Ihab Y A Sharaf

Preliminary Matters:

Background

1. The Registrant is registered with the HCPC as an Operating Department Practitioner (‘ODP’). The Registrant was employed by Buckinghamshire Healthcare NHS Trust (‘the Trust’) from 02 October 2017. At the time of the matters arising the Registrant was working as a Band 6, Senior ODP based at Wycombe General Hospital (‘the Hospital’).

2. In November 2017, complaints were made by colleagues about the Registrant’s conduct towards them, as well as clinical concerns in undertaking his role as an ODP and a failure to adhere to Trust policies. Following informal discussions, the decision was taken to suspend the Registrant and formally investigate the alleged conduct.

3. The above Allegation came before a panel of the CCC in September 2021. The Registrant denied all of the matters alleged. The HCPC called six witnesses to give live evidence, comprising of a Nurse Consultant, who undertook the investigation into these matters on behalf of the Trust, and five eye witnesses to the matters alleged. The Registrant also gave oral evidence to the substantive hearing panel.

4. The Substantive Hearing panel found the majority of the matters alleged proved, save for those relating to Person C and the particular that conduct at 5(b) was dishonest.

5. When it addressed the statutory ground of misconduct, the Substantive Hearing panel concluded that the Registrant’s actions breached the following paragraphs of the HCPC Standards of Conduct, Performance and Ethics (2016):

• 3 - Work within the limits of your knowledge and skills (Particulars 2 and 5(a)

• 4 – Delegate appropriately (Particular 4)

• 6 - Manage risk (Particulars 2 and 3)

6. The Substantive Hearing panel also concluded that the Registrant breached the following Standards of Proficiency for ODPs (2014):

• 3 - be able to maintain fitness to practise 3.1 - understand the need to maintain high standards of personal and professional conduct (Particulars 1(a)(b), 6(a)(i), 6(c)(i), (ii) and (iii))

• 4 - be able to practise as an autonomous professional, exercising their own professional judgement 4.4 – recognise that they are personally responsible for and must be able to justify their decisions (Particular 3)

7. The Substantive Hearing panel went on to state:

‘Particulars 1 and 6 concerned conduct that the Panel has found to be either aggressive (Particulars 1(a) and (b), 6(a)(i)), or aggressive and threatening (Particular 6(c)(i), (ii) and (iii)). The Panel was of the view that no colleague should face aggressive or threatening behaviour in the workplace by another’s actions or words. Exercising its own professional judgement, the Panel concluded that the conduct found proved in each sub-particular fell seriously short of what would be appropriate in the circumstances and amounted to misconduct. It indicated a pattern of inappropriate behaviour towards the Registrant’s colleagues that was wholly unacceptable.
In relation to Particular 2 - the Registrant acting outside of his scope of practice when attempting to carry out an arterial cannulation - the Panel considered that there was the clear potential for harm to be caused to the patient and that the level of risk posed by the Registrant’s actions was unacceptable. The Panel was in no doubt that the Registrant’s actions in this case were serious and reached the threshold required to be properly considered misconduct.
In relation to Particular 3 - the Registrant leaving the anaesthetist in theatre, without appropriate support, to obtain further Propofol - the Panel considered that the Registrant’s actions in leaving a patient in a compromised position without adequate support placed the patient at significant risk. It was of the view that the Registrant’s reasoning that the anaesthetist had asked him to obtain more Propofol and that, “we work under the responsibility of the anaesthetist consultant and follow their orders”, was not appropriate and that, as an autonomous professional, the Registrant had not displayed the required level of responsibility or accountability.
The Panel considered that the Registrant’s actions fell seriously short of the standards expected of an ODP, placed the patient at risk of harm and amounted to misconduct.
In relation to Particular 4 – the Registrant giving the controlled drugs cupboard key to Colleague E who was not qualified to hold them - the Panel considered that the public would expect the handling of drugs to be carried out correctly and policies and procedure adhered to. The Panel considered that, whilst this incident of itself would not amount to misconduct, it was indicative of a pattern of not following his employer’s policies or procedures, which raised serious concerns about the Registrant’s adherence to the required standards.
In relation to Particular 5(a) the Panel considered the particular context of the Registrant performing venous cannulation on the patient. It accepted the Registrant’s case that he knew he was acting outside of Trust policy but did it in the interests of the patient, to relieve their pain, when the consultant anaesthetist asked him to, as he (the anaesthetist) could not perform the cannulation at that time. The Panel was of the view that this action did not cause significant risk to the patient and, in these circumstances, could not be properly described as serious misconduct. In relation to Particular 5(b), the Panel reminded itself of its findings in relation to the circumstances of the Registrant being asked the question by Colleague G and the apparent confusion of a number of matters being discussed. The Panel also bore in mind that the Registrant spoke to colleagues that same day to say that he had performed venous cannulation. In light of the confusion that the Panel had accepted the Registrant felt, the Panel did not find that the Registrant’s response to Colleague G amounted to misconduct.
The Panel found that the Registrant’s conduct, as a whole, demonstrated behaviour that fell far below the standards expected of a registered ODP. The Panel was in no doubt that the Registrant's behaviour had the clear potential to undermine public confidence in the profession and it found that to characterise it as other than misconduct would fail to uphold proper professional standards and would undermine public confidence in the profession and in the regulatory function of the HCPC. In these circumstances, the Panel determined that the ground of misconduct was well founded.”

8. In reaching its decision that the Registrant’s fitness to practice was impaired, the Substantive Hearing panel said:

“The Panel first considered the personal component of impairment and adopted the approach formulated by Dame Janet Smith in her Fifth Report of the Shipman Inquiry by asking itself the following questions:
Do our findings of fact in respect of the Registrant s misconduct show that his fitness to practise is impaired in the sense that he:

(a) has in the past acted and/or is liable in the future to act so as to put patients at unwarranted risk of harm; and/or has in the past brought and/or is liable in the future to bring the Operating Department Practitioner profession into disrepute; and/or has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the profession; and/or has in the past and/or is liable in the future to act dishonestly?
The Panel determined that limbs (a) to (c) were engaged in this case. It considered that the Registrant had, in the past, placed patients at unwarranted risk of harm by acting outside of his scope of practice and leaving theatre during a surgical procedure; and that the Registrant had, in the past, brought his profession into disrepute and breached fundamental tenets of the ODP profession by acting unprofessionally towards colleagues, and by not properly managing risk. In considering whether he would be liable in the future to act so as to put patients at unwarranted risk of harm, or to bring the profession into disrepute or to breach fundamental tenets of the profession, the Panel carefully considered the personal component of impairment and considered the Registrant's level of insight, whether his misconduct was capable of remediation, whether it had been remedied and the risk of repetition. The Panel considered that, in theory, the misconduct was capable of remediation through meaningful reflection into the failings and retraining on the fundamental importance of adherence to the principles set out in the Standards detailed above.
The Panel took the view that something went seriously wrong for this Registrant over a four-month period at the Trust. The Panel was mindful that the Registrant qualified as an ODP 35 years ago with, on the information before the Panel, no previous concerns regarding the Registrant his practice. The Registrant has told the Panel that he has found it difficult to secure work as an ODP since the referral to the HCPC.
The Panel first considered whether the Registrant had displayed any remorse for his misconduct. It noted that the Registrant had apologised directly to several of the HCPC witnesses in the hearing, which the Panel considered to be much to his credit.
The Panel next considered the Registrant’s level of insight. It took into account the HCPTS guidance around insight, particularly that insight is a registrants genuine understanding and acceptance of the concerns, which have been raised in relation to their conduct,” and was of the view that the Registrant had presented a rather mixed, not entirely straightforward picture. In oral evidence, the Registrant had spoken about the importance of looking at himself in the mirror and recognising that he needed to change. He had told the Panel that he discussed the matters with his wife and that he accepted that he needed to improve in a number of areas. The Panel had found this evidence compelling and considered that the Registrant had shown understanding and a degree of humility which, again, were to his credit. In his submissions, however, the Registrant had said that he did not regard grabbing Colleague E by the arm or wrist to be aggressive behaviour and that, although local policies and procedures were to be followed, he worked under the responsibility” of registrars and consultants and we cant move away from that.”

The Panel had some concerns about the Registrant’s professional judgment and considered that, on the information before it, the Registrant had not fully understood or accepted the severity of his conduct and had not yet properly reflected on these errors to the extent necessary to demonstrate to this Panel that he has developed full insight into his misconduct since leaving the Trust. It further noted that he had not completed any re-training on the fundamental importance of adherence to the principles set out in the Standards detailed above and his responsibilities to patients, colleagues, his employer and the profession. The Panel was of the view that it had no evidence of deep reflection on the Registrants part.
The Panel did not consider the Registrant was incapable either of properly reflecting on his misconduct or that he could not achieve full insight into his shortcomings should he choose to do so in the future. However, at this stage, in the Panel’s view the Registrant had shown only partially developed insight into his misconduct; his level of insight was not fully developed.

The Panel next considered any evidence of the Registrant’s remediation of the misconduct. The Registrant has told the Panel, in oral evidence, that he had received no further complaints and that he had spoken regularly to the theatre teams he worked with about his practice. The Panel noted, however, that most of the character references provided by the Registrant pre-date the incidents at the Hospital and that only one reference-provider was aware of the HCPC allegations faced by the Registrant. In light of all the information before it, the Panel found insufficient evidence of remediation by the Registrant of his misconduct and, as such, the Panel could not exclude the risk of repetition of such misconduct by the Registrant.
In these circumstances, the Panel has concluded that the Registrants fitness to practise is impaired on the personal component.
The Panel next reminded itself of the public component in Cohen v General Medical Council [2008] EWHC 581: the need to protect the individual and the collective need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour which the public expect…and that the public interest includes, amongst other things, the protection of service users and the maintenance of public confidence in the profession.” The Panel was satisfied that, given the nature of the matters and their potential seriousness - namely managing risk and placing patients at unwarranted risk of harm; personal and professional accountability; and aggressive and, in some cases, threatening behaviour towards colleagues - public confidence in the ODP profession would be undermined if there were no finding of impairment in this case. The Panel was also satisfied that it would be failing in its duty to declare and uphold proper standards of conduct and behaviour in the ODP profession if it did not find impairment in this case. ODPs should be in no doubt that this sort of behaviour is unacceptable.

The Panel therefore found, on the public component, that the Registrant’s fitness to practise is impaired.”

9. In reaching its decision on sanction, the Substantive Hearing panel identified the following aggravating and mitigating factors:

“Aggravating factors:

• the Registrant has only partially developed insight into his failings;

• some of the misconduct identified put patients at risk of harm (Particulars 2 and 3);

• the “aggressive behaviour” identified in this case was repeated and involved more than one colleague.

Mitigating factors:

• the Registrant has repeatedly expressed what the Panel considered to be genuine remorse throughout the hearing;

• the Registrant has repeatedly stated a strong commitment to improve and to remediate fully;

• the Registrant has demonstrated a genuine motivation and passion to help patients;

• the HCPC witnesses described the Registrant as a usually pleasant colleague with whom they got on well;

• the Registrant has an unblemished regulatory record prior to and since these events. The Panel is not aware of any further complaints against the Registrant in the period of three years since the events at the Trust in 2017/2018;

• the professional testimonials presented to the Panel attest to the Registrant’s good clinical practice.”

10. In determining that the appropriate sanction was a Conditions of Practice Order for a period of 18 months, the Substantive Hearing panel stated:

“The Panel was of the view, as previously stated in its determination at the Impairment stage, that the Registrants failings in this case are capable of remedy. It took into account the Registrants full engagement in proceedings. As the Panel has already determined, the Registrant is developing insight and the Panel was satisfied that the Registrant has demonstrated a willingness to comply with conditions (having been subject to interim conditions of practice since September 2019) as well as a desire to improve his professional practice. The case had not concerned the Registrant’s competence as an ODP and there was no evidence before the Panel of persistent or general failures which would prevent remediation. The misconduct relates specifically to his conduct towards colleagues, working within his scope of practice and managing risk which, in the Panel’s view, is capable of being remedied and, for which there are workable conditions that can be formulated to allow him to remain in practice whilst ensuring the public interest issues are addressed. The Panel was satisfied that a Conditions of Practice Order was a proportionate and appropriate sanction to protect the public and the public interest; such an order was also appropriate to declare and uphold proper standards and maintain confidence in the profession. The Registrant has told the Panel repeatedly that the Interim Conditions of Practice Order has stopped him from obtaining work as an ODP. Having reviewed the current Interim Conditions of Practice Order, however, the Panel could not see why those conditions would be such an obstacle to the Registrant securing work via an agency or a substantive role as a Band 5 ODP or above. In any event, the Panel concluded that the Conditions set out at the end of this determination are adequate and proportionate in the circumstances of this case. The Conditions of Practice Order will apply for a period of 18 months. The Panel believes that this will give the Registrant sufficient time to meet the Conditions (especially in light of likely delays in many aspects of employment due to the Covid-19 uncertainty), which will demonstrate that the deficiencies in his practice have been addressed."

11. The Substantive Hearing panel also considered a period of suspension would be “disproportionate and punitive given that Conditions of Practice could be formulated which were sufficient to meet public interest considerations. The Panel also considered that a Suspension Order would be contrary to the public interest, which includes the retention of a registrant who is able to make a valuable contribution to the profession and to patients.” The Substantive Hearing panel also considered that a future review panel would be assisted by the Registrant attending to give oral evidence and providing up to date and relevant professional or other testimonials attesting to his appropriate and effective management of risk, his conduct towards colleagues and his ability to work within his scope of practice.

12. The Order was reviewed on 13 March 2023 for the first time, where the conditions of practice were varied and extended for a further period of 9 months. The Order was reviewed for a second time on 01 December 2023, where the Order was extended for a further period of 4 months.

13. On 03 April 2024, the Order was due to be reviewed again however, that review panel determined that the Order had lapsed. On appeal of that panel’s decision, by the Professional Standards Authority (‘PSA’), the High Court quashed the reviewing panel’s decision and directed that the Conditions of Practice Order be extended for a further period of 4 months, taking effect from the sealing of the Order, which occurred on 27 February 2025. The Order is therefore due to expire on 27 June 2025.

14. The conditions of practice imposed by the High Court were as follows:

1. You must produce a written reflective piece using a reflective tool (such as the Gibbs cycle). This should set out what you have learned from the incidents that gave rise to the HCPC hearing, including any learning you have gained through your Specialist Skills and Post Registration Development since the incidents.

2. When working as an ODP, you must identify a named person (the "Named Person") who is a team leader or manager within the department at your place of work. The Named Person should monitor your behaviour and adherence to your employer's policies and procedures. For the avoidance of doubt, your practice does not require constant oversight.

3. The Named Person should confirm your adherence to policies and procedures, conflict management and communication with colleagues. This confirmation of adherence to policies, good communication with colleagues and appropriate management of conflict must be submitted to the HCPC no later than 5 working days before a Review hearing.

4. You must provide a copy of these Conditions of Practice to your Named Person.

5. You must inform the HCPC within 5 days whenever you take up any employment in the role of a registered ODP.

6. You must immediately inform the HCPC of any disciplinary proceedings or complaints identified by your employer.

7. You must inform the following parties that your registration is subject to these Conditions of Practice:

a. any organisation or person employing or contracting with you to undertake professional work;

b. any agency you are registered with or apply to be registered with (at the time of application) and c. any prospective employer (at the time of your application)

Submissions and oral evidence:

The submissions and oral evidence outlined below are a summary of the parties’ submissions and oral evidence to the Panel and are not a verbatim account.

HCPC:

15. Mr Scholfield briefly outlined the background of the case to the Panel, as the Panel had indicated, at the outset of the hearing, that it had read all of the papers placed before it, which included the following:

i. HCPC hearing bundle – 132 pages;

ii. HCPC review hearing bundle for 03 April 2024 – 145 pages;

iii. HCPC addendum bundle for 03 April 2024 – 4 pages;

iv. High Court Judgment – 14 pages; and

v. Registrant’s references (provided during the hearing) – 5 pages.

16. Mr Schofield submitted that the Registrant’s fitness to practise remains impaired on both the personal and public components and that the HCPC was inviting the Panel to strike the Registrant from the HCPC Register. Mr Schofield submitted that the Registrant had not provided sufficient evidence demonstrating that he is no longer impaired and he has failed to demonstrate compliance with the previous panel’s recommendations.

17. Mr Schofield further submitted:

i. there is not yet sufficient evidence to demonstrate a sustained and maintained change, or that the original findings made by the substantive hearing panel have been addressed by the Registrant;

ii. the reflective piece provided for todays review hearing is “cursory” and does not address the identified concerns in any great detail;

iii. the Registrant has not provided sufficient evidence of remediation and has failed to utilise the Gibbs method, or similar, to demonstrate appropriate reflection;

iv. there has been sufficient time for the Registrant to demonstrate remorse, reflection and remediation and he has not done so;

v. the Registrant has not discharged the persuasive burden and has not addressed the core concerns of the Substantive Hearing panel;

vi. the Registrant has not provided the required information sought by the previous reviewing panel; and

vii. the HCPC invite the Panel to strike the Registrant from the HCPC Register.

Registrant:

18. The Registrant elected to give oral evidence to the Panel. In doing so, he stated the following:

i. he was grateful for the opportunity to address the Panel;

ii. the matter had been ongoing and enduring for a significant period of time;

iii. his conduct had not affected patients and the issues around communication arose with managers and staff;

iv. he had worked when the Order had expired and he had done so for approximately nine months. During that time the HCPC had not received a further complaint in respect of his practice;

v. this demonstrated that he had worked appropriately and without concern arising for this period of time and this demonstrated that the previous concerns amounted to an “isolated issue” with the Trust;

vi. he wanted to be permitted to return to practise as an ODP;

vii. he had provided: references from surgeons and anaesthetists; reflections; and evidence of learning and completion of courses and he was unsure of what else he could provide to the Panel;

viii. he had provided a reflection for the purpose of this hearing;

ix. he is a father of four children and is a “peaceful man”;

x. whatever had happened at the Trust was an isolated incident and not a reflection of his wider practice. The concerns amounted to “bad circumstances” and this experience had made him “alert” to other situations which will ensure that they are not repeated; and

xi. he had learnt a “large lesson from this situation” and he wanted the opportunity to return to practise.

19. In response to questions from Mr Schofield, the Registrant also stated the following:

i. in respect of page 132 of the HCPC hearing bundle – this was the reflection piece that he had submitted;

ii. he had “learnt from his mistake”;

iii. he did not know what the Gibbs reflective cycle is;

iv. in respect of page 113, paragraph 35, the Registrant had not used a reflective piece or model and he did not understand what the Gibbs reflective cycle is;

v. he was subject to an interim order prior to the substantive order being put in place, and the interim order was imposed in 2019;

vi. in respect of page 130 of the April 2024 review bundle – he had given his employment agency the information about his conditions of practice order being in place, but the client had refused the booking and that is why it appeared that he had not complied with the conditions of practice by informing the employment agency, but he had complied;

vii. in respect of page 69 of the same April 2024 bundle and Conditions of Practice to notify any employer – he accepted that if he didn’t inform the agency at the time, that he would be in breach of the conditions of practice, but he refuted any assertion that he had not complied with the conditions of practice;

viii. he had returned to working as an ODP during the lapse of the Order and he had practised for a period of approximately 9 months; and

ix. he was not clear on why he had to provide the information, from his employers from April 2024 and he had “done the work perfectly” and the HCPC had not received “any complaint” during this time.

20. In response to questions from the Panel, the Registrant stated the following:

i. he returned to practise when the Order was not in place and prior to that date he had updated his knowledge with “the internet and with colleagues”;

ii. whilst away from practice, he had updated his knowledge from “the internet” and associations he is a member of;

iii. he worked from May 2024 until January 2025 at: the ‘Royal London’ hospital; the Royal Free hospital; Whipps cross hospital; and University College hospital (‘UCH’). He could ask for references from the professionals at the hospitals as the people he worked with were “friends”;

iv. when referring to ‘making a mistake’ in his reflections, his mistake was that he did not remain calm during the situation with his manager and if someone is shouting at him, he now understood that he should remain calm;

v. in respect of his professional work in the UK, he should adhere to the code of conduct and within his scope of practice. His error was that in other jurisdictions he had worked in anaesthesia and he had worked alone and, in the USA, “he worked as a technologist” and so now he realised that he had to remain within his scope of practice;

vi. in respect of the reflection piece, point 2 talks about implementing “proactive measures” and by this he meant that he had to “look and reflect and learn from the mistake”. He had also reflected on “his culture” and that this is different from what he was used to in the UK. He now realised that he had to remain professional at all times; and

vii. he had undertaken a “body language course” and he had also completed 48 different courses some of which had to be completed online and some in person and he could provide documentary evidence to support this to the Panel should the Panel wish to see it.

ORDER: The Registrar is directed strike the name of Mr Ihab Y A Sharaf from the Register on the date this Order comes into effect.

The Order imposed today will apply from 27 June 2025.

History of Hearings for Ihab Y A Sharaf