For three years I worked as a charge nurse on night duty with overall responsibility for the care of 72 desperately ill and dying elderly ladies and gentlemen on three geriatric wards - two with 26 beds, one with 20 - at Stepping Hill Hospital, Stockport. They were admitted only if critically ill from strokes, heart attacks, chest infections, cancers, kidney failures and other serious conditions. Every night two or three of them might die.

Many came in with what we know as multiple pathology: for example,a lady might be a diabetic, suffer from arthritis, be hard of hearing and partially sighted and be brought in following a heart attack. They could be confused, senile, hallucinating, unconscious or paralysed. They were liable to wander, fall out of bed and injure themselves. Many of them were incontinent and had to be put on commodes or changed frequently through the night.

All of them were distressed at being away from home (a crucial factor for old people) and separated from their loved ones. Often they were grieving over the loss of a spouse or in fear of impending death. Thus the degree of dependency and the amount of care they needed was very high indeed.

Night after night, I was distressed by our inability to give them proper care and attention. The very members of our community who were the most vulnerable and who deserved the greatest care, respect and love were being humiliated and ill-used. We had only one nurse on each ward, working eleven-hour shifts, with two auxiliaries on the 26-bed wards and one on the smaller ward.

For a year I reported the desperate consequences of this understaffing in detail to the nurse managers. Finally, on 25 August 1989, I wrote directly to Mr Frank Richards, the then Chairman of the Stockport District Health Authority (DHA). My letter expressed deep admiration for my colleagues who worked always 'with a quiet dignity and sublime skill way beyond the call of duty'. But I wanted him to appreciate the distress, humiliation, neglect and danger to which our patients were exposed.

I asked for three more nurses so that we could at least provide a minimum level of reasonable care. I believed that we would then be able to stop so many patients falling out of bed; to reduce the chance of a patient being left to lie in their own excrement; to find time to comfort the frightened, the confused and the bereaved, and to sit with a patient who was dying alone; and generally to minister to the sick, as I was taught was my duty 40 years ago.

It soon became clear that Mr Richards was no more able or willing than my managers to provide more nurses (as they never once discussed my evidence with me, I do not know which applies). I then wrote widely to geriatricians and DHA members; to the Regional Health Authority; to Sir Tom Arnold and Mr Tony Favell, two local MPs; to the nurses' professional body; to Mr Duncan Nichol, Chief Executive of the National Health Service; to Mr Kenneth Clarke, the Health Secretary; to Mr Speaker Weatherill (to request him to ask Mr Clarke to reply to my letters - he never did); to the Health Service Commissioner; and to No.10 Downing Street. For well over seven months I tried quietly within the health service to seek help. I did not wish the matter to become public. But no one wanted to know. No one appeared to care that, for example, when the lights were switched on at 5.25am one morning after a frantic night on C5 ward, three patients were found dead in their beds.

Perhaps to those in authority over me that was acceptable, nothing out of the way. Never having spoken to them, I don't know. But it is not acceptable to me to know that someone is close to death and to have to leave them alone. No one should die alone in hospital. But it happened night after night, and it will happen tonight.

Finally, another local MP, Mr Andrew Bennett, advised me to take my evidence to the press. I was reluctant to seek outside help but I could see no other way to end the neglect and distress of the patients. Silence was not an option. Like Burke, I was confronted by events "upon which it is difficult to speak, and impossible to be silent".

As a nurse, I was bound by a Code of Professional Conduct, the first clause of which reads: 'Act always in such a way as to promote and safeguard the wellbeing and the interests of patients'. Clause 11 enjoins a nurse to: 'Have regard to the workload of and the pressures on professional colleagues and subordinates and take appropriate action if these are seen to be such as to constitute abuse of the individual practitioner and/or to jeopardise safe standards of practice.' Clause 10 charges the nurse to bring to managers'attention any circumstances which 'could place patients in jeopardy'.

On 11 April 1990, the Guardian published extracts from my correspondence and other newspapers, television and radio began to follow their lead. It did not for a moment cross my mind that anyone, and certainly not senior nurses, would want to punish me for insisting on decent standards of patient care. I did not realise that what I thought to be an imperishable right to freedom of speech in Britain was as fragile and vulnerable as the health and safety of those I sought to protect.

I was telling the truth, and nothing but the truth. It is something that nurses often fear to do, but I believed that at least the truth would be my protection. I could not have been more wrong. It was telling the truth that brought about my dismissal.

I continued to press management for more staff. They could not refute my evidence, nor could they any longer ignore it. But a solution was at hand. Within four months I was suspended from duty on four counts of gross misconduct - the most serious being a charge of breach of confidentiality. This charge was inspired by a local newspaper article in which I had described a distressing case of a dying patient who desperately needed attention that none of us were available to give.

There was no breach of confidentiality. I did not give the patient's name nor any information by which he could be identified. I simply described the general circumstances of the case, just as countless other doctors, nurses and other NHS staff have done in the past. My intention was to let local people know what was happening in a local service that was vital to their own and the community's well-being.

Three 'makeweight' charges were added to the account, none of which in any way represented a threat to a patient's recovery, or neglect or lack of care on my part. In ordinary circumstances, none would have merited a disciplinary hearing. But these were not ordinary circumstances. I was raising serious issues which compromised management with all the authority of what I witnessed every night at the bedside. My crime was not that I had broken confidentiality, but secrecy. Suspension was clearly intended to exclude, punish, silence and humiliate me; it had nothing to do with protecting patients or improving the hospital's quality of care. The disciplinary hearing in the autumn of 1990 would have shocked the Queen of Hearts. Two of the three members of the tribunal were the Hospital Manager and the Chief Nursing Officer, both of whom I had, by implication, criticised severely over the previous twelve months.

The hearing was also conducted in a most hostile, aggressive and, I felt, non-judicial manner. The rules of natural justice were obliterated in the tribunal's eagerness to find against me. But I found the tribunal's attitude towards the incident at the heart of the case against me even more repugnant than its hanging demeanour. The tribunal members crawled like snails interminably over every aspect of procedure - "Why had I failed to do this?"; " Why had I failed to report that?"; "Why had I informed the local paper?" The circumstances which led to the neglect and humiliation suffered by a dying man counted for nothing.

I was declared guilty on all four counts and denounced as incompetent (without ever being so charged) by the Health Authority Chairman. I appealed against dismissal to the District Health Authority. It had been reorganised since my first letter and was now wholly made up of members appointed by the Regional Health Authority, itself a body of government appointees. No-one knows the terms on which the new members were appointed. I declined the offer of a post as a Community Nurse and, on 17 September 1991, I was dismissed.

The National Health Service belongs to the British people. The first duty of those who work in the service is to their patients. But the management of nursing has too often been premised on fear - "Keep your head down, your mouth shut and question nothing".

In 1981, a major survey of nurses who, like me, felt compelled to speak out about the neglect of patients found that we were too often met by discouragement and intimidation from managers. The survey called for action to create a climate of openness in the NHS that would encourage nurses to speak up, free from the fear of reprisal or intimidation.

More than ten years on, matters have gone from bad to worse. Managers have become more defensive, rigid and inflexible. Some new Trust hospitals are imposing 'gagging clauses' on their staff. These clauses are not there to protect patient confidentiality. They are there primarily to protect the managers against the honest concern for professional standards of nurses and doctors.

Recently, more than 100 nurses have confided their worries about poor standards and understaffing to our professional body. They write eloquently of their feelings of isolation and insecurity, of not knowing who to turn to for advice, of fears of discrimination and reprisals. They describe the 'unnerving' intimidation they experience if they do complain, of being labelled a 'trouble-maker', of management's 'bullying tactics , belligerence or apparent indifference.

"Two colleagues wrote official letters outlining their very deep concerns," wrote one nurse. "Neither received a reply for two weeks, but now they have both been informed that they are being moved from their wards . . . Personally, I find it all rather suspicious that the two who complained are being moved." I myself have received some 500 letters from nurses, all giving me their support and voicing similar concerns and experiences.

For a while, Minister of Health Virginia Bottomley gave us hope. She promised us a Whistle-blowers' Charter. But the draft guidance she published on 16 October leaves us blowing in the wind. She acknowledges our right - and duty - to speak out on issues of concern. She says this right should be a recognised and acceptable part of NHS life. She says clear procedures must be put in place so that nurses' 'concerns can be fairly and effectively aired, and responded to' .

But not only does she not ban 'gagging' clauses, she imposes what amounts to an absolute duty of confidentiality. This means that doctors, nurses and other staff are forbidden to illustrate their complaints with properly anonymous examples of the neglect and distress which inspire their concern. Yet it is these examples which give meaning to the complaints.

She limits the right to pursue concerns to the level of Chairman of the District or Trust - that is, to unelected people who are not publicly accountable for their decisions. It is clear from my own experience - and that of countless other nurses - that this is insufficient. She makes no provision for nurses to take their concern further, nor for proper internal or public debate. There is no public right to know in Mrs Bottomley's scheme of things.

And while she allows for a nurse in my position to contemplate taking their concerns to the media, she doesn't intend to put in place the statutory protections for whistleblowers that exist in other countries. Instead, Mrs Bottomley warns that the employer may take disciplinary action. I cannot imagine a clearer warning - shut up or be sacked. Every nurse in the land knows what happened to me. Now Mrs Bottomley is telling them that if they speak out too, it will happen to them.

Her guidance is not in the spirit of the Patient's Charter and the new emphasis on responsiveness to clients. This is closed, not open government that is being imposed. For nurses are there at the bedside, day and night. We are better placed than anyone else to ensure that the care the NHS provides meets patients'needs and professional standards. But we are being silenced by defensive managers within undemocratic structures. These structures stifle public debate about local budgets, staffing levels and standards of care. Now Mrs Bottomley has cut off the last resort of the concerned professional - access to the media. But where neglect goes unreported, surely 'silence augmenteth grief. For patient, nurse and community.

I now await an Industrial Tribunal in March 1993. The DHA is said to be spending 500,000 in defence of its naked abuse of power - money that would be better spent on wards C5, A14 and A15. My legal costs will be about 50,000 - a huge sum for an out-of-work nurse to raise from public donations. But my case must be heard and won. If it is not, then every nurse in the country will know that telling the truth about the enforced neglect of patients will lead to their dismissal. Graham Pink will have been sacrificed, 'pour encourager les autres'.

I came from obscurity and I would like nothing better than to return to obscurity. But before I do, I want to assert a common right that we are in danger of losing. The words of Sir Robert Morton in Terence Rattigan's fine play, The Winslow Boy, come to mind. Speaking in the House of Commons of Ronnie Winslow, he says: "It is not Winslow's guilt or Winslow's innocence which concerns us now; it is something greater by far. It is Winslow's right as a common citizen of England to be heard - to be heard in defence of his honour so wantonly pitched into the mire."

With Sir Robert, I say, "Let right be done".

 

Graham Pink was born in Manchester in December 1929. He served his National Service in the Royal Navy (Sick Berth Branch), returning to nursing as a State Registered Nurse in October 1952. He left nursing to teach in secondary education for nearly thirty years, then in 1984 went back to nurse. He has worked in acute surgery (general, genito-urinary, plastic surgery) and care of the elderly. He was appointed a Justice of the Peace in 1985.