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GMC investigates complaint against Dame Barbara Hakin

The General Medical Council has launched an investigation into a complaint against national director for commissioning development Dame Barbara Hakin, HSJ can reveal.

The complaint alleges Dame Barbara, a former GP, placed United Lincolnshire Hospitals Trust under pressure in 2009 to prioritise hitting waiting time and A&E targets ahead of patient safety, amid warnings the trust was over capacity. The complaint relates to her tenure as chief executive of the former East Midlands Strategic Health Authority.

Emails obtained by HSJ reveal the medical watchdog has instructed lawyers from London-based Field, Fisher Waterhouse to investigate the complaint. They have been asked to speak to former United Lincolnshire chief executive Gary Walker and chairman David Bowles, as well as other staff from the trust.

An email from 6 August, signed by Caroline Jaggard, a senior associate at the firm, said: “We have been instructed by the GMC to assist in the investigation of your complaint against Dr (Dame) Barbara Hakin.

“Assuming that you are happy for the complaint to be disclosed to Dr Hakin… the investigation will begin as soon as possible.”

The process could result in the GMC deciding to take no further action, issue Dame Barbara with a warning, refer her to a fitness to practise panel where she could be struck off, or negotiate undertakings to allow her to keep her registration.

The initial complaint was made earlier this year by medical journalists Phil Hammond and Andrew Bousfield.

A dossier was sent to the GMC and included minutes from meetings of the trust management and letters from clinicians and trust managers raising concern. It also included a note allegedly written by Dame Barbara in April 2009 to SHA chairman John Brigstocke which said United Lincolnshire needed “to meet targets whatever the demand”.

United Lincolnshire had significant capacity problems during the winter of 2008-9, with bed occupancy levels at 96 per cent or higher between November and January, according to an SHA report from 2009.

In June that year the trust board made a resolution, in private, that it would not give an undertaking to meet targets due to concerns about patient safety and capacity problems.

Chairman David Bowles resigned in the summer of 2009 and went public with his concerns over SHA “bullying” to meet targets.

A 2009 probe led by former Greater Manchester SHA chief executive Neil Goodwin cleared the SHA and found no evidence of bullying.

United Lincolnshire chief executive Gary Walker was sacked for allegedly swearing in February 2010 after seven months off sick with stress. He brought an unfair dismissal claim but has since accepted a compromise agreement and payment thought to be worth more than £500,000.

In his initial complaint to the GMC Dr Hammond claimed: “This evidence shows the possibility that Dr Hakin has insisted on targets being met and has failed to understand the damage to surgical interests and to patients from that insistence.”

The GMC said it does not comment on investigations but confirmed Dr Hakin was fully registered with a licence to practise.

Dame Barbara Hakin declined to comment.

Readers' comments (29)

  • Bizarre. Surely it is just co-incidental that she remains a registered doctor? These issues about her management role have been investigated already and she was cleared.

    Can't see what it's got to do with the GMC.

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  • Anonymous 11:16 am- I am puzzled as to why you are puzzled because the need to investigate the complaint and the relevance of her registration as a GP are self evident. Anyway my view is as follows:

    - Hakin was given the role of Director of Commissioning in part because she is a GP and the central thrust of the Government's policy was about transferring commissioning from "bureaucrats" to GPs.

    - The suggestion is that she may have failed to uphold the ethical standards required of a GP by placing the achievement of targets above patient safety. This would clearly reflect on her fitness to practice.

    - Finally the previous enquiry which cleared her did not consider the evidence assembled by these journalists.

    Not bizarre at all really- unlike the current approach to "reforming" the NHS...

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  • What an interesting reply, 11.16. Who investigated her performance in that role? How impartial were they and what where their TOR? What were their findings? What other events prompted individuals to share further information with journalists and lawyers? Does clearing someone in one process mean that any related concerns or new evidence can never be bought up in any other forum? Do you think that advice/ instruction from a manager in a senior position is the same as that from a medic? That managers take the Hippocratic oath and are subject to the same code of conduct?
    I have no opinion on the issue - I do not know the details of that health economy - but in the climate that allowed Mid Staffs to happen, I welcome a more open and transparent approach to safety and quality over finance and targets.

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  • This issue is now manifesting itself everywhere. There will be many more such cases in the next 12 months

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  • There has been bullying endemic from the top. If she is indeed guilty of bullying (and unethical) behaviours, is anyone going to investigate what drove that behaviour. I'm not defending wrong doing if it is proven, there is no excuse and clinical leaders need courage to stand up for what is right, but, if the mitigation is (at least in part) proven to be bullying from the DH then this needs to be tackled. It used to happen and I'm sure it still does, as once people get to positions of power they will do/say anything to keep that power, even if it is not ethically right or even what they believed in on the way up.

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  • is there an ongoing police investigation into the leaked confidential emails?

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  • Anon 1:13 - Leaking confidential emails is probably a breach of contract - for which an employee can be fired - but it's not a criminal offence, so the police won't be interested.

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  • Anon 1pm - indeed: paving the way for the management of the NHS to be prised away from clinicians and into the hands of the private sector. It's all part of the ConDem strategy.

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  • It does seem bizarre that it is referred now and one wonders about the timing
    Bullying (as stated) is endemic at the top of the NHS and trickles right the way down to the clinical environment including the medical profession..why is this a surprise?.One could understand it if the NHS was a multinational bank but its "business"is care and yet the upper echelons dont know the meaning of the word!

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  • David Hooper

    Nothing in this report surprises me. A normal day's work in the NHS.

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  • Well, what a flurry of emails.

    Should this relate - as I am sure it does - to Dame Barbara's acts and omissions in relation to Gary Walker, then as anyone who has bothered to follow his case would know, it's about time too.

    As for the more general issue of bullying, the evidence at the Francis Inquiry seemed pretty conclusive to me. Until it is decisively challenged and the evidence accepted at the DH that a bullying culture undermines good care we will have more institutions where shortcomings in care are hidden from view until they become cataclysmic.

    Let's give the GMC the benefit of the doubt - they appear to be putting their money where their mouth is

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  • The GMC have been reluctant in the past to look at doctors in wider NHS roles, but this is an important area of practice, informed by clinical & public health knowledge. It's about time, with GP commissioning in progress.

    Doctors in such positions have massive influence and can apply pressure in ways that wouldn't be credible with a lay manager, but it's no carte blanche to bully NHS colleagues and it IS a professional issue as long as they're registered to practice and employed in posts where their clinical knowledge is required. There's no point at which a doctor under such circumstances ceases to be responsible for their professional conduct, irrespective of the JD.

    I welcome this step and wish that the hopeless NMC could tackle some of the issues involving RN directors and commissioners.

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  • Stella's (3.16) comments in particular highlight that we appear to be moving to a position where managers will be held to different standards of conduct, depending on their professional background and registration.

    This must be bound to put off clinicians considering a management career.

    There should be a single consistent code of conduct for managers and some regulatory mechanism which doesn't rely on the vagaries of the stance taken by clinical regulatory bodies.

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  • Anonymous | 25-Sep-2012 3:37 pm

    I hear what you say, but while the very senior posts specify clinicians or draw heavily on their background knowledge, they should maintain a dual accountability to their profession and to their employer.

    Managers who don't have clinical registration are still responsible for what they do and should be answerable for their conduct as such to their employers and perhaps in law too. But we ask more of clinicians because they will bring a different & particular set of skills to management. They shouldn't be able to dodge either of their responsibilities. Yes, professional bodies are sometimes pretty hopeless at this, but that's another problem altogether.

    I agree about making non-clinical managers accountable to some code of conduct, but given their diverse backgrounds & values, how would you do this? Seem to vaguely remember Ken Jarrould having a go at this in the past....

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  • I strongly suspect that Robert Francis may have something to say about holding senior leaders to account when he finally submits his report on Mid Staffs.

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  • Stella, I fully support your view that clinicians must remain answerable to their professional bodies for their decisions taken in a managerial/commissioning role. If this basic principle is lost then there really is no point in having them in commissioning at all. This will become even more important as Nicholson challenge round 2 starts to bite

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  • Plenty of non-clinical managers have codes of conduct enforced by professional bodies, most obviously in finance.

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  • I hope she is treated with the same respect,empathy and tolerance she has shown to so many people who worked in her SHA

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  • Phil Hammond

    The evidence in this case has not been heard in public because of the super-gag imposed on Gary Walker by lawyers acting for the NHS at his employment tribunal (http://drphilhammond.com/blog/2011/11/09/private-eye/medicine-balls-private-eye-issue-1301-november-9-2011/).

    In referring the matter to the GMC, I am hoping that the gag will not apply and that Mr Walker will be able to speak freely and openly, although this is by no means certain given the effort and legal expense the NHS goes to in silencing whistleblowers. It is legal debate as a result of the gag that has delayed this action.

    I have made three referrals to the GMC about doctors in management positions failing to act appropriately to support whistleblowers and prevent patients suffering avoidable harm. This is my duty as a doctor, and I too would be liable to referral if I did not act. One case was rejected, although the doctor was criticised by an independent inquiry and left his post. Two are ongoing. The orignial Gary Walker story is available here http://drphilhammond.com/blog/wp-content/uploads/2010/07/Shoot_the_Mesenger_FINAL.pdf

    I make no judgement on the outcome, other than to say people in positions of such authority need to be held to account in public when such serious allegations are made.

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  • one wonders if Messers Nicholson and Flory are slightly nervous about this move by the GMC....

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