House of Commons - Environment, Food and Rural Affairs

Select Committee on Environment, Food and Rural Affairs Sixth Report

3 Other changes to the regulation of the profession proposed by the RCVS

Proposals for a mandatory practice standards scheme

50. The RCVS has implemented a voluntary scheme since 2005 to accredit veterinary practices in the UK. The scheme aims to promote and maintain the highest standards of veterinary care through setting standards and carrying out regular inspections.[83] To become accredited, practices volunteer for rigorous inspection every four years and will have met a range of minimum standards including hygiene, 24-hour emergency cover, staff training, the availability of certain types of equipment, and cost estimation procedures. They may also be subject to spot-checks between inspections. An accredited practice logo indicates to pet owners that the practice has passed an independent inspection. Currently about half of all practice premises belong to the scheme.[84]

51. The RCVS proposed that there should be a mandatory practice scheme to regulate the delivery of veterinary services, whether by a traditional partnership of veterinary surgeons, a corporate body (under veterinary or non-veterinary control) or a charity. The RCVS considers that a mandatory practice standards scheme is necessary as the number of practices owned by companies or other corporate entities is growing and the College has no jurisdiction at present over the actions or omissions of managers or practice owners who are not veterinary surgeons. The RCVS estimated that a fifth of the practice premises known to the RCVS were in corporate ownership.[85] Under a mandatory scheme the RCVS claims that, both in corporate practices and in partnerships, complaints over relevant aspects of staffing, practice protocols, clinical standards, emergency cover, hygiene and equipment could be pursued without holding veterinary surgeons to account for matters outside their control or being forced to tell complainants that their concerns cannot be addressed.[86]

52. The RCVS proposal has proved to be controversial with the profession. RCVS told us that it acknowledged that a mandatory scheme did not have the wholesale support of the profession and that it remained an area for debate.[87] The RCVS was in discussions with the BVA over it: "it is undoubtedly one of the sticking points."[88]

53. Several submissions to the Committee expressed concerns over the proposal to introduce compulsory practice standards,[89] and considered it both unnecessary and likely to be costly:

Mandatory standards would be expensive and complicated to implement, enforce and oversee, and might not achieve the desired result anyway. [90]

It is essential that all members of the veterinary team work with equipment and in premises fit for the services which they provide. However, the emphasis should still be on the quality of the individuals and their responsibility to provide appropriate facilities, rather than the facilities themselves […] the operation of a voluntary scheme will provide the public (and the practitioners themselves) with reassurance that a facility has met the threshold standards. [91]

[t]his would be extremely demanding in terms of time and resources, yet would not necessarily improve the delivery of veterinary services nor animal welfare.[92]

The costs of a mandatory scheme may result in compromises in the service provided by veterinary practices or may be passed on to clients, resulting in certain procedures being pushed out of their financial reach.[93]

54. The British Veterinary Association (BVA) was against the introduction of a mandatory scheme. It felt that employment and health and safety law already covered elements within the practice standards scheme, and that many vets did not see an added benefit to the practice, or their clients, of belonging to the RCVS scheme.[94] Instead of a mandatory scheme, the BVA would favour a form of self-regulation backed up by disciplinary powers. It suggested that a "Guide to Practice Standards" could stipulate the minimum standards which practices are expected (and obliged) to adhere to. The RCVS should have the power to inspect the practice concerned following any complaint and would judge it against the standards set out in the guide. Adherence to these standards would be considered in any disciplinary case which may be brought against a practice.[95] We note, however, that many premises are not owned by the vets who work in them.

55. The BVA were of the firm opinion that a mandatory scheme would not be in the public interest. It believed that the associated costs to practices of a mandatory scheme would also almost certainly result in higher costs for the animal owning public.[96] The BVA also raised the issue of non-vet ownership of practices and the question of who should be responsible if the employer instituted policies which contravened RCVS rules.[97]

56. However, several submissions to the Committee did support the RCVS's proposal.[98] In particular, the Central Veterinary Society (a territorial sub-division of the BVA) thought that this would provide a level of protection for the general public in corporate practices where the influence of vets at senior management level was significantly reduced in comparison to traditional practices.[99]

57. Defra was less clear about whether or not there should be a mandatory practice standards scheme.It considered that RCVS should do more to encourage take up of the existing voluntary scheme,[100] and argued that some of the issues raised by RCVS were already covered by existing regulations (e.g. health and safety legislation and rules for storage and dispensing of veterinary medicines), whilst others could be matters for individual businesses to decide. From Defra's point of view, a mandatory scheme that duplicated some existing statutory requirements would not be an attractive option. For example, the Veterinary Medicines Regulations 2007 were bringing into force a new requirement for the registration of premises used by veterinary surgeons for the storage and supply of veterinary medicinal products. This would enable controls on veterinary medicinal products to be enhanced and bring premises used by veterinary surgeons into line with those of other Registered Qualified Persons such as pharmacists.[101]

58. Defra also thought that the RCVS proposal appeared to be motivated in part by the growth of non-veterinary ownership of practices and the RCVS's fear that this increased the risk of conflict between the requirements of veterinary professionalism and commercial imperatives.[102] The Department did not consider that there was any evidence to support RCVS concerns that non-veterinary ownership could lead to inadequate veterinary care. In the absence of any hard evidence, Defra considered that it would be difficult to see how a mandatory practice standards scheme could be justified at the present time. It would require a persuasive cost benefit analysis for the Department to support any proposal for a mandatory scheme in new legislation.[103]

59. The BVA was not concerned about the growth of practices owned by non-veterinary surgeons:

There is no evidence to suggest that the nature or the pattern of the complaints has changed in any way because of ownership by a non-veterinary surgeon. The ethical pressures upon an individual veterinary surgeon remain the same whether they are employed by another vet or by a non-veterinary person.[104]

In addition, the BVA believed that some of the larger, non-veterinary owned corporate practices have set "extremely promising" standards.[105]

60. We also probed the RCVS and BVA on concerns raised with reference to the financial connection between the pet food industry and the veterinary profession. The BVA told us that it was up to individual vets whether or not to sell pet food through their practices and vets tended to sell food if they had been scientifically convinced that the food was of value.[106] Subsequently, the BVA has written to us to clarify the situation on the scale of the pet food market as sold through veterinary practices.[107]

61. The RCVS's case for a mandatory practice standards scheme does not appear to be proven or to have the support of the wider veterinary profession. The RCVS should for the present focus its energies on promoting its voluntary scheme to the profession to demonstrate the potential benefits to veterinary surgeons who do maintain high standards of a mandatory system.

Proposals for compulsory continuing professional development and revalidation

62. Although veterinary surgeons and registered veterinary nurses have a professional obligation to undertake continuing professional development (CPD), the RCVS believed that it, and Veterinary Nurses Council, should have power under new legislation to require that in order to remain on the register any professional had devoted time to keeping abreast of new developments.[108] The RCVS considered that mandatory CPD was necessary to maintain public confidence in the profession, and that there would be "no extra costs involved" for the profession in introducing compulsory CPD.[109]

63. The RCVS also thought that revalidation or re-accreditation of qualifications would provide "a positive assurance of continuing competence".[110] The subject of revalidation had been under debate by the profession for some years, but the RCVS had no firm proposals for what form revalidation might take.[111]

64. There was general agreement in the submissions to the Committee that CPD was a good thing. Several responses agreed with the proposals for compulsory CPD and revalidation.[112] However, a number of responses, including the BVA, questioned whether CPD should be compulsory and whether revalidation should be introduced. In particular, the concerns focussed on over the potential cost and time of compulsory CPD and revalidation, and the increase of bureaucracy, especially for smaller practices and professions.[113] Mr Chris Barker, MRVS, a veterinary surgeon from a small practice in Cumbria, said that "I am not sure that making it mandatory will make anybody obey it more than they are at the moment. Any vet worth its salt will be keeping up to date as it is."[114] The Oxford College of Equine Physical Therapy advised that compulsory levels of CPD must be realistic in terms of content and time spent.[115] Mr Stuart Hudson, Director of the College, told the Committee:

In all likelihood, there are a lot of people out there doing pretty good work who are not earning an awful lot of money but who are doing no harm and are very competent. You can make things extremely difficult for them to carry on doing what they do if you set out something that is unattainable for them.[116]

65. The BVA, and some other submissions, supported mandatory CPD but were less convinced of the case for revalidation without an evaluation of how it would work in practice and a cost benefit analysis.[117] Mr Nick Blayney, President of the BVA, told the Committee that an institute the size of one of the veterinary schools would be necessary in order to allow for revalidation of all the veterinary surgeons currently in practice. He also believed that very few of the complaints made to the RCVS about veterinary surgeons would have been avoided by greater attention to CPD.[118]

66. Mr Chris Barker thought that there was a gulf between the profession and its ruling body which did not give sufficient thought to how its proposals might be complied with.[119]

They are talking about revalidation with no idea of how they would apply it, but—"it is a good idea; trust us, we will do it right" […] their expectations are just not realistic for the profession to deliver […] I do not think they have thought though the consequence of how we would provide it and what the costs would be.[120]

67. Defra agreed with the RCVS that it should be able to require mandatory CPD and revalidation, as life long learning was considered essential to ensure safe and effective practice.[121] The Department argued that the details of how mandatory continuing professional development and revalidation should be achieved would need further detailed consideration and would need to take into account the cost of additional requirements on what were relatively small, private practice-based professions.[122]

68. We accept that continuing professional development is good practice, but the RCVS still has a long way to go to convince the profession of the need for mandatory continuing professional development and revalidation. We support some form of mandatory requirement in principle, but the College, together with other bodies in the veterinary professions, should consider carefully the potential impact of these proposals on smaller practices and prepare an analysis of the likely costs for consideration as part of the work towards a new Act.

Should "Para-professionals" be regulated?

69. In recent years there has been an expansion in the number of non-veterinarians or "para-professionals" providing veterinary services. Currently, for example, there are some 7,415 veterinary nurses, 76 equine dental technicians, 652 artificial inseminators (of mares), and 132 ultra-sound scanners (of cattle). The activities of the latter two of these practitioners are regulated through a process of specific exemption orders granted by Defra under Schedule III of the Act; the others are self-regulated. There are approximately 2,500 farriers who are regulated separately under Farriers (Registration) Act 1975. There are also approximately 2,000 staff employed by the Meat Hygiene Service (MHS) to carry out ante and post mortem inspections of animals and meat intended for human consumption under veterinary supervision.[123] The MHS is itself going through considerable change with the proposals to privatise and outsource the Service being pursued by Defra despite the controversy this is causing. In addition, and as in the sphere of human health, a significant complementary/alternative treatment sector has evolved. These include chiropractic, osteopathy, physiotherapy, homeopathy, aromatherapy and acupuncture.[124]

70. Several submissions raised concerns over the lack of regulation of non-veterinarians providing services to animals, and therefore the lack of protection for animals and their owners.[125] The RCVS has said that animal health and welfare could be at risk if people without veterinary training diagnose illness and prescribe treatment.[126] The BVA had serious concerns about the risk to animal welfare and public health posed by other unregulated groups and individuals performing acts of veterinary surgery in contravention of the Act.[127] The BVA believed that the system of granting exemption orders under Schedule III should be continued, and would support further exemptions where appropriate. It said that it was "not opposed" to the extension of regulation to other providers of veterinary care, but had not reached any conclusions how that might practicably be done.[128]

71. In its submission, the RCVS argued that although Ministers can make exemption orders allowing non-veterinarians to carry out specified procedures, the order-making process has proved slow and laborious and the powers did not extend to full regulation of the conduct of these practitioners. For example, work towards an exemption order for equine dentistry had taken six years.[129] The RCVS suggested that veterinary surgeons should have power to delegate appropriate procedures to people holding qualifications recognised by the RCVS, provided the animal remained under the care of the veterinary surgeon. The RCVS believed that this could offer a quicker way forward when new disciplines emerged and encourage team working between veterinary surgeons and other trained providers of veterinary services.[130]

72. The Committee received submissions from several groups of para-professionals including spinal therapists, physiotherapists, equine dentists and hoof trimmers. Opinion across these groups varied as to whether para-professionals ought to be brought within a new statutory framework, or whether they should continue to self-regulate.

73. The Chartered Society of Physiotherapists raised the issue of a lack of regulation in the animal physiotherapy field in that people were able to call themselves animal physiotherapists without specific animal physiotherapy training.[131]

74. The Association of McTimoney-Corley Spinal Therapists told the Committee that many providers of alternative veterinary services were members of their own professional organisations, underwent appropriate training to ensure they were competent in their particular field of expertise, followed a code of conduct and had knowledge of contra-indications and referral procedures should veterinary help need to be sought. They were also covered by indemnity insurance, should something go wrong. In these circumstances, where the veterinary service provider worked in a professional capacity alongside veterinary surgeons, the Association thought that it would seem sensible to make certain changes to the 1966 Act to allow alternative providers of veterinary care that were recognised by the veterinary profession to treat an animal where appropriate, as long as they were competent to do so, without direct veterinary referral.[132] The Association also thought that representatives on the governing body of the RCVS ought to take into account the views of all organisations providing veterinary care, including manipulative therapy.[133] The Oxford College of Equine Physical Therapy considered that properly trained physiotherapists ought to be able to administer treatment without the need for referral by a vet.[134] It thought that it would be difficult to use a risk assessment to decide which groups of para-professionals should be brought under the new regulatory structure.[135]

75. Unlike for physiotherapy, an exemption order had not yet been granted for equine dentistry. The British Equine Veterinary Association submission said that it was extremely concerned about unregulated groups and individuals treating horses, and did not feel that animals were being adequately protected.[136] It thought that the current system of exemption orders did not adequately protect animals and their owners against unsatisfactory work, and instead recommended that regulation should be extended to all providers of veterinary care within a new legislative framework. Therefore, it did not agree with the proposal of the RCVS for vets to be able to delegate procedures to qualified persons.[137] The British Horse Society regularly received complaints from horse owners about paraprofessional groups. It was "very strongly of the opinion that there is a need for robust and transparent regulation of all providers of veterinary care whether veterinary surgeons or those in differently qualified, but associated, roles."[138]

76. The British Association of Equine Dental Technicians told the Committee that it had its own practice standards scheme, that its members took compulsory examinations, were subject to a code of conduct, and that both insurance and CPD were mandatory for its members. It would want the regulation of equine dentistry to be brought within a new Act to prevent untrained or unqualified people calling themselves an equine dentist.[139] Other equine dentists agreed that equine dentistry ought to be regulated, but suggested the Farriers' model of regulation, with an overarching responsibility by the RCVS for monitoring training and discipline.[140]

77. The Equine Podiatry Association believed that self-regulation for hoof-trimmers was preferable to a statutory framework.[141]

78. Defra stated its position as being that any new regulatory framework would need to reflect the full spectrum of veterinary services in the UK and not simply focus on those provided by veterinary surgeons. The Department defines "veterinary services" as:

[…] interventions by suitably qualified practitioners ultimately to promote the health and welfare of animals and avoid unnecessary pain and suffering. This would, therefore, include diagnosis and treatment of injuries and diseases in animals, surgery, palliative and nursing care, humane euthanasia, assisted reproduction services, the taking of samples from animals for diagnostic purposes, diagnostic testing, prescription and administration of medicines, complimentary treatments and alternative therapies, ethology (animal behaviour), prophylactic interventions including dentistry and farriery, as well as other preventive measures e.g. farm health planning, disease control, control of animal by-products, health certification for travel/trade, veterinary epidemiology, etc. [Defra's] definition would also include veterinary public health which involves both preventative measures and pro-active intervention through inspections.[142]

79. Defra believed that the current restrictions on which procedures were exclusively the preserve of RCVS registered veterinarians and the current policy and legal mechanisms for enabling some of these activities to be done by others (via exemption orders) were inadequate and not sustainable.[143] The Department saw value in the approach adopted by the Legal Services Bill in defining "reserved legal activity", and considered that a set of "reserved services" could be circumscribed that could only be provided by registered RCVS members. Services outside that scope could be provided by other qualified persons.[144]

80. Defra also believed that all veterinary service providers should be subject to regulation, but that the extent of that regulation should depend on a risk assessment:

Where there is a high risk to animal health and welfare as a consequence of any intervention, then this would establish a prima facie need for statutory regulation of the provider of veterinary service. Where there is low or no risk, then voluntary self regulation should be encouraged and left at that. The proportionality test would need to take into account the numbers of practitioners of a given type of intervention/activity in determining the appropriate form of regulation.[145]

Consequently, the Department did not agree with the RCVS' proposal that the RCVS should have the power to delegate specified procedures to people holding qualifications recognised by the RCVS. In addition, Defra stated that statutory regulation would only extend to those disciplines that were supported by scientific evidence as to their efficacy.[146]

VETERINARY NURSES

81. There are some 7,415 veterinary nurses in the UK. The RCVS Veterinary Nurses Council was established in 2002 and replaced the Veterinary Nurses Committee. It has overall responsibility for all matters concerning veterinary nurse training, post-qualification awards and the registration of qualified veterinary nurses. The RCVS has stated that veterinary nurses should be recognised as a profession in their own right and has proposed the creation of a new Veterinary Nurses Council, separate from a new Council for veterinary surgeons.[147] The BVA strongly supported this proposal as it considered that veterinary nurses were "an integral part of the veterinary team".[148] The British Veterinary Nursing Association believed that the availability of qualified nursing care for veterinary patients has "enabled the veterinary surgeon to delegate appropriate aspects of clinical management to suitably trained individuals which in turn allows for the maximisation of patient welfare."[149] The Association agreed that appropriately trained veterinary nurses should be required to subscribe to a framework of accountability by a regulatory body.[150]

82. The Republic of Ireland has given formal recognition to nurses, with a Veterinary Nurses Board due to be created. In its submission, Defra said it was attracted by this approach: "[w]e are of the view that in the UK, there are sufficient numbers of veterinary nurses […] to justify the establishment of a separate regulatory body."[151]

FARRIERS

83. Farriers are regulated by a separate Act. We received several submissions from both individual farriers and farriery associations which showed the profession to be divided between those who thought that farriery should not be brought in any form within a new veterinary regulatory framework,[152] and those who thought that it should.[153] The Department said that it will have to consider whether to bring this within the scope of any overarching veterinary services legislative framework.[154]

OUR VIEWS

84. There appears to be general agreement that the veterinary nurse profession has evolved to a stage where it warrants its own statutory framework of regulation. We recommend that the Royal College of Veterinary Surgeons and the Veterinary Nurses Council develop their proposals further to present a clear structure for future consideration. However, there is no clear view across the animal care professions on how other "para-professionals" ought to be regulated, but the balance of opinion, which we support, is in favour of some form of regulation to protect animals and their owners against the depredations of the wholly unqualified practitioners of potentially harmful treatments. There is more work to be done by Defra, the RCVS and the veterinary and animal health professions on Defra's proposal for a risk-based approach to a new veterinary services legislative framework.

83 See RCVS website for information on its Practice Standards Scheme, http://www.rcvs.org.uk/Templates/InternalHome.asp?NodeID=94628 Back

84 Ev 2 Back

85 Ev 2 Back

86 Ev 2 Back

87 Q 86 Back

88 Q 85 Back

89 Ev 77, 87, 92, 100, 106, 110, 112 [Eamon McAllister; British Equine Veterinary Association; Society of Practising Veterinary Surgeons; Mervyn Harris; Professor S A May; Richard Matson; British Small Animal Veterinary Association; British Horse Society] Back

90 Ev 92 [Mervyn Harris] Back