Leanne Patrick, 35, rushed home from her shift two Fridays ago to dial into the latest Royal College of Nursing (RCN) meeting from her phone.
The gender-based violence specialist nurse and RCN member knew this particular meeting was important. After months of industrial action over pay, the union and its boss Pat Cullen had recommended that members accept the Government’s offer of a five per cent pay rise and one-off cash payment — but while Unison’s NHS members had voted to accept the pay offer, 54 per cent of RCN members had voted to reject it.
Naturally, Patrick and many of her fellow 480,000 RCN members had questions for their leader, who insisted she would listen to their concerns. Why had Cullen encouraged them to accept a deal so much lower than they had expected? What were the next steps for members? Would leadership be behind them?
Cullen — a steely mental health nurse from Belfast who started as leader in April 2021 — addressed each of these queries carefully on the Teams meeting, explaining that the pay issue was complex and that the RCN was just one of 14 unions campaigning on the issue, despite being the world’s biggest nursing union, with the late Queen as its patron since the 1950s.
But Patrick says the most unexpected revelations of Cullen’s weren’t those about pay, but that she had been receiving intimidating threats to her home address. Most members were aware of Cullen and other RCN leaders being abused over social media, but this latest wave of harassment marked a terrifying escalation — not only because this person or group had targeted Cullen at her personal address, but because there were concerns that she had enemies inside her union, as well as outside.
After a succession of controversial leadership resignations in recent years, the past six months have seen members report a growing “civil war” within the college. There has been division between leaders and hard-left nursing groups, reports of a “toxic” and misogynistic culture, and an anonymous petition calling for a vote of no confidence in Cullen’s leadership, believed by some to have been started by members of the RCN who disagree with various leadership decisions made by Cullen.
So what exactly is going on at the world’s biggest and one of its most respected nursing unions? Could this reported infighting be harming nurses’ chances of securing a pay rise? And what is the future for Cullen, the woman brought in on more than £100,000 a year to turn the whole thing around?
“It really is quite extraordinary for a union that represents some of the most popular and admired members of society to have this kind of dark problem,” says one London health commentator, who has been following the RCN dispute for many years.
Indeed, this inner turmoil within the college is nothing new. When Cullen, 58, took over in April 2021, the 107-year-old union was suffering from a litany of leadership and culture issues and was widely seen as in desperate need of an overhaul. According to the Mail on Sunday, her predecessor, Dame Donna Kinnair, had resigned from the £197,000-a-year job after a period of ill health and was later discovered to have been suspended amid several concerns, including accusations that she held four meetings with then-health secretary Matt Hancock, without telling RCN officials, and for failing to declare earnings from other organisations.
She had also faced a disciplinary investigation over claims that she had accepted hospitality from multi-millionaire businessman George Farha while on holiday in Morocco, but reportedly struck a deal with the RCN to step down from the role with a £135,000 payoff and an understanding that the situation would be kept quiet within a fortnight of the investigation being launched. The Evening Standard has approached her for comment.
Three years previously, Kinnair’s predecessor, Janet Davies, also controversially resigned as general secretary after an NHS pay blunder that left tens of thousands of nurses expecting a three per cent pay raise which only half of them received. The rest were left furious after being told they would actually have to wait nearly a year until their appraisal and Davies was forced to apologise and step down. Her colleague, the RCN’s then-chief negotiator Josie Irwin, also resigned over the blunder and took a job at rival union Unison. At the time, the RCN said it was “awaiting the full findings of a review into the past few months’ events” and would then “take an informed decision as to the long-term executive leadership of the organisation”.
When Cullen was brought in as interim leader in 2021, a wider culture problem had also been bubbling behind the scenes at the college. Despite representing an overwhelmingly female profession, insiders say the RCN was dominated by a clique of mostly male, “grassroots” members who reportedly bred a culture of misogyny and sexual harassment and, until that point, had sought to sabotage almost every attempt at reform by leadership.
RCN members hoped that Cullen, a proven leader described as “formidable” and “tenacious” by her supporters, would help to change this. Nursing was in her blood — she is the youngest of six girls, four of whom have gone on to become nurses; she’d spent the early years of her career working as a mental health nurse, including in Belfast during the Troubles; and had already served as director of the RCN in Northern Ireland.
Just months into the job, Cullen commissioned leading barrister Bruce Carr KC to conduct an independent investigation into the alleged culture problem, which was published in September and found a culture of bullying, misogyny, and sexual harassment and that the union was “riddled with division, dysfunction and distrust”. Carr also reported that the council is seen as “a misogynistic environment in which loud and abrasive male voices dominate the environment to the detriment of women”.
The RCN’s annual five-day conference, known as congress, was singled out as a particularly grave concern in Carr’s 77-page report. “The evidence that I have seen suggests that there is a level of expectation amongst a significant number of [male] attendees that opportunities for sexual activity will present themselves at congress,” he said of the event, which has been held in locations including Liverpool and Brighton over the years and tends to include a packed schedule of smart evening receptions and awards ceremonies.
Carr described a culture where delegates went to the event with the intention of extramarital sexual activity. He said younger members, like student nurses, were at risk of “alcohol- and power-related exploitation” and “grooming”, and concluded that the male-dominated governing body was “not fit for purpose”, calling for “significant change”.
Patrick, who was one of the original complainants that led to the Carr report, says this culture was an “open secret” when she became a member in 2016. A relative of hers had been a member before her, so she had “always been aware” of this culture of misogyny and sexual harassment, avoiding events like congress because of it. “Congress was well-known as one big booze-up where predatory RCN council members would hit on the younger women,” another industry insider told the Evening Standard this week.
Cullen apologised on behalf of the union and got to work as soon as the report was published, forcing that year’s congress online, suspending at least five members of the council, and referring former chairman Dave Dawes to the Nursing and Midwifery Council. His employment tribunal preliminary hearing found that there had been complaints of tweets of a sexual nature, including the following, sent in July 2011 to another user: “As a nurse I can detect abnormalities in breast tissue :) Covering them in ice cream and using my tongue is part of technique.”
Dawes lodged and later lost a claim of unfair dismissal by the union, saying the “12-year-old jokes on Twitter” had been used “as a pretext” to get rid of him. “I am aware that the people who originally dug up the 12-year-old jokes on Twitter and sent them to Pat Cullen also keep sending them to lots of other people in the two years since (even though they were deleted in 2021),” he said. “I think this is a campaign by a small group of RCN members who wanted to remove me from office.”
So has Cullen managed to deliver on her promise of stamping out that toxic culture? Eighteen months on from Carr’s damning report, most members believe that the RCN boss has done her best in delivering on it — though cleaning up a decades-long problem doesn’t happen overnight. “Today, it finally feels like a professional organisation,” says Patrick. “[Cullen] seems to have a really good grip on where the issues are... but it takes time when it’s something that’s so embedded to tackle every nook and cranny that it’s reached.”
But this newfound professionalism seems to have come at a price, with Cullen’s fight to eliminate toxic figures from the union’s ruling elite sparking a fierce power battle within the college. Shortly after the five per cent pay deal was announced last month, an anonymous online petition called for an emergency general meeting (EGM) of the union on May 13, to bring a vote of no confidence in Cullen and her executive team. It also called for a vote of no confidence in the RCN’s negotiating committee.
The petition gathered more than 1,000 signatures, quickly passing the threshold required for an EGM, with RCN insiders suspecting the group behind the petition to be linked to members of the RCN unhappy with Cullen — some over the Carr Report, some for not being tough enough over pay.
The petition was not the end of the infighting, however, with the battle between warring factions of the college taking yet another extraordinary turn. Within hours of the petition going live, the RCN accused its authors of fraudulently adding hundreds of names to it, including at least one nurse who’d passed away and others who were unaware that their details had been used. “A recent no confidence ballot has been discredited and invalidated after a verification process revealed a significant number of names had been added fraudulently, including that of a deceased member. This is now being further investigated,” said an RCN spokesperson.
Former consultant nurse Ken Spearpoint is one of those whose name was added without his permission. “I am affronted with what they have done and quite angry about it,” he said last week. “What struck me about it was that these are professionals, or they’re meant to be, and to falsify records like that is staggering.”
The RCN is currently seeking advice from the police and the nursing regulator over how this breach happened, and cyber-security firm Dionach has been brought in to investigate further.
So what does this mean for the future of the union — and can Cullen heal the divisions that seem to be widening by the week? It depends who you ask. An RCN spokesperson told the Evening Standard this week that Cullen’s determination to clean up the RCN remains strong, though some insiders say her failure to secure the backing of 54 per cent of RCN members over the pay offer suggests it’s time for her to leave. “The RCN is becoming farcical,” says Tom Milligan*, 35, a cardiac nurse who believes Cullen’s five per cent recommendation was “nothing short of ridiculous” and “does absolutely nothing to address safe staffing levels and retention and recruitment of nurses”.
Others believe that the 54 per cent figure hides the true story, claiming that many relatively new members were persuaded to vote against the pay offer by a minority of disgruntled old hands looking to get their revenge on Cullen. “Like any organisation, there are going to be people who are power hungry... It comes with the territory of being a national leader,” says community staff nurse Josh Gilroy, 25, another RCN member and keen supporter of Cullen.
Patrick believes Cullen still has the backing of most RCN members she speaks to. They voted for her and are proud of what she is doing in fighting for a pay deal while cleaning up the culture of a previously male-dominated union. Some nurses back her so much that they have actually joined the RCN from other unions such as Unison since the pay deal rejection.
So can Cullen clear up the remaining issues before the next set of strikes? “I’d say, at national, full-time officer level, the culture has changed,” says one health commentator, pointing out that the RCN council is made up of a majority of women now. “So yes, things have improved... The problem is the lack of confidence that members have in the full-time leadership that stems from the historical conflicts between council and executive.”
Whether Cullen can successfully clean up the stains of the RCN’s past and mark an end to that Carr Report era remains to be seen, but she might want to make some hasty decisions. The NHS is currently challenging the college’s upcoming two-day strike this weekend, saying its second day falls outside of the legal mandate it secured for industrial action.
It is understood that the RCN has said it will “forcibly resist” employers’ attempts to block the strike starting this Sunday, and is willing to go to court over it. But with internal tensions reportedly continuing and commentators suggesting it’s unlikely the RCN will get the votes for a second strike mandate when this one runs out, the battle within the country’s biggest nursing union seems unlikely to reach a conclusion anytime soon.
