A high price to pay for a nurse's rounds

The picture, taken six years ago with a long lens, is grainy, and difficult to discern: a huddle of two or three figures standing in front of some market stalls in South Molton, a small north Devon farming town. One of the blurry figures is said to be a health visitor, Carol Rudd. She had been under covert surveillance by the local health authority for two weeks. Three internal auditors had sat in their cars tailing her to and from work. They believed she was fiddling her expenses. They claimed later that the photograph constituted proof that she had been shopping when she should have been at work.

This was the start of a battle which still, even to those directly involved, seems touched by unreality: a fable, some say, of the modern National Health Service. It has involved spying, unannounced raids on private offices, a bogus survey. It divided a community. It still divides the health authority, which has already admitted to spending £90,000 (the equivalent of hiring six health visitors for a year) on it; sources have indicated that the costs may now be as high as £150,000. And it was all over a mileage claim for £99.17.

At the centre of it all is Carol Rudd, 51, who has spent the past five years fighting to clear her name. Small in stature but huge in her determination, she does not fit in to South Molton easily - a broad Birmingham accent and hair the colour of marmalade mark her out as an incomer.

Carol, who had been working in Norway as a midwife, came to the town in the early 1970s to work as a health visitor. She had planned originally to stay a few months but, soon after she arrived she met Terry, a local farmer, whom she married. The two of them make an unlikely couple: Carol, incapable - by her own admission - of boiling an egg, Terry, a farmer who wants to learn how to sail - he has just bought a tiny inflatable boat.

The two had plans. "We decided not to have children," says Carol today, sitting at the kitchen table in the very cold farmhouse, "but to work hard for a few years, then tour the world in our Dormobile." Those plans (though they did buy the Dormobile) are unlikely now to be realised. The costs of her battle with the local health authority have been great - at least £75,000. They are not rich. They managed to renovate one half of their farmhouse and that is now rented out. Terry cannot afford any help on the farm and now sleeps three hours a night. "Once he had three dogs," says Carol. "Now we have only got one."

The dispute began in October 1986 when a new health visitor joined Carol at the local surgery. Allwyn McKibbin was a quite different sort of person to the ebullient Midlander. She was a Territorial Army reservist, a newly-qualified health visitor, and meticulous in the administration of her work. She began to complain about the more informal, less textbook approach that Carol took with her clients. After three years, she finally accused Carol of gross misconduct in failing to conduct a routine check on a disabled child.

Carol says that the allegation was untrue. In fact, she claims that it was Mrs McKibbin who had failed to make the visit. Mrs McKibbin did make mistakes: on one occasion she told a mother to put cotton wool in the teat of her baby's bottle; afterwards she said this was just a joke. Mrs McKibbin cannot, however, reply to Carol's accusations because she died of cancer last year.

But Mrs McKibbin was to play only a small role in the dispute. After she had made her complaint (in June 1989), officers of the authority prepared a secret strategy, focusing on her mileage claims, to prove whether or not Mrs Rudd was guilty of misconduct. Why they did this, and in the manner they did, remains unexplained.

On 18 September, the health authority auditors first put Carol under surveillance. After three weeks of snooping, they waited for her to file an expenses claim. She did, in October, and then they pounced. Senior officers raided her office in the South Molton health centre. She was not given any advance warning. Everything was taken, including the contents of the dustbin. The same night she was given sick leave for severe stress. Her own GP wrote on her patient record: "A very stressful day as a result of unexpected and extremely invasive collection of files, personal papers, etc, by NDHA officials. Discussed and commiserated." She was not told what the charges against her were.

However, it emerged some weeks later that the authority claimed to have evidence that she was guilty of gross misconduct, did not visit her clients, and claimed mileage for bogus trips.

In the armoury of its evidence was a "survey" which the authority said proved that she had not visited her clients as she claimed to have done. This survey has become the most controversial of the health authority's tactics.

The authority had, it emerged, secretly approached her clients in South Molton, told them they were conducting a region-wide survey into health visiting (which was untrue), and then asked their opinion of Carol's work. They also wanted to know when Carol had last visited. Many of the patients now say that the survey returns did not reflect the answers they gave - where they said Carol was good, the returns said she was bad; where they said they could not remember the date of her last visit, the form said there was no visit.

Nevertheless, Carol was formally dismissed in May 1990. Her former clients rallied around her. Ten of the mothers met in a local school and decided to complain to the health authority, to their MPs, and anyone else they could think of. In 1993, several took the witness stand during a hearing against the officers convened by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC). One parent went to Oxfam to buy a suit for the occasion, the first he had ever owned. Another was so nervous that she vomited.

All three officers involved in the survey - Jeslyn Gerlach, currently in charge of child abuse cases in north Devon; Anita Filer-Cooper, now director of nursing in a neighbouring health trust; and Ms McKibbin - were cleared by the UKCC. The health authority said that the officers had misled parents about the survey because it did not want to embarrass Carol Rudd by publicly announcing that she was under investigation.

But the parents involved are still angry. "I trusted them; they were health workers," says Lesley Jury. "Then we found out that the form had been used to get rid of Carol."

Meanwhile, tension increased in the town and within the health authority. Ms McKibbin accused Carol's mother, who had come from Birmingham to stay, of spitting at her in church. One senior nurse, accused of warning two health visitors not to take Carol Rudd's side in the dispute, claims this evidence was invented because they did not want her working with them.

"There were two crowds in the school playground," says one mother. "People who were McKibbin's patients would not talk to us. One of Carol's patients had to stop going to the mother and toddler group because of the pressure."

After the hearing against the health authority officers, the UKCC considered the charges against Carol Rudd. Ian Whyte, the chief auditor and organiser of the surveillance, was discredited as it emerged that his team sometimes knocked off at 5.30 in the evening - before Carol actually did many of the rounds for which she was claiming mileage.

In the end, he was forced to admit to the hearing that she could have driven the distances she claimed. Carol was acquitted on all substantial counts. Explicitly, she was cleared of any allegation of fraud or dishonesty to do with claiming mileage. The UKCC upheld one charge of misconduct relating to her failure to remind a GP to visit a patient, but ruled that this deserved no punishment and would not allow the fact to be recorded on her file. The panel urged the parties to resolve their differences and get back to work. They did not. Carol found that she could not find work in neighbouring health authorities.

Meanwhile, Carol claimed for mileage covering the last two months she worked - September and October 1989 - an amount totalling just over £200. Eventually, north Devon agreed to pay part of it, but refused to pay the period of the authority auditing team's surveillance, and continued to insist that these were dishonest claims.

Carol finally decided to take it to the small claims court. She did this because the small claims court is supposed to be cheap and quick. She did it, she said, on principle. "All these families stood behind me before and I wanted to just make the authority acknowledge that it had been wrong all along," she says.

That case has dragged on now for six months. At a hearing last Friday, solicitors for the health authority said that it had no intention of backing down. "The authority believes that people will understand that it must, as any other employer would, stand by its decision to dismiss on the grounds of gross misconduct," it said in a statement last week. "The authority cannot pay out for travel costs, unless the journeys can be substantiated."

Last week Nick Harvey, the local Liberal Democrat MP, tabled a parliamentary question asking the Secretary of State for Health, Virginia Bottomley, to confirm how much money had been spent in legal fees by the health authority on the case.

Dr Bluett, the local consultant, sitting in his spartan office in Barnstaple hospital, shakes his head with genuine regret.

"Everybody has lost. We have lost Carol - a terrible waste of a very valuable resource. There is a shortage of health visitors, even a number of vacancies. That says something, doesn't it? That says something about the management of the modern health service."