Nurses' leaders will today debate a motion of no-confidence in the Health Secretary, Andrew Lansley – just hours before he arrives at their annual congress to take part in a "listening exercise".
In a sign that ministerial attempts to reassure nurses about their plans for NHS reform are failing, members of the Royal College of Nursing voted overwhelmingly to debate the emergency motion shortly after being addressed by the Health minister Anne Milton. If passed it will be the first such no-confidence motion in 30 years.
Tomorrow they will vote on plans for industrial action if the Government pushes ahead with proposals to allow trusts to implement incremental pay freezes for some staff. Members are particularly incensed that Mr Lansley will only be speaking to a selection of around 60 members, split up into tables of eight, for 45 minutes, and accused him of not having the "guts" to address the conference as a whole.
To loud applause, Julian Newell, an A&E nurse from Sheffield, told the conference: "I think it's a shame Andrew Lansley does not have the guts to come up and face congress as a whole.
"I would rather us say if you can't face congress as a whole, then we don't want to meet with him."
Another nurse, Tom Bolger, added: "Mr Lansley's refusal to join us in the main hall should not count in his mind as him having listened to the nurses. Listen to nurses in our congress, not in a closet somewhere else."
Today Labour will attempt to capitalise on the Government's difficulties when Ed Miliband holds a press conference to highlight its opposition to the Government's plans. However ministers pointed out that no senior Labour politician was attending the RCN congress.
Yesterday Ms Milton, herself a former nurse and member of the RCN, attempted to reassure members that the Government had the interests of the whole of the NHS at its heart.
Asked if the Government's listening procedure on its health reforms was a tick-box exercise, she replied: "This is real, this is for real and the general principle that we've got to change I think is generally accepted.
"The question is making sure that those changes actually give us what we want, and that's why this is not a tick-box exercise. It's really important.
"I know Andrew Lansley is coming up tomorrow to listen to you and he wants to hear how it actually works on the ground."
But despite not suffering the fate of Patricia Hewitt in 2006 and being booed by the nurses, it was clear that she had not reassured her former colleagues.
They shouted "no" when she raised the issue of pay and her name was specifically mentioned in the "no-confidence" motion.
She later caused confusion when she suggested that Mr Lansley was prepared to speak to all nurses.
"I'm sure he's got the guts to talk to all of them. I'm sure he'd be very happy to talk to all of them, I think it's probably just fitting it into conference," she said.
But the RCN's chief executive, Dr Peter Carter, said Mr Lansley had rejected the chance to speak. "Andrew's office has said what he would prefer is to come and speak to a smaller group, not to the whole of congress."
He said Mr Lansley wanted to "have more of a dialogue" in a small group, but added: "There is widespread discontent because members feel that if he's here he should talk to the whole of congress."
A spokeswoman for the Department of Health said: "Andrew Lansley is going to listen and reflect on a wide range of nurses' views. "We agree with Peter Carter that our reforms won't work unless we listen to nurses."
In a separate move, nurses voted to lobby for mandatory staffing levels on wards amid concerns that trusts might try to reduce the numbers of nurses to "dangerous" levels in order to cut costs.