NATIONAL industrial action is being considered for the first time by nurses, amid mounting concern over job cuts, NHS deficits and the pace of reforms.

As Tony Blair admitted that the health service faced a “challenging year”, nursing leaders said that growing uncertainty in the NHS, and the fear that valid nursing concerns were simply being ignored, had pushed the profession into an “unprecedented position”.

With Patricia Hewitt, the Health Secretary, receiving a rough ride as she spoke to a Unison conference, the Royal College of Nursing said that while it would not sanction full-scale walkouts, nurses refusing to work unpaid overtime was now a possibility.

Beverly Malone, the RCN’s general secretary, said that the action equated to an extra day’s work per week for each nurse. “The reality gap between what the Government is saying and what we are experiencing at coalface level is very wide,” she said.

Josie Irwin, head of employment relations at the RCN, said that the “work to rule” action had been considered before in localised disputes, but never on a national scale. “Nurses are feeling the most insecure they have ever felt about their jobs . . . there is clearly a temperature out there where members are considering the possibility of action in light of the redundancies, deficits and disappointing salary rises,” she said.

“The discontent has not been as widespread before, which does indicate a mood change across the NHS among the membership . . . this is the first time it has ever been discussed by the general secretary.” Ms Irwin said that under RCN rules, members could not act in a way that was detrimental to the wellbeing of patients. She said that if the action occurred, health trusts would have to pay for agency staff or pay for nurses’ overtime.

The nursing leaders were speaking on the second day of the RCN’s annual conference in Bournemouth. Ms Hewitt is scheduled to speak to the conference tomorrow after facing sustained criticism for describing how the NHS had enjoyed its “best year ever”.

Yesterday 1,000 delegates sat in stony silence when Ms Hewitt was introduced at Unison’s health workers’ conference in Gateshead. She was heckled, booed and hissed during her speech. She slightly modified her claim, saying that it had been the “best year for patients”. Her compliments and assurances were met with angry cries of derision and frequent interruptions from delegates. She said that she understood the concerns of those threatened with job losses, but change and reform were necessary if the founding ethics of the NHS were to be preserved.

She said: “We’ve written a very big cheque for the NHS. But it’s not a blank cheque. Overspending hospitals and organisations do have to put their houses in order.”

After addressing the conference she faced a barrage of angry questions from delegates, who reeled off lists of ward closures and service cuts. Earlier Dave Prentis, the Unison general secretary, said that his union would not stand by and watch staff suffer “in a climate of fear”. Unison would support members who had no option but to strike, he said, adding that patients would be hit by the cuts.

Mr Blair defended Ms Hewitt yesterday as he insisted that there had been significant improvements in the NHS since Labour came to power. He said that waiting lists had never been lower, cancer and cardiac care treatment was the best it had been, and there was a record number of extra doctors and nurses.

He acknowledged difficulties as the service entered the next phase of its ten-year plan. “Whatever the challenge — and the next year will be very challenging — there have been improvements,” he said.

David Cameron, the Tory leader, criticised the Government’s “arrogant” manner in blaming the crisis on health bosses. He said: “Nine thousand people are threatened with redundancy in the NHS and hospitals are threatened with closure.

“This is not caused by reform but by a lack of reform and mismanagement.”

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