Pat Cullen, the general secretary of the Royal College of Nursing (RCN), has called on Health Secretary Stephen Barclay to restart pay negotiations with a double-digit pay rise.

RCN members will be balloted again for strike action on 23 May after the existing six-month mandate ran out at the start of the month.

Ms Cullen described striking as one of the “hardest decisions”, and told The Sunday Times that fresh negotiations were needed to prevent six more months of action.

“They [ministers] owe that to nursing staff not to push them to have to do another six months of industrial action right up to Christmas,” she said ahead of Sunday’s RCN congress in Brighton, telling Mr Barclay talks needed to “start off in double figures”.

“It’s just not right for the profession,” she said.

“It’s not right for patients. But whose responsibility is it to resolve it? It is this government.”

Ms Cullen had advised members to accept an offer of 5%, but this was rejected despite being accepted by 14 other unions.

This was picked up by cabinet minister Grant Shapps responding to the fresh demand for a double-figure pay hike.

Speaking to Sky News’ Sophy Ridge On Sunday programme, he said: “I find this a very curious story indeed because Pat Cullen just recently was encouraging her members to settle for the pay rise that was put on the table.

“I thought this was a great settlement.

“It’s frankly rather confusing having encouraged her members to accept that deal she seems to now be coming back and saying the opposite.

“You have got to balance that with the rest of the public purse.”

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Earlier this month: Nurse strikes could go ‘right up to Christmas’

A health department source added: “It is strange how quickly the RCN leader has changed her tune from recommending this pay deal, which she now refers to as an insult to nurses.”

An RCN spokesperson said: “The negotiations covered two financial years which resulted in a consolidated NHS pay increase of 9%. When our members rejected that, it is clear they expect an offer into double figures.”

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Ms Cullen said: “It’s not so long ago since the prime minister went on the media and very publicly said nurses are an exception,” she said when asked why nurses warrant a larger increase than other healthcare workers.

“I would totally agree with him… they should be made an exception because they are exceptional people.”

The mental health nurse, 58, from Co Tyrone, said patient safety was “at the centre of everything that we do”.

“We will do nothing that will add further risk to the patients that we look after,” she said, saying increased pay would see nurses return to the profession and ease a staffing crisis.

“The truth is that patient safety cannot be guaranteed on any day of the week. How could you guarantee patient safety when you have 47,000 nurses from your workforce every single day and night?”

She warned Rishi Sunak not to take her members lightly.

“Looking back on this pay offer, I may personally have underestimated the members and their sheer determination,” she said.

“I think what I would be saying to the prime minister, Rishi Sunak, is ‘Don’t – don’t make that same mistake, don’t underestimate them’.

“Nurses believe it’s their duty and their responsibility because this government is not listening to them on how to bring it [the NHS] back from the brink and the message to the prime minister is that they are absolutely not going to blink first in these negotiations.”