Date: 7 April 2015

Dear Mr Barnard
Re: Complaint against Dr Hakin
I write in response to your letter of 1 April 2015 in which you confirm that the GMC
will be undertaking a review of the 'patient safety' aspects of the original complaint
because the original review "may have been materially flawed" and that a "review is
necessary for the protection of the public or otherwise necessary in the public
interest."
In your letter you mentioned my Judicial Review application. I note that the Assistant
Registrar's review, while mentioning the issues raised in the application, did not
address them.
In paragraph 57 of the Assistant Registrar's decision she states that "there were no
substantial conflicts of evidence" between the evidence given by Dr Hakin and the
claims made by Dr Hammond, Mr Bousfield, me, Professor Hands and Mr Bowles.
This is evidently not the case. Notwithstanding that no one outside of the GMC has
seen Dr Hakin's evidence the comments made by the case examiners were in direct
conflict with the facts and the allegations. So polarised were the views between the
parties that there can be no question they were disputed. To claim otherwise is
preposterous. It may also be the case that Dr Hakin has misled the GMC and I am
surprised the GMC is not reviewing that matter. Here are just a few examples of how
the evidence was in dispute:
1. Dr Hakin claimed there was no let out clause for targets when there plainly is
as provided by a national contract.
2. Dr Hakin claimed that a capacity review was not possible when in fact the
criteria had been met in 2008 and 2009 (although matters in 2009 were not
put to Hakin presumably because the GMC did not understand the issues or
the allegations prior to summarising them in Rule 7).
3. Dr Hakin claimed she did not refuse a capacity review when she did and in
any case one was never carried out.
4. Dr Hakin claimed patients did not come to harm when they did (but the test is
not did patients come to harm but did Dr Hakin meet the standards required
of any doctor for example to "make the care of your patient your first concern"
- there is copious evidence Dr Hakin did not meet the very first standard in
Duties of a doctor1).
5. Dr Hakin claimed there was "nothing different" about Lincolnshire and yet
omitted to tell the GMC that she personally authorised 8million to be spent
on 4 additional prefabricated wards to be urgently assembled and put in place
to make services safe.
There are many other points I would challenge in the Assistant Registrar's findings
since they appear to accept many points as fact while at the same time accepting
that because of the possible material flaw they cannot be relied upon. The purpose of
this letter is, however, to ask you to please clarify several matters relating to the
documents you sent last week:
Discrepancies between the Assistant Registrar's decision and your letter

1 http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp

Your letter refers to a review under Rule 12 limited to "Paragraphs 3. (f) & (g) and the
whole of paragraph 5 as put to Dr Hakin at Rule 7". The Assistant Registrar's
decision refers to Paragraph 3. (h) not (g).
Could you clarify which are the correct paragraphs and sections of Rule 7 document
that are being explored in the new review?
The Assistant Registrar's omission of patient safety issues as set out in the
Rule 7 document
This is the first occasion I have seen the issues put to Dr Hakin in the Rule 7
document. This document contains a number of discrepancies and omissions from
the original complaint. Notwithstanding these concerns, which I detail below, my first
concern is that there are aspects of the Rule 7 document that describe patient safety
concerns which are not included in the GMC's new review. For example, the
following paragraph from Rule 7 is omitted in the new review:
"(i) On 9 April 2009 you met with Mr Walker, and in response to Mr Walker
raising serious patient safety concerns you told him that his career would be
in tatters and you would not be able to save him or words to that effect if he
continued in his current post,"
This meeting was self-evidently one where patient safety was discussed but which
the Assistant Registrar has omitted from the terms of the new review.
Can you explain why the events on 9 April 2009 (included in the Rule 7 document)
and any others have been excluded in the new review?
Discrepancies between the original complaint and the Rule 7 document
The Rule 7 document excludes a number of allegations made Dr Hammond and Mr
Bousfield in their original complaint to the GMC on 29 June 2012. The following is an
example of those allegations omitted:
"On 18th February 2009 Dr Hakin in conversation with Dawne Bloodworth,
the Director of Operations at ULHT, made comments to Ms Bloodworth which
were interpreted as threats that if Ms Bloodworth did not deliver the targets,
the jobs of the management team would be at risk [Annexe 1]. We also hold
documents which show that Dr Hakin has confirmed that this email is an
accurate description of the conversation."
I understand Ms Bloodworth would not provide further evidence to the GMC because
she continued to fear reprisals. Further, I understand no attempt was made to
support Ms Bloodworth and it would appear the GMC were quick to remove this
aspect of the complaint despite the fact Dr Hakin did not dispute it in her evidence to
an employment tribunal. This omission is deeply disturbing, as it tends to show a
repeated pattern of behaviour by Dr Hakin in threatening the safety of patients. It also
demonstrates how little insight Dr Hakin had into her own adverse conduct which is
central to the matters of the original referral and central to the issues of patient
safety.
Irrespective of Ms Bloodworth's position the GMC should have included this in the
original review and certainly should do so now. The GMC does not require evidence
from dead or reluctant patients in pursuing claims against Doctors. The GMC ought

to have treated Dr Hakin in the same manner and should not have been treated this
particular doctor more favourably than others by removing the allegation.
This allegation is also completed omitted from the Rule 7 document and is central to
the complaint about Dr Hakin's wilful disregard of patient safety:
"In May 2009 Dr Hakin refused to heed the warning of her own staff that
United Lincoln Hospital was suffering an outlier problem, i.e. patients being
treated in non appropriate wards because of over capacity [Annexe 2]. Dr
Hakin also refused to allow United Lincoln Trust to invoke the well-known
"overfull" provision within the Payments By Results Code of Conduct which
allows suspension of targets whilst a capacity review is carried out."
There is no mention of Dr Hakin's attempts to prevent a mortality study, which is also
central to the allegations of Dr Hakin's attempts to put patients at risk and cover it up
as set out by Dr Hammond below and supported by my witness evidence:
"It is also notable that Mr Walker appears to have angered Dr Hakin by
suggesting commissioning a mortality study in A&E. Many members of the
public would believe this to be good practice to be commended."
This list is not exhaustive. There are further examples of complaints raised by Dr
Hammond and Mr Bousfield including all the events from July 2009 to March 2010
that are entirely omitted from the Rule 7 document. This period in particular covers
the impact of Dr Hakin's actions and adverse comments from at least four doctors.
There is no explanation as to why the Rule 7 document selected some aspects of
patient safety allegations and not others. Anyone comparing the original complaint to
the Rule 7 document would be hard placed to reconcile the two. In any case, the
allegations in Rule 7 do not reflect the original complaint and in these circumstances
the process appears to be deeply flawed from the outset. It must be wrong that
allegations made by Dr Hammond and Mr Bousfield that were supported by my
evidence were not put to Dr Hakin under Rule 7. It is evident that the GMC sought to
water-down the original complaint for reasons unknown. The effect of which has
been to treat Dr Hakin far more favourably than other doctors.
Can you clarify why the Rule 7 document does not include a substantial number of
allegations put to the GMC by Dr Hammond and Mr Bousfield?
Can you also clarify why the Assistant Registrar does not comment on the many
inconsistencies and omissions from the original complaint?
Discrepancies between the Rule 7 document and my witness statement
While omitting a number of allegations from the original complaint, the list set out in
the Rule 7 document does, in fact, include a number of additional allegations not
included in the original complaint. At least some of these allegations appear to come
from my statement to the GMC in June 2013. However, not all of the allegations I
make relating to patient safety are included. For example the following is omitted and
nothing is mentioned in the Rule 7 Document:
"79.
On 29 June 2009, I was then due to meet Dr Hakin again. I had, in a
letter, which I now attach and produce as Exhibit GW/32, provided Dr Hakin
with a list of things I wanted to discuss, but we didn't really talk about any of

them. She wasn't interested in what I had to say, and got angry when I raised
concerns about patient safety.
Additionally, written proof of Dr Hakin's demands to hit targets regardless of
demands was omitted:
"112. A few days after the Goodwin Review was finalised, the SHA released
further documents to David Bowles, following a Freedom of Information
request that he had made several months previously. The documents
included an annotated copy of an email from Avril Johns to John Brigstocke,
dated 20 April and copying in Dr Hakin, regarding David Bowles' draft
objectives for 2009/2010. Those objectives included delivery of the 18 week
target, subject to demand management. Dr Hakin had annotated the email:
"Main things about DB objectives that worry me: (1) Need to meet targets
whatever demand". For the reasons previously stated this is a dangerous
instruction to have been made by Dr Hakin, which is in direct conflict with
patient safety.
No allegations about the effect of Dr Hakin's actions on the increased risk to patients
or the increased mortality that followed were listed in the Rule 7 document. Indeed
no allegations after July 2009 appear to have been investigated despite sufficient
evidence and a request to do so by Dr Hammond and myself. This is represents a
fundamental error in the procedure that the GMC simply did not put all the allegations
to Dr Hakin or the case examiners.
While the case examiners say they considered "all the evidence" they clearly did not
understand all the evidence since they had no external expert opinion but more
importantly they set their limited understanding against an even more limited version
of the allegations prepared by the GMC.
Can you clarify why the Rule 7 document included some of the allegations I made
against Dr Hakin regarding her disregard for patient safety and why others were
excluded?
Could you clarify why the Assistant Registrar has not commented on the fact the
Rule 7 document is so at odds with the allegations, and Case Examiners so
constrained by their lack of knowledge about patient safety and the protections
afforded in the NHS contract and of the full details of the complaint, that the GMC
could in no manner claim to have investigated the allegations? And with that
understanding why did the Assistant Registrar not recommend that the GMC
commence a new investigation into all the allegations?
As matters stand it would appear the GMC have deliberately or otherwise altered
without good reason the allegations in such a way as to play down or weaken those
allegations. The effect of which was to make it impossible for the case examiners to
ever reach a negative decision in respect of Dr Hakin. In other words, to protect Dr
Hakin.
I should remind you that in my interview with the GMC the legal officer said at the
end of that interview she considered that Dr Hakin had a case to answer.
Immediately after this meeting the Rule 7 document was written removing most of
the allegations made by Dr Hammond, Mr Bousfield and myself. I assume it also
excludes claims by Professor Hands and Mr Bowles.
Conclusion

The comments I make above are limited to matters of patient safety. There are a
considerable number of additional omissions relating to the allegations of misconduct
that have not been investigated by the GMC. By failing to examine all the issues, Dr
Hakin has been allowed to put patients at risk, something most Doctors would not
find acceptable or expect to get away with. Dr Hakin appears to have been treated
more favourably than other doctors, which is completely unacceptable.
The only conclusion that can be reached as to why so many allegations were omitted
is that either the GMC acted so incompetently as to ignore the majority of the claims
in front of them or more likely the GMC wanted to water down the charges against
one of the most senior doctors in the United Kingdom. Either way the effect must be
that the case as put by Dr Hammond and others was not put to Dr Hakin or the case
examiners and this must render the entire process void.
Given the issues raised in this letter and by the GMC failing to carryout a
professional and proper investigation into all the matters raised in the original
complaint and the allegations and concerns raised by witnesses how can any
reasonable member of the public be reassured that the GMC is protecting patients?
If it would assist the GMC, I continue to offer to meet with you to discuss how to take
this matter forward. The test that Dr Hakin must face is whether she made patient
safety her number one priority. The evidence the GMC had before it was
comprehensive and against Dr Hakin. The Rule 7 document prevented a majority of
that evidence from being assessed. The current review of patient safety in being
limited to only the areas mentioned at the head of this letter will not correct the
underlying error. The GMC must widen the issues to look at all patient safety issues.
As I submitted in my Judicial Review application Dr Hakin may well have misled the
GMC in any number of her responses. This must also be addressed.
I look forward to your urgent reply since the issues in this letter must be resolved
before the appointment of an independent external expert in patient safety.
Yours sincerely

Gary Walker