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EXCLUSIVE: Hakin cleared of bullying and endangering patient safety

NHS England’s interim deputy chief executive Dame Barbara Hakin has been cleared of acting in a “bullying” and unprofessional manner by the General Medical Council, HSJ can reveal.

Dame Barbara – who is also the organisation’s chief operating officer – was accused of disregarding patient safety in a drive to ensure trusts met performance targets during her time as chief executive of the East Midlands Strategic Health Authority in 2009.

However, following a year-long investigation into 17 separate allegations, GMC case examiners ruled the case should be closed as there was no realistic prospect of finding Dame Barbara’s fitness to practise as a doctor was impaired in relation to any of the claims.

Barbara Hakin

The GMC found “insufficient evidence” of bullying by Barbara Hakin

The allegations were made by Private Eye journalists Andrew Bousfield and Phil Hammond and relate mainly to Dame Barbara’s treatment of former United Lincolnshire Hospitals Trust chief executive Gary Walker.

In a document explaining the reasoning behind the decision, seen by HSJ, the case examiners state: “It is clear there were frank exchanges of views about the trust’s performance [between Dame Barbara and Mr Walker]. A fitness to practise panel would be bound to make due allowance for the robustness of conversations which may need to take place between senior and experienced managers in these circumstances… we found insufficient evidence that this amounted to bullying or unprofessional behaviour.”

The case examiners, one of whom is from a medical background and one from a lay background, also found “no evidence that Dr Hakin’s conduct put patients at risk” and noted she had taken steps to assure herself that patient safety was a priority at the trust through an external review.

They supported Dame Barbara’s argument that the trade-off between hitting targets and ensuring patient safety, as presented by Mr Walker, was a “false dichotomy”.

During an appearance before the Commons health committee earlier this year, Mr Walker told MPs that Dame Barbara had told him that if he did not resign from the trust his “career would be tatters” and suggested he construct a story to tell his chair that he had decided to leave voluntarily.

In her evidence to the GMC, Dame Barbara acknowledged she had said it would be “detrimental” to Mr Walker’s career if he continued in a job which was beyond his capabilities but said this was intended to be “supportive” advice. She said it was Mr Walker’s decision to construct a story to tell his chair and she had merely indicated she would not “go out of her way to contradict him”.

The case examiners concluded these allegations would come down to a case of Mr Walker’s word against Dame Barbara’s if considered by a GMC fitness to practise panel. It added that the NHS England director’s account was “more credible”.

They said: “Even assuming Mr Walker’s account is preferred (which we doubt), we are doubtful that this allegation crosses the threshold of bullying or that impairment would be found, particularly in the absence of evidence to demonstrate that patient safety was at risk… Advice, even if bluntly given, that continued failure to meet targets in these circumstances would put a chief executive’s career in jeopardy could hardly have been unexpected.”

The GMC investigation found “some support” for the core allegation, that Dame Barbara told Mr Walker the four hour accident and emergency and 18 week waiting time targets must be met despite his concerns that to do so could compromise patient safety. However, they noted she denies Mr Walker raised any concerns about patient safety and, crucially, there was no evidence that patient safety was at risk.

Mr Bouncefield and Dr Hammond also alleged that an email sent to all East Midlands chief executives in March 2009 implied the consequences of less than 99 per cent compliance with the four hour A&E target would be “considerable and personal”.

However, the case examiners found a “plain reading of the email” did not support Mr Walker’s suggestion that “it meant there would be unjustified personal consequences to him if his trust did not achieve its targets”.

Readers' comments (21)

  • Well, what a surprise.

    I'd have eaten my hat if the GMC held such a senior person to account.

    As in other recent cases, the GMC gives the impression it is happy to shoot foot soldier doctors but wont tackle the generals.

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  • When will the NHS start to tackle this inappropriate behaviour, which may not be 'bullying' under the definition.

    It is not developing an open, transparent and supportive culture. Have we really learned from the Francis report?

    You just have to look at the Staff Attitude Survey figures last year to see that this is a real issue in the NHS. The staff have just had enough of this inappropriate behaviour, which we know affects patient care and quality.

    Its time for a culture change for real!

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  • When is a bully not a bully? When the definition is manipulated to protect self interested groups.
    The reality of managing services under a period of severe austerity, with real terms cuts in funding makes this type of behaviour quite normal in very abnormal circumstances.
    Politicians are setting up managers and clinicians to fail based on an ideologically driven agenda.

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  • The Chairperson of EMSHA Vice-Admiral Sir John Brigstock was the man behind of all of this, doubtless instructed Dr. Hakin in exactly what to say, yes his name seems to be suppressed.

    Everyone knows bullying is endemic in the NHS space and this is yet another failure to tackle it. NHS England and the CQC are world-class at bullying if little else.

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  • I think her fitness for practice as an NHS manager remains in doubt.

    Medical practice wasn't quite the issue, neither was competence. This is a troubling issue of character.

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  • The GMC are not fools. After a year long investigation they have found no substance to these claims. Why are people so quick to suggest that they are wrong?

    It is very easy to throw mud and have trial by media with only one side of the story being told, but what chance does a falsely accused person have when even after the disciplinary process has exonerated them, they are still abused.

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  • The GMC is there to ensure good conduct in medical practice, not management. The allegations appear to relate to management.

    The GMC will have taken a very correct MEDICAL line on this. But is it really the point?

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  • Not quite Anon 3:13.

    See: GMC's 'Leadership and management for all doctors' http://www.gmc-uk.org/guidance/ethical_guidance/management_for_doctors.asp

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  • I sometimes wonder how we survived in senior management posts 30 to 40 years ago.

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  • ...Or it could just be that the GMC is correct, that Barbara Hakin was (is) simply a very tough manager who doesn't mince her words, and that Gary Walker has very effectively played the victim throughout...

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  • I'd agree with Anon 5.13pm. CEOs and Exec Teams in the patch were robustly held to account. Delivery whether on performance or finance wasn't optional, you were expected to deliver all commitments. Never was patient safety or quality expected to be compromised, it wasn't an either/or with performance. Quarterly reviews with the SHA were tough in tone but entirely reasonable. And yes, the accountability was personal, not just organisational. If you take the salary, you should expect accountability.

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  • I don’t know Dame Barbara Hakin, I don’t know Mr Gary Walker, I didn’t witness the exchanges that led to the allegations, neither do I have all the facts upon which the GMC investigators have based their findings; yet, just excerpts quoted in this post by HSJ makes the investigators’ findings appear frustratingly implausible. Armed with just these few quotes (which seem irrefutably sufficient to make a robust judgment) NHS leaders appear once again to be proving themselves immature and in need of a strong political leadership to deliver in the interest of patients.

    Firstly we are told here that “Dame Barbara acknowledged she had said it would be “detrimental” to Mr Walker’s career if he continued in a job which was beyond his capabilities but said this was intended to be “supportive” advice.” Now, the job of investigators is to weigh the plausibility of evidence, and determine findings on the balance of probabilities – i.e. what is more likely than not. Can investigators honestly and reasonably find that Ms Hakin’s assertion as stated above is remotely supportive not only on the face of it, but in view of the fact that a capability procedure appears never to have been invoked at any time in all of this? Certainly, if there were serious concerns about any employee’s capability CEO or not, a capability procedure was not only the credible but also fair way to go (with a view to giving the employee the chance to improve), wasn’t it? Certainly in these circumstances, a vocalized suggestion that an employee may be better off out of their job than staying on (an that is putting it Ms Hakin’s version of events)without having given them a formal and mutually agreed opportunity to improve, is anything but “supportive” and in fact nothing short of unprofessional, and bullish?

    Then we are told that the GMC investigators’ view was that: “these allegations would come down to a case of Mr Walker’s word against Dame Barbara’s if considered by a GMC fitness to practise panel. It added that the NHS England director’s account was “more credible”.” Now I call on honest and decent leaders in this community to judge, which of these accounts on the face of it, and from ordinary human experience is more credible than the other:
    Hakin: “acknowledged she had said it would be “detrimental” to Mr Walker’s career if he continued in a job which was beyond his capabilities but said this was intended to be “supportive” advice. She said it was Mr Walker’s decision to construct a story to tell his chair and she had merely indicated she would not “go out of her way to contradict him”.”
    Walker: “told MPs that Dame Barbara had told him that if he did not resign from the trust his “career would be in tatters” and suggested he construct a story to tell his chair that he had decided to leave voluntarily.”
    If the majority of earlier comments are anything to go by, we already have a decisive vote for what is otherwise decently obvious.

    Then in addition the GMC investigators found: “Even assuming Mr Walker’s account is preferred (which we doubt), we are doubtful that this allegation crosses the threshold of bullying or that impairment would be found, particularly in the absence of evidence to demonstrate that patient safety was at risk…” A CEO, after clearly articulating his concern for patient safety, is instructed to meet targets regardless or lose his job, as his patient safety against targets concern is seen as false dichotomy. No facts are provided as to why Mr Walker’s concerns were seen as false dichotomy in the particular circumstance; but we know all too well from Mid Staff that desperate resolve to meet targets undoubtedly created catastrophic patient safety incidents. Again, without a capability procedure having been operated how were the investigators able to find no risks were posed to patient safety? Hope anyone with the slightest facts supporting the investigators conclusion would share them please.

    I know next to nothing about the facts of this matter as earlier declared, but there are far too many cases in the NHS where a deliberately botched investigation has been conducted, and ranks have been closed yet again simply to preserve an ongoing bullying culture – and this smells (on the face of it) like one of such investigations.

    Whilst I am a strong advocate of leadership capability (and that includes being reasonably able to deliver on targets as well as quality) that should not provide an excuse for superiors to bully subordinates. If an employee is not delivering to contractual expectation, a robust capability procedure must be employed to address this. Failure of a superior to do so deprives a subsequent detrimental action to the employee of any valid legitimacy. It does not matter the seniority of the superior concerned. Management actions fallen short of the required standards must be identified as such by investigating NHS leaders. Otherwise, we will continue to keep a bullying culture alive and active in the NHS, putting patients safety at risk, and making ourselves appear to the general public and politicians as unworthy of trust to run a world class National Health Service.

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  • Reading the piece, following a year of scandal and shocking revelations about nothing less than killing fields across the NHS especially of older citizens shames the GMC and Ms Hakin.

    there is a lack of logic between the decision reported in the HSJ and the Francis Reports clear evidence of just such killing fields.

    The real question for the GMC to answer is the one of public confidence in Ms. Hakin either as a medical practitioner or a manager.

    If the GMC does not have the courage or to ask that question then Ms Hakin should ask it of herself. after all she claims high office with its moral responsibility.

    The very act of doing so by either party would demonstrate the very confidence in both which is currently lacking.

    the report in the HSJ shatters confidence in both and adds to a growing public awareness of powerful elites such as MS Hakin and the GMC contemptuous of the public and their welfare. one only has to see the growing public anger with utilities, banks and such as NHS elites.

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  • Those who would like to see the full GMC report can do so by clicking on the 'Read the GMC's Hakin decision in full' link under the 'Related Articles' section towards the top of the page.

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  • Barbara Hakin is a tough manager and leader who expects nothing but the best because it matters for patients.

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  • I don't doubt it anon 9.03. The end clearly justifies the means eh ?

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  • Read the report, it seems to be gaps in evidence and people declining to give or supply evidence which led to the verdict. Difficult position GW was in trying to survive the pressure, which meant his responses and documentation are tempered by this survival instinct. I hope BH takes it as a warning not to do this again and she'll have her concience to answer to.

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  • I have now read the report, and I'm afraid to say there was a lot of what appears like simply going through the motions, but ensuring the outcome only led to one favoured conclusion. There were a number of pointers to such inclination in the report: such as confirming for instance, that the trust did have capacity problems, and yet insisting it should have been able to cope with increased demands without showing how this would be possible in the circumstance. The report also kept referring to reviews conducted by various external bodies post events suggesting there were no serious patient safety issues in the Trust, as evidence that Dame Hakin's insistence that targets be met posed to patient safety risk.

    It seems the investigators failed to recognise the patient safety risks were inherent in the overriding pressure to meet targets, and not the reality at the frontline afterwards particularly when the CEO had in fact resisted such offending pressure. Worse still was the fact that when the CEO and Chairman then presented evidence from frontline staff of patient safety and mortality issues, they rejected this saying it had no causal link with Ms Hakin's pressures. Seems hypocritical then for the GMC investigators to attach so much relevance to external reviews of the trust, as the causal link rebuttal might just as well apply, had the external reviews including CQC's confirmed patient safety problems.

    If NHS leaders continue to act without integrity, and to indulge the management bullying culture at high costs to patients and staff, they should be under no illusions that the Francis proposed criminal liability for serious harm or death to patients would be more than justified in these circumstances.

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  • Dont we love a victim.... perhaps important roles require grown up robust conversations - without such the NHS certainly has not go a hope. If you cant stand the heat get out of the kitchen.

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  • Posted on page with full report but perhaps more relevant here

    Wow. Astonishing reading for many reasons, including the GMC case handler's apparent ability to consider some written evidence (a formal letter from the Trust Chair) as 'hearsay', while also considering conjecture from another CEO as strong enough to be used to dismiss an allegation without a proper test.

    But more interesting is the exposure of the culture at that SHA at the time. An email requiring the A&E target to be met 100% of the time at all Trusts over a number of weeks is included. I wonder if Dr Hakin truly believed that was possible to achieve. Not a single breach for clinical or operational reasons for days on end? At every Trust? Really? And without compromising elective activity and meeting the 18W target?

    My reading of that email was that it was asking Trusts to ensure that the *recorded achievement* was 100%, regardless of the facts on the ground. Of course that is not clearly stated but those of us who have worked in organisations who wanted to achieve targets in a similar fashion will recognise the style. The unwritten instructions, contained in a message that allows the author to plead innocence and ignorance if a fiddle is exposed.

    I would be interested to know if Dr Hakin believes that the recorded A&E performance at her Trusts was accurate and would have stood up to independent audit during that period. And, if those same Trusts are performing less well now, why that might be - it cannot be due to system pressures, as her (and her colleagues') evidence is that the failure was down to poor management alone.

    Across the country, senior people (in Trusts and SHAs) who conspired to pressurise more junior staff to risk their careers by bending the rules knew exactly what they were doing, and they should be ashamed.

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