Memorandum submitted by Mr Mike Christian,
BVM&S MRCVS (W15)
Brief C-V Currently a partner in one of the
largest farm veterinary practices in Cumbria having spent 17 years
in mixed rural practice. Spent 6 months on secondment to MAFF
at the Carlisle DECC during FMD.
SUMMARY
This is a timely review of farm veterinary services.
I would submit that the current trends in veterinary practice
are likely to accelerate rapidly in response both to present levels
of farm income and imminent changes in veterinary practice.
In this submission I have briefly covered the
following areas:
1. The current provision of veterinary services
and how they are financed.
2. Current trends and their likely impact
on veterinary services.
3. The effect of the reduction in large
animal clinicians on health and welfare standards and on surveillance.
4. The feasibility of the Animal Health
and Welfare Strategy.
5. The impact on the SVS.
6. The future and possible outcomes.
1. THE CURRENT
PROVISION OF
VETERINARY SERVICES
AND HOW
THEY ARE
FINANCED
The income for rural farm veterinary practice
that provides the majority of veterinary services to the agricultural
industry has traditionally come from 5 major areas.
— Clinical services.(Examining and
diagnosing individual animals, calvings, lambings individual surgery,
routine fertility, dehorning and castrating. Traditional "On
Farm" Professional Fee work)
— LVI income from DEFRA/MAFF in the
eradication of Notifiable Disease: Tuberculosis, Brucellosis,
Anthrax, etc. Many practices also were involved with Meat Hygiene
and inspections at abattoirs.
— The dispensing of pharmaceuticals.
— The provision of veterinary advice
on farm management and welfare.
— The majority of veterinary partnerships
are mixed practices: a consideration must be given to the fact
that small animal work makes up a variable proportion of the work
and income to veterinary practice.
It is my opinion that clinical farm animal practice,
the examining and diagnosing of individual animals is already
uneconomic for both the veterinary surgeon and the farmer. It
is only happening because of the cross subsidy of the professional
fees by other income, and because of the good will of most farmers
to give animals a chance.
As the harsh economics are coming home to vets
and farmers this is rapidly becoming, with James Herriot, a part
of rural history.
2. CURRENT TRENDS
AND THEIR
LIKELY IMPACT
ON VETERINARY
SERVICES
What are the current trends within agriculture
and veterinary practice and what effects will that have?
Both in agriculture and farm veterinary practice
there are trends that can be identified, how fast, how far these
trends will go is difficult to predict, but my own experience
is that change when it comes, change is often slow at starting
but then dramatic in its speed. The effect of decoupling and other
EU decisions on agriculture are unknown but the current trends
are likely to continue.
In agriculture farm size has to continue to
grow. As farms make less and less per animal, they have to spread
costs over larger and larger numbers. The individual value of
each animal continues to drop in real terms, efficiency and mechanisation
continues to increase. Chicken farms are now routinely 100,000
animals plus. Since foot and mouth disease the average dairy herd
size has increased from 90 to 114 an increase of 20% which talking
to many dairy farmers is only going to increase as more herds
are going to be 300+ animals. These increases are usually with
out an increase in labour on the farms. This means the care of
individual animals is likely to be less important, but the care
of the overall heath of the herd much more.
In veterinary practice the major changes are
likely to be from the Competition Inquiry in to the cost of pharmaceuticals.
The subsidy of professional fees by sales of pharmaceuticals has
been an increasing trend since the late 60's. Then professional
fees were subsidised by the large-scale eradication schemes by
MAFF who paid very good fees to get the vets on the farm and help
eradicate the Notifiable Diseases.
The competition inquiry is recommending that
pharmaceuticals be dispensed by pharmacies as well and that prescriptions
be provided free of charge. Which private organisation is going
to provide a service free of charge has yet to be ascertained,
but the current level of income derived from pharmaceuticals is
not going to be sustained. This inevitably means that the cross
subsidy will disappear and farmers will have to pay the full cost
of veterinary clinical service, and it will not be economic to
do so.
At the same time the costs of providing veterinary
services continues to rise.
The cost of veterinary time is continuing to rise.
Students are now graduating with debts of £15-20K because
of the loss of grants and payment of tuition fees. This means
there will need to be a further raise of £2-3K per annum
to pay veterinary assistants to match the status quo. Farm animal
practice already pays assistants less than companion animal practices
despite offering a less favourable "On Call" rota.
In the short term following FMD many practice
principals worked additional On Call to make the rota acceptable
to attract assistant vets. Where this is viable in the short term,
in the long term it is not acceptable. As partners profit becomes
commensurate to the salaries they have to pay to veterinary assistants
they will be aiming to increase charges for clinical work or look
to other avenues for decreasing costs/increasing turnover.
Providing an out of hours emergency cover is
not economically practical for vets. (except in the big cities
where practices join together to provide an emergency clinic.)
Currently there is an RCVS obligation to provide 24hour cover,
but the RCVS is not involved in the commercial pricing of services.
As the value of individual animals continues
to drop in real terms then the cost of treating individual animals
becomes less and less viable. Where there is no cross subsidy
for out of hours work it will become untenable.
As many mixed practices have a dwindling farm
animal side that is less financially attractive, many will decide
to concentrate on the companion animal side of the business.
In a lot of mixed practices, it is a senior
partner who will do the largest amount of the farm work. This
means the younger vets will not have the case load to become experienced
and confident in farm work. There is a cohort of practitioners
in this situatuation heading towards retirement in the near future,
will the practice continue to be involved with farm work?
As fewer practices become involved with farm
veterinary services, the cost of travel to the more distant farms
has to rise beyond the already accelerated rate.
All this means that farm veterinary practices
will lose income from clinical services and from pharmaceutical
sales. They will have to move more towards the pig/ poultry model
of providing veterinary advice and charging for it.
Vets have already moved out of nutritional advice
leaving this field to nutritional experts. The reason for this
is that most nutritional advice is provided "free" to
the farmer by the firms who then put that cost into the feeds
that are sold to the farmers. This cross subsidy of fees by sales
is apparently acceptable where the subsidy of veterinary fees
by pharmaceuticals is not.
This model is beginning to appear in other areas.
Whereas vets provided most mastitis control, the dairies who buy
the milk are now providing "free" or subsidised advice
to farms on cell counts and high bacterial counts. (Including
bacteriology with a variable back up and quality of advice)
NMR and other recording agencies are already
offering fertility information on their recording products, and
it is a short step to actually providing the fertility work.
I believe that these factors will contribute
to a dramatic decrease in farm animal clinicians in the next five
years.
3. THE EFFECT
OF THE
REDUCTION IN
LARGE ANIMAL
CLINICIANS ON
HEALTH AND
WELFARE STANDARDS
AND ON
SURVEILLANCE
As the number of clinical veterinarians reduces
then there will be much less on farm surveillance.
This means that outbreaks of novel or unusual
diseases is much less likely to be noticed or recorded at an early
stage.
The routine care for the animals will be done
by stockmen under veterinary guidance.
The guidance will probably be by quarterly or
six monthly or annual visits and by herd health plans.
Individual animals are much more likely to be
treated ad hoc by the stockmen, rather than by veterinary surgeons.
The quality of this treatment in some cases may be adequate but
in most will be poor. The significance of symptoms or illness
may not be appreciated. Diagnosis and treatment seen as a high
cost and used as a last resort. Any outbreak of disease will be
well developed and losses occurring before veterinary advice is
sought.
As herd sizes increase and labour decreases,
then the attention to individual animals must reduce, with a drop
in welfare standards.
Ill animals are likely to be culled quicker,
as limited manpower becomes more important. The use of vets as
additional expert man power for calvings/ lambings will be seen
as too expensive.
The demands of the system must mean that high
heath status is important, with routine vaccination and herd health
policies being put in place.
DEFRA seems to set high regard to laboratory
diagnosis results as a form of surveillance. Most of the common
problems are diagnosed/treated with out the resort to laboratory
aids. Fertility, lameness, mastitis, pneumonia, PGE, are rarely
referred to the lab except where treatment is not working. Most
samples are taken/referred by vets in practice. Fewer vets would
mean fewer samples.
The lack of veterinary advice to ill pigs and
ill sheep on farms at Heddon-on-the-Wall shows how the lack of
a clinical veterinary service can lead to in the terms of delay
and spread of disease.
The local knowledge of the current LVI system
is an invaluable asset that is in danger of being thrown away.
The idea that a farm is a box which can be assigned a number in
Page Street and dealt with as a single entity is a problem that
has still not been resolved. The complexity of many of the local
farming links through trade, working together, machinery, shared
grazing, fell rights, and family ties cannot be reduced to a computor
screen on DCS.
4. THE FEASIBILITY
OF THE
ANIMAL HEALTH
AND WELFARE
STRATEGY
In my opinion they are not. I was hoping to
cover this more fully but lack of time has prevented me.
5. THE IMPACT
ON THE
SVS
The impact on the SVS is likely to be slow to
be realised.
The SVS is not known for its ability to meet
challenges or streamline its systems.
As the number of vets involved in farm work
decreases it will have to provide more of its own resources to
tackle tasks currently done by LVI's.
The more flexible private practice takes up
the challenge of getting backlogs in testing done and can respond
to new challenges for example the licensing brought in during
FMD. Private practice can fit the work around other duties. Whereas
if it is going to be done by the SVS it will be more expensive
to take on vets to do these tasks alone.
The SVS was notoriously unreliable in its work
allocation during FMD, the record being sending five vets to the
same farm on the same day has yet to be beaten!
Though I hope it would be a lot better in normal
circumstances, there are still problems with the allocation system
that can only be put right by local knowledge.
In areas where there are few farm animals there
may well not be LVI's willing to carry out the routine testing
for Notifiable Disease. Who is going to provide veterinary cover
for these? Both for clinical caseload and for the LVI work.
There will not be vets available to second to
DEFRA for the next FMD or exotic disease outbreak. The contingency
plan confidently states that resources for 20 TVI's are to be
kept at each centre in case of an outbreak of Notifiable Disease,
with out addressing where these will come from. There will not
be 20 TVI's available at short notice. During March 2001 the majority
of vets at the Carlisle DECC were LVI's.
6. THE FUTURE
AND POSSIBLE
OUTCOMES
The picture I have painted is what in my opinion
will happen if the government allows the situation to develop.
I would hope that there would be some "joined up government"
when decisions are to be made in response to the Competition Inquiry
Report.
There are a mixture of outcomes that are possible:
— The numbers of vets in farm animal
practice will reduce. This can be minimised by maintaining the
cross subsidy of professional fees for providing clinical services,
either directly by DEFRA work in surveillance or other Notifiable
Disease work and/or from pharmaceutical sales. (The option of
increasing fees is not possible.)
— Veterinary services will be provided
by other means. Eg Vets working for feed firms/ Dairies/ manufactures/retailers
to ensure a welfare/surveillance standard; Consultancy firms providing
fertility/mastitis/specialised advice.
— DEFRA/ Local Authority will have
to provide vets for notifiable disease testing/surveillance tasks.
— Developing the French model of farm
cooperatives employing vets for their own farms.
— The pig/poultry model of regular
advisory visits, but minimal involvement in the day to day running
or with individual animals.
Only the first of these provides for the continuation
of the successful LVI structure. The other outcomes mean a loss
of clinical veterinary services.
The loss of clinical services means a drop in welfare
standards and the loss of on farm surveillance.
Farm veterinary services are in a transitional
time facing economic challenges, changes in agriculture, increased
regulation and increased competition for the pharmaceutical and
services they provide. There will be increased competition between
practices as they try to meet the higher expectations of new veterinary
graduates starting their careers, and providing a cost effective
service to the rural community.
28 April 2003
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