Examination of Witnesses (Questions 1-19)
Monday 12 May 2003
MR PETER
JINMAN AND
MR CARL
PADGETT
Q1 Chairman: Good afternoon, gentlemen
and others who I know have come along to join us this afternoon.
Welcome to this, the first of our evidence sessions in our inquiry
into the veterinary profession and the veterinary service. The
main Committee, of which we form a sub-committee, decided that
this was an important area to look into, particularly in the light
of the experience of the foot and mouth outbreak and the questions
that were raised therein about the state veterinary service and
the contribution of the private veterinary profession to that
and many other matters. You will be aware that the Committee has
also just recently undertaken and published a report on matters
connected with TB and again it raises some very important issues
which I am sure colleagues will want to touch on in the evidence
that we are going to be taking. We have first in front of us the
British Veterinary Association, Mr Peter Jinman and Mr Carl Padgett.
I wonder if you would respectively identify yourselves for the
Committee and tell us what roles you have?
Mr Jinman: Thank you very much
and thank you for the opportunity to come and speak today. My
name is Peter Jinman. I am currently the president of the British
Veterinary Association. I am a practitioner in Herefordshire in
a mixed practice and so well in a position to discuss the subject
matter of the day.
Mr Padgett: Carl Padgett, another
veterinary practitioner from the Lancashire area, much nearer
your part of the world I believe. I am currently a member of the
British Veterinary Association Council and Honorary Secretary
of the British Cattle Veterinary Association.
Q2 Chairman: Thank you for sending
us copious quantities of evidence, magazines and other very useful
information. I have tried my best to absorb that information.
I see in the audience that a very good friend of mine, Barry Johnson,
is here so I am feeling very much at home with all this Lancastrian
input. One of the themes that comes through from the evidence
which the Committee has received so far is the juxtaposition between
falling profitability in the cattle sector and what appears to
be a question about the amount of veterinary service professional
help, which particularly the livestock sector can afford to buy,
the implications that that has on the size of the profession,
the work the profession undertakes and the relationship that has
to some of the statutory work which the veterinary profession
has to do. I am thinking obviously about animal health welfare
issues. By way of an opening shot on that, I wonder if you would
like to comment on whether the livestock sector is financed well
enough to continue to employ your services.
Mr Jinman: No doubt the NFU will
give you some facts and figures on that. Our perception undoubtedly
is that when profitability in an industry and a sector rises the
usage of the veterinary profession also rises. When the capital
value of stock rises then also it is true to say that the use
of veterinary time rises. If one thinks this through, it is not
exactly illogical. As a veterinary surgeon, what I will be doing
when I go on to a farm is discussing with the farmer the cost
of treatment related to the event with which we are dealing. This
is very often on a flock or herd basis. When one is dealing with
cattle, it is very commonly on an individual basis, when we are
dealing with what we term "fire brigade" medicine. In
other words, sick animal, phone call in the morning, go out, see
it and then we would discuss what the options are, what the chances
of survival are, what the costs of treatment are related to the
value to the farmer of that animal. When we are dealing with slightly
larger scale herd and flock health problems, clearly we are looking
across a group and making a diagnosis or suggestion or indeed
hopefully trying to look ahead and plan for the farmer a way to
avoid losses and improve the outturn. That is a different basis
but it is still always based upon what that industry is looking
for in terms of its return and trying to assist that.
Q3 Chairman: What do the economics
of the livestock sector currently tell us about the prospects
for work in the field of large animals? There is an undeniable
common strand that runs through all the evidence again, which
says that because of the economics of the livestock sector, the
reducing demands for veterinary services, large animal experience,
the practices that deal with that are on the decline and there
will be implications arising from that.
Mr Jinman: Clearly, it is a market
based economy. Therefore, the price varies on demand. One accepts
there is also a very substantial subsidy system in certain parts
of the country and in certain relationships within the farming
system. The difference between that and veterinary medicine in
the companion animal sector and the equine industry—and
I am looking there at equine as companion equine rather than the
stud or racing area where it is more akin to a market basis—is
that it is profit driven. If there are sufficient funds in it,
we will be asked to do the duty of looking after, treating, etc.
A good example of this is that a short while ago any male calf
born had no value whatsoever. We would go to assist a cow calving,
perhaps do a Caesarian section, and immediately bring the calf
out and have the sad situation of having it put to sleep. How
do we deal with it? How do we dispose of it? If you go back a
sufficient number of years, the value of the calf used to cover
the cost almost of doing the Caesarian section. It does depend
very much on market forces and what is happening in the industry
generally as to what response the farmer will have. When we look
at the dairy industry, the price of milk has a dramatic effect
on demand.
Q4 Chairman: Does that also explain
the rise in the small animal work at the expense of large animals?
You said it is a market driven economy. Does that mean that the
profession is positively opting into small animal work, pets and
equine work that you have indicated and saying, "Thanks,
but no thanks" to large animal work?
Mr Padgett: There are a couple
of strands going on there. One, at the basic practice level where
we all have to manage our own businesses and have certain professional
staff on board. If there is some down time, it is very expensive
down time and one has to develop services appropriately to fill
that time. It is surprising how many veterinary surgeons who are
mixed start to fill their down time up trying to create more demand
for veterinary services in the small animal sector. Small animal
work, by its very nature, is much more interesting and gives a
lot more job satisfaction by the carrying through of individual
cases. It is much more akin to the human medical situation where
you can get pretty involved with individual cases. The draw for
that on the large animal side is much less. You have to have a
much greater understanding of the economics and the general farm
situation to get that drive for farm work to deal with population
medicine because you are not going to get involved with individual
animals. The vets who prefer the individual way of working move
much more towards the small animal side.
Q5 Chairman: What are the implications
for the way in which veterinary medicine is taught? Is the teaching
still broad enough based to give people the knowledge to choose
which sector to go into or is it also responding to what the market
place is saying?
Mr Padgett: I believe the teaching
is broad enough to give them an opportunity to go into any aspect
that they wish to go into. One of the problems that exists is
the availability of caseload at veterinary schools. The small
animal, equine sector seems to have more funding at veterinary
schools and access to farm animal cases is much less. I personally
believe that, with some degree of restructuring, there is still
the possibility of getting students to spend time with farm animal
veterinary surgeons who are appropriate teachers.
Q6 Chairman: I noticed that in paragraph
four of your evidence, W18, you talk about the increasing feminisation
of the veterinary profession and, at the same time, the pressures
of doing large animal work do raise issues about 24 hour cover.
It says there may be some lifestyle issues creeping into what
vets will do and will not do, particularly if those female members
of your profession also have family responsibilities. Perhaps
you could tell the Committee how those two particular trends enmesh
and what it means for the ability of your profession to give a
24 hour cover service, particularly for farm based animals?
Mr Jinman: Our colleagues from
the Royal College will give you more detail on some of the demographics
because they have done quite a lot on that in the paper to you.
The principle is, at the present time, that the profession in
this country as in others is becoming predominantly female and
it will be so in a few years' time. The outturn from the intake
to veterinary schools is predominantly female. There is a difference
in lifestyle. There is undoubtedly a statistical truth that the
working life is less so there is time out and also time spent
with family. Part time working becomes a more important part of
the structure. That comes quite difficult to fit into some of
the large animal format and is perhaps more easily accommodated
within the small animal format where it is based upon a consultation
in a surgery. With regard to 24 hour cover, this does mean that
there is a requirement. That is true whether it be for small or
large animals. What we see in the cities is that the practices
get together and, in the larger cities, they will even have full
time, 24 hour night time surgeries that purely work at night.
The alternative is that there may be a swap over in the smaller
animal area between different practices, night cover provided
by one practice for another or for a group of practices. In the
rural areas, this is not possible because of the distances, depending
upon the area. It is done in some areas but in many areas we are
dealing with considerable distance and knowledge of the particular
countryside. I can assure you that wandering around some of the
parts of Herefordshire at night, trying to find farms is not exactly
a task that is easily successful unless you have some knowledge
of the area. It takes a little while to acquire that. There are
potential difficulties and there are just difficulties, full stop,
in getting 24 hour cover, contrary to that which is on page 40
of the Competition Commission report on our profession. We would
like to clearly refute that particular statement.
Q7 Chairman: There is not a case
to have the equivalent of NHS Direct, a Vets Direct, where people
can ring a helpline number to get some telephone consultation?
Mr Jinman: We all do that. I did
a log on Monday of last week of the calls that came into me when
I was on duty on Bank Holiday Monday. In 10 telephone calls, one
required a journey out, so nine were dealt with purely with telephone
advice or were matters that could be dealt with not on the Bank
Holiday. We are ahead of the NHS by a long way, I think.
Mr Padgett: Generic advice is
very difficult in the rural situation because many of the scenarios
are very farm specific, on a individual basis. It is very rare
that you would give generic advice, except in the individual animal
case where it is exceptionally generic in a very similar way to
humans, but on the whole you could be dealing with cases that
may have implications for the rest of the herd. The advice accordingly
may need prior knowledge of what is going on on that farm so somebody
generically answering questions by telephone is not always appropriate
if they have not been on the farm.
Q8 Paddy Tipping: All that sounds
difficult enough but your role is changing. Could you spell out
for us how you think your role might change over the next few
years?
Mr Jinman: There are a whole lot
of pressures upon the industry and farming. We are dealing here
with the farming industry rather than across the whole of the
veterinary industry. We are well aware that the small animal has
grown from next to nothing. Practices that 20 years ago were 90%
farm animal based are now 10% or they are giving up the farm side
because the cost of servicing it is excessive against its returns.
That is perhaps the key problem that we are facing. When you hit
about 10 or 15% of turnover coming from large animal return, it
becomes quite difficult to service that. Coming back to the role
of farming in this country, that is also dependent upon the mid-term
review. It is dependent upon the EU policy and position. It is
dependent upon government policy and position. The profession
has always adapted. Whatever happens, it will adapt; it will cover;
it will cope with things. The problem we face is one of the economics
of covering distance, of driving a distance to see a individual
animal or a group of animals. The likelihood is we are going to
move more towards herd health planning and away from the individual
case treatment. There is a problem in that and it is one of surveillance.
How do we maintain what is required in this country in terms of
surveillance? The obvious answer in terms of good surveillance
is getting the veterinary surgeon on the farm because the person
who is trained in this country is the veterinary surgeon. We have
to square that circle somehow to ensure that we manage to get
the veterinary surgeon on the farm and improve the education thereby
of the farmer, work in cooperation with the farmer; but we still
have to be able to provide the income and any expertise, the continuing
professional development that the veterinary surgeon will require
to provide that service. There is a bit of a chicken and egg problem
here. If the farmers do not know what we can do for them, how
do we get there to do it in the first place? A touch of pump priming
is going to be required somehow to ensure the system works. At
the moment, in those areas where we have TB, we do an immense
amount of education at the time we are there doing the TB test.
Unfortunately, we always get a little tied up in looking at TB
testing instead of saying, "Here is an opportunity. What
can we do to add to that TB test that will benefit the farmer
and the taxpayer in terms of return?" You are putting an
expert on the farm to carry out a particular process but we never
take back from it all the other information and education that
we carry through at that time. Nobody knows about it because it
is never recorded in any form or looked at. The farmer knows because
he usually has about 10 things he would like to discuss with us
when we turn up there that have been hanging around for the last
week at least. "I knew you were coming. While you are here,
will you have a look at . . ?" Those words "while you
are here" usually send any veterinary surgeon disappearing
so please do not use them to us today. It is an important part
of our function to provide that information when we are there,
but it is not being used to the greatest benefit for the taxpayer.
Q9 Paddy Tipping: In effect what
you are saying is you are going to be asked to do more hygiene,
more food safety issues. Is there a case for government to be
paying something towards that? There is a notion around, for example,
of a whole farm audit. Do you see yourselves fitting into that?
Mr Jinman: There is little doubt
that the veterinary surgeon is the cornerstone of this. I would
refer you back to the Competition Commission report which I see
you have there by you, in which it says that if indeed the decision
is made that it is for the public good then the public should
pay because they are the beneficiaries. To that end, we would
be perfectly happy to see a proper system developed. At the present
time, we are in consultation with government with regard to a
new contract for the local veterinary inspector, the official
veterinary surgeon under the EU rules. We would very much wish
to work towards that end because we think that is important. We
would add to that the feeling that we really have to get to grips
with the concept of a territorial army, if you like, some sort
of reserve to back up the state veterinary service because the
state veterinary service plainly, as we saw with the foot and
mouth situation, is not in a position to cope. Not only is it
not in a position to cope; it does not have the knowledge and
expertise on the ground that our members do directly. Those vets
who are working in an area prove their worth during the foot and
mouth outbreak because of their local knowledge and their ability
to interface with not just the farming community but the whole
community. It was absolutely fundamental. We have to build a structure
much as is being done in Australia. They have learned a lot from
what happened over here. They have funded vets to come across
and they have taken back all they learned and gone through it
with a fine tooth comb. They are looking at setting up a reserve.
The Americans have done the same. The New Zealanders are doing
the same. The Canadians are doing the same. I have just spent
the weekend with them discussing this whole subject. Your Committee
here is sitting and there are committees sitting in other countries.
Reports are being drawn up on the same sort of problem, the rural
vets' issue, surveillance and disease control. These are common
areas and we are certainly playing our part in trying to discuss
it with our colleagues, to try and come up with some helpful solutions.
Q10 Paddy Tipping: While you are
here, there are public good issues that the public ought to be
paying for in some way. We need to work out a mechanism. There
is also a set of territorial cover issues that again are public
good issues that need to be paid for in some way by the government.
Mr Jinman: That is absolutely
right and there is also benefit to the industry, which is a third
strand. Quite rightly, the industry should pay for that. In many
of the areas we are talking about, the industry itself has a problem.
It is moving away from subsidy as we get decoupling. Perhaps one
of the points here is that, where you have decoupling, you have
modulation and maybe part of that modulation should be cross compliance
and involvement in animal welfare, which is the suggestion within
the EU rules. Now of course the OIE also has taken the same sort
of view and has a committee looking at that. We are linking welfare
with infectious disease.
Q11 Mr Drew: Looking at disease surveillance,
following foot and mouth, would you give me an appreciation of
whether disease control is better now in this country or is it
very little different or is it possibly worse in that we are looking
at a lot of pressure on people in the veterinary profession?
Mr Jinman: The jury is out still,
looking at this whole subject. Part of the reason for that is
that the government has put forward its plan for the next foot
and mouth outbreak and how to control it, but it has not run yet
any full scale exercises. It has run one or two in-house but it
has not run them like the Americans have. The Americans have done
two. The Australians have done one and New Zealand has also. Admittedly,
the Australian one is a desktop one but it has not got down to
the grass roots. Nobody has yet. That takes time. One of our concerns
is that we are seeing a considerable number of veterinary surgeons
leaving rural practice. We are well aware that there are pockets
of the country now where there is difficulty in finding a veterinary
surgeon to cover at night in the farming area. Indeed, we are
losing some of the expertise in those areas and we are having
difficulty getting younger members in. One of the things that
we need to do is some proper, statistical work on it. The timescale
between your request for information and coming here was a little
short to do what I would deem proper survey work. I note that
in Australia there was a proper commission that looked at it and
indeed in one or two other countries they have settled down and
looked at this in a proper, statistical way. The perception undoubtedly
is we learned a lot. We would be able at this stage to pick up
on where we were but it will not take many years before we will
find ourselves in difficulty. Possibly in manpower terms there
might be difficulties but I would stress that one of the problems
during the foot and mouth outbreak was not the lack of vets. It
was the lack of manpower control. It was management that was lacking.
We had good people sitting around waiting for jobs to do and going
places where they need not. There were a lot of lessons learned
there in management terms. We could probably have managed with
fewer vets, properly trained, doing the job better.
Mr Padgett: It is the management
that we really need to get sorted out. There were many vets inappropriately
used and that to a degree disenchanted many of the veterinary
surgeons in practice. Arguably, also there was the possibility
that we did not necessarily have the expertise being used in the
field to deal with the outbreak at that time. As we sit here now,
the LVI review is hopefully going to address how that manpower
is going to be used in the future and I hope it will address how
we are going to draft people in from practices with the relevant
experience to be used in the most appropriate manner.
Mr Jinman: We are slightly concerned
that we see adequate staffing of veterinary surgeons with practical
knowledge within DEFRA. We are aware that there is not a problem
in the field service per se, but there is in London, getting
them into the centre. As the planning strategy builds from the
centre, it is crucial that the input is there. We are certainly
working whenever we are asked with government to try and assist
in that regard because the expertise we built up with our members
during that time was colossal.
Q12 Mr Drew: Clearly you are a key
part of the national surveillance programme. Are there occasions
when you could be put in an invidious position in that the national
surveillance programme is all about the state asking you to early
notify; and yet you are employed by individual farmers to see
to the welfare of their animals. Disease is not at all a black
and white issue. It is shades of grey and yet to be effective
we know speed is of the essence. How do you advise your members
and how do you try to cope with this growing conflict?
Mr Jinman: This is a question
that is often raised within Europe because we are unusual. The
LVI system whereby a practitioner changes his coat and is immediately
a member of the government service has always been seen as a difficulty.
On the whole, we would say we have never had great difficulty
in that regard but in one or two of the industries, particularly
where we are dealing in poultry and pigs, the confidentiality
issue does arise and it has to be considered as to how it can
be best dealt with. There has been some consideration with the
influenza problems at the moment and this sort of issue is being
raised As a generality, I do not believe that it is a great problem.
I do market inspection. I see the farmers on one side of the fence
as the client who I would know normally. I go round there with
another hat on and tell them off if they are doing something wrong.
On the whole, it is built on trust and respect. As long as that
is there, it is usually the other farmers who will come and tell
me if something is wrong. They will say, "Go and look at
pen 63," hint, and I go and do it. The farming world is very
responsible in its own way. It wants to make sure that it is acting
properly. We found during the foot and mouth outbreak that, because
of the amount of advice we were giving on the phone and the number
of contacts we were making, we were getting to the point of calluses
on our rear ends and elbows as we were listening to the farmers
day and night, trying to help them. We were the key point of contact.
The local vet still remained the key point of contact. There was
no difficulty if somebody rang up and said, "We think we
may have it. What do we do?" It was a very simple answer.
Q13 Mr Drew: We are talking about
non-notifiable diseases as well?
Mr Jinman: Absolutely.
Mr Padgett: Yes, set against any
potential conflict of interest of course for the benefits of the
relationship. The local knowledge of a veterinary surgeon on that
farm is formidable. Things that can be picked up while the veterinary
surgeon is on the farm may not be necessarily picked up by any
independent association that might be developed. Secondly, by
DEFRA's own knowledge transfer work that has been going on through
various sources, farmers have identified that they find the veterinary
surgeon the most valuable source of veterinary advice and also
will take certain advice regarding notifiable diseases and disease
control from their veterinary surgeon over and above taking it
from DEFRA. They can talk around the subject. They trust that
person. They will then accept much more what the private veterinary
surgeon is saying.
Q14 Mr Drew: I wonder what your views
are on NADIS, the National Animal Disease Information Service?
Is this bedding in well? Is it potentially going to make a significant
addition to the armoury of information?
Mr Padgett: NADIS potentially
provides one part of a very comprehensive surveillance system.
What NADIS provides is information about what the individual veterinary
surgeon is seeing on the farm. At the moment, it has had a relatively
small number of veterinary surgeons involved. I know a number
of them and I have just been invited to be one of the contributors
in the future. I am learning a little more about the system myself.
The one potential problem is that it is anecdotal at the moment
and that creates data capture problems. That is where it needs
substantial help with development to ensure that all the data
capture is uniform across the country. It has the potential to
provide some form of regular monitoring of what is going on in
terms of conditions in particular on the farm which are affecting
animal health, not necessarily notifiable.
Q15 Mr Drew: It sounds as though
you welcome this.
Mr Jinman: We welcome any scheme.
It has limitations until such time as it is more fully adopted
and standardised. It is clearly sensible that some sort of scheme
that can record this information is put in place. There have been
various other attempts and various other units. Even getting the
nomenclature the same across them so that you are clear what you
are defining in any particular condition is crucial. There is
still a little way to go but, yes, we welcome anything of that
sort.
Q16 Mr Drew: Do you think vets will
welcome this degree of information sharing because the notion
would be that there would be early capture of a disease outbreak
that would then work its way up the system through all the different
means of communication so vets would be aware in different parts
of the country.
Mr Jinman: That is one way it
will happen but it is also happening all the time through the
journals and letters written about a particular disease. If you
look back historically, for example, at BSE, it came out of a
practitioner talking about this new disease that he had come across.
When various others said, "Me also", we realised we
had a problem. The same with digital dermatitis. A practitioner
wrote a letter in to The Veterinary Record and made a comment
about it and others soon started saying, "Me also."
The system exists as always in novel disease. The advantage of
some of these recording schemes is they give better information
of the trends of the growth of those particular problems.
Mr Padgett: The outputs must be
of use so we can put them into place back on the farm in terms
of improving the health situation of the stock.
Q17 Chairman: Is there not a slight
problem here? If we go to foot and mouth and we look at a farmer
who does not want to have much official or professional help,
not running a particularly well organised farm, there is a vulnerability
there for disease and problems to occur in the area where your
profession is going to be the least likely to be invited in. You
are telling us a story here that there is a danger. If we have
lots more visits from the vet, we would be on top of every possible
new occurrence in terms of disease but does not the foot and mouth
outbreak tell us something different?
Mr Jinman: It is a nice idea.
If you have knowledge of the farm and knowledge of what is going
on, you have a much better idea of how a disease process might
be generated and how it might be promulgated around the area.
We also have the opportunity of visiting that farm to educate.
Q18 Chairman: You can only go where
you are invited.
Mr Jinman: Yes, at the moment
this is true. This is one of the questions that arises at the
present time if you look at the EU directives in this regard and
with regard to animal welfare. There is the suggestion that perhaps
farms should have a statutory visit as part of their being. It
is one of the peculiarities of our food system that as soon as
you take an animal into an abattoir it is inspected all the way
though, many times. As it is produced into a format that is consumed,
it is still inspected. If it goes into a restaurant in the City
of London, it is inspected in the process, but nobody looks at
it from the moment of its inception to when it arrives at the
abattoir.
Q19 Chairman: What is your view?
Should we have a statutory inspection system?
Mr Jinman: I think we have to
do a risk analysis and look at a cost benefit analysis on that.
We are aware that the EU may well make this recommendation on
welfare grounds and I think we are looking at it here as a profession.
We are interested in animal health, animal welfare and public
health. There is a duty upon us in all three areas.
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