A small, elegantly dressed black woman with a drawl from America's Deep South will tomorrow present the Government with evidence of why Britain's nurses need a mountainous pay rise.
As union leaders go, Beverley Malone is about as striking a contrast from the firefighters' man, Andy Gilchrist, as it is possible to be. Her manner is not confrontation but negotiation; she does not threaten strike action, but instead points out that without the money, thousands of nurses will simply find other, better-paid jobs.
For Dr Malone, who has faced a rocky ride as the general secretary of the Royal College of Nursing, the next few months are make-or-break time. Her institution is less a hardline union, more a professional body of non-striking staff. But its members are deadly serious about winning a pay rise of up to 15 per cent to put them on a par with teachers and police officers.
To back up their case, she will present new evidence that nearly one in three nurses now has a second job, in order to make ends meet.
A survey of members shows enormous levels of discontent over pay, with two-thirds of them working in excess of their contracted hours. A quarter of that overtime is unpaid.
Over the next few months, her task is to negotiate a deal way above the rate of inflation for the College's 340,000 nurses (there are 600,000 nurses and midwives in the UK altogether) as part of the price for agreeing to the Government's proposals for changing working practices. As a leader of a highly demoralised workforce, she cannot afford to lose this battle with Ministers.
Dr Malone has been under relentless scrutiny since she took up the job in July 2001, and became the RCN's first overseas, first black general secretary. Born in Kentucky in 1948, she was the oldest of seven, and was mostly brought up by her grandmother, known as Miss Addie, after her mother took her six younger siblings to Louisville, Kentucky.
But as she worked her way up through a series of nursing posts, her talents shone through, and she became president of the American Nursing Association in 1996.
Four years later and with three degrees under her belt, Bill Clinton took her on as his aide and health adviser in Washington. Her dynamism, her beliefs and her ability to network gained her a reputation as a powerful 'motivator'. In one poll, she was voted one of the country's 100 most influential black Americans.
Then, in July 2001, she surprised everyone by beating three other strong British candidates to become the general secretary of the RCN, a coveted position within the health profession, and a very high-profile job within British society. The 53-year-old saw off the competition because of her reputation as a charismatic public speaker. She was said to have a gift for 'mesmerising' her audience.
But the preacher style appears not to have worked on a British public, possibly less easily impressed by such skills. Many felt she delivered a lacklustre speech to the RCN's annual conference earlier this year, and that she fell flat when she appeared on Question Time as a panellist.
The feisty American, who had been a surgical nurse, clinical nurse specialist, even dean of the School of Nursing in North Carolina, faced the unpleasant prospect of a vote of no confidence in her leadership over the summer, as grassroots unrest grew. In a heated and tense private meeting of the RCN's ruling council, she won their support and the threat was averted, but the criticism about her skills as a leader has never entirely subsided.
Her biggest problem has been internal wranglings. Maria Cook, a popular activist and regional director for Oxford and Anglia, has been suspended for five months following a disciplinary matter. In August this year, the then chair of the RCN council, Pat Bottrill, was forced to resign after she used the word 'nigger'. What she actually said, after colleagues had returned late from a coffee break, was 'it's like Ten Little Niggers', a jokey reference to the Agatha Christie novel where characters are killed one by one. Ms Bottrill had no choice but to step down over her unfortunate comment.
Perhaps all this would not have mattered so much if Dr Malone's pay packet had not already been the subject of controversy among the members. Her predecessor, Christine Hancock, had also been well-paid but, strangely, was not similarly criticised.
When Dr Malone, who is divorced with two grown-up children, transferred from Washington, she negotiated a deal under which she was entitled to two free return trips to the US each year. She was also given free accommodation in a London flat while she settled down to life in the capital. Her remunerations packet is said to be worth around £200,000 this year, of which half is relocation expenses.
The run of bad publicity came to a head over the saga of her mother's medical treatment. It emerged that her elderly mother, Dorothy Black, had received treatment twice on the NHS although she is not herself a British resident (she is rumoured to be seeking permanent UK residency). She had not only had cataract surgery, but also a major gynaecological operation at a London hospital this summer. NHS managers are adamant that the correct procedures were followed, and stressed that there was no question of queue-jumping.
The media intrusion into her mother's affairs enraged Dr Malone, but there was nothing she could do about it. She told friends that the criticism of her 'was breathtaking in its stupidity' but dealing with the British newspapers was always going to be part and parcel of such a high-profile job.
Many of her difficulties stem from the culture of the Royal College itself. At its smart Cavendish Square headquarters in London, there is a sense of secrecy, bedevilled by bureaucracy. More than 50 staff there are paid more than £50,000, when the average nurse's wage is around £16,000. And though highly respected for its research on nursing issues, the professional organisation is not seen as modern, open or approachable.
Her biggest task is to focus on the Government's Agenda for Change, its plan to link a change in working methods to signed agreements with the different professional groups. The idea is that those who perform best stand to win most, but the details have yet to be seen, and nurses are becoming tired of the delays. They know they have the public on their side, and the profession can only gain from the contrast with the consultants, who have rejected pay deals which would put up the top salaries to £85,000, because of the doctors' concern over management control.
Nurses are more used to being managed, and may be happier with the changes as long as they know rewards are on the way. What no one is sure of is at what point Dr Malone will risk a showdown with Ministers to win the lowest nursing grades the salaries they need. Newly qualified nurses begin on £16,000, more than £6,000 less than a teacher's starting salary.
Despite the whisperings of rebellion, many activists are behind her. One, Ray Rowden, said: 'She's a world-class communicator and she's got very good political access. She gets through the right doors.'
Perhaps Dr Malone did not realise quite what a conservative organisation she was walking into when she took the job, but she has certainly found out the hard way. Now it is up to her to use her considerable personal skills to get the backing of her colleagues, to consolidate the public support for nurses into a well-argued pitch for pay increases and to make sure that the rank-and-file nurses feel she is on their side. It will be a tough few months, but if Dr Malone plays her cards right, she can deliver that long-awaited breakthrough for nurses and her own greatest personal triumph.
Born: 25 August 1948 (Elizabethville, Kentucky)
Family: Been married (and divorced) twice. There are two children
Jobs: Currently general secretary of the Royal College of Nursing; previously held several nursing jobs, was head of nursing at South Carolina community college, and was an adviser to President Bill Clinton
The future of the NHS: Observer special www.observer.co.uk/nhs
