despite her qualms, national opinion polls carried out during the

campaign for national pay awards showed that public support for nurses

and their action never wavered. However, Hancock’s fight is far from

over. Having secured national awards for RCN members, Hancock will

continue to lobby for better pay and conditions, and critically, for

greater recognition.

’While nurses are much better paid than the average taxi driver it

doesn’t mean it is enough for the skills that they have,’ says Hancock.

’Nurses want to be treated fairly. You don’t want to come into nursing

to get rich, they want to be treated reasonably.

’If you are not paid or valued properly, or feel frustrated because you

can’t do you job properly, then the thought of working in Marks and

Spencer or British Airways starts becoming a bit more interesting. The

biggest form of industrial action that nurses take is leaving the

profession.’

LOBBYING ALLIES: COMPLEMENTARY MEDICINE

The passing of the Medicinal Products: Prescription by Nurses Act in

1992, marked the culmination of more than ten years’ lobbying work for

the RCN. The Bill theoretically allows for nurses to routinely prescribe

in their own right within limited rules but has turned into what

Christine Hancock describes as ’the longest pilot in history.’

There is currently a commitment to run a pilot scheme in eight regions

plus Scotland, Wales and Ireland, but the RCN is continuing to lobby for

the extension of prescribing to all community nurses in the UK.

’It is as if every time we take the eye off the ball (it slows down). In

a way the lobbying becomes much harder the moment it is more diffuse. If

you know who your target audience is, it is much easier. Something like

getting the Bill through was easier than making sure it is implemented

across the country.’

The RCN has been extremely successful in forming lobbying coalitions and

relationships with other parties such as mental health charities MIND

and SANE, as well as the Royal College of Psychiatry, on issues such as

its campaign to double the number of psychiatric nurses caring for the

mentally ill in the community.

’We are building up other people to argue our case as well as us, people

whose primary interest is the patient and the public, and patient groups

have been very important from that point of view,’ says Hancock.

The RCN is also working in conjunction with a large number of pressure

groups including the Alzheimer’s Society, Age Concern, Help the Aged and

the Registered Nursing Homes Association to lobby for free nursing care

in nursing homes. The RCN’s argument being that as nursing for the

elderly is available free in hospitals, at home and in residential care

that nursing costs should be separated out from residential payments in

nursing homes.

’We have been working very closely with voluntary organisations and

pressure groups as well as home owners, because part of lobbying

successfully also means you have to really understand the detail of how

nursing home charges work and who actually pays.’