Woman's Hour - Baroness Cumberlege, Nurses' strike, Balaclavas, Iran diaries, Whistleblowing

Episode Date: December 14, 2022

Two and a half years ago Baroness Cumberlege wrote a report looking at two drugs and a medical device which caused women or their babies harm. She made a list of recommendations to support victims and prevent future, avoidable damage. Yesterday she appeared in front of the Health and Social Care Select Committee and expressed her frustration at the slow progress of the Department of Health on this issue. She updates Emma Barnett about her concerns.Nurses in England, Wales and Northern Ireland are due to start strike action tomorrow. Since we spoke to the general secretary of the Royal College of Nursing Pat Cullen yesterday on this programme, the RCN has been urged to do more to 'avoid patient harm' and 'alleviate unnecessary distress' for dying patients on strike days by the Chief Nursing Officer for England Ruth May, and the chief nursing officers of Scotland, Wales and Northern Ireland as well as the NHS's head of cancer care. Emma is joined by BBC health reporter Jim Reed and then Baroness Watkins, cross bench peer and a nurse for 50 years. She's also Visiting Chair of Nursing at Kings College London, and is hoping that the strike will be called off.In this cold weather, we’re all reaching for our winter woollies. One of the things you may be wearing is a balaclava, that piece of headwear that covers your head and chin traditionally knitted by your grandma. These winter warmers originated during the Crimean War and they’re having a moment this year, thanks to big name fashion brands, Gen Z’s and Tik Tok and Instagram influencers. Fashion writer Tiffanie Darke is here to tell us how we can be warm and stylish.Protests have been taking place across Iran since mid-September after the death in custody of a 22-year-old woman, Mahsa Amini who had been detained by Iranian morality police for not wearing her headscarf correctly. Over the last two and a half months, women living in Iran have been sending their thoughts and diaries in secret to the BBC’s Saba Zavarei. They come in the form of voice notes, writings, videos and drawings, which the women then destroy on their phones in case they are searched. These diaries show the everyday risks and dangers that women face, as they continue to protest in Iran. We speak to the Elizabeth Gardiner the CEO of the Whistleblowing charity Protect about what protection is available for women who do put their careers on the line to report malpractice and wrongdoing.

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petrozzella, and from the BBC, this is Extreme Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2, and of the risks we'll take to feel truly alive. If I tell all the details, you won't believe it anymore. Extreme, peak danger. Listen wherever you get your podcasts.

BBC Sounds. Music, radio, podcasts. Hello, I'm Emma Barnett and welcome to Woman's Hour from BBC Radio 4. Good morning and welcome to the programme. Today we're going to hear the latest about the nurses' strike and discord in the profession, which is 90% female on the eve of a historic national strike by the Royal College of Nursing, the first in its 106 year history, still on, as I'm talking to you, for tomorrow. Yesterday we heard from the head of that union, Pat Cullen. You can catch up on that particular interview on BBC Sounds. It's worth hearing in full if you have the time. Also on today's programme, the woman behind a

landmark report about a women's health scandal who is frustrated, to say the least, with the slow progress of the government on this front. Of course, it's linked in some ways because we're talking about patient safety at the heart of all of this. We will hear the voices of Iranian women recorded in secret and shared with the BBC, who have been part of those headline-making protests since mid-September. And why, in these frosty climes, more and more women are apparently reaching for the balaclava. Yes, that's right.

Although I keep nearly saying baclava. No, not pastry. For a balaclava, there you go. Apparently brightly coloured ones are all the rage and are having a moment. It did get us thinking today as we're still dealing with frosty climes. If you have one item you always reach for when the temperature drops below a certain level what is it and why who made

it where did you get it from is it the same every year probably for a lot of people mine's this black thermal vest but due to a pregnant belly this year it's not happening what is yours what is the item maybe you have also made something new this year for this particular weather moment. You can text me here on 84844. Text will be charged at your standard message rate on social media at BBC Women's Hour. You can email me through the Women's Hour website or send a WhatsApp message or voice note on 03700 100 444. I'm sure your detailing of your warm item of choice will warm us up a little bit. Your woolly item, whatever it is, let us know. But first, nurses in England, Wales and Northern Ireland are due to start strike action tomorrow.

Since we spoke to the General Secretary of the Royal College of Nursing, Pat Cullen, yesterday on this programme, it's still going ahead. That's what we understand. The Royal College of Nursing has now been urged to do more to avoid patient harm and alleviate unnecessary distress for dying patients on strike days by the Chief Nursing Officer for England, who's made this intervention, Ruth May, and the Chief Nursing Officers of Scotland, Wales and Northern Ireland,

as well as the NHS's head of cancer care. So those are the interventions that have been made, the overtures, if you like, to try and avoid this moment. And yet the Royal College of Nursing has replied saying, nurse leaders are working closely with us as part of our commitment to make this strike safe and effective. This letter is already out of date as we have met senior clinicians and agreed key points. The safety of patients, the Royal College of Nursing is saying, is everybody's top concern. The public back our campaign. That's what they say. We heard from a lot of you on this yesterday. I have to say a lot were

in support i can't give you numbers a lot of sentiment was certainly there but there were some of you who were not in support but carrying on with the royal college of nursing statement the public backs our campaign and knows that patients need a strong nursing workforce but at the moment there are record losses jeopardizing safe care so that that is a statement from the Royal College of Nursing since there's been this intervention from the Chief Nursing Officer for England and the Chief Nursing Officers of Scotland, Wales and Northern Ireland. So that's the latest state of play in terms of who said what, but also what the Royal College of Nursing has said.

I'm joined now by the health reporter, Jim Reid. Jim, good morning. Morning, Emma. The four Chief Nursing Offic officers then have written to the RCN this is a slightly different point rather than the government per se or even the public. This is within the profession there's discord about whether this historic strike should go ahead tomorrow. Yeah there's these intense discussions around something called derogation so this is the areas which will run to a certain extent as normal in some cases, but in a limited way tomorrow if the strike goes ahead.

So there's been some big discussions about this. There are specific health services which the union, the RCN has already agreed to run as normal. So these are things like chemotherapy, intensive care, paediatric, A&E. The question for these chief nurses is do those areas go far enough?

So they wanted more assurances around things like community services, in particular end-of-life care. They're particularly concerned that on certain wards, there might be a switch to something called night shift duty, which would be what the concern would be. That would be a lesser level of care. And they're keen that that does not happen tomorrow. Well, while you catch your breath, because you did just run in and were grateful for us at the start of the programme,

let's listen to what Pat Cullen, the head of the Royal College of Nurses, the general secretary, said to us about those areas, those measures that had been put in place to keep people safe. Well, we've been working night and day with our organisations, our hospitals and our community staff to make sure that we continue to provide life preserving services. I'm a registered nurse myself. We are going to do nothing on Thursday or on the 20th that will add any additional harm or unsafe care for our patients. I've made sure that we have exempted a significant number of services from taking strike. And indeed, only on Friday past, I signed off what is known as derogation or exemption for paediatric A&E services as a consequence of the strep A cases.

So we have taken a very steady measured professional hand. So nurses won't be striking if they're in paediatrics? No, they absolutely won't. And there's no such thing as our nurses on Thursday walking away. We have made sure that we continue to have minimum staffing levels in all of our wards and organisations. Pat Cullen talking to me yesterday. The health reporter, Jim Reid, still with me. Has that reassured the chief nursing officers? Well, the RCN is saying that on that first letter

that we're talking about, essentially it's old news. And since that letter's been received, they've had meetings with health bosses and agreed to most of these key points. What's happening, Emma, is at a national level, there are certain services, the ones we discussed, chemotherapy, paediatric A&E, which are completely derogated. They should be completely protected.

Then at a local level, it'll be up to individual strike committees in individual hospitals to discuss with health bosses at some point down to the individual patient level. So they literally might be saying, Mrs Smith needs two nurses to come around tomorrow morning to give her some medicine. That should continue and that will then be agreed with the nurses committee. So there's these national derogations, but there's these local discussions

which are likely to go on through today into tomorrow morning. And in terms of our listeners, patient safety and where they are on this, is there a sense that this has been done in the safest possible way? I mean, what's your read on that, having spoken across this world, this industry, that is your patch? Well, the thing with this strike is that word sort of unprecedented gets used a lot, but we've never had a situation quite like this before so until 1995 the rcn actually had a no strike policy in its rule book and since then we've had one level of industrial action 2019 in northern ireland with nurses there but this is the

first time there's going to be a national strike of this level across england wales and northern ireland so these discussions, although unusual, have never had to take place before, which is why you're seeing this quite heated talks going into essentially the day before this strike begins. And as we understand it, it is still happening. There's no update at the moment from the government or otherwise, is there? It seems very unlikely at this stage that it could be called off. We had these talks earlier in this week. The Health Secretary for England, Steve Barclay, sat down with Pat Cullen. The result of that didn't go very well. I mean, she came out of that accusing the governor of

belligerence. So it seems unlikely at this stage there's going to be any huge breakthrough. I think one thing that's worth watching at the moment is what's going on in Scotland. So in Scotland, the strike has been suspended, while the RCN currently talks considers this new pay offer by the Scottish government, which is worth roughly about seven and a half, 8% to nurses. Now we should get the result of that. So they've gone back to the membership in Scotland to see if they'll accept that offer. We should get the result of that next week. So that could put a lot of pressure on the government in England, because of course, if nurses accept that in Scotland, that gives you an indication. And it's not a guarantee, but an indication they might accept a similar kind of pay deal in England.

Although just going back again to what we believe is the latest statement from the government on this front from the Department of Health and Social Care, because we did we should say we did invite a minister on this morning, the secretary of state and then any other health ministers that are available. No one was available. And we also should say we invited to talk to us this morning, the Chief Nursing Officer, Ruth May, again, not available. But the latest statement we can sort of glean is the Health and Social Care Secretary, Steve Barclay, has repeatedly made clear his door is always open, has arranged a meeting or did arrange a meeting with the RCN as soon as they indicated they were willing to talk. But he said that any further pay increase would mean taking money away from frontline services and reducing the 7.2 million elective backlog. He said he would continue to engage with the RCN as we move into the pay review process for next year and on non-pay related issues so it doesn't look still and as

and also going off what pat cullen said yesterday that the government's willing to talk uh about this from a pay point of view at the moment no and what the government also say is that they asked the independent pay review body so this is a group of roughly eight or nine uh economists former people that worked in in hr to look at pay in the NHS. And their recommendation came through last July, and they recommended £1,400 increase for NHS staff, which is what the government has put in place. Now, there's lots of debate about how that body is certainly independent, but it's given a certain remit, which includes looking at the overall budget constraints, the government's level for inflation or target level for inflation in the UK.

So it does have these constraints around what it can look at. But the government are saying, look, we did ask the independent body to look at this and we have followed their recommendations. Health reporter Jim Reid, thank you very much for that. As I said, we did invite the government on and we also invited the chief nursing officers for England and for Wales and Scotland and also made attempts to invite for Northern Ireland. Well how safe should patients feel? Are the British public behind this? A lot of you as I say got in touch yesterday on this when we were hearing from Pat Cullen. Feel free to do the same today as we're on the eve of

the strike. Joining me now Baroness Watkins, crossbench peer and a nurse for 50 years. She's also visiting chair of nursing at King's College London. Good morning. Good morning. You've written a piece this morning on the website Politics Home hoping that the strike will be called off. How hopeful are you? Well, I believe that all parties would like to see it at very least suspended

and if a strike is necessary delay it until after Christmas. I believe that if we got ACAS involved now there would be a solution and I think as your reporter has just said we've got the negotiations going on in Scotland and if we could just delay things until we're clear on that outcome, I think it would be very much better for the profession and for the population of the other three countries.

Well, I've got a message here. Maybe I can put this to you with your experience of some time, it's safe to say, about nursing, with nursing. Staffing will be no less, says this from one of our listeners, than on Christmas Day.

So if it's not safe tomorrow, it'll be even less safe on Christmas Day when even fewer staff are available. This isn't being discussed. What do you make of that? I think that that is probably just a bit of a red herring. We always reduce staff over Christmas, but only in areas where many patients aren't admitted, for example, for routine surgery. Acute mental health services and A&E are staffed completely normally at Christmas. OK, so you'd see that as a red herring. There's one more message, just before we come back to what you've written and why you are hoping it could be delayed. There's one that says here, what an insult to all those dedicated nurses that they would do anything to cause harm

secondly what a shame that those leaders haven't spoken out about how the government and its decisions cause danger to life with a huge lack of staff we know there are big vacancies in nursing for instance no action on social care and the rolling consequences of a lack of beds ambulance queuing and therefore excessive response times absolutely not the fault of the workforce what do you say to that well i think that's true i think we haven't had a 25-year strategic approach to health and social care we've tended to have a situation where we put out fires increase student numbers briefly reduce them again and we haven't developed the right approach to the challenging needs of people happily living much longer,

but often with very complex health and social care needs. If you want the strike to be, as you say, at least delayed, but certainly not going ahead tomorrow, it sounds like it definitely is, according to the RCN, according to Pat Cullen, who I spoke to just 24 hours ago at the moment. And she sounds confident that it's the right thing to do. And if not, it's actually the timing is key. It has to be now because they've been trying for months

to engage with the government with no success. Well, I think that there was a clear majority in some areas for strike through the RCN. The RCN have followed proper policies in negotiating with their staff to make this decision. I'm a member of the RCN. I would rather that nurses didn't have to strike. But I do understand that particularly clinical nurses feel very, very undervalued at the moment, and some of whom actually are frankly struggling to make ends meet. And that really isn't right.

But you still don't want the strike to happen? I would rather it didn't, but I do believe that nurses will make sure that patients are protected, even if the strike goes ahead. So this isn't something you would leave the RCN over if it goes ahead tomorrow? I thought very, very long and hard about it, and the answer is no. I will stay with the RCN. I've been a member since I was a student nurse. I do believe they've followed due process, but I'm very uncomfortable that it's come to this situation. And your particular discomfort, just to make

sure I've got that clearly, is around what? The service tomorrow or the fact it's come to this? The fact that it's come to this because I do not know a single nurse who would choose to strike. It is because they feel that they haven't been heard and that, as you've alluded to earlier, that patients are daily at risk in some services because of the shortness of staff. And therefore, they feel unless they highlight the problem and are properly remunerated, we will continue to have people leaving the profession,

which actually continues to make the situation worse. As a cross-Brench peer, what do you think needs to happen today to stop the strike? I believe that if the government and the RCN agreed to call ACAS in and to sit down together and look sensibly at what can be done, the strike could at least be suspended. Do you think the Health Secretary, Steve Barclay, would do that? I believe that his door is open. He has said that.

But not about pay? Well, I think that if we sit down and talk sensibly about workforce development plan, continued CPD, the possibility of paying off student fee bursary loans, and I believe a small pay increase. But he said he won't do that. I mean, I know you're coming up here and it's important to hear what you think the solutions could be. But he called a meeting and said, and we've even got it in the statement, and said, we won't do pay. I wasn't at that meeting. It was clearly very difficult. I have high regard for Pat Cullen, but I also have high regard for the health secretary and the Department of Health. And I believe still that there is a potential for solution. But I'm an optimist and I'm a mental health nurse and I'm used to negotiating in difficult situations. I bet you are. It's just I suppose today who could potentially not blink first, but get together and make that happen.

And as of yet, it doesn't. That's why we might need to get ACAS involved. I think, you know. I think things may be too difficult just with two parties involved. is sad that it has come to this, but also has empathy for why it has. Well, at the heart of any discussion around these strikes, and these particular ones being unprecedented, as we've talked about, at this level from the Royal College of Nursing, at a national level from the Royal College, but also we know this is a force of a workforce which is 90% dominated by women. It's a largely female workforce. At the heart of the discussion around this is patient safety. And that is something that has concerned my next guest for some years with a specific case around women's health. Two and a half years ago, my next guest, the Conservative peer, Baroness Julia Cumberledge, wrote a landmark report called

First Do No Harm, looking at two drugs and a medical device, vaginal mesh, which cause women or their babies serious harm. She made a list of recommendations to support victims and prevent future avoidable damage. Well, yesterday, she appeared in front of the Health and Social Care Committee and expressed her frustration at the slow progress of the Department of Health on this issue. I should also say on this topic, we invited specifically the Minister for Women's Health, Maria Caulfield, to come on Woman's Hour and talk about this from the government's perspective, but she was not available. We have also asked for a statement, which I believe we've got in.

I will check that in just a moment and I will read to you. But first, Baroness Cumberledge is here. She's actually joined me in the studio. Good morning. Good morning. Thank you for making the time. I know you, talking of time, have been waiting for a government response for some months. Tell us a bit about that. And I believe it only came in at six o'clock the night before this committee meeting. Is that right? That is correct. Actually, to be fair to Maria Caulfield, she did send it to me over the weekend. But can I just say that one of the things that I found with the Department of Health is that they are diligent, they are thorough. And when you look at these documents, there are no gaps in them. They have covered everything. But the implementation

is so slow. And that is what we found very difficult in terms of our report. To briefly remind our listeners, some will be painfully all aware of what you have been looking into and are talking about. But for those who who aren't can you remind our listeners about the the drugs and and the medical device that did cause so much harm well the first one was primidos and um that has not been um uh it really hasn't been used for about uh since the 70s. So the next one is sodium valproate, which is still used, and it is to help epileptic women manage their epilepsy, their seizures, all the awful things that they have to cope with. And the third one is surgical mesh, which was inserted to women for stress urinary incontinence and it has been used for decades. And the result for many women has been total disaster.

Yes, I mean, constant pain, needing a stick to walk, all these sorts of details did come out at the time. And I know you travelled around the country to talk to hundreds of women for that report. And actually at the Health and Social Care Committee yesterday, several women spoke very movingly of their experiences. Emma Murphy, one of the founders of the Independent Fetal Anti-Convulsant Trust, explained how she was affected by taking that drug that you mentioned with regard to epilepsy, sodium valproate. Let's have a listen.

Me and my husband, we questioned at every appointment would valproate harm during pregnancy and we were never warned at all. I was always told that it is the safest medicine to take during pregnancy to control the seizures. I've now obviously five children affected, and they're all diagnosed with fetal valproate spectrum disorder, along with autism. Other diagnoses include cerebral palsy, hypermobility, scoliosis, deformed feet, valgus foot. My daughter Lauren was born with a hole in her heart, curved toes, speech and language delay, social interaction problems, sensory processing disorder.

So it is a long list of diagnosis, and I'm just one person affected, and there's approximately 20,000 babies in the UK and it is a national disaster. So it has massively affected your life and those of your children and what has it done to your to your mental health and much your physical health and of course the mental health of those around you. It's devastating. It is to know that a medication you prescribe is deemed as safe from health professionals to later find out that it is the cause of your children's disabilities, to watch them every day struggle. As parent that is just devastating Emma Murphy there and Kath Sampson head of the campaign group Sling the Mesh also talked of her experiences of pelvic mesh so my story was I went for surgery I was never warned of any of the risks nine out of ten

on my group were not warned of any risks of mesh I had no idea it was polypropylene plastic I had Mae'r rhysgion yn unig. 9 o 10 o'n grŵp ni ddim wedi cael eu gwarnio o rysgion mesh. Doeddwn i ddim yn gwybod mai'r rhysgion oedd plastiwl polipropil. Doeddwn i ddim yn gwybod mai'r rhysgion oedd yn permenant. Fe wnes i ystyried ei fod yn rhywbeth fel cwyl cyntraseptol, felly os nad oeddwn i'n mynd â'r rhysgion, gallwn i gael ei gadael fel a ddigwyddodd gyda Marina. Doeddwn i ddim yn mynd â Marina ac fe wnes i gadael hynny. Felly doeddwn i ddim yn brynu am y cas cyffredin, gwaith gwrtau, gwaith gwrtau sylfaenol sylfaenol. gold standard minimally invasive surgery that I went for. I went in super fit. I used a high board dive. Yes, really off the top boards, box, mountain bike, really super fit. And that was sort of half the reason why I was suffering stress incontinence because I was just so active.

And so went in super fit and came out in enormous amounts of pain. And at first, I just assumed that was surgery. But as the days went on, that pain got worse. Roeddwn i wedi mynd i mewn yn ffurf, ac fe ddododd yn ffyrdd o fain. Yn gyntaf, roeddwn i'n ystyried bod hynny'n gweithio, ond wrth i'r diwrnodau fynd ymlaen, fe ddodod y fain yn gweithredu. Yn fy nghymru, yn fy nghymryd, yn ymgysylltu, yn ymgysylltu â'r fain yn ymlaen. Roedd yn deimlo fy mod wedi cael fy nghymryd â'r bat bwysig yn ôl fy ngheg. Roedd yn ddifrifol. Roeddwn i'n ddod yn ddyn unig, yn ddibynnol ar hynny. Fel gwirfyr yn ein llyfrgell lleol, roedd yn rhaid i mi ddod i'r gwaith. self-employed at that time as a journalist in our local newspaper I just had to keep going to work

and after a couple of weeks and things were getting worse I at that stage decided to google up and my mesh was called a TVT and it's the type of incontinence mesh that Baroness Cumberledge suspended four and a half years ago so I googled that up and I was horrified to find that that had been suspended in Scotland a year earlier. I hadn't been told about any of that. Cath Sanson there. Mentioning you, Baroness Cumberledge, what you had said in terms of banning that, that particular mesh that she had had the experience of.

You made nine recommendations in your landmark report. What progress do you feel has been made? Well, it's been very slow. We've had three of our recommendations accepted. We've got four still under consideration. And we've got two that have been refused. And one of those is redress for those who have suffered so much. We're not talking about compensation

which you have to go through the courts to get. We are saying that the government should set aside some funding for those women who have suffered so much and if they had a little financial help it would make their lives so much easier. Yes, and because they're still struggling. I mean, that's the point. Well, they are struggling very much indeed. And we just feel that when something like this has happened, and it is something that is so devastating, the heart-wrenching stories that we heard, which were just so awful.

It really is up to us, the nation, to recognise that and to ensure that those lives that were harmed through no fault of their own should receive, those women should receive some help to get through the rest of their lives. And indeed, some women are no longer alive because they could not take the pain any longer. Which is also very much worth remembering and important to remember. On that point of compensation, of financial recompense, where is the government up to on that? Where is it? What is the response? Well, we've had an outright, no, they won't do it.

But recently, the health minister, Maria Caulfield, who I rate very highly, she said that she would reconsider this. So we are living in hopes of that. And we know that there is a precedent for infected blood, for vaccine damage and so on. So it's not as though they're starting something new, but it would just make such a difference

to so many lives that have been ruined. We do have a statement from the Department for Health and Social Care. It reads, which addresses some of this, Our sympathies remain with all those affected by the side effects of sodium valproate. Patient safety is our top priority and we are committed to improving how the system listens to people. We have published a one-year implementation update on the Independent Medicines and Medical Devices Safety Review

with good progress towards the accepted recommendations and we will continue to take robust steps towards this. We have taken action with the NHS Resolution, with NHS Resolution, forgive me, to address the difficulty some patients have faced in accessing information they need on clinical negligence claims. NHS Resolution has published a claims gateway for those affected by pelvic mesh and sodium valproate. A claims gateway? What does that mean?

Well, that's a very good question. That is something that was actually considered at the select committee yesterday morning. And it isn't what we want at all. As in you'd have to go to something and try and make your case and fight for it? Absolutely. I imagine that's the last thing these women would like to have to go and do. resources. They are coping with very difficult lives. And we're just saying that the government should really understand this is a national issue that was caused not by the women themselves. They had no idea that either pelvic mesh inserted and sodium valproate taken would cause the harm that it has done. And sodium valproate is still being taken by some women

because they need it, is that right? That is true, but the numbers are going down. But we do know that three babies are exposed still to sodium valproate when they're born, and one in ten actually are left with physical disabilities. And just to clear something up, I mean, we've talked about the compensation side of things. If I do get a minister onto the programme, I will try and ask that question because I think it's quite confusing about what they mean by that and how it may work. But you say you hold the ministers in high regard.

You say you hold the Department of Health in high regard. Well, sorry, you were saying that they were thorough. I don't want to put words in your mouth. Let me get it which way. You just shook your head when I said you hold the Department of Health in high regard. Please correct me on that. But I suppose what I'm trying to get at is you talked about the implementation not happening. Whose issue is that?

And what do you mean about the Department of Health? Well, certainly the issue for implementation lies with a number of sources, NHS England, the Department of Health, and all the other organisations that are part of this healthcare system that we have, which is so complicated. And a lot of people in those organisations are very sympathetic to what we're trying to achieve. And we heard a lot from the medicines, the MHRA, the health regulator. And, you know, they are sympathetic, but we need to go further. I feel like you're being very diplomatic.

Are you incredibly frustrated by this, as well as trying to work within the system? Because it's years on now. You're so right. I am frustrated because we must avoid this sort of harm happening again. And we believe that with our recommendations, if all nine had been accepted by the government, and indeed one of them, we had to go through Parliament in order to get an Act of Parliament to establish the Patient Safety Commissioner, who we believe will help enormously in the future to stop these sort of tragedies happening. Six health secretaries in five years, I believe. Yes, but actually, I have to say, one of them came and went and came back again. So it's, I think, four actually.

Right. But I'm sorry, but six of a change is my point. And that, I suppose, is also something each person in your sort of role is facing as well when trying to get progress. Yes. I mean, I can't do anything about that. And, of course, what we do is we work very closely with those that are appointed to ensure that they recognise the urgency of the situation that we have outlined in such detail. And, you know, these heart-wrenching stories that we hear are just so appalling. And compensation is not the answer. Redress is. Do you have faith that in your lifetime, these women will have justice and your bigger goal of do no harm will be achieved? Yes of course I will work ceaselessly. Baroness Cumberledge thank you very much for your time this morning. Getting a sense there of what it's like some years on from a landmark report

of the implementation side of things and we know that many of you have been certainly following this story and if not affected by it so we hope that's brought you have been certainly following this story and if not affected by it so we hope that's uh that's brought you a bit more up to date with with the lay of the land as it is we'll still try to get a health minister onto the program many of you getting in touch this morning about what you reach for when it gets a bit colder and apparently one of the things you may be wearing is a balaclava, that piece of headwear covering your head and chin,

often associated with bank robbers and the like. Well, apparently, they're having a moment. And this is being seen all over social media. And also, apparently, I'm just learning this myself, these winter warmers originated from their use at the Battle of Balaclava during the Crimean War of 1854, referring to a town in the Crimea where British troops there wore knitted headgear to keep them warm. So there

you go. But they probably weren't shocking pink, as some of them are on social media at the moment, it seems to be. Tiffany Dark, the fashion analyst and writer, is here. Good morning, Tiffany. Good morning, Emma. I can see you on our video call. No balaclava inside. No, but it's very cold. You do look warm.

And we've got lots of messages from people coming in, which I'll get to in a minute, about what they reach for. But the balaclava, it's a thing. Yes, it's back, strangely, in the last... Well, actually, it started to come through last season. The women's wear, Miu Miu,iu the fashion brand put it on the catwalk and they had it in a very sort of sweet baby pink crocheted bonnet number which had a little button strap that you attached under your chin and I think all the fashion influencers took one look at this and thought fantastic and they started wearing it

all over TikTok and Instagram I mean know, it stops you in your scroll if you're wearing a kind of cute knitted bonnet, especially one that's made by Miu Miu. And it just kind of took off from there. I love it. It stops you in your scroll. I haven't heard that yet, but I'm going to use that and borrow it.

It's though, are we talking, I mean, how much are we talking in terms of coverage here? Because I suppose the bank robber reference is what some people will go to when they hear that word. Yeah, yeah, yeah. Well, actually, this whole thing started in menswear before it hit womenswear, where it definitely did have those confrontational vibes.

It rose out of the South London drill music scene about 18 months ago, which is, as you know, is sort of quite gang-ridden and has quite aggressive vibes. And a lot of those drill stars sell merchandise they sell tracksuits and they were selling balaclavas along with the tracksuits so kind of boys started wearing it but obviously the girls vibe is completely the opposite with these little sweet knitted bonnets and and pretty different in terms of color i

imagine as well you mentioned baby pink lovely sherbets and pastels and nice brights as well. Yes and and it's interesting as well I mean do you see that a lot with menswear I think things that can start in menswear then going across to women or is it usually the other way around or is it a bit of both? Well it can be a bit of both but also there's a big trend for unisex now so kind of girls wear boy stuff and you know boys wear girl stuff so actually women's wear and men's wear are not too different these these days it's it's quite interesting seeing what people reach for when it gets colder a lot of what they reach for they've had a very long time because i suppose we don't live for long periods of time in very very cold climes in this country and people tend to treasure what what's the thing that you reach for is there

one item well it's something beautiful and hand knitted isn't it I mean I've actually I've got a really beautiful hand knitted tank top which is so lovely to put over a blouse and warms anything up or you can have like a scarf or a you know a hand knitted hat but that idea that somebody has made something for you and it's taken hours if not days for them to put together you keep that and there's something rather special to it especially And it's taken hours, if not days for them to put together. You keep that and there's something rather special to it, especially if it's your mum or your grandma or your sister who might have done it for you. Yeah, I'd quite like that to be in my repertoire. But sadly, no one in my family seems to have had those skills. Perhaps I'll have to adopt them. I'm

not sure. But there's a message here. My go to in cold weather is a scarf knitted by my lovely friend Jan. It's a Tom Baker Doctor Who scarf. It's not enormously long like his was, but it's very warm and comforting. So to your point about who's made it for you, I wear it all day. If my neck is warm, life is bearable. I'm also wearing a puffer jacket that she gave me. I'm being kept toasty by the kindness of my friend.

Lucky me. Rosemary, though, to your point about perhaps also maybe it being a bit more luxury. My go-to garment, warm garment, silk long johns bought as a base layer for mountaineering many moons ago. Silk long johns. Very nice. Well, if you ride a motorbike, they're absolutely derogare, apparently. I'm learning. I'm learning a great deal here. Another one. My lovely woolen Laura Ashley duffel coat, other brands available Now, 30 years ago, 30 years old, rather, which I wear throughout December only. I date it precisely as I was wearing it in the year that we moved home when my neighbour stepped out in the same coat. This coat continues to bring a response to be called Little Red Riding Hood at my age of 70. Makes me very indeed says sally good morning to you and so it so it carries on a shocking pink fleece snood gifted from my brother-in-law nick who himself had been given it to from his mother for skiing somehow he couldn't bring himself to wear it it's now my annual garment to bring me comfort and joy comfort and joy we also just saw while i've got

you tiffany i know you look across the fashion scene we also saw last week um perhaps bras coming a little bit back we saw them go away certainly the underwired ones in trends when it was uh lockdown and apparently um still not not the most amount of love for the underwired ones but a bit of a return as we head out to the party scene yes I mean what you want now is a nice sort of cast uh satin bustier which you can actually don't be if don't be afraid you can wear it over over a silk shirt so it's almost like a bit of corset outerwear but that's that's more for glamour rather than support yes i need support right now tiffany dart thank you very much for bringing us up to date the fashion analyst and writer and your message is still coming in about what you reach for at this time of year when it's a bit colder.

One message here, I haven't seen many balaclavas in West Yorkshire yet, returning to our original theme, but I still have a thermal I've had since I was 16 and now I'm 41. You just don't get rid of them, do you? However, I can thoroughly recommend knitting a pure wool tank top, which is in line with what Tiffany was saying. They keep you warm without the bulk. A pair of thick red gloves reads this message very thick wool fleece inside bought over 35 years ago in

deptford market for one pound i wish i'd bought more i always wish i'd bought more when you get a good thing went berserk when i thought i'd lost them luckily i found them well on that i managed to lose not one pair of gloves yesterday which i've managed to keep for about six years but two because my husband then lent me his and i promptly got rid of them as well so I'm having a I'm having a good run on that front I was absolutely mortified uh but there you go that's what happened to me yesterday and another one Emma I'm a black thermal top girl for the first time I've been wearing the black thermal leggings too what a difference they make to my overall warmth factor highly recommend says Maureen.

Good morning to you, Maureen. Thank you for the message. Keep them coming in. Now, protests have been taking place across Iran since mid-September after the death in custody of a 22-year-old woman, Mahsa Amini, who had been detained by Iranian morality police for not wearing her headscarf correctly. Over the last two and a half months, women living in Iran have been sending their thoughts and diaries in secret to the BBC's Sabah Zaveri. They come in the form of voice notes, writings, videos and drawings, which the women then destroy on their phones in case they are searched. Well, these diaries show the everyday risks and dangers that women are facing as they continue to protest in Iran. And we've got some excerpts for you to listen to today from a video that was put together and directed by the BBC's Kate Forbes. Thank you to her. With the hope of showing us the more intimate details of the daily lives of these women that we don't normally get to hear from or about in much detail.

The journalist's voice you will hear is Sabah Zaveri and the names of the women have been changed for their safety. Their comments are voiced by BBC producers. Every time I go out, I have my bag searched. Any evidence of protests could give the security forces another excuse to arrest me. Some of my friends who have been arrested have disappeared. I have to go, but please, keep all my messages and videos for me, will you? When freedom comes, I want to remember what hell we had to go through. Protests in Iran have raged for months.

Since 22-year-old Mahsa Amini was killed after she was detained by morality police. I have been in secret contact with female protesters since the start. They create their diaries, send them to me, then they destroy them as they can't keep them. We identify each other discreetly by asking a simple question like, what's the weather like today? It's 9th of October, more than three weeks since the start of the protests. A photograph of a rubber bullet wound.

It's 5am in Iran. She must have been up all night. They shot me. I was just walking past a line of riot police. Some of them stared at me. I asked if there was anything wrong. Then suddenly, one of them pointed the gun at me and fired. Can you actually believe it? There is no logic. You feel like they're zombies. They grabbed my hair and pushed me to the ground.

Every time I turned my head, I saw many guns pointing at me. Over days, her mom nursed her bruised body. More messages came in. What did you have for dinner? I had soup. We know it's safe to speak now. Tonight, for the first time ever, I saw my mom confronting the authorities. She used to tell me to observe the hijab rules to protect me from the morality police. But now, she's actually gone to challenge them. It's mid-October. Now 11 women across Iran are sending me their diaries, including Neda, who's texting me from Mahshad,

a very religious city in northeast of Iran. Hello, what's the weather like? There is so much happening, Sabah. I'm drawing and writing what is happening, but you know it's not safe for me to keep a diary. Even my very conservative mother is changing because of these protests. Her and her friends study Quran in a religious group. They are horrified by seeing videos of police killing young people on social media.

It's the first time she has ever openly criticized the regime. But still, I have to keep my protest a secret. It's the 27th of October. The crackdown on the school protests continues. Children are outraged at the killing of a 16-year-old schoolgirl. My niece is protesting in her high school and she told me how the militia and headmistress have searched them and threatened them. Less than a month later, eyewitnesses in the Kurdish regions of Iran describe an ongoing massacre against protesters. I get a message from Rujin in Salandaj.

I've seen such horrendous scenes. They shot a protester right in front of my eyes. I've been filming what I can. I want to make a documentary, but I have to delete all my videos for now in case my phone is searched. Please keep the videos for me. Today I smuggled medical supplies into a safe house where they are treating wounded protesters. They can't go to hospital. The police tried to search my bag. I screamed, get out! I have my underwear here.

It was night, so by torchlight I managed to show them my clothes and not the bandages and saline underneath. I got away, but it was so scary. The Iranian government claims that the protests are being organised by terrorists rather than citizens. They have intensified the crackdown across the country. Things are getting even worse where Rojin lives. In Kurdish cities of Iran, nothing is normal.

In a taxi today, we drove past a body lying on the street. But at least I feel like I'm actually doing something, and I feel alive. Across Iran, more and more women refuse to observe the Islamic dress code, risking imprisonment, even death. After being shot, Par had told me, I can see the dawn of freedom, so I will keep fighting in one way or another. I try to contact her. Hi, what did you have for dinner? Hello? Hello? My messages are not delivered. I have heard nothing from her since. women and some of whom we don't hear directly from very often indeed. So thanks to all for putting that together and allowing us to be able to play that to you this morning. Now last week

you may remember Helen Evans, Oxfam's former global head of safeguarding, was on the programme. She was one of the whistleblowers involved in highlighting allegations of sexual abuse against overseas Oxfam staff back in 2011. The charity issued an unreserved apology to the government, donors, supporters and the people of Haiti following the revelations. However, for Helen, despite her role in bringing these crimes to light, she was left jobless and the decision to whistleblow impacted her whole life. She told Woman's Hour a bit about how her life has been affected. It was really tough and it was tough for my son and my husband at the time. We've since

divorced but it was necessary unfortunately. It was hard and it became something that I struggled to think about other things. I think you become so focused on these. When you become a whistleblower, that issue becomes everything. And sometimes that can be to the exclusion of other people. I want to acknowledge Protect, their whistleblowing charity, and they are one of the few organisations you can go to for legal advice. But then you're on your own. You know, they can give you advice,

but there is absolutely no one to accompany you through that and there was me against a three four hundred million pound charity and you know I spent money I didn't have getting additional advice I personally believe there needs to be a public funded organization that supports whistleblowers through that process and accompanies them so they're not alone because a lot of good can come out of whistleblowing. It's in everybody's interest for wrongdoing to be called out and remedied. So why is it whistleblowers have to pay such a personal price for something that's in the public interest? Well, with me now is the Chief Executive of Protect, Elizabeth Gardner,

and that's the whistleblowing charity Helen was talking about there. They provide advice and support for those who want to call out wrongdoing. Elizabeth is here to talk about what protection is available for whistleblowers, but also what needs to be done to make sure women who confront and report malpractice are given support. Good morning. Good morning. Why is whistleblowing so important? Might be a slightly counterintuitive question to you, but what is its role and what does it actually involve? Well, I think whistleblowing is essentially a public good. It's about people in the workplace who are speaking up to stop harm. And insiders, the workers of an organisation, are often the

first to identify risks. And so they're speaking up, telling their employers about these risks, giving them a chance to put things right before those small risks become major scandals. And so every day up and down the country, people are speaking up, preventing health and safety problems, stopping crimes, holding organisations to account. So whistleblowers are that vital early warning system and good employers are listening to them and they realise how valuable that gift of information is that they're providing. Is there any data on whether it's more men who do it, more women who do it, the difference there? Well, there's not a lot of research on whether it's more women or men that speak up. On our advice line, and we talk to about 3,000 callers a year, about half the callers are women, and that may be that some of our key sectors are health care, charity sectors, which are female-dominated sectors.

But there is a gender dimension to whistleblowing. There's some international research that says women are more likely than men to suffer retaliation when they blow the whistle. And that can be bullying, harassment, all sorts of other things. And that increases with the seriousness of the wrongdoing that they've raised. There's also some research that's about women facing the tribunal system that says women are less likely than men to have a legal representation when they go to the tribunal and more likely to report the impact on their health. And you heard there from Helen about the serious impact it can have on whistleblowers' health. I mean, some listening to that may think it's not worth it doing it. That's interesting.

And a lot of the whistleblowers, you know, one of the important things is that if you are thinking of blowing the whistle at work, come and talk to us at Protect. And we can talk you through the risks, you know, and there are risks sometimes associated with whistleblowing, but we always have two points to our advice. One is to talk to people about the employment rights, are risks sometimes associated with whistleblowing, but we always have two points to our advice. One is to talk to people about the employment rights and the law is there to protect you from being treated badly or from being dismissed for your whistleblowing. And secondly, we try and help

people raise their concerns safely with least risk for them and the most chance of it being addressed. So the law, let's talk about the law. Are you protected by employment law? Are you not meant to lose your job? That's right. There is a piece of employment law that says, you know, it is unlawful to treat a whistleblower badly or to dismiss them for their whistleblowing. Now, of course... You're not going to want them in there though, are you? If they've just blown the whistle on you and it's a bit awkward, to say the least, and could be very serious indeed, what they're alleging. You're not going to...'re not going to you're not going to want them to be working in your organized i mean that's the the reality that's where law and reality yeah yeah

kind of combined also also yes i mean the law provides effectively a remedy and what i think we need to see is much more uh responsibilities on employers to actually put in place effective whistleblowing arrangements, to listen to and act on those concerns. Because actually, at the end of the day, it's good for business. You know, whistleblowers are helping organisations because they're stopping the risks early. In the health service, they can be saving lives and preventing, you know, financial wrongdoing. Oh, your line has just frozen on me there elizabeth gardner she's the chief executive of the whistleblowing charity protect she's just back elizabeth sorry you froze slightly there you

said the law is there to to protect but you said it's a remedy and the the the incumbent should be on the on the employer to do this absolutely yes yeah i mean there is no responsibility for most employers in the country to even have a whistleblowing policy in place, let alone ensure that they have created an environment where it's safe to speak up. And that's really short sighted. Good employers are listening employers. They pick up these risks early and they recognise that whistleblowers are giving them a gift of information, allowing them to tackle harm before it becomes serious. And with that in mind, what you've just said, do most cases like this end up going to court? Do they go to tribunal because people do lose their jobs or do feel they can't continue? Unfortunately, too many people do have a breakdown in relationship and either lose their jobs or feel that they can no longer work with an employer who hasn't listened to them. But the fact that there's an employment law protection there allows a lot of other people to reach a settlement and they don't have to face the tribunal. And I do think that it's important

that up and down the country every day people are raising concerns safely and successfully. You know, nurses are pointing out patient safety to their line managers and they're getting the action. Factory workers are talking about hygiene and somebody is dealing with that. So, you know, it's really important that we encourage whistleblowing and what we need is a safer working environment so everybody feels that they can speak up without suffering any harm. I mean, I suppose in some ways you would say that you believe in it greatly, you've seen the good it can do, but the on people's lives is is very different and I wonder I mean you just brought it very much into the news agenda with what you were saying about

nurses speaking up we're on the eve of a historic strike and patient safety has been very much in the news about that but do you think because of the cost of living crisis because of some of the issues that we're facing economically at the moment, do you fear that we will have fewer people who wish to risk their jobs? Yeah, I think particularly, you know, that affects women in particular because they're more likely perhaps to be in precarious work and it does take courage to speak out. But most of the whistleblowers who call our advice line say, look, it's not a matter of choice. And that's what Helen said as well last week. You know, I didn't have a choice. I'm speaking out because I'm doing the right thing because it's the right thing to do.

And I can't live with myself if I let this concern go. Chief Executive of Protect, Elizabeth Gardner there. That's the whistleblowing charity which was mentioned in our previous interview with Helen. You've been getting in touch throughout today's programme, which you know I love, and I always want to hear from you, with what you've reached for when it gets a bit chilly because of this moment that apparently balaclavas are having, especially on social media and with some of the high fashion brands through to people making their own. We heard from the fashion analyst Tiffany Dark on that. I love this. 41 years ago, as a member of the territorial army,

I was issued a combat uniform. The trousers are my go-to in cold weather. Fully lined, very unglamorous, so very warm. They sound brilliant. I go for my Del Boy sheepskin coat, bought it at a charity shop in Sweden. Cashmere all the way, says Ms. Varney on Twitter. My sheepskin winter hat doesn't leave my head from November to April every year.

I need a wash. Though this year, I didn't actually start wearing it until early December. It's definitely my flexible friend for the whole winter, says Delphine, who's listening in Winchester. Good morning. Hello, Emma Bump. Oh, hello. Thanks.

And the whole team. Every winter, I reach for a beautiful silk velvet scarf that I inherited from my grandmother. That sounds lovely. It's gorgeous, very warm and always gathers many compliments. As soon as the mercury drops, I go ferreting around in the airing cupboard to retrieve it, casting bedding and towels as, and came from a posh department store in York. The shop has long since disappeared, but I have such heartwarming memories of mooching around Leekenthorpe feeling very grown up. Have a good day. Thank you. You too.

Have a good day. And so it continues. Someone else saw a short coat a few years ago made of teddy bear fur reduced to £30. I bought one now on its fourth winter. It's my essential. No teddy bears were harmed. Thank you so much for that reassurance.

I'll be back with you tomorrow at 10. That's all for today's Woman's Hour. Thank you so much for your time. Join us again for the next one. Hello, it's Chris Van Tulleken here. My brother Zand. That's me. I'm here too.

And I are back. Now, in series two of our radio four podcast a thorough examination we are on a mission to find out whether or not people can change it's called can i change we're thinking about all the things we want to change about ourselves and each other wait what i want to be more confident i'd like to be less of a people pleaser i'd like to be more of an extrovert but then sometimes I also think I should shut up. A quiet confident man. That's very attractive. Yeah I'd like a quiet confidence.

I think everyone has something they'd like to change about themselves. Change is important to me because I think it's gonna improve the key relationships in my life. And one of those is you, Zand. You can change whatever you like, just don't make me do it again. Well, nonetheless, Zand, we are gonna speak to some experts

who are gonna guide us through the idea of change. The last time you made me do this, it changed my life for the better. Yeah. But I still don't want to do it. And if you at home think there's something stuck in your life that needs changing, this might be helpful for you to search for a thorough examination with Dr. Chris and Zond on BBC Sounds. And the deeper I dig, the more questions I unearth. How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby.

It's a long story, settle in. Available now.