Who'd be a NHS whistleblower?

Margaret Haywood worked undercover on a Panorama documentary

Undercover Nurse Margaret Haywood put a 20-year career on the line to help Panorama expose serious failings in the care of the elderly at one NHS hospital.

Undercover Nurse aired in July 2005 after Ms Haywood wore a hidden camera to film conditions on an acute care ward at Royal Sussex County Hospital in Brighton.

Her findings were striking, including nursing basics that were routinely ignored such as pain control, toileting and even ensuring that some terminally ill elderly patients were getting enough to eat and drink.

Ms Haywood then spent four years battling attempts to have her struck off the nursing register for breaching her profession's code of practice.

On 16 April, she lost that fight when the Nursing and Midwifery Council (NMC) struck her off for violating patient confidentiality rules.

All of the patients identified in the original Panorama film were included only after permission was granted from either the patients themselves or their next of kin.

Whistleblower dilemma

In Who'd be a NHS whistleblower? Panorama delves further into the reality of whistleblowing protections in the NHS, asking if Ms Haywood's punishment paints a disturbing picture of what really happens when someone blows the whistle.

"I'm absolutely devastated - I just don't know what I'm going to do now," Ms Haywood told Panorama after the decision to strike her off was announced.

I did have an idea that they'd try and shoot the messenger and that's exactly what they've tried to do Margaret Haywood, undercover nurse

"I did have an idea that they'd try and shoot the messenger and that's exactly what they've tried to do."

Ms Haywood explains why she took the decision she did to go undercover and tells Panorama that the final days of some of those she nursed during that time still haunt her.

"I didn't take the decision lightly I did look into it, I did give it an awful lot of thought and I knew you know that my position would be compromised by doing it. But I think the public needed to be aware of what was going on on the ward."

While her decision to help Panorama reveal conditions at the hospital cost Ms Haywood, now 58, her livelihood, it also earned her tremendous support from patients and their families, including the relatives of those elderly and frail people featured in the original programme.

Response to the decision to remove her from her profession has led to online petitions and hundreds of emails urging the governing body to reconsider.

Roundly praised

The undercover investigation at Royal Sussex County Hospital - for which the trust has both apologised and instituted a series of measures to address the shortcomings - is roundly praised by families and friends of the frail patients who Ms Haywood encountered.

The hospital has both apologised and instituted key changes

Four years later, Panorama hears from Waida Dando, a close friend and the next of kin to Jessie, an 86-year-old cancer patient who died during the time that Ms Haywood was working as an agency nurse on the ward.

Despite a career with the United Nations that took her to Geneva, the ability to speak three languages and financial independence in her retirement, Jessie died alone and unnoticed one night when Ms Haywood was not on shift.

Her death was first noticed by an undercover Panorama journalist who had gotten work with the private contractor that delivers meals to patients in the hospital and who was also secret filming.

"If you didn't have that film who would believe anything?" said Ms Dando. "People have to know what is going on, you can't just bury it and pretend it didn't happen. You could see it everyone was desperate wanting help - but there weren't any nurses."

Rachel Hatton's father Gilbert was one of Ms Haywood's patients on the ward. When Ms Haywood encountered him he had been given an enema and left in his own dirt by a nurse going off her shift.

Ms Hatton felt so strongly about the issues raised by the secret filming for Panorama that she wrote the NMC and spoke in Ms Haywood's defence at her tribunal.

"I found the coverage of Panorama a realistic overview of the appalling conditions I viewed myself," she wrote. "I admire Ms Haywood for her professionalism and bravery in the whole matter...she has put her career on the line because she was not willing to sit back and watch the injustice."

'Post Panorama' rules

Following the broadcast of the Undercover Nurse programme in July 2005 the hospital produced comprehensive guidelines called the 'Ward Checklist Post Panorama', which address the basic nursing care issues that the programme had exposed.

I think the whistleblower policies we've got at the moment are absolutely inadequate Dr Richard Taylor, MP

Duncan Selbie, the current chief executive of the hospital, told Panorama in a letter: "We have worked extremely hard to improve standards in every area of our hospitals.

"We apologised unreservedly that in 2004 we allowed standards to fall. There is never room for complacency and there will always be more we can do in everything that we do. I can assure you that we are working extremely hard to deliver safe and high quality clinical care and to ensure we treat our patients and the carers with kindness and compassion."

Who'd be a NHS whistleblower also travels to Staffordshire to meet Julie Bailey, whose mother, Bella, was admitted to Stafford General Hospital in late 2007.

Shocked at the conditions they saw on the ward, Ms Bailey and her family set up a 24-hour vigil at Bella's bedside, being on hand to advocate for her care for eight weeks and keep a record of what they saw.

Her mother died in the hospital in November 2007 and Julie Bailey decided to take on the hospital and make others aware of the poor state of care being given to vulnerable patients.

She also set up a campaign group without knowing that the government regulator, the Health Care Commission as it was called at the time, had already begun an investigation into high death rates at the hospital between 2005 and 2008.

Their report, released last month, indicated that managers had put targets ahead of patient care.

The Mid Staffordshire NHS Foundation Trust told Panorama that quality of care is now its primary concern.

The Trust said it is investing £12m in "frontline clinical staff" along with improved training and has published a "no blame" whistleblowing policy with an aim of "bringing poor practice out in the open".

'Absolutely inadequate'

Panorama asks why, of all the doctors and nurses at Stafford General who knew that something was wrong, no one spoke out, no one blew the whistle.

Dr Richard Taylor, a hospital consultant for many years who is now an MP, believes while there may be whistleblower legislation on paper, a culture of fear still exists across many parts of the NHS.

Ms Haywood and a BBC journalist secretly filmed on the ward

"They're frightened because...their jobs, their salaries, their prospects...depend on the good word from the managers and if the managers are more focused on targets, financial deficits then they are frighten to go to them."

"I think the whistleblower policies we've got at the moment are absolutely inadequate, or else people wouldn't be coming to me as an MP instead of going to their immediate bosses."

The statistics bear Dr Taylor out. In one survey by the charity Public Concern at Work, 38% of nurses said they suffered serious or lasting damage to their career for raising their concern. Of those, 36% said the serious risk they identified went on to cause harm to patients.

In a statement to Panorama, the Department of Health said whistle-blowing protections are adequate under the Public Interest Disclosure Act.

"We expect that any member of staff who reports concerns about the safety or quality of care to be listened to by their managers and action taken to address their concerns.

"The new NHS Constitution includes an explicit right for staff who report wrong doing to be protected."

Staff 'protected'

The department also said it has contracted the charity Public Concern at Work to provide a helpline that is manned by lawyers with expertise, who can provide advice and support to NHS staff. Any calls to the charity are confidential, the department says.

Stuart Burnham, whose mother Hilda, herself a former nurse, provided one of the most poignant moments of the programme as she spoke eloquently of the duty of nursing, said he was outraged that Ms Haywood was struck off.

"I was absolutely disgusted with the verdict - it shouldn't have been Margy on trial - its should have been the supervisors at the hospital - they were the ones that were wrong because they were the ones that weren't doing their jobs properly."

Margaret 'Margy' Haywood's life has been changed forever by her decision to participate in the secret filming.

What she encountered touched her so much that she wrote a letter to her children, asking them to ensure, should she ever fall that ill in old age, that she be cared for with the dignity and respect that should be the right of every NHS patient - the very patients that she sacrificed so much to protect.

Panorama: Who'd be a NHS whistleblower? Monday, 27 April on BBC One at 8.30pm.