‘We can help women stop a tragic cycle’: meet our RCN Nurse of the Year 2021
Nicola Bailey defied opposition to set up an early medical abortion service in Northern Ireland amid the pandemic
- Sexual health services nurse manager Nicola Bailey set up the Rose Clinic when pandemic lockdowns meant women were unable to travel to England for a termination
- Operating outside of formal commissioned services in Northern Ireland, the clinic offers an early medical abortion service, plus sexual healthcare
- RCN Nursing Awards 2021 judges lauded her passion for promoting women’s health, and bravery for continuing despite protests and political resistance
A nurse who has revolutionised women’s sexual healthcare in Northern Ireland has been named RCN Nurse of the Year 2021.
Nicola Bailey, a sexual health services nurse manager at the Belfast Health and Social Care Trust, set up the Rose Clinic, an early medical abortion (EMA) service for women up to the tenth week of pregnancy.
Lockdown meant women were unable to travel to England for free NHS abortion care
For decades, abortions in Northern Ireland were only allowed if a woman’s life was at risk, or there was a risk of permanent and serious damage to her mental or physical health.
But on 31 March 2020, regulations decriminalising abortion in the country came into effect, permitting terminations in the first 12 weeks of pregnancy in any circumstance, and beyond that under certain circumstances (see timeline below). However, just before the change was implemented, COVID-19 hit.
‘If we did not carry on, who would care for these women? All it takes is one person to stand up to make a change, and sometimes you have to put your foot down and push on through the barriers’
Nicola Bailey, RCN Nurse of the Year 2021
At the time, no services existed in the Belfast area and lockdown rules meant women were suddenly unable to travel to England to access free NHS abortion care, as they had previously been able to do. In 2019 alone, 1,014 women from Northern Ireland travelled to England or Wales for a termination.
Within days of the change in regulations, Ms Bailey set up the Rose Clinic. Working within the trust's sexual health service, she rearranged services and used some of the existing budget to make time and space for EMA care.
‘Already, before this change, travelling to England for an abortion was often only an option for some women,’ says Ms Bailey. ‘It wasn’t an option for the most vulnerable, the poorest, the youngest, the ones in controlling relationships and those who could not just leave their children to go to England for a termination.
‘The pandemic limited women’s options even further because of the difficulty in travelling. We had to get a local service in place straight away.’
Rapid clinic set-up during lockdown
In the days that followed, Ms Bailey got to work developing clinic protocols and standard operating procedures with her colleague, associate specialist Siobhan Kirk. Drug cupboards were acquired, legal paperwork organised and online consultation forms and patient information leaflets designed.
‘Medication had to be ordered from pharmacy and Nicola to make several trips to collect supplies herself,’ Dr Kirk recalls. She also forged links with the Northern Ireland sexual and reproductive health charity Informing Choices, which agreed to act as a central access point for EMA self-referral.
EMA is a two-stage treatment process in which a woman is given a mifepristone pill within a clinical setting and a misoprostol pill to be taken at home 1-2 days later.
‘We have women coming in who have had numerous children removed from their care. Now if they come in to see me with an unwanted pregnancy I can help them stop that cycle’
Setting up a new service in lockdown was a challenge, but the sensitivities surrounding abortion in Northern Ireland made it even more so. Ms Bailey says one of the most significant challenges was and still is the regular presence of protestors outside the clinic.
Legal challenge mounted by anti-abortion campaigners
‘Often the women coming to my clinics are vulnerable and it is hard for them to walk past the protestors stuffing leaflets in their bags,’ she says. ‘I go out to wherever my patients are and walk them in.’
Despite the regulation change, no formal abortion services have been commissioned in Northern Ireland because of disagreement between the main political parties.
In July 2021, the UK government introduced new powers enabling secretary of state for Northern Ireland Brandon Lewis to direct Stormont to set up full abortion services throughout the country by March 2022.
But in October 2021 a second legal challenge was mounted by anti-abortion campaigners opposing the move. Dealing with the political opposition and the protests is not easy, Ms Bailey says, and is sometimes exhausting.
‘But if we did not carry on, who would care for these women? All it takes is one person to stand up to make a change, and sometimes you have to put your foot down and push on through the barriers.’
‘I don’t feel I’ve done anything outside my role as a nurse’
Ms Bailey was nominated for an RCN nursing award by her colleague, associate specialist Siobhan Kirk.
Dr Kirk says: ‘Nicola regularly goes above and beyond the call of duty and is one of the most caring, compassionate and skilled nurses I have ever worked with. She deserves to be recognised for her immense efforts and dedication to nursing and to the women of Northern Ireland.’
Winner of the Innovations in Your Specialty Award
Ms Bailey won the Innovations in Your Specialty category at the awards, sponsored by the Nursing and Midwifery Council, before being chosen as the overall Nurse of the Year.
She says she is ‘delighted and honoured’ to win. ‘I don’t feel I have done anything outside my role as a nurse – to put my patients at the heart of everything I do and provide healthcare to women that need it, whatever it maybe.’
The RCN Nursing Awards judges lauded her passion for protecting and promoting women’s health, and commitment to transforming her nurse team to ensure that women have the best sexual healthcare. They praised her effective collaboration with healthcare colleagues, politicians, the police and charities.
They were also impressed by her bravery in launching the clinic in a challenging environment.
Ms Bailey says: ‘This has been a team effort and I am proud to win on behalf of the whole team. We have provided an abortion service under difficult and challenging circumstances and have supported each other.’
Extending services and improving sexual health education
As well as setting up the Rose Clinic, Ms Bailey has maintained existing sexual health services and developed others during the pandemic. This has included overseeing a new contraceptive telemedicine service and a patient helpline that she operates single-handedly, alongside her other duties.
Ms Bailey has also completed training enabling her to fit subdermal contraceptive implants, and provides two implant clinics a week, as well as offering immediate implant insertion to EMA patients.
She is an active member of the Northern Ireland Abortion and Contraception Taskgroup, which campaigns for formally commissioned services. ‘It is so important to press for commissioned services for our women,’ says Ms Bailey. ‘Without this, clinics offering EMAs are liable to fold.’
‘You never know how your kindness can turn someone else’s life around, especially when people are at their most vulnerable’
She is proud of the holistic care her clinics deliver. ‘We have women coming in who have had numerous children removed from their care, which is a tragedy for them and the children. Now if they come in to see me with an unwanted pregnancy I can help them stop that cycle.
‘In Northern Ireland the sexual health and contraceptive services are on their knees and sex education in schools is poor. Some teenagers I see have no sexual health knowledge at all and it is no wonder we have so many unwanted pregnancies. I am able to talk to them about contraception and cervical smears and build trust, which helps them look after themselves.’RCN Nursing Awards 2021: all the winners
RCN general secretary Pat Cullen applauded Ms Bailey’s tenacity and perseverance. ‘Nicola Bailey identified an area where she could use her knowledge and skills to improve access to care and treatment and moved swiftly to create an excellent person-centred service within her trust,’ she said.
‘As nurses we often work in challenging environments and we work to challenge barriers and develop solutions to problems – Nicola is no exception and as a result of her tenacity, she has overcome every obstacle in her way to ensure women and girls get the support they need.’
Timeline of abortion rights in Northern Ireland
1967 – A law legalising abortion in Great Britain up to 24 weeks is passed, coming into effect the following year, but it is not extended to Northern Ireland, where terminations are only allowed if a woman's life is at risk or there is a permanent or serious risk to her mental or physical health.
February 2010 – Abortion policy is devolved from Westminster to the Northern Ireland Assembly at Stormont as part of the devolution of policing and justice powers.
2013 – Sarah Ewart, a woman from Belfast, speaks publicly about how she had to travel to England for an abortion when a scan revealed her baby had anencephaly, a condition in which the brain has not developed. She describes the additional hardship and emotional and financial stress the journey caused.
November 2015 – The High Court in Belfast rules that abortion legislation in Northern Ireland is in breach of human rights laws, following a challenge brought by the Northern Ireland Human Rights Commission.
February 2016 – The Northern Ireland Assembly votes against legalising abortion in cases of foetal abnormality, rape and incest.
November 2016 – The power-sharing arrangement at Stormont collapses, leaving the country in political limbo.
2017 – A UK Supreme Court ruling prompts the government to offer women who travel from Northern Ireland free abortions. The Belfast High Court ruling that abortion laws infringed women’s rights is effectively overturned by the Court of Appeal.
June 2018 – The Northern Ireland Human Rights Commission takes its case over the legality of abortion laws to the Supreme Court but fails, mainly due to a technicality in that it was not the correct body to bring the case. A majority of judges consider the law on abortion to be incompatible with human rights.
January 2019 – Sarah Ewart brings a High Court challenge in her own name and the judge rules that Northern Ireland legislation breaches the UK’s human rights commitments.
July 2019 – MPs at Westminster approve an amendment to the Northern Ireland Executive Formation Act, proposed by Labour MP Stella Creasy, that will decriminalise abortion if the power-sharing government at Stormont is not restored by 21 October 2019.
October 2019 – The Northern Ireland government is not restored, and abortion is decriminalised.
31 March 2020 – A new framework for lawful abortion services comes into effect, allowing abortions in the first 12 weeks, and up to term in cases of fatal fetal abnormality or if there is a substantial risk that the fetus will die or, if born, the baby will suffer a severe mental or physical impairment. The Northern Ireland Department of Health is in charge of commissioning abortion services.
July 2021 – No abortion services have been commissioned, due to resistance by the Democratic Unionist Party (DUP) and disagreement between the main parties. The UK government introduces new powers enabling secretary of state for Northern Ireland Brandon Lewis to direct Stormont to set up full abortion services throughout the country by March 2022. First minister Paul Givan of the DUP vows to fight the move.
October 2021 – Anti-abortion group the Society for the Protection of the Unborn Child mounts a legal challenge in Belfast High Court, seeking a judicial review of the move by Brandon Lewis to press Stormont to formally roll out abortion services, saying he exceeded his legal authority.
Campaign to improve care and combat misinformation
Keen to keep moving care forward, Ms Bailey is putting together a proposal to extend abortion services at the Rose Clinic for women who are 10-12 weeks’ pregnant.
She also wants a public health campaign to signpost to regulated abortion services, to deter women from buying tablets for termination on the internet, and to raise awareness of services that appear to be offering full choices to women but are actually run by anti-abortion groups.
And while the political stalemate doesn’t look like being resolved in the near future, the number of women attending her clinic is rising. ‘These women and the impact our services have on their lives keep me going,’ says Ms Bailey. ‘You never know how your kindness can turn someone else’s life around, especially when people are at their most vulnerable.’
Building trust and offering choice for the first time
Aine McKenzie of PAUSE, a charity that works with women who have experienced, or are at risk of, repeat removals of children from their care, says Nicola Bailey has made a huge difference to the health of those the charity supports.
‘We would be absolutely lost without Nicola,’ says Ms McKenzie. ‘We work with women who have had one child removed through to those who have had ten children removed. They are at high risk of repeated pregnancies, but Nicola and her service are changing that.’
Ms McKenzie says the women the charity supports are often marginalised, vulnerable and may have little understanding of sexual health and contraception.
She says Ms Bailey ‘instinctively knows’ how to pitch her advice and information, giving clear explanations that suit the individual’s understanding.
‘Most services have a lack of awareness of our women’s needs… The women see the way people look at them and they feel that. But Nicola makes them a cup of tea and has a bit of banter with them’
Aine McKenzie, PAUSE
‘Most services have a lack of awareness of our women’s needs,’ says Ms McKenzie. ‘They make judgements just by looking at their bad dental care, for example. The women see the way people look at them and they feel that. They are not valued as human beings. But Nicola makes them a cup of tea and has a bit of banter with them.
‘The women have never come across someone like Nicola. She knows just when to use humour to break the atmosphere and the women enjoy their time with her.’
‘She is helping vulnerable, marginalised women care for themselves’
Ms McKenzie says that for many of the women the charity supports, travelling to England for a termination is not a viable option. ‘Even if they wanted to have a termination because they thought it was best in their circumstances, they could not afford the journey, and because of their lack of education may not know about it.
‘They are forced to go through with the pregnancy only to have to give up their child. And so their trauma continues – every child is another loss and it’s another child in a broken system.’
She says the way Ms Bailey communicates with the women gives them the ability to make a choice about whether to to have a termination or not. In addition, she talks to them about their long-term sexual health, including smear tests.
‘We have women who have never had a smear before or ever seen anyone about their sexual health,’ says Ms McKenzie. ‘We know women from low socioeconomic groups are more likely to die of cancer. These women would never ask their GP for a smear, but they trust Nicola, and by building that relationship with them she is helping them care for themselves for the first time.’
The Innovations in Your Specialty Award is sponsored by the Nursing and Midwifery Council