Waqas Ahmad

Preliminary Matters
Service
1. Notice of the hearing was sent to the Registrant by a letter sent on 22 January 2024 by email. The notice contained the information required by Rule 6(1) of the HCPC (Conduct and Competence Committee) (Procedure) Rules 2003 (“the Rules”) and gave the period of notice of 28 days as required by Rule 6(2).

2. The Panel had sight of a Certificate of Registration confirming the email address held by the HCPC for the Registrant to which the notice of hearing was sent. The Panel also had sight of a confirmation of email delivery dated 22 January 2024.

3. The Panel was satisfied that good service had taken place in accordance with the Rules.

Proceeding in absence

4. Mr Molloy on behalf of the HCPC submitted that the Panel should exercise its discretion to proceed in the Registrant’s absence, referring to Rule 11 of the Rules. Mr Molloy referred to an email which the HCPC had received from the Registrant on 8 February 2024. This was in response to an email from the Hearings Officer of the same date enquiring about the Registrant’s intentions as regards attending the hearing. In his email the Registrant stated:

‘hello hope my mail finds you well sorry i just recived ur email because here in my country the general election is going so the internet is disconnected by government so i will be unable to respond on ur email due to internet issue happen in our place i will be unable to attend my hearing but i wanna say this all thing is just a case of racism i didn’t do anything and im bot guilty in this matter its all just misunderstanding because our company didnt gave us a proper training because working in the UK is new for me and u can check i dont have anything like this in past due to this matter i suffer alott and my future is at risk please please remove these alligation from my license so i will start working again . kind regards’. [sic].

5. Mr Molloy noted that the Registrant had stated that he did not intend to be present at the hearing. The Registrant referred in his email to the internet in his country not being operational due to elections. However, Mr Molloy noted that the Registrant had replied by email and had not requested an adjournment, nor indicated that he would attend in future if one were granted. Mr Molloy referred to the Registrant’s recent history of non-engagement with the HCPC in not responding to emails. Mr Molloy submitted that in the circumstances it was in the public interest that the Panel should proceed to hear the matter in the Registrant’s absence.

6. The Panel considered the submissions on behalf of the HCPC. It accepted the advice of the Legal Assessor. The Panel referred to the HCPTS Practice Note of June 2022 on proceeding in absence and to the guidance that a hearing panel should consider in the cases of R v Jones (Anthony) [2004] 1 AC 1HL and GMC v Adeogba and GMC v Visvardis [2016] EWCA Civ 162. Applying that guidance, the Panel was careful to remember that its discretion to proceed in absence is not unfettered and must be exercised with the utmost caution and with the fairness of the hearing at the forefront of its mind.

7. The Panel considered that the Notice of Hearing dated 22 January 2024 informed the Registrant of the date and details of the Conduct and Competence Committee hearing, and of his right to attend and be represented. The Registrant was also advised of the Panel’s power to proceed with the hearing in his absence if he did not attend. He was informed of the potential consequences of non-attendance. The Panel concluded that it was clear from the Registrant’s email of 8 February 2024 that he was aware of this hearing taking place. In his email, the Registrant stated he would be unable to attend the hearing due to internet issues, but he had not provided any detail or supporting evidence, nor had he explored further with the HCPC how his remote participation in the hearing might be facilitated. The Registrant had not requested an adjournment, nor was there any indication of when he would be able to attend a hearing if the case were to be adjourned.

8. Taking the above circumstances into account, the Panel concluded that it was unlikely that an adjournment would secure the Registrant’s attendance on a future date. The Panel took the view that the Registrant had voluntarily waived his right to attend and adjourning this hearing would serve no purpose.

9. The Panel was mindful that it must also consider fairness to the HCPC and took into account the impact of an adjournment on the HCPC’s witnesses who were ready to give evidence at this hearing. Two witnesses were the Service Users who were the subject of the allegations and they had been accepted as vulnerable witnesses for the purpose of these proceedings. The Panel took into account as part of its considerations that it was in their interests for this matter to proceed today. The Panel also took into account the public interest in the expeditious resolution of these disciplinary allegations which are serious and date back to 2021. The Panel was mindful of the impact an adjournment in terms of cost and delay caused to other cases.

10. The Panel noted from the Registrant’s email of 8 February 2024 that he denied the allegations. The Panel took into account that there would be a disadvantage to the Registrant in not being present at this hearing to put forward his defence. However, the Panel concluded that the Registrant’s interest was outweighed by the public interest in resolving these allegations and by the issue of fairness to the HCPC and its witnesses. Following the guidance in the case of Adeogba, the Panel concluded that there was no good reason to adjourn the hearing and that it was in the public interest to proceed in the Registrant’s absence.

11. The Panel was reminded that in proceeding with the hearing in the Registrant’s absence, it should ensure that the hearing was as fair as circumstances permit. The Panel had noted that in his email of 8 February 2024 the Registrant denied the allegations. The Panel also accepted the advice of the Legal Assessor that it should ask questions and consider points which may be in the Registrant’s interests and which were reasonably apparent from the evidence.

Documents

12. The Panel received the HCPC hearing bundle, numbered pages 1-192 and a small bundle of correspondence concerning service. No written submissions or documents had been received from the Registrant for the purpose of the hearing, other than his email of 8 February 2024.

Background

13. The Registrant is a registered Physiotherapist who was employed by A&A Medical Limited (A&A Medical) from 13 July 2021. He worked at an A&A clinic in Newcastle.

14. Service User B and Service User C received treatment from the Registrant in July 2021. These Service Users each made a complaint to A&A Medical about the Registrant’s conduct during their treatment sessions in July 2021. The complaints were dealt with by Mrs Bernadette Curtis, Clinical Manager for A&A Medical.

15. Service User B alleged that the Registrant had acted inappropriately to her in a treatment session on 23 July 2021. Service User C alleged that the Registrant had acted inappropriately during her treatment session on 21 July 2021 and that he had acted inappropriately and communicated inappropriately with her at a treatment session on 28 July 2021. The Registrant was suspended by A&A Medical on 29 July 2021 whilst an internal investigation was undertaken.

16. On 5 August 2021, the HCPC received a referral from A&A Medical. On 14 April 2022, a panel of the Investigating Committee considered the Registrant’s case and referred it to the Conduct and Competence Committee for a final hearing.

17. At a preliminary meeting on 19 April 2023, a panel of the Conduct and Competence Committee made directions that Service Users B and C would be permitted special measures when giving evidence on the basis that they are vulnerable witnesses. Both witnesses were permitted to give their evidence to the Panel at this hearing in private.

The HCPC’s evidence
Bernadette Curtis
18. Mrs Curtis confirmed her witness statement dated 27 September 2022 and gave evidence under affirmation.

19. Mrs Curtis had worked as Clinic Manager at A&A Medical since January 2018 and she provides support to Mr. Aarons, the Clinical Director and owner of A&A Medical. Mrs Curtis confirmed that following receipt of the complaints, A&A Medical commenced an internal investigation and that she obtained records relating to the service users’ treatment at A&A Medical, which were exhibited to her witness statement.

20. Mrs Curtis confirmed that the Registrant was suspended as part of the internal investigation and a disciplinary process was commenced. Mrs Curtis submitted an employer fitness to practise referral to the HCPC.

21. In answer to questions from the Panel regarding the Registrant’s comment in his email of 8 February 2024 that he was not given training by the company, Mrs Curtis stated that she provided training in virtual sessions for all the company’s Physiotherapists. The Registrant received this training on joining A&A Medical. Mrs Curtis told the Panel that the training would comprise three or four sessions which would include dealing with incoming referrals, the company’s clinical systems, Health and Safety relating to working in a managed building, lone working and maintaining patient dignity. She told the Panel that this included the use of modesty sheets, removal of clothing and privacy, during appointments.

22. Mrs Curtis stated that all the therapists are able to contact her directly, or if there is a clinical issue, they can contact Mr Aarons, the Clinical director, who is a Physiotherapist.

23. Mrs Curtis confirmed that there are modesty sheets available in all clinic rooms. These are disposable and towels are not used for hygiene reasons. All the company’s therapists are informed that modesty sheets should be used.

24. When asked about the Registrant’s response to the allegations and whether he had shown any insight, Mrs Curtis said she had not spoken to him in person and had only received the emails which she had exhibited in her witness statement. She observed that he appeared to apologise and stated that such conduct would not occur again, but that he did not appear to show that he understood the gravity of the allegations.

25. When asked about the suggestion by the Registrant that there was an element of racism in the allegations, Mrs Curtis stated that she was 100% sure that this was not the case. She said that all the therapists who worked for A&A Medical come from overseas and are employed on a health and social care visa.

Timothy Edbrooke - Expert witness

26. Mr Edbrooke was instructed by the HCPC to provide an expert opinion in this matter. He provided a written report dated 19 January 2023.

27. Mr Edbrooke qualified as a Chartered Physiotherapist in 1990 and has practised continuously as a Chartered and State Registered Physiotherapist since that date.

28. Mr Edbrooke’s report set out his opinion on the issues relating to the Registrant’s conduct in relation to the issues referred to in the allegations in respect of Service User B and Service User C. His conclusion in respect of each particular was, in summary, that the Registrant’s conduct fell far short of the standards expected of a registered Physiotherapist.

Submissions of the HCPC
29. In his submissions on behalf of the HCPC Mr Molloy referred to the HCPC’s case summary which identified the evidence he submitted was relevant to each of the particulars and referred the Panel to the HCPC’s relevant Practice Notes.

30. Mr Molloy submitted that on the basis of the evidence presented the Panel should find the alleged facts proved and the alleged ground of misconduct established. He submitted that the Panel should conclude that the Registrant’s fitness to practise is currently impaired by reason of misconduct.

Submissions of the Registrant

31. No submissions or evidence had been received from the Registrant. The Panel bore in mind the comments in his email to the HCPC of 8 February 2024.

Decision on Facts

32. The Panel received and accepted the advice of the Legal Assessor. The Panel was reminded that the burden of proof is upon the HCPC. The standard of proof in HCPC proceedings is the civil standard, the balance of probabilities. This means in order to find a fact proved, the Panel must be satisfied it is more likely than not that it occurred.

33. In relation to the allegation in particular 5, that the conduct alleged in Particulars 1 - 4 was sexually motivated and/or sexual in nature, the Panel was referred to the HCPC Practice Note, Making Decisions on a Registrant’s State of Mind (November 2022). The Panel was reminded to consider all the guidance set out in the Practice Note, including the guidance from the cases of Basson v GMC [2018] EWHC 505 (Admin) and Haris v GMC [2021] EWCA Civ 763. These explain that in deciding whether there was sexual motivation, a panel should consider whether the conduct was done “either in pursuit of sexual gratification or in pursuit of a future sexual relationship” and that if the conduct in question is overtly sexual in nature, the absence of a plausible, innocent explanation for the conduct will invariably result in a finding of sexual motivation.

34. The Panel was reminded, as also set out in the Practice Note, that in the absence of direct evidence of sexual motivation, a panel may draw an inference from the primary evidence on the balance of probabilities, taking into account all the circumstances and considering any information as to the Registrant’s character.

35. The Panel had received no submissions or evidence from the Registrant. In considering the allegations, as a matter of fairness, the Panel bore in mind the brief comments in the Registrant’s email to the HCPC of 8 February 2024. As this was not sworn or tested evidence, the Panel concluded that very little weight could be given to it. However, the Panel had investigated whether any training had been provided to the Registrant by his employer, A&A Medical, and accepted the evidence of Mrs Curtis regarding the training sessions she provided. The Panel also asked questions of the factual witnesses regarding the Registrant’s claim that the allegations arose from racism. All the witnesses were clear that this was not the case and the Panel found no evidence to support the Registrant’s contention.

Particular 1
On or around 23 July 2021, you acted inappropriately when treating Service User B in that you:
a. did not obtain informed consent from Service User B to lower their trousers and/or underwear;
b. requested that Service User B remove their top, when this was not necessary for treatment and/or not clinically justified.

36. The Panel received the written and oral evidence of Service User B and the written accounts she provided to Mrs Curtis at A&A Medical and to the police in her police witness statement. The Panel had sight of the clinical record which was produced by Mrs Curtis and the evidence of the HCPC’s expert witness, Mr Edbrooke.

37. The Panel found Service User B to be an honest and credible witness with a clear recollection of the Registrant’s conduct as described in the particulars. Service User B confirmed she was able during the appointment on 23 July to understand clearly what the Registrant was saying to her. He was not wearing a face mask and she did not consider there were any difficulties in communication with him.

38. The Panel noted that Service User B had prepared a note for Mrs Curtis at A&A Medical of what had taken place at the appointment given close to the date of the appointment and had subsequently given a police witness statement. These statements were consistent with her account as given to the Panel. In particular, Service User B was clear in her evidence that the Registrant did not provide her with any explanation or justification for his actions and he did not seek her consent. Service User B referred to having undergone physiotherapy sessions with other practitioners for the same injury and found the Registrant’s actions to be very different. The Panel accepted Service User B’s witness statement and her oral evidence which supported the facts alleged in 1a and 1b.

39. The Panel took into account the evidence of the HCPC’s expert witness, Mr Edbrooke in respect of particular 1a, as follows:

‘Clothing sometimes needs to be moved or removed in order to expose the area to be treated and to allow the physiotherapist direct access to the skin. This is to allow for accuracy of palpation of anatomical landmarks, to facilitate “feel” when applying manual therapy techniques, and to allow the hands to move over the skin when using soft/deep tissue massage. It is my opinion that it is possible to treat the lower back without the patient removing their top, and that to ask a patient to remove clothing unnecessarily constitutes action falling far below the standard expected by a reasonable body of physiotherapists. It is my opinion that if treatment was being applied above the level of T12 (the bottom of the rib cage) it would be clinically justified to ask the patient to remove their top. It is unclear from the clinical notes and SUB’s statement how far up the back the treatment was applied.’

40. In respect of Particular 1b, Mr Edbrooke’s opinion was that it is possible to treat the lower back without the patient removing their top, and that to ask a patient to remove clothing unnecessarily constitutes action falling far below the standard expected by a reasonable body of physiotherapists.

41. The Panel took into account Mr Edbrooke’s evidence relating to his review of the clinical record relating to Service User B and also reviewed the record itself. The Panel concluded that there was no evidence of any assessment having been undertaken by the Registrant, nor any record of any clinical justification for his actions. There was no record of the treatment given or of his having sought or obtained Service User’s B’s consent to his action in 1a, in lowering and removing her trousers.

42. The Panel was satisfied having taken all these matters into account that the Registrant’s conduct in relation to Particulars 1a and 1b was inappropriate and not consistent with the standards expected of registered Physiotherapists. The Panel was satisfied that the facts of Particulars 1a and b were proved on the balance of probabilities.

Particular 2
On or around 21 July 2021, you acted inappropriately when treating Service User C in that you asked Service User C to remove their sports bra during the consultation which was not necessary for treatment and/or not clinically justified.

43. The Panel received the written and oral evidence of Service User C and the written account she provided at the request of Mrs Curtis at A&A Medical when she raised her concerns. The Panel had sight of the clinical record produced by Mrs Curtis and the evidence of the HCPC’s expert witness, Mr Edbrooke.

44. The Panel found Service User C to be an honest and credible witness who gave a clear account of her two appointments with the Registrant in July 2021. The account she gave to the Panel was consistent with the account in the notes she prepared for Mrs Curtis at the time she reported her concerns in July 2021.

45. Service User C confirmed she was able to understand clearly what the Registrant was saying to her and there were no difficulties in communicating with him. She was clear that the Registrant did not give any rationale for asking her to remove her sports bra during the consultation. The Panel accepted Service User C’s witness statement and her oral evidence which supported the facts alleged.

46. The Panel accepted the opinion of Mr Edbrooke who stated:

‘There is no indication in the clinical notes that SUC was complaining of pain in the area of her back likely to be covered by a sports bra. It is therefore my opinion that there was no indication of a need to remove her bra, and that asking SUC to remove her bra was unnecessary and inappropriate, and as such constitutes action falling far below the standard expected by a reasonable body of physiotherapists.’

47. The Panel noted that from the clinical record there was no documented justification for the request to remove Service User C’s sports bra.

48. The Panel was satisfied having taken all these matters into account that the Registrant’s conduct in relation to Particular 2 was inappropriate and not consistent with the standards expected of registered Physiotherapists. The Panel was satisfied that the facts of Particular 2 were proved on the balance of probabilities.

Particular 3
On or around 28 July 2021, you communicated inappropriately with Service User C in that you:
a. told Service User C that they were ‘beautiful’ or words to that effect;
b. told Service User C that they had ‘nice boobs’ or words to that effect;
c. asked Service User C about their personal relationships;
d. asked whether Service User C would provide ‘special treatment’ to you if you attended hospital, or words to that effect.

49. The Panel accepted the evidence of Service User C which was clear and consistent. Service User C confirmed she was able to understand clearly what the Registrant was saying to her and there were no difficulties in communicating with him. The Panel accepted Service User C’s witness statement and her oral evidence which supported the facts alleged.

50. In considering whether the comments referred to in Particulars 3a to d were inappropriate as alleged, the Panel accepted the opinion of Mr Edbrooke who stated in his report:

‘In my opinion, to make comments about a service user’s body, particularly when those comments are suggestive and/or sexualised, constitutes action falling far below the standard expected by a reasonable body of physiotherapists’.

51. The Panel considered that Service User C found herself in a vulnerable position as a patient receiving treatment and in a state of undress. She described how she was made to feel uncomfortable. In the view of the Panel, the comments referred to in Particulars 3a, b and c were personal and sexualised comments about the Service User’s appearance and about her personal relationships. They had no relevance to the treatment she should have been receiving from the Registrant and there was no clinical justification for such comments in a professional healthcare setting. The Panel had no doubt that these comments were inappropriate.

52. In relation to Particular 3d, the Registrant appeared to suggest that Service User C might provide “special” treatment to him in her role as a registered nurse. The Panel concluded that these words formed part of the pattern of inappropriate comments to Service User C during this session. They had a suggestive connotation which was inappropriate in a professional healthcare setting.

53. The Panel was satisfied that the facts of Particular 3 were proved on the balance of probabilities.

Particular 4

54. In relation to all the sub-paragraphs of Particular 4, the Panel accepted the evidence of Service User C as to what had taken place in the treatment session on 28 July 2021. It found her evidence clear, consistent and credible. The Panel also accepted the expert evidence of Mr Edbrooke.

55. Further in relation to the individual sub-particulars:

On or around 28 July 2021, you acted inappropriately when treating Service User C in that you:

a. asked Service User C to remove their trousers when this was not necessary for treatment and/or not clinically justified;

56. The Panel noted Service User C’s evidence that the Registrant asked to move her trousers down to her knees and that he commented that her trousers were tight. However, the Registrant proceed to take off her trousers entirely without informing her or seeking her consent or providing any rationale. The clinical note contained no reference to the Registrant’s actions, nor any record of any clinical justification.

57. The Panel accepted the opinion of Mr Edbrooke that:

‘It is my opinion that to remove a patient’s trousers in the circumstances described by SUC would have been unnecessary because the areas to be treated could be exposed without doing so, and there was no plan to move SUC through a range of movement in which clothing would be a restricting factor. The removal of SUC’s trousers would therefore constitute action falling far below the standard expected by a reasonable body of physiotherapists.’

b) did not afford privacy to Service User C when they were removing their trousers;

58. Service User C’s evidence was that she was not offered any privacy or dignity measures throughout the treatment session. The Panel heard from Mrs Curtis that training about privacy and dignity issues was provided to the Registrant. She also stated that disposable privacy sheets were available in the company’s clinic rooms.

59. The Panel accepted the opinion of Mr Edbrooke that:

‘It is my opinion that a service user should be provided with sufficient covering to maintain their modesty, whilst acknowledging that a degree of exposure is necessary when applying manual therapy techniques, electrotherapy, or carrying out an examination that requires freedom of movement that is inhibited by clothing. If clothing has to be removed exposing the patient, alternative covering such as a towel should be provided to maintain modesty as far as possible. If the Registrant failed to maintain SUC’s dignity by exposing her unnecessarily, or by failing to provide a towel of sheet to maintain her modesty, his action would fall far below the standard expected by a reasonable body of physiotherapists.’

c. massaged Service User C’s arms, legs, in between her legs and around her buttocks when this was not necessary for treatment and/or not clinically justified.

60. The Panel accepted the evidence of Service User C. The Panel heard of the embarrassment and distress Service User C experienced by the touching of such intimate and sensitive areas without her consent. The Panel also concluded there was no clinical justification for this touching. The Panel accepted the opinion of Mr Edbrooke that:

‘There is no indication in the clinical notes that SUC was complaining of arm, leg, or gluteal pain, and massage of the areas listed is not indicated in a service user complaining of low back and/or neck pain following an RTA. It is therefore my opinion that this treatment was not justified, and that to provide a treatment that is not clinically justified, particularly of an area that might be viewed as ‘intimate’, would constitute action falling far below the standard expected by a reasonable body of physiotherapists.’

61. The Panel noted that from the clinical record there was no documented justification for the massaging of Service User C’s “arms, legs, in between her legs and around her buttocks”.

d. on one or more occasion, adjusted Service User C’s underwear without obtaining informed consent to do so and/or when this was not necessary for treatment and/or not clinically justified;

62. The Panel accepted the evidence of Service User C. It accepted the opinion of Mr Edbrooke, as follows:

‘It is my opinion that to adjust a service user’s underwear without consent, or to do so when it was not clinically justified, would constitute action falling far below the standard expected by a reasonable body of physiotherapists.’

e. adjusted and/or unhooked Service User C’s bra without obtaining Service User C’s informed consent;

63. The Panel accepted the evidence of Service User C. It took into account the opinion of Mr Edbrooke but noted that Service User C’s evidence was that the Registrant had not told her what he was going to do or sought her permission. Mr Edbrooke stated:

‘Clothing sometimes needs to be moved or removed in order to expose the area to be treated and to allow the physiotherapist direct access to the skin. This is to allow for accuracy of palpation of anatomical landmarks, to facilitate “feel” when applying manual therapy techniques, and to allow the hands to move over the skin when using soft/deep tissue massage.

It is my opinion that some women, particularly when lying prone, find it difficult to undo their bra. Under such circumstances it is reasonable for a physiotherapist to offer to undo it, and to do so with permission.’

f. did not afford adequate and/or any privacy to Service User C when they were putting their top and/or bra back on;

64. The Panel accepted the evidence of Service User C. It accepted the opinion of Mr Edbrooke, as follows:

‘It is my opinion that if he failed to give SUC adequate space and privacy, and watched her dressing, this constitutes action falling far below the standards expected by a reasonable body of physiotherapists.’

65. The Panel noted that in Service User C evidence that the Registrant stared at her while she was getting dressed and how uncomfortable that made her feel.

g. offered to fasten and/or fastened Service User C’s bra.

66. The Panel accepted the evidence of Service User C. It noted the opinion of Mr Edbrooke, as follows:

‘It is my opinion that some women, particularly when lying prone, find it difficult to refasten their bra or to maintain modesty whilst doing so. Under such circumstances it is reasonable for a physiotherapist to offer to refasten it, and to do so with permission. It is not clear from the documentation whether SUC found it difficult to fasten her bra, and it is therefore not possible for me to opine on whether it was appropriate for the Registrant to offer to do so for her.’

67. The Panel concluded there could be circumstances where it would be appropriate for a Physiotherapist to offer to assist a service user in this way, for example if their mobility was restricted. However, in this case the Panel heard from Service User C that the reason why she was struggling to fasten her bra, (which was undone without her consent) was because she was flustered because the Registrant was staring at her while she was trying to dress. She described feeling awkward at this point. Having heard the evidence of Service User C, the Panel concluded that the Registrant’s actions were inappropriate in the circumstances.

68. The Panel accepted Service User C’s witness statement and her oral evidence which supported all the facts alleged in Particular 4. The Panel was satisfied on the balance of probabilities that the Registrant’s conduct as alleged in all limbs of Particular 4 was proved and the Panel was also satisfied that the conduct was inappropriate.

Particular 5

Your conduct at particulars 1 - 4 was sexually motivated and/or sexual in nature.

69. The Panel referred to the guidance as previously mentioned in the Practice Note, Making Decisions on a Registrant’s State of Mind.

70. In respect of Particulars 1a and b, relating to Service User B, the conduct in question did not concern comments of an inappropriate nature, but it involved the removal of clothing leaving intimate areas of the service user’s body exposed in a situation where the Service User was alone with the Registrant in the clinic room. The Panel had found that the Registrant’s actions were without Service User B’s consent or any clinical justification and that they were inappropriate. Having considered all the circumstances, the Panel could not identify any plausible or innocent alternative explanation for the Registrant’s conduct.

71. The Panel concluded on the balance of probabilities that the Registrant’s conduct in respect of Particulars 1 a and b was sexually motivated, in that it was undertaken for the purpose of sexual gratification. The Panel was also satisfied that it was conduct of a sexual nature.

72. In relation to Particular 2, concerning the treatment of Service User C on 21 July 2021, again the conduct involved asking the service user to the remove clothing, leaving intimate areas of her body exposed. The Panel had found that the Registrant’s actions were without any clinical justification and were inappropriate. Having considered all the circumstances, the Panel could not identify any plausible or innocent alternative explanation for the Registrant’s conduct. The Panel concluded on the balance of probabilities that the Registrant’s actions were sexually motivated in they were for the purpose of sexual gratification. The Panel also concluded that this was conduct of a sexual nature.

73. The Panel considered the Registrant’s conduct during the treatment session with Service User C on 28 July 2021, as alleged in Particulars 3 and 4. The Panel considered this demonstrated a pattern of highly inappropriate behaviour in the form of both verbal comments and physical actions during the session. The Registrant made sexualised comments regarding Service User C’s body and her personal relationships. The physical actions involved exposing and touching intimate and sensitive areas of her body without her consent and without clinical justification. Throughout the session, she was not provided with any appropriate measures to protect her dignity or privacy.

74. Having considered all the circumstances, the Panel could not identify any plausible or innocent explanation for the Registrant’s conduct. The Panel noted in particular Service User C’s evidence of the Registrant stating “I probably shouldn’t be saying this” more than once, and giggling. The Panel considered this indicated that he was aware that his conduct was inappropriate. Service User C described the Registrant staring at her as she tried to dress and no privacy being provided.

75. The Panel concluded that the Registrant’s actions in Particulars 3 and 4 demonstrated that he had a clear desire to pursue a sexual relationship with Service User C. The Panel further concluded that his actions in Particular 4 were also for the purpose of immediate sexual gratification.

76. The Panel was satisfied on the balance of probabilities that the Registrant’s actions in relation to Service User C were sexually motivated and sexual in nature.

77. The Panel concluded that Particular 5 was proved in relation to all of particulars 1-4.

Decision on Ground - Misconduct

78. The Panel considered the submissions of Mr Molloy on behalf of the HCPC. It received and accepted the advice of the Legal Assessor.

79. The Panel bore in mind that misconduct was a matter for its own judgment and took account of the guidance from the case law relating to the meaning of misconduct, including the explanation given by Lord Clyde in Roylance v GMC [No 2] 2000 1 AC 311. The Panel also reminded itself that not every falling short of the expected standard amounts to misconduct: the falling short must be serious and may be considered deplorable by other professionals.

80. The Panel was of the view that the conduct found proved in the Registrant’s case demonstrated a serious departure from the standards expected of a registered Physiotherapist. The Registrant’s actions involved deliberate conduct which was an abuse of his professional position, and which breached professional boundaries. The conduct was sexually motivated and was conduct of a sexual nature towards service users, including the removal of clothing to expose intimate areas and physical contact without clinical justification and without consent. In the case of Service User C, it involved highly inappropriate sexualised comments.

81. The Panel considered that the following paragraphs from the HCPC standards were relevant in this case:

HCPC Standards of Conduct, Performance and Ethics (2016)
1.1 You must treat service users and carers as individuals, respecting their privacy and dignity.
1.4 You must make sure that you have consent from service users or other appropriate authority before you provide care, treatment or other services.
1.7 You must keep your relationships with service users and carers professional.
2.1 You must be polite and considerate.
2.2 You must listen to service users and carers and take account of their needs and wishes.
2.3 You must give service users and carers the information they want or need, in a way they can understand.
9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

HCPC Standards of Proficiency for Physiotherapists (2013):
2.1 understand the need to act in the best interests of service users at all times
2.3 Understand the need to respect and uphold the rights, dignity, values, and autonomy of service users including their role in the diagnostic and therapeutic process and in maintaining health and wellbeing
2.6 Understand the importance of and be able to obtain informed consent
2.7 Be able to exercise a professional duty of care
3.1 Understand the need to maintain high standards of personal and professional conduct
4.4 Recognise that they are personally responsible for and must be able to justify their decisions
8.1 Be able to demonstrate effective and appropriate verbal and non-verbal skills in communicating information, advice, instruction and professional opinion to service users, colleagues and others
8.4 Be able to select, move between and use appropriate forms of verbal and non-verbal communication with service users and others.

82. The Panel considered that the Registrant’s actions fell far short of the standards expected of a registered Physiotherapist and would be considered deplorable by fellow professionals. The Panel found that all the facts proved amounted to misconduct.

Decision on Impairment
83. The Panel considered the submissions of Mr Molloy on behalf of the HCPC. His submission was that the Panel should find current impairment in relation to both the personal and public components of impairment. The Panel accepted the advice of the Legal Assessor and referred to HCPTS Practice Note, Fitness to Practise Impairment (December 2023).

84. The Panel considered, in the light of all the information known to it, whether the Registrant’s fitness to practise is currently impaired. The Panel applied its own judgment and bore in mind that not every finding of misconduct will indicate that there is current impairment.

85. In this case, the Panel had found proved misconduct which constituted an abuse of the Registrant’s professional position and breached professional boundaries. It involved conduct which was sexually motivated conduct and of a sexual nature towards service users, including highly inappropriate sexualised comments and sexualised physical contact. This was without clinical justification and without the consent of the Service Users.

86. The Registrant’s conduct occurred in a professional setting whilst the Registrant was responsible for the treatment of Service Users B and C. It caused distress to them and affected their trust in the profession of Physiotherapy.

87. In relation to the personal component of current impairment, the Registrant has not engaged with the HCPC hearing, nor has he provided any evidence to the Panel to demonstrate acknowledgment of his actions or any remorse. The Panel considered that his response to Mrs Curtis at A&A Medical did not represent any meaningful acceptance of the allegations, nor any apology or remorse, but rather sought to deflect the allegations and blame others. In relation to his comments about being new to practice in this country and lack of training, the Panel noted that that as an HCPC registered practitioner, the Registrant is required to practise in accordance with the HCPC’s standards. Further, the Panel had heard evidence of the training the Registrant did receive from Mrs Curtis on joining A&A Medical.

88. The Panel was mindful that insight is a critical part of remediation and assessment of future risk and that is difficult for a Panel to assess this where the Registrant has not engaged in the hearing process. The Panel did not consider that the Registrant had shown any meaningful insight. Sexually inappropriate conduct is difficult to remedy and, in this case, there was no evidence before the Panel of any attempt by the Registrant to remedy his past actions.

89. The Panel concluded that harm had been caused to the two Service Users, both of whom had expressed their concerns about seeking treatment from Physiotherapy practitioners in the future and this could have compromised their recovery from their injuries and could affect whether they seek physiotherapy treatment in the future. The Panel concluded that there remained a risk of repetition of this conduct by the Registrant towards service users, and therefore there is a risk of harm in the future. The Panel found the Registrant’s fitness to practise is currently impaired in respect of the personal component of current impairment.

90. Considering the guidance in the case of CHRE v NMC and Paula Grant [2011] EWHC 927 (Admin), and the Practice Note, the Panel was mindful that it must consider the wider public interest considerations. The Registrant’s actions brought the profession into disrepute and breached a fundamental tenet of the profession. The Panel concluded that members of the public would be concerned if the fitness to practise of a Registrant who had acted in this manner were not found to be currently impaired. The Panel took the view that public confidence in the profession of Physiotherapy and in the regulatory process would be undermined if a finding of impairment were not made in this case. The Panel found the Registrant’s fitness to practice is impaired in respect of the public component.

91. The Panel therefore concluded that the Registrant’s fitness to practise is currently impaired in respect of both the personal and public components of current impairment.

Decision on Sanction

92. Mr Molloy addressed the Panel on the issue of sanction. The HCPC did not propose a particular sanction in this matter, but Mr Molloy submitted that, given the nature and gravity of the Panel’s findings, and the risk which the Panel had found to the public and the public interest, a sanction at the higher end of the range was likely to be appropriate. Mr Molloy referred the Panel to relevant sections of the HCPC Sanctions Policy (March 2019).

93. No submissions on sanction had been received from the Registrant.

94. The Panel received and accepted the advice of the Legal Assessor. The Panel was mindful that the purpose of a sanction is not to be punitive, though a sanction may have a punitive effect. The Panel bore in mind that its primary function at this stage is to protect the public, while reaching a proportionate sanction, taking into account the wider public interest and the interests of the Registrant. The Panel referred to the HCPC’s Sanctions Policy (March 2019) and applied it to the Registrant’s case on its own facts and circumstances.

95. The starting point for the Panel was that the Registrant’s misconduct was serious. The Panel has found that he engaged in a pattern of sexually motivated behaviour and conduct of a sexual nature to two Service Users who were receiving treatment from him. The Panel was of the view that the Registrant presents a continuing risk of harm to service users and that the Registrant’s actions are likely to undermine confidence in the Physiotherapists profession in the eyes of service users and the public.

96. The Registrant has not engaged with this hearing or provided any submissions or mitigation evidence. The Panel has no indication that he has undertaken any reflection or remediation, nor has he demonstrated any insight. The Panel has previously indicated that it was able to give very little weight to the only communication the Registrant has sent in connection with this hearing, his email of 8 February 2024. The Registrant has provided no up to date information about his current employment or personal circumstances.

97. The Panel proceeded to consider the aggravating and mitigating factors present in the case.

98. The Panel identified the following aggravating factors:
• The Registrant was a qualified Physiotherapist and his conduct towards the service users was an abuse of his professional position;
• The Registrant breached the trust of Service Users B and C;
• The Registrant had caused actual harm to both Service Users;
• The Registrant’s conduct was predatory in nature;
• The conduct found proved involved a pattern of deliberate sexually motivated conduct and sexualised conduct to the two service users;
• The conduct was repeated and represented a pattern of behaviour;
• The failure of the Registrant to engage substantively with the HCPC proceedings means that there is no information before the Panel by way of apology, remorse, reflection, insight or remediation.
• The Panel considered that the Registrant’s conduct poses a risk of future harm to service users and harm to public confidence in the profession of Physiotherapy and in the HCPC as the regulator.

99. The Panel identified the following mitigating factors:

• The Panel has seen no information indicating that the Registrant has been the subject of any previous regulatory findings;

100. The Panel referred to the HCPC Sanctions Policy (March 2019) in deciding what sanction, if any, should be applied. This included reference to the guidance applicable where a panel has made findings of abuse of professional position (paragraph 67-69); predatory behaviour (paragraphs 71-72) and sexual misconduct (paragraphs 76-77). The Panel considered these sections of the Sanctions Policy were applicable in this case. The guidance indicates that, because of the gravity of findings of impairment by reason of predatory behaviour or sexual misconduct, a panel is likely to impose a more serious sanction in such cases.

101. The Panel took a proportionate approach and considered the available sanctions in ascending order of seriousness.

Mediation
102. This was not appropriate, as the issues found proved were too serious to be addressed by means of mediation and because the Registrant was not engaging with the HCPC.

No Further Action
103. Given the identified risk of harm to the public and the public interest as a result of the Panel’s findings, the matter was too serious for no further action to be appropriate.

Caution
104. The factors indicating that a Caution Order may be appropriate were not present. This was not an isolated incident, nor was the conduct of a minor nature. The Panel had no evidence of insight or remediation and was not reassured that the risk of repetition was low. The Panel also considered that a Caution would be insufficient to mark the seriousness of the findings and to maintain the confidence of the public and the profession.

Conditions of Practice Order
105. The Panel did not consider this was a case in which conditions of practice were appropriate. There was no indication that the Registrant would be willing to comply with conditions. Further, it was difficult to formulate conditions which could address the Panel’s findings of inappropriate sexual and sexually motivated behaviour towards service users. The Panel decided that a Conditions of Practice Order would not be effective in marking the seriousness of the findings, nor would such an order protect the public or the public interest.

Suspension
106. The Panel carefully considered whether a period of suspension would be an adequate response in this case. In so doing, the Panel referred to the HCPC Sanctions Policy as to when a suspension order is appropriate, at paragraph 121. Referring to that guidance, the Panel has found that the concerns represent a serious breach of the HCPC’s Standards of Conduct, Performance and Ethics. The Registrant has not engaged with the HCPC process and there is no indication of any remorse or remediation, nor any evidence that the Registrant has insight. The Panel was not reassured that the Registrant’s conduct is unlikely to be repeated. There is no evidence before the Panel that the Registrant has taken steps to resolve or remedy his misconduct. The Panel concluded in these circumstances that a Suspension Order would not be sufficient or appropriate.

Striking off order
107. The Panel went on to consider whether the ultimate sanction, a striking off order, was required in this case. It was mindful that this is the sanction of last resort.

108. The Panel referred to the Sanctions Policy which indicates, at paragraph 130, that in cases of sexual misconduct and abuse of professional position, a Striking Off Order may be appropriate. Given the nature and gravity of its findings, the Panel concluded that any lesser sanction would be insufficient to protect the public, public confidence in the profession and public confidence in the regulatory process.

109. In the circumstances of this case, the Panel concluded that a Striking Off Order was the appropriate and proportionate sanction which would protect the public, the public interest and would demonstrate the seriousness of the matter to the profession and the public.

ORDER: The Registrar is directed to strike the name of Waqas Ahmed from the Register on the date this Order comes into effect.

Right of Appeal

You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.
Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you. The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.

Interim Order
Application
110. Mr Molloy on behalf of the HCPC made an application to proceed in the absence of the Registrant for the Panel to consider his application for an Interim Order.

111. The Panel had decided on the first day of this hearing that there had been good service of the Notice of Hearing dated 22 January 2024 and had made the decision to proceed with the hearing in the absence of the Registrant.

112. The Panel noted that the Notice of Hearing had including information in the form of a hyperlinked factsheet entitled Substantive Hearings which referred to the possibility that an application for an Interim Order could be made at this stage of the process. The Panel was therefore satisfied that the Registrant was on notice of this potential application.

113. The Panel considered there had been no change in circumstances since the Panel’s decision to proceed in absence, specifically there had been no further communications from the Registrant indicating that he wish to be present.

114. Mr Molloy on behalf of the HCPC made an application under Article 31 (1) and (2) of the Health Professions Order 2001 for an Interim Suspension Order for a period of 18 months.

Decision

115. The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.

116. The Panel determined that duration of the Order should be 18 months. The Panel considered that this period was required to cover period of any appeal which may be made by the Registrant.

117. This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.

History of Hearings for Waqas Ahmad