Pat Cullen: the Tyrone woman at the helm of the UK’s first nursing strike

Staring at a portrait of Pope John Paul ll on her Mother Superior’s wall, Pat Cullen thought she was about to be expelled.

It was the late 1970s and the Co Tyrone schoolgirl had been summoned by Sr Barbara Faul.

“I visited Sr Barbara’s room more than most of the convent girls. I remember looking for ages at the pope’s picture as he was coming to visit Ireland and wondering what he would think of me being rebellious,” she says.

Outraged at the separate queuing system for “poor kids” receiving free dinners at the Loreto Grammar School in Omagh, she challenged the system.

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She was 13 years old.

“I hated an injustice and quickly realised in my first year that the nuns, in my opinion, made a difference between those that had money and those that didn’t.

“And that was us, the people that didn’t have money.

“We were entitled to free school meals, and I got to thinking, ‘There’s two queues here’. There’s the queue for the people that have and then there’s a queue – it’s a sentence I use many times now – for the ‘back of the bus’.

Cullen was not expelled that day, though she left three years later “by mutual agreement”. But the exchange with Sr Faul lives with her: “When I walked out of her office, I got the feeling she knew I was doing the right thing. Those queues stopped. They didn’t stop immediately, because they didn’t want to be seen as attributing it to a renegade pupil, but they stopped soon afterwards.”

This Thursday, Cullen will mount her biggest challenge when she leads more than 270,000 nurses in the largest strike in the National Health Service’s history – the first time nurses in England, Wales and Northern Ireland have gone on strike together.

Nurses from hospital wards, clinics and the community will take part in the national 12-hour walkout. A second strike is scheduled for December 20th. Under trade union laws, the Royal College of Nursing (RCN) has to ensure life-preserving care is provided during the action.

Head of the of the UK’s RCN for the last 18 months, the Co Tyrone woman has become the face of the walkouts, but it is familiar territory for the former mental health nurse who oversaw the first RCN strike action in Northern Ireland in 2019.

The union had never picketed in its 103-year history, but the NI move is widely accepted as a catalyst that led to the restoration of the Stormont Executive in 2020 – and secured her members a pay deal.

“If I hadn’t gone through the walkouts in Northern Ireland, I definitely couldn’t have done this now,” she admits.

Today, every day is filled with an endless round of television interviews and Westminster meetings, concluded with late-night walks along the Thames where she phones her husband of more than 30 years, Enda, a GP back in Belfast, and sister Petra, her “soulmate” with a “wicked sense of humour”.

Daniel O’Donnell and Dolly Parton are on her playlist for work flights and long car journeys.

“People are going to think I’m a country bumpkin, but I love Dolly and yes, I own a Daniel calendar. I sew in my spare time and just finished making curtains for my daughter, Teresa.”

Nurses across England, Wales and Northern Ireland voted overwhelmingly for strike action last month, beginning with a national 12-hour walkout on December 15th. A second strike is scheduled for December 20th.

The union is asking the UK government for a wage increase of 5 per cent above RPI inflation – equating to a 17.6 per cent pay rise, arguing that a decade of austerity has forced thousands to quit.

British prime minister Rishi Sunak has branded the pay ask “unaffordable”, even though his government has “enormous gratitude” for nurses and NHS staff “for what they do and have done for us over the past couple of years”.

But in her soft Tyrone accent, Cullen insists: “I just can’t sit back and allow that Tory government to walk all over nursing, I can’t do it.”

Negotiations have stalled, she adds, unlike in Scotland where strike action has been suspended.

“I’m not dealing with anyone in the British government at the moment as they won’t talk to me. We went down to meet Steve Barclay [the UK health secretary] four weeks ago in Westminster and he made it very clear we would be talking about non-pay issues. I haven’t returned since.

“I met with Scottish first minister Nicola Sturgeon two weeks ago at her request. That happened on the Friday morning, and I suspended their strike that Friday night.”

But is a near 18 per cent pay demand realistic?

“My message to the Tories is: I’m not unreasonable; if you get in a room and start to talk to me, look what happened in Scotland.”

Those close to Cullen are not surprised by her refusal to back down: “She’s a good people person and works well with others. She doesn’t appear as a threat but is steely when it comes to digging her heels in and will actually take on the system – and has done so often at a cost to herself,” says retired Belfast GP Dr George O’Neill, a friend and colleague for almost 20 years.

“My experience in dealing with her is if she thinks something needs to be sorted or is wrong, she will deal with it head on. She was always willing to take a risk – but was not reckless.”

Anne Marie Marley worked alongside her on the RCN board in Northern Ireland during the 2019 strike vote: “I was so upset for patients missing out on appointments and theatre slots. I was in tears. Pat said: ‘Now, dry the tears, this is for the greater good, this is for all the nurses and patient safety in the long run’.

Marley remembers her charisma and “boundless energy” visiting picket lines.

“She knew the emotional and professional impact it was having to be the first nurses ever to go out on strike.”

The youngest of seven, Cullen grew up on a farm in Carrickmore, a predominantly nationalist village 16km from Omagh.

Reflecting on her early life, she says she was shaped by “very strong” women.

Four of her sisters became nurses.

“Nursing was genuinely in my blood. But a lot of it was driven by the fact I had a sister with a learning disability, and I watched my mother, a really strong woman, look after her.”

Her mother’s sudden death from a heart attack a week after her 18th birthday caused trauma, with her sister Petra and herself forced to live apart for the first time.

Continuing her studies at Dean Maguirc secondary school in Carrickmore – where she “thrived” – Cullen needed to pay her way through nursing college.

She began working as a domestic in Antrim Health Centre and cleaned doctors’ offices at night.

“I would watch the doctors and nurses go out and knew that’s what I aspired to be. I thought nothing should stand in my way.

“I got into nursing school and loved every single minute of it.”

By the early 1990s, she was back in Antrim as assistant director of nursing at a psychiatric hospital where she attempted to overhaul a “horrendous” care system at a huge personal cost.

“Vulnerable patients were not being treated the way they should have been. I couldn’t sit back and watch them locked up most of their day.

“I went about driving forward at all odds, significant change and taking on what was a really engrained establishment. I was warned to be ‘very careful’ about what I was doing.”

Cullen began receiving death threats in the form of sympathy cards.

“I received many cards telling me to back off or they were going to kill me. They were dropped in through my work door and indeed at home. I came out one night and there was a dead cat on the bonnet of my car. Another night my tyres were let down.

“My daughter was three months old at the time and my son was five. One of the children’s bedroom windows was put in at home.

“I stayed on, but it was decided I was too much of a problem and I was asked to move on.”

Prior to Antrim, she worked in the nationalist Twinbrook and Poleglass areas of Belfast in the early 1980s during the height of the Troubles. Her health centre was “like a barracks to get in and out of”: “I can remember being scared as I was only in my early 20s.

“The one thing that struck me was the impact of the Troubles on family life. With many men in jail, the backbone of that community was women.

“There was no difference between loyalist and republican women, they looked after us. Any time there was any threat to us getting in and out of an area, of our cars being hijacked, stolen or burnt out, they sorted it.”

After nursing in the hospital and the community sector for almost 20 years, Cullen became a senior nursing officer at the Department of Health.

“I realised the impact of influencing policy and legislation on behalf of nursing – it wasn’t about pushing pieces of paper around. It can absolutely change the direction of travel for the lives of nurses and patients,” she says.

She subsequently held senior roles with the North’s NHS, including the Public Health Agency (PHA), where she was instrumental in setting a up 24-hour counselling service during a major spike in suicides among young people in north and west Belfast.

But in 2016, frustration with “target-driven” commissioning of health services saw her leave the NHS and take up post with the RCN. By mid-2019, she was NI director.

“When I went in there, I could see that nurses weren’t being treated decently, being left behind. That feeling of being at the ‘back of the bus’ and not having a place at the front when you want to.”

Recalling her role during the NI strike, one Stormont insider says: “She was full-on. She had previously worked for the department and PHA, so she was part of the system – and then she became the number one revolutionary denouncing the system.

“There’s no doubt she was an effective leader. There was a suspicion at the time the RCN in London were looking upon Northern Ireland almost as a test case for potential national industrial action.

“She certainly went over with the battle spurs she’d won here.”

Emergency and life-saving care will not be affected by next week’s strike, but it will cause huge disruption for routine surgery and appointments.

Does she fear a public backlash?

“Sometimes I sit here and think, why am I not scared about this? But I believe, and maybe this sounds naive, if you’re doing the right thing, it doesn’t make you scared.

“I have to live with hope and that the health secretary cannot continue to ignore 270,000 nurses.

“One thing we must never do is take the public for granted; this strike is actually more about the public than it is about nurses because it’s about those seven million people on waiting lists. It’s scandalous.

“The Tories have lost contact with the people on the ground; when you do that, you’re on a hiding to nowhere.”