Ismael Hussain

Preliminary Matters

Potential Bias or conflict of interest

1. Before the hearing began, the Panel raised the question of whether there was a conflict of interest or a situation giving rise to perceived bias.

2. The Registrant Member of the Panel informed her colleagues and Mr Ive that she had been employed 22 years ago by the same Trust which had employed the Registrant in 2022. In 2003, she had worked with SW, who had raised the initial complaint with the HCPC. She had had no contact with her since, to the extent that she did not immediately recognise her by her married name. She was clear that she had no prospect of working with her in the foreseeable future.

3. She also revealed that she had known BH, the Radiographer in charge of the Registrant’s supervision, when BH was a student. She had had no contact with him since 2003 and she had no prospect of working with him in the foreseeable future.

4. Mr Ive submitted that there was no reason why the Registrant Member of the Panel should not continue to hear this case.

5. The Panel received and accepted the advice of the Legal Assessor, which it accepted and has followed in its decision set out below.

6. The Panel bore in mind the test in Magill v. Porter [2001] UKHL 67, “The court must first ascertain all the circumstances which have a bearing on the suggestion that the judge was biased. It must then ask whether those circumstances would lead a fair-minded and informed observer to conclude that there was a real possibility, or a real danger, the two being the same, that the tribunal was biased."

7. The Panel also bore in mind the guidance given to Panels in Suleman v GOC [2023] EWHC 2110, namely the importance of bearing in mind how long ago the Registrant member had contact with the parties in this case, whether there was any continuing link between the Panel member and either the witnesses or the trust where the Registrant worked and the likelihood of her having a relationship with either in the future.

8. The Panel had careful regard to the length of time since the Registrant Member knew any of the witnesses, namely over 22 years, the fact that she had no contact with either the witnesses or the service at present and there was no likelihood of her doing so in the future.

9. Having regard to all these matters the Panel was satisfied that the fair minded and informed observer would not conclude that there was a real possibility or risk that the Panel was biased.

Service of notice on the Registrant

10. At the outset of the proceedings the Registrant was neither present by video link or telephone, nor was he represented.

11. The Chair invited the Hearings Officer to set out the steps that had been taken to serve notice of the hearing on the Registrant.

12. The Hearings Officer put before the Panel the following documents:

a. an email dated 14 January 2025 headed “Health and Care Professions Council – Conduct and Competence Committee Hearing.”

b. a certificate dated 14 January 2025 and a document headed “proof of service” which, taken with the heading of the email demonstrated that the document described above had been sent to the email address of the Registrant held by the HCPC on the Radiographer part of the HCPC register under Registration Number RA81703.

13. The Panel observed that the email of 14 January 2025 gave the Registrant notice of the hearing in the following terms:

“The Health and Care Professions Tribunal, sitting as a Panel of the Conduct and Competence Committee, will convene remotely to hear your case on Thursday 13 February 2025 - Friday 21 February 2025.”

14. The Panel observed that the email of 14 January 2025 set out the date and time of the hearing and indicated that it would take place remotely, using Microsoft Teams. It set out the powers of the Panel and said that “if you do not attend, the committee may proceed with the hearing in your absence…” It contained contact details so that the Registrant could attend the hearing and invited the Registrant to confirm by 28 January whether he would be attending.

15. The Panel saw the following emails between the HCPC and the Registrant:

a. an email from the Registrant to the HCPC, dated 14 January 2025, in which he said, “Thanks for your email. I will not be attending the meeting due to work and no AL available. It is difficult for me to admit to my errors as it has been a long time. I judge that you will make the correct decision on my behalf.”

b. An email from the HCPC to the Registrant date 15 January 2025 asking if he proposed to attend and advising him about seeking a postponement of the hearing if he needed one:

Further to the emails below, I just wanted to confirm whether you are content for the hearing to proceed in your absence.

If it is the case that you cannot attend on the days the hearing is currently listed, but that you could on some other date, you can request that the hearing is postponed. The reason I am checking this with you is that you had previously confirmed that you would like to attend the hearing. It is, of course, up to you whether you wish to do so. I just wanted to be sure of your decision in this regard.

c. An email from the Registrant to the HCPC in which he said:

Thanks for your email. I will not be attending the meeting due to work and no AL available. It is difficult for me to admit to my errors as it has been a long time. I judge that you will make the correct decision on my behalf

Thanks
Ismael

16. Mr Ive drew the Panel’s attention to the relevant rules and submitted that the HCPC had served notice of the hearing on the Registrant in accordance with Rules 6(1) and 3(1) of The Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules).

17. The Panel received and accepted the advice of the Legal Assessor, and has followed in its decision on service, set out below.

18. The Panel had regard to the HCPTS Practice Note of June 2022, and Rules 3(1) and 6(1) of the Rules, as amended.

19. The Panel observed that Rule 3 provides that notice of a hearing may be served on a Registrant by sending it to the email address held for him by the HCPC and Rule 6 provides that the notice must be served at least 28 days in advance of the hearing and shall contain, “notice of the day, time and venue for the hearing.”

20. Having examined the documents set out above, the Panel was satisfied that the HCPC had served notice of this hearing, accordance with the Rules.

Proceeding in the absence of the Registrant

21. In light of that decision, Mr Ive applied to the Panel to proceed in the Registrant’s absence.

22. He drew the Panel’s attention to the relevant law and guidance, to which the Panel refers below. He submitted that The Registrant had been notified that the hearing could proceed in his absence and had replied stating clearly that he would not attend and was effectively content for the hearing to proceed in his absence.

23. Mr Ive reminded the Panel of the public interest in deciding this case within a reasonable time and the adverse effect further delay would have on six witnesses who had set aside time to attend and on the quality of their evidence.

24. The Panel again received the advice of the Legal Assessor which it accepted and followed in the decision set out below.

25. The Panel had regard to the HCPTS Practice Note entitled Proceeding in the Absence of the Registrant dated June 2022, the decision of the House of Lords in R v Jones [2002] UKHL 5 and the further guidance given to Panels by the Court of Appeal in GMC v Adeogba [2016] EWCA Civ 162. These include the following:

• The discretion to continue in the absence of the Registrant should be exercised with great caution and with close regard to the fairness of the proceedings;
• The decision about whether or not to proceed must be guided by the HCPC’s primary objective of protecting the public;
• Fairness to the Registrant is very important, but so is fairness to the HCPC and the public;
• Whether all reasonable efforts have been taken to serve the Registrant with notice;
• The Panel should consider the nature of the Registrant’s absence and in particular whether it was voluntary;
• Whether there is any reason to believe the Registrant would attend or make submissions at a subsequent hearing;
• Any disadvantage that the Registrant was likely to suffer if the Panel proceeded in his absence;
• The duty of professionals to engage with their regulator;
• There must be an end to the “adjournment culture”.

26. The Panel had regard to the direction given by the Court of Appeal in Adeogba (above) “Where there is good reason not to proceed, the case should be adjourned; where there is not, however, it is only right that it should proceed.”

27. The Panel reminded itself of the correspondence set out above and was satisfied that the Registrant knew of the hearing and had decided to absent himself (as he is entitled to do) for personal reasons.

28. The Registrant had been reminded in writing that he could ask for an adjournment but had not done so and had confirmed he was content for the hearing to proceed in his absence. Accordingly, the Panel concluded that there was no reason to believe that an adjournment would secure the Registrant’s attendance on a future date.

29. The Panel acknowledged that there is almost inevitably a potential disadvantage to a Registrant in not attending a final hearing but concluded that any disadvantage to the Registrant must be balanced against the reason for his non-attendance and the public interest in proceeding with this hearing.

30. The Panel reminded itself that six witnesses had arranged to attend and give evidence and further delay which resulted in the loss of the allocated days for the hearing was likely to cause them significant inconvenience and adversely affect the quality of their evidence.

31. Having regard to all these matters, the Panel concluded that there was no good reason to adjourn this hearing, and it should proceed in the absence of the Registrant.

Background

32. The Registrant is a registered Radiographer. He was employed by the Leeds Teaching Hospitals NHS Trust (‘the Trust’) as a band 5 Therapeutic Radiographer at the St James University Hospital on 14 March 2022.

33. The Registrant started his employment with a period of induction under the overall supervision of a band 7 Radiographer, BH. Induction involved the Registrant observing a number of the 2 or 3 person teams that worked the machines delivering therapeutic radiation doses to patients, often those diagnosed with cancer of the breast or prostate.

34. Each of the machines required a minimum of 2 people to administer treatment and during his induction period, the Registrant was a supernumerary or additional member of the team, observing and carrying out work only under the direct supervision of the Radiographers assigned to the machine.

35. The expectation was that the Registrant would be observed by BH at the end of his induction period, who would assess whether the Registrant was safe to work as a full member of a treating team.

36. There is no dispute that the induction period is usually between four and 12 weeks although it was initially hoped that the Registrant would complete his induction within four weeks because he had previous employment experience.

37. The Panel notes, for ease of reference, that after the Registrant started work on 14 March 2022, four weeks ended on 11 April 2022, eight weeks ended on 9 May 2022 and 12 weeks ended on 6 June 2022.

38. During the Registrant’s induction a number of concerns were raised, and he had still not been assessed as sufficiently competent by July 2022.

39. The Registrant was introduced to a band 7 Radiographer, MG, to support him. She is described in the documentation as “a trained mentor and has training in coaching and counselling for staff support and is involved with the black, asian, ethnic minority support group within the Trust.”

40. On 28 July 2022 (during week 19 of the Registrant’s induction) a meeting was held between the Registrant, BH and MG to ensure that the Registrant could complete his induction.

41. Further meetings were held on 4 August 2022, 18 August 2022 and 1 September 2022 and 15 September 2022.

42. At the meeting of 15 September 2022, BH signed off the Registrant as having completed part of his induction, namely work in the treatment room. He was not signed off as having completed his induction in imaging, planning or paperwork.

43. At that meeting the Registrant said that he would resign from the Trust although he would work his notice. The contemporaneous note of that meeting indicates that the Registrant explained that “he felt it was all too much. He was struggling with the travelling as well and his personal situation at home. He felt he had been well supported during his 6 months with us. We discussed the fact he had struggled considerably with the induction and had not yet achieved full sign off and acknowledged this must be very difficult. Ismael handed in his notice formally after the meeting.”

44. Following that meeting the Registrant worked briefly as a member of the treatment team on one of the machines but further concerns were raised about his competence, as set out below. The Registrant stopped working at the trust on 23 September 2022.

45. SW, the deputy head of radiography at the Trust, contacted the HCPC and then formally rereferred the Registrant to the HCPC on 18 February 2023.
Evidence and documents before the Panel

46. The Panel had before it a case summary from the HCPC and a bundle of 272 pages, which contained (but is not limited to) the following documents:

a. Statements of the witnesses referred to below;
b. Notes and emails written by the witnesses in 2022, to which the Panel also refers below;
c. Notes of meetings held with the Registrant
d. Reflective pieces from the Registrant dated 15 and 23 August 2022;
e. An email from the Registrant dated 15 January 2025.

47. The Panel also heard evidence from the following witnesses:

a. BH: as indicated above he was the band 7 Radiographer who supervised the Registrant and collected feedback from the Radiographers with whom the Registrant worked during his induction.
b. CH is a now band 6 Radiographer who worked with and observed the Registrant during the period August to September 2022. She was assigned as the Registrant’s mentor and recorded her initial concerns in an email dated 31 August 2022, to SW.
c. CM is now a Palliative Trainee Advanced Clinical Practitioner Therapeutic Radiographer since December 2022. At the relevant time in 2022, she was a band 6 Radiographer and worked with the Registrant on a number of machines at various times in May, June and July 2022. She set out her concerns at the time in an email dated 25 July 2022, to BH.
d. JW is now a band 6 Radiographer and level 2 IView imager. At the relevant time in 2022, she was a band 5 Radiographer. She worked with the Registrant during the first 3 months of his induction, on the machines known as LA9 and LA10 and subsequently in June 2022 on the machines LA5 and LA6. She set out her concerns at the time in a typed note dated 25 July 2022.
e. RC is a band 6 Radiographer who was a band 6 Team Leader Radiographer at the relevant time in 2022. She observed the Registrant during June 2022. She did not record her concerns in a document at the time but dictated a statement to the HCPC solicitors in October 2023 and signed that statement on 25 January 2024.
f. SJ was and still is a band 6 Radiographer, who worked with and observed the Registrant in September 2022. She recorded her concerns in a typed noted dated 23 September 2022.

48. The Panel has set out the evidence relevant to each paragraph of the Allegations when considering them in turn below.

Submissions and advice

49. The Panel heard the submissions of Mr Ive who reminded the Panel of the burden and standard of proof and set out the evidence relevant to each paragraph in a way that the Panel wishes to record was very clear and helpful.

50. The Panel also received and accepted the advice of the Legal Assessor which was as follows.

51. The burden of proving each paragraph of the allegation rests upon the HCPC and the standard of proof is the balance of probabilities, that is to say the HCPC must establish that each allegation is more likely than not to have occurred as alleged.

52. The Panel should not draw an adverse inference against the Registrant because he has not attended and accordingly not given evidence.

53. The Panel must decide the stem of the allegation, that is to say “you were unable to demonstrate that you would be capable of working safely without supervision” by reference to the 9 examples set out in the allegation.

54. When assessing the witness evidence, the Panel must remember that memories fade over time and the Panel should not judge witnesses by their demeanour. In this case the Panel should judge the evidence by looking at contemporaneous documents and remember that those are likely to be the most reliable source of evidence.

Decision on Facts

55. The Panel then considered each paragraph of the Allegation in turn:

1 a. Were unable to explain the ‘inverse square law’;
i. On 1 April 2022; and/or
ii. On 14 April 2022.

56. BH told the tribunal that he was satisfied that his written statement was correct, and the Panel adopted it as his evidence in chief.

57. BH gave evidence to the Panel that the inverse square law is a basic principle of radiography taught to every first-year radiography student so that they can calculate the relationship between the distance from the radiation source to the patient and the dose of radiation delivered.

58. BH recorded in his statement that the Registrant did not understand this rule when he asked him about it on both 1 and 14 April 2022. In his oral evidence he said that the Registrant “seemed to have no knowledge of this rule whatsoever.’ The Panel observed that BH had recorded this in his notes typed on 1 July 2022 Under his entries for both 1 and 14 April 2022.

59. This evidence was not contradicted by any other evidence.

60. Accordingly, the tribunal accepted BH’s evidence and found this paragraph proved.

1 b. On 26 May 2022, incorrectly uploaded the patient’s treatment plan to the machine.

61. The Panel heard the evidence of CM, who observed the Registrant at various times in May, June and July 2022 as set out above. She also told the tribunal that the contents of her written statement were correct, and the Panel adopted it as her evidence in chief.

62. In her statement, CM gave a clear account of how, on 26 May 2022, the Registrant was instructed how to upload a patient’s treatment plan but did not absorb this information and asked again. On the same day, the Registrant made a mistake while practising uploading the patient's treatment plan in a way which would have adversely affected treatment if it had not been corrected by those observing him.

63. The Panel observed that CM had recorded her concerns about the Registrant absorbing the instructions he was given in an email dated 25 July 2022, despite being involved in a large number of similar cases.

64. This evidence was not contradicted by any other evidence.

65. Accordingly, the tribunal accepted CM’s evidence and found this Particular proved.

1 c. On 21 July 2022, did not review images prior to setting the machine ready for treatment.

66. The Panel received CM’s evidence regarding this particular in the same way as it did above. Her evidence was that she observed the Registrant on machine LA6 on 21 July 2023.

67. Ms Martin set out in her evidence the procedure for delivering radiotherapy to a patient. She emphasised the importance of reviewing images prior to treatment to ensure the dose is delivered to the intended treatment area. She described what occurred as follows:

The next step is to then open the image review software to review the images and match these to enable the registration of the images to take place, i.e. matching today’s setup to the planned setup and performing the necessary moves. The Registrant did not perform this step, instead clicked “confirm” on the treatment field window, effectively locking the system and indicating the treatment was ready to be started. The Registrant was going to start treatment without having reviewed the images because he began to move his hand toward the control console where the “beam on” button was located indicating he would have done this were he not being supervised. I intervened to inform the Registrant that he had not looked at the imaging prior to providing treatment. The Registrant initially paused and gave a slightly vacant look, suggesting to me he did not realise he was about to do something wrong, then stated something along the lines of “oh yes, sorry”.

68. The Panel observed that this event was also recorded in her e-mail dated 25 July 2022 and referred to above.

69. This evidence was not contradicted by any other evidence.

70. Accordingly, the tribunal accepted CM’s evidence and found this Particular proved.

d. On 28 July 2022, did not know how to conduct quality assurance for the Linac machine.

71. In respect of this particular the Panel received the evidence of CM, who gave her evidence in the same way as the other witnesses.

72. Her evidence was that on 28 July 2022 she was watching the Registrant conduct quality assurance for the Linear Accelerator (Linac) machine. She recorded the following evidence in her statement.

“The Registrant said he didn’t know how to do it because he’d “not done it for a while” but, in my opinion, he should have been doing it every day until he felt competent. I showed him one day and then I let him have a go and he got it right but didn’t appear understand or know what he needed to check without prompting.”

73. The Panel observed that CM had recorded her concerns about the Registrant in an email dated 25 July 2022 to BH in which she does not mention this event, not least because it occurred after the email was sent. Nevertheless, the Panel observed that CM recorded her concern that feedback was offered, only for the same error to be made again later without the Registrant realising that he was making the same error.

74. The Panel observed that this observation is consistent with the performance she saw from the Registrant the following day.

75. The Panel also observed that CM’s evidence was not contradicted by any other evidence.

76. Accordingly, the tribunal accepted CM’s evidence and found this Particular proved.

1 e. On an unknown date, did not identify a potential contraindication before providing treatment to a patient.

77. SJ gave evidence in the same way as the other witnesses. She described that she had observed the Registrant during the week of 19 September 2022, when he had been signed off to the limited extent that he could work as part of the team in the treatment room.

78. She recorded the following had occurred during that period.

“he failed to identify a potential contraindication when a patient complained of pain down her legs. The patient was being treated for rectal cancer, in which a higher dose of radiation is provided, and if a patient has pain or numbness in a leg then it could be an effect from the treatment. During treatment, the patient raised a concern stating she had a pain shooting down her leg. When I informed the Registrant that we need to stop the treatment and raise it with a doctor, he laughed and said words to the effect of, 'she always complains about pain, she moaned about it the day before'. This information is included in a protocol detailing with adverse reactions to radiotherapy which is mandatory for all staff to read …”

79. The Panel also observed that CM raised her concerns with SW in an email dated 23 September, in the following terms: “patient complained of pain down legs and Ishmael laughed and instead, she always says that, didn't realise this is a contra indication to treatment.”

80. The Panel observed that this evidence was not contradicted by any other evidence.

81. Accordingly, the Panel accepted CM’s evidence and found this particular of the Allegation proved.

1 f. On an unknown date, did not discuss side effects with the patient before their treatment.

82. In respect of this paragraph, the Panel received the evidence of JW in the same way as the other witnesses.

83. JW recorded the following when observing the Registrant in June 2022.

On one occasion, before commencing treatment, the Registrant did not probe the patient for side effects information or ask about their overall wellbeing. I cannot identify the patient concerned. When first meeting a patient, we ask them how they are on a personal and professional level, which leads into a conversation to go over their side effects and enables us to decide whether a doctor or nurse needs to check the patient prior to their treatment. If there are side effects that we are unaware of and proceed with the treatment then this creates a risk of harm to the patient. The Registrant ought to have known to probe the patient for such information as it is included in all radiography training.

84. The Panel also observed that JW recorded her concerns about the Registrant’s performance in a typed note dated 25 July 2022. The Panel noted that JW did not record this particular concern but noted that the Registrant did not seem to pick up information that is told to him and has to be told many times. The Panel was satisfied that this observation is consistent with JW’s observations in June 2022.

85. The Panel observed that this evidence was not contradicted by any other evidence.

86. Accordingly, the Panel accepted JW’s evidence and found this Particular of the Allegation proved.

1 g. On an unknown date, did not obtain consent from the patient before lowering their gown.

87. The Panel received JW’s evidence in the same way as above. It observed that she recorded in her statement that while they were preparing a patient for treatment in June 2022,

“The Registrant then started to lower the patient’s gown without asking for consent. I stepped in to inform the patient that we were going to lower their gown to the waist to provide treatment. The Registrant should have been aware of the importance to ensure consent before lowering the patient’s gown because it is part of basic practice. It is standard practice to ask the patient or state to them what you are going to do, before you do it.”

88. The Panel observed that this incident was not mentioned in JW’s notes referred to above, but appeared for the first time in her statement dated 23 March 2024. Accordingly, the Panel asked JW a number of questions about this incident and the impression it had made upon her.

89. Having considered the evidence as a whole, the Panel was satisfied that JW’s evidence was correct.

90. It also noted that her evidence was not contradicted by any other evidence and accordingly found this Particular of the allegation proved.

1 h. On more than one occasion, did not conduct / correctly conduct the necessary checks, as part of setting up a patient’s treatment.

91. The Panel again received evidence from JW who described observing the Registrant helping to prepare a patient for treatment in June 2022. She recorded:

“The Registrant was being talked through how to do the movements by Mr S, to ensure the correct buttons were pressed. Radiographer 2 uses the handsets to move the bed, and also reads out the directions, watching the bed to ensure it does not collide with a part of the machine. The bed was not near the machine to collide. The Registrant read out the directions correctly but did not do the visual checks. The Registrant was not watching the bed as it moved. On this occasion, there was no concern with the movement with the bed because there was a lot of space, but best practice is to watch the bed at all time when moving it.”

92. The Panel observed that this incident is not mentioned in JW's notes referred to above but is satisfied that it is consistent with her observation in those notes that the Registrant does not “pick up information being told to him”.

93. The Panel asked JW about this incident and was satisfied that she recalled it accurately.

94. The Panel also received the evidence of RC in the way set out above.

95. The Panel observed that in her statement she set out a different occasion when the Registrant did not carry out visual checks.

96. The Panel has set her evidence out in more detail because of its importance:

“On treatment, the patient will be set up to their tattoos in order to get them into the same position as their planning scan, CMA will then be done using the hand pendant and computer to send the shifts from the reference point (one of the tattoos is classed as the reference point), to move the bed to the isocentre position where the patient will receive treatment….. We always check that the isocentre has landed in a reasonable position and that the CMA has been done correctly which is done by visually and verbally checking on the patient that shifts are correct. If the CMA is sent too soon before the patient is set up, the computer will remember the position that it was sent from and will send from that position regardless therefore landing in an incorrect position. This was an issue we faced with the Registrant on multiple occasions, as we had not finished getting the patient in the correct position. The Radiographer performing CMA should always watch the patient when conducting the shift to ensure that there are no collisions. The Registrant often continued looking at the screen and not the patient when doing this.”

97. The Panel observed that RC had not recorded a note of these matters at the time and asked her a number of questions about them. Having probed this incident, the Panel was satisfied that it did occur in the way that RC stated. The Panel was impressed by the level of detail in her recollection, and that she recalled that the Registrant did on occasions show improvement when problems were pointed out to him but then appeared to forget what he had been told and repeat his errors.

98. The Panel observed that the evidence of JW and RC was not contradicted by any other evidence.

99. Accordingly, it accepted their evidence and found this particular proved.

1 i. Between 18 May and 8 June 2022, when undertaking MOSAIQ training, incorrectly answered all of the card calculations.

100. The Panel received the evidence of BH who set out in his statement that he had started the MOSAIQ training in May 2022. The Panel noted that MOSAIQ is an image-enabled electronic medical record system (EMR) used for the managing work flow in the treatment of cancer.

101. The Panel observed the following evidence from BH:

“When we did the MOSAIQ training, I asked the Registrant to do the card calculations independently and asked him to place it on my desk by 18 May 2022. This would have given him three days to complete but it took him a month because he handed it to me on 08 June 2022, and the answers were all incorrect. None of what he had done made sense to me. It would be expected for a trained Radiographer to complete in about 30-60 minutes and have 100%.”

102. The Panel also noted that this concern is reflected in BH’s notes made in July 2022.

103. The Panel observed that this evidence was not contradicted by any other evidence.

104. Accordingly, the Panel accepted BH’s evidence and found this Particular proved.

105. The Panel then considered whether the particulars set out above and found proved showed that that the Registrant was unable to demonstrate that he was capable of working safely without supervision.

106. The Panel first considered his e-mail of 15 January 2025 in which he set out his position as follows.

“I have taken more time out to read the publication and allegations on the pdf you have attached. I would just like to say I am sorry that I didn’t meet the expectations required of Leeds trust. I did try my best and believe I gained a lot whilst working as a practitioner there. I feel I was a little shy and hence I didn’t really build a good rapport with the team. I wasn’t given a fair chance and was treated like a student throughout. So it was difficult for me to build confidence. I still truly learnt a lot. But it was getting to that point where the commute was getting difficult and journey was becoming difficult getting to Leeds. If I had spent a little longer with the team and didn’t resign so early, the team would have seen my potential. It does take time more than others for some people. But at the time I felt as long as we left with good terms. Maybe I didn’t have too much luck with this post unfortunately.”

107. The Panel has had regard to the number and nature of the matters proved, the extensive steps that were taken to assist his development, including the appointment of a mentor, and the extension of his induction to 20 weeks, which is significantly beyond the normal maximum of 12 weeks.

108. The Panel was also satisfied that none of the witnesses displayed any hint of hostility to the Registrant. On the contrary, they displayed a real determination to support him to complete his induction and spoke well of him as a person. Indeed, the Panel was impressed by the measured and professional way the witnesses gave evidence, acknowledging what they could not remember and agreeing that the Registrant’s performance had improved, albeit temporarily and inconsistently.

109. The Panel also noted that the Registrant was not dismissed from his position. The Panel accepted the evidence of Mr Hicken that a comprehensive process of mentoring and support was in place for the Registrant. The approach was one of encouragement and did not reflect the concerns held by colleagues. As an example, the Trust took the unusual step of signing-off the Registrant’s induction in a limited respect so that he could work in the treatment room delivering a limited range of treatment techniques. However, the Registrant resigned before the process of competency sign off was completed.

110. In those circumstances, the Panel is satisfied that the Registrant was given extensive opportunities to complete his induction successfully.

111. The Panel also had careful regard to the observations that were made during and after the August and September meetings set out in the background, above. The Panel noted in particular:

a. Meeting notes from 28 July 2022 in which BH recorded: Happy we have made a lot of progress over the last 2-3 weeks and we have seen vast improvement… The level at which you have been working at over the last week and the feedback received are very promising. This is the level we wish you to be working at.”

b. The letter of 9 September 2022 from SW to the Registrant in which she observed that “Overall, the progress you have made is fantastic and we will continue to support you to build that confidence. I will meet with you next on the 15 September.”

112. The Panel examined carefully whether this was evidence that the Registrant had demonstrated that he could work safely without supervision.

113. The Panel questioned BH closely about these matters and accepted his evidence that the documented encouraging improvement of the Registrant was set against the background of a very low base and indicated the Trust’s hope that the Registrant could become capable of working without supervision but that he still needed to make further progress in particular in imaging, treatment planning and paperwork.

114. The Panel also reminded itself of the matters found proved above, which demonstrated that the Registrant’s standard of work had again deteriorated in September 2022 following his resignation.

115. Accordingly, the Panel was satisfied that the observations made in July and August 2022, did not show that the Registrant had demonstrated he could practise safely without supervision.

116. Finally, the Panel considered whether the matters proved were sufficient to show that the Registrant had not demonstrated he could work without supervision.

117. The Panel reminded itself of the evidence of CM that the Registrant was “quite dangerous” and her evidence that the Registrant would need “constant and direct supervision” if he were to practise safely. The Panel also accepted the evidence of RC that she “would not be happy to sign him off to work on his own". The Panel also accepted the evidence of BH that the Registrant would make progress and then “go back a step”.

118. The Panel was satisfied that these were conclusions that qualified Radiographers were entitled to reach on the basis of their direct observations of the Registrant and their views also coincided with the Panel's own view of the evidence it had heard.

119. For all those reasons, the Panel is satisfied that the matters found proved above establish that, the Registrant was unable to demonstrate that he would be capable of working safely without supervision.

120. Accordingly, the Panel finds Paragraph 1 of the Allegation proved in its entirety.

Decision on Grounds

121. Having found the facts proved, as set out above, the Panel considered whether they amounted to misconduct and/or lack of competence and, if so, whether the Registrant’s fitness to practise is currently impaired.

Submissions and advice

122. The Panel heard the submissions of Mr Ive, who took the Panel through the relevant law, which the Panel has set out below.

123. He submitted that the matters found proved amount to misconduct and/or lack of competence and he set out what he submitted were a large number of breaches of the Standards of conduct performance and ethics for all those registered with the HCPC and the Standards of proficiency for Radiographers.

124. Mr Ive also submitted that the Registrant’s fitness to practise was impaired and drew the Panel’s attention to the relevant law, which the Panel also sets out below.

125. He reminded the Panel that it was considering whether the Registrant’s fitness to practise is currently impaired. He submitted that the risk of the Registrant repeating the failings found by the Panel was high because the Registrant had not demonstrated insight or remediation. He also submitted that a finding of impairment was necessary in the wider public interest, to maintain public confidence in the profession and uphold standards of conduct for the profession.

126. The Panel heard the advice of the Legal Assessor which it accepted and has followed in its decision set out below.

The Panel’s decision

127. The Panel first considered whether matters proved arose from lack of competence or amounted to misconduct.

128. The Panel reminded itself that the Allegation which it had found proved was that “you were unable to demonstrate that you would be capable of working safely without supervision.” The Panel also reminded itself that the Registrant was a junior member of staff going through an induction process during which he was effectively supervised throughout. It also reminded itself that it was the view of those seeking to enable the Registrant to complete his induction that he lacked the necessary knowledge and skill, and they hoped that a period of support and mentoring would enable him to practise unsupervised.

129. The Panel reminded itself of the Trust’s supporting performance policy which contained the following guidance:

‘Lack of performance at work is normally caused by one of… reasons. The employee does not perform the full range of duties to an acceptable standard because:

a. They do not have the skills or knowledge. This is known as not having the required level of competence

b. They have the skills, knowledge and health to perform the role but they deliberately do not perform in the role to the level required. This is a conduct issue.’

130. The Panel also had regard to the observations of Dame Janet Smith in the 5th Shipman report: the distinction between competence and performance is that competence describes knowledge and skills, that is what the doctor can do, and performance describes what he does.

131. The Panel also had regard to the authorities on misconduct, including to Roylance v General Medical Council (No.2) [2000] 1 AC 311 and Solicitors Regulation Authority v. Day and Others [2018] EWHC 2726 (Admin). The Panel accepted that the latter case showed that the Panel should consider culpability when assessing whether there should be a finding of misconduct.

132. Having regard to all these matters, the Panel was satisfied that the Registrant's failings arose because he was unable to meet the standards required rather than because he knew how to do so and had chosen not to. Accordingly, the Panel concluded that the Registrant's failings were more appropriately described as arising from lack of competence rather than misconduct.

133. The Panel concluded that because of his significant and fundamental lack of competence the Registrant was in breach of a number of Standards of Conduct, Performance and Ethics for all those registered with the HCPC and the Standards of Proficiency for Radiographers although it has born in mind that he was under supervision during most of his time at the Trust and at an early stage in his career.

134. Accordingly, it found the following provisions were engaged:

a. The Standards of Proficiency for Radiographers 28 May 2013

5.3 be able to provide appropriate information and support for service users throughout their radiotherapy treatment and care or diagnostic imaging examinations
14.18 be able to operate radiotherapy or diagnostic imaging equipment safely and accurately;
14.20 be able to check that equipment is functioning accurately and within the specifications, and to take appropriate action in the case of faulty functioning and operation;
14.39 be able to perform the full range of radiotherapy processes and techniques accurately and safely.

b. Standards of conduct performance and ethics (20216)

3.5 You must ask for feedback and use it to improve your practice.
6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.

Decision on Impairment

135. Turning to the question of whether the Registrant’s fitness to practise is currently impaired the Panel had regard to the HCPTS Practice Note ‘Finding Impairment’ dated November 2023.

136. It observed that the Practice Note reminds Panels that Fitness to practise is not defined in the Health Professions Order 2001, but it is generally accepted to mean that a Registrant has the skills, knowledge, character and health to practise safely and effectively.

137. The Panel adopted the following approach. The Panel had regard to the over-arching objective of protecting the public, which involves the pursuit of the following objectives:

• to protect, promote and maintain the health, safety and well-being of the public;
• to promote and maintain public confidence in the professions regulated under the Order; and
• to promote and maintain proper professional standards of conduct for members of those professions.

138. It also bore in mind that in deciding whether the Registrant’s fitness to practise is still impaired, it should follow the approach of Dame Janet Smith endorsed by the High Court in CHRE v NMC and P Grant [2011] EWHC 927 (Admin):

"Do our findings of fact in respect of the (Registrant’s) misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he:

a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or
b. has in the past brought and/or is liable in the future to bring the… profession into disrepute; and/or
c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the … profession; and/or
d. has in the past acted dishonestly and/or is liable to act dishonestly in the future”.

139. The Panel also had regard to the HCPTS Practice Note of November 2023 which directs Panels to look at both the personal and public components of impairment of fitness to practise. The “personal” component relates to the Registrant’s own practice as a Radiographer, including any evidence of insight and remorse and efforts towards remediation. The “public” component includes the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession and the Regulator.

140. Accordingly, the Panel looked at the personal component first and reminded itself of the key questions which need to be answered:

i. are the acts or omissions which led to the allegation remediable?
ii. has the Registrant taken remedial action?
iii. are those acts or omissions likely to be repeated?

141. The Panel bore in mind that an important factor will be the Registrant’s insight into those acts or omissions, the extent to which the Registrant:

• understands how and why it occurred and its consequences for those affected; and
• can demonstrate they have taken action to address that failure in a manner which remedies any past harm (where that is possible) and avoids any future repetition.

142. The Panel also bore in mind the public component of impairment which encompasses the second and third limbs of the overarching objective, namely promoting and maintaining public confidence in the profession and promoting and maintaining proper professional standards of conduct for the profession.

The Panel’s decision

143. The Panel observed that the Registrant had put few, if any, patients at direct risk of harm because he was so closely supervised throughout his employment at the Trust. Nevertheless, it was satisfied that the Registrant’s inability to learn the most fundamental skills of radiography meant that he was liable to do so in the future. The Panel has found that his failures included being unable to align a laser to the tattoos on a patient or carry out the correct dose calculations and also overriding error messages on the Linac without understanding the critical importance of recognising what those messages meant.

144. The Panel was also satisfied that the Registrant's inability to practise safely meant that he was liable to bringing the profession into disrepute in the future and breach a fundamental tenet of the profession of radiography namely to deliver safe treatment to patients.

145. Focusing on the personal component of impairment, the Panel assessed the risk of the Registrant repeating his failings. The Panel acknowledged that the failures found proved were capable of remediation, because they related to basic skills which all radiographers learn. However, The Panel observed that it had no material before it indicating that the Registrant had addressed, much less remediated his significant failings, despite the significant time and support he had been given.

146. The Panel concluded that there was no material before it to demonstrate that the Registrant had developed any insight which would enable him to undertake proper remediation. The Panel found that, on the contrary, the e-mail from the Registrant dated 15 January 2025 in which he maintained that he “wasn't given a fair chance” demonstrates that he has no understanding of the extent of his failings and the steps taken by the trust and his colleagues to assist him.

147. In those circumstances, the Panel is satisfied that the risk of repetition is high, and a finding of impairment is necessary to protect the public.

148. The Panel then considered the public component of impairment. It was satisfied that, in particular while a significant risk of repetition remains, a finding of impairment is necessary to maintain public confidence in the profession and hold proper standards of conduct for the professional. The Panel has no doubt that an informed member of the public would be shocked and lose confidence in the profession and its regulator if a Registrant were allowed to practise without restriction in circumstances where he remains a risk to patients.

149. Accordingly, the Panel finds that the Registrant’s fitness to practise is impaired under both the private and public components.

Sanction

150. Having found the Registrant’s fitness to practise impaired, for the reasons set out above, the Panel considered, what, if any sanction it should impose on the Registrant.

151. The Panel heard submissions from Mr Ive on the issue of sanction. He drew the Panel’s attention to the relevant guidance and indicated that the HCPC was neutral on the question of sanction. The Panel also accepted the advice of the Legal Assessor and had regard to the HCPC’s Sanctions Policy (SP). The Panel has followed both in its decision set out below.

152. The Panel is aware that the purpose of a sanction is not to be punitive but to protect the public and the wider public interest, which includes the reputation of the profession and public confidence in the profession and the regulatory process.

153. The Panel also bore in mind the principle of proportionality and balanced the Panel’s duty to protect the public against the impact on the Registrant.

154. The Panel took into account the following mitigating factors:

a. The Registrant’s lack of competence was demonstrated at an early stage in his career.

155. The Panel also considered the following aggravating factors:

a. The Registrant’s lack of competence encompassed the fundamental skills of a Radiographer and had the clear potential to put patients at significant risk of serious harm. The Panel accepts that the Registrant was likely to have done so if he had not been so closely supervised by other Radiographers.
b. The Registrant’s lack of competence endured over six months, with repetition of errors, despite the help and support given to him.
c. The Panel has found that the Registrant initially had very limited insight into the extent of his failings but the email of 15 January 2025, referred to above, indicates that his understanding has deteriorated even further since he left the Trust, in that he appeared in that email to blame others for his failures.
d. The Panel has seen no evidence of any efforts by him to address those failures identified.

156. Having considered both the mitigating and aggravating factors in this case, the Panel found that the effect of the aggravating features taken together, outweighed that of the mitigating features because the mitigating features were not sufficient to demonstrate to the Panel that the Registrant had developed sufficient insight or undertaken sufficient remediation to reassure the Panel that repetition is unlikely. Accordingly, the Panel found that a sanction was necessary to protect the public and the wider public interest.

157. The Panel then considered the sanctions available to it in ascending order of severity. It reminded itself that the sanction of a striking off order is not available to the Panel at this stage, and this is set out in paragraph 129 of Sanctions Policy:

129. A striking off order may not be made in respect of an allegation relating to lack of competence or health unless the Registrant has been continuously suspended, or subject to a conditions of practice order, for a period of two years at the date of the decision to strike off. Interim orders do not count towards the period of two years.

158. The Panel concluded that to take no action or to impose mediation or a caution would not be appropriate given the serious nature of the Registrant’s lack of competence. Such a course would not be sufficiently restrictive to protect the public, nor would it uphold the wider public interest.

159. The Panel considered whether a conditions of practice order would be sufficient to protect the public. The Panel had already found that the failings of competence are capable of being remediated and the Panel acknowledges that conditions are, on occasions, sufficient to protect the public in cases or lack of competence.

160. The Panel had regard to paragraphs 106 and 107 of the Sanctions Policy.

106. A conditions of practice order is likely to be appropriate in cases where:

• the Registrant has insight;
• the failure or deficiency is capable of being remedied;
• there are no persistent or general failures which would prevent the Registrant from remediating;
• appropriate, proportionate, realistic and verifiable conditions can be formulated;
• the Panel is confident the Registrant will comply with the conditions;
• a reviewing Panel will be able to determine whether or not those conditions have or are being met; and
• the Registrant does not pose a risk of harm by being in restricted practice.

When might a conditions of practice order not be appropriate?

107. Conditions will only be effective in cases where the Registrant is genuinely committed to resolving the concerns raised and the Panel is confident they will do so. Therefore, conditions of practice are unlikely to be suitable in cases in which the Registrant has failed to engage with the fitness to practise process or where there are serious or persistent failings.

161. Taking each of those considerations in turn, the Panel found that the Registrant has demonstrated very little, if any, insight and his insight appears to have deteriorated. The Panel acknowledged that the Registrant's failures and deficiencies are theoretically capable of being remediated but saw no evidence that the Registrant himself is capable of such remediation. The Panel observed that the Registrant’s failures have been so persistent and covered such a wide range of his practise that remediation is likely to require very extensive retraining. In those circumstances, the Panel cannot be satisfied that appropriate conditions can be formulated. The Panel received no material from the Registrant capable of satisfying it that he would comply with any conditions. The Panel has already found that even when supervised the Registrant posed a risk to patients and placed a significant burden upon his colleagues.

162. The Panel also reminded itself that the Registrant has not engaged in these proceedings and has put no material before the Panel which could satisfy it that he is genuinely committed to resolving the concerns in this case.

163. The Panel has been told that the Registrant has been subject to an Interim Conditions of Practice Order but there is no material before the Panel to demonstrate that he has worked subject to conditions or otherwise addressed the concerns found in this case.

164. For these reasons, the Panel does not impose a conditions of practice order.

165. The Panel is satisfied that, in those circumstances, the only sanction available to the Panel to protect the public and the wider public interest is a period of suspension.

166. The Panel considered the length of time for which a suspension order should be imposed. It decided to impose the suspension order for a period of 12 months because it was satisfied that no shorter period was sufficient to give the Registrant time to complete the significant remediation he needs to do and mark the seriousness of his lack of competence.

167. The Suspension Order will be reviewed shortly before its expiry. The Panel does not purport to bind a future panel but indicates that a reviewing panel is likely to be assisted by:

a. the Registrant engaging with the HCPC,
b. a compelling demonstration of developed insight into his lack of competence and its consequences,
c. attending the review hearing, and,
d. demonstrating that he has undertaken sufficient education and remediation to address his significant and fundamental failures.

ORDER: That the Registrar is directed to suspend the registration of Mr Ismael Hussain for a period of 12 months from the date this Order comes into effect.

Interim Order

1. After the Panel announced its decision on sanction, Mr Ive applied for an interim order to cover the period before the Suspension Order will come into effect (that is to say, initially 28 days or the final determination of the appeal if the Registrant appeals the Panel’s decision within the initial period of 28 days).

2. He drew the Panel’s attention to Article 31 of The Health Professions Order 2001 (the Order) and the relevant paragraphs of Sanctions Policy, to which the Panel refers below.

3. The Panel also received and accepted the advice of the legal assessor which it has followed in its decision set out below.

4. The Panel first considered whether it was right to consider the application for an interim order in the absence of the Registrant, having regard to Article 31 (15) which provides that no interim order may be made “in respect of any person unless he has been afforded an opportunity of appearing before the Committee and being heard on the question whether such an order should be made in his case.”

5. The Panel was satisfied that it was appropriate to consider the HCPC’s application for an interim order in the absence of the Registrant because he had been informed by the notice of hearing sent to him by email on 14 January 2025 that such an application might be made, and he has not responded with regard to that warning.

6. The Panel found that all the conclusions that it reached at the outset of the hearing when considering the application to proceed in the absence of the Registrant still apply.

7. The Panel reminded itself that Article 31 of the Health Professions Order 2001 as amended provides that the Panel may make and interim order if it is satisfied that it is necessary for the protection of members of the public or is otherwise in the public interest, or is in the interests of the person concerned, for the registration of that person to be suspended or to be made subject to conditions.

8. The Sanctions Policy gives guidance in the following terms:

i. 135. An interim order is likely to be required in cases where:

• there is a serious and ongoing risk to service users or the public from the Registrant’s lack of professional knowledge or skills, conduct, or unmanaged health problems; or

• the allegation is so serious that public confidence in the profession would be seriously harmed if the Registrant was allowed to remain in unrestricted practice.

9. For the reasons already explained in the determination relating to the substantive issues, the Panel has concluded that the public would be at significant risk of serious harm and that public confidence in Radiographers would be undermined if the Registrant were allowed to practise without restriction pending the substantive order coming into force.

10. For those reasons, the Panel was satisfied that an interim order is required both to protect the public and in the wider public interest of maintaining public confidence in Radiographers

11. Having decided that an interim order is required, the Panel next considered whether an interim conditions of practice order would offer sufficient protection during the period while the Registrant’s appeal rights remain extant. The Panel concluded that it would not for the same reasons that it rejected substantive conditions of practice as an appropriate sanction.

12. For those reasons, the Panel concluded that an interim Suspension Order is required.

13. Turning to the length of this interim order, the Panel determined that it should be for the maximum period of 18 months. If the Registrant does not appeal the Panel’s substantive decision the interim order will simply fall away after 28 days, and therefore the maximum length of the order will not prejudice him. If, however, she does appeal the final determination of the appeal could well take 18 months from the present time, and it is appropriate that there should be the full degree of public protection until that final determination.

14. 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.

15. 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.

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.

 

History of Hearings for Ismael Hussain

Date	Panel	Hearing type	Outcomes / Status
13/02/2025	Conduct and Competence Committee	Final Hearing	Suspended
14/11/2024	Conduct and Competence Committee	Interim Order Review	Adjourned
21/05/2024	Investigating Committee	Interim Order Review	Interim Conditions of Practice
07/08/2023	Investigating Committee	Interim Order Application	Interim Conditions of Practice