Memorandum submitted by the Central Veterinary
Society (Vet 16)
EXECUTIVE SUMMARY
1. Although the Act remains functional,
Central Veterinary Society considers that the multiplicity of
changes in legislation, the structure of the profession, and public
perception of regulation of the professions, including the veterinary
profession, since 1966 make revision of the Veterinary Surgeons
Act inevitable. However, we consider it important that any proposals
take into account the Charter.
2. Central considers that the increasing
number of paraprofessionals involved in the provision of veterinary
services makes some form of regulation important to ensure the
purpose of the Act (to protect the public and their animals' welfare)
continues to be effective. Any regulation of paraprofessionals
must address issues of their competence.
3. Central considers the rise of corporate
veterinary practices, where the influence of veterinary surgeons
at senior management level is significantly reduced compared to
traditional practices, must result in changes to the process of
regulation. This could be achieved through regulation of practice
standards but should be in conjunction with regulation of individual
veterinary surgeons.
4. Continuing professional development is
important but care should be taken, if compulsion is to be introduced,
to ensure that any system is practical and not excessively bureaucratic,
and would have the desired effect to ensure that standards are
maintained by all those who have contact with animals including
those who work in the public sector.
5. Central considers the involvement of
lay persons at every level of regulation to be crucial in maintaining
public confidence that it is functioning properly. Those lay persons
must not be in a majority as the technical input from veterinary
surgeons is essential to providing fair regulation. The burden
of proof in disciplinary cases should remain at beyond reasonable
doubt.
6. The implications of a separate conduct
committee are not entirely clear as such a mechanism is already
in existence. However, some form of evaluation of individual veterinary
surgeons' health with regard to fitness to practise may be desirable.
7. Central considers that the delegation
of certain procedures requires careful evaluation of what effect
it might have on external bodies, particularly where certification
is concerned.
INTRODUCTION
8. The Central Veterinary Society is the
most long-established Territorial Division of the British Veterinary
Association covering Greater London and parts of the suburbs.
Consequently the Central is unusual in having a significantly
higher proportion of members who are, or have recently been, actively
involved in the profession at a political level including retired
DEFRA Chief Veterinary Officers, past BVA Presidents, and senior
officials and officers of the Royal College of Veterinary Surgeons
(RCVS). We therefore consider the Central to be uniquely qualified
to comment on the issues raised by the EFRA Select Committee.
This paper addresses the questions raised by the Committee as
below:
Whether the provisions of the 1966 Act are out
of step with developments in the veterinary surgeon and related
professions
9. Since the recognition of the veterinary
profession by Royal Charter in 1840, there have been only three
principal statutes relating to the veterinary profession: the
Veterinary Surgeons Acts of 1881, 1948 and 1966. The change in
the structure of the profession since the last of these has been
very significant and arguably more than change between previous
Acts. The most notable changes since 1966 have been the introduction
of a formal veterinary nursing qualification, the introduction
of formal specialist qualifications for veterinary surgeons in
specific disciplines, the rise of Continuing Professional Development
(CPD), and the rise of corporate veterinary practices. In addition
changes outside the profession, such as entry into the EU and
devolution, have also had significant influence with the introduction
of significant amounts of animal-related legislation and mutual
recognition of qualifications. Other professions have changed
in parallel and the consequent effect of inquiries, such as that
into the actions of Dr Shipman, and EU legislation have similarly
influenced the other medical professions. Global change has also
had an influence with significant numbers of veterinary surgeons
from countries outside Europe now practising in the UK.
10. The Act has remained essentially unchanged
and we consider it is, in some respects, becoming less fit for
purpose although it remains functional. The rise of corporate
practice perhaps best illustrates a deficiency of the Act. Corporate
practices may have no veterinary representation at Board level
where significant decisions are made on funding that affect the
work of the veterinary surgeon in the practices and may compromise
their professional obligations. Under current legislation RCVS
is unable to influence the Board and can only take action against
individual veterinary surgeons.
11. The 1966 Act and the Royal College's
Supplemental Royal Charter of 1967 are complementary and the amendment
or replacement of the Act should not be considered without scrutiny
of the Charter and awareness of changes which would have to be
requested in the latter. Doubts have been raised about the legality
of applying members' annual retention fees to any but the statutory
obligations of the Act. Central does not share this view: the
exercise of the College's powers under the Charter is an example
of proper purposes for the use of members' fees. Any amending
legislation should make clear the right of RCVS (subject to the
approval of the Privy Council as at present) to charge fees to
cover not only its statutory functions but also its role under
the Charter as a Royal College.
12. Devolution also raises issues in the
drafting of new legislation, applicable to the whole of the United
Kingdom. There is already an instance of this, in the differing
views on, and subordinate legislation by the Westminster and Scottish
Parliaments on the matter of the docking of dogs' tails. More
fundamental issues are quite likely to arise in future.
Whether there ought to be regulation of providers
of veterinary care other than veterinary surgeons
13. We assume that the term "providers
of veterinary care" indicates persons other than veterinary
surgeons who might be permitted to carry out certain minor acts
of veterinary surgery under prescribed conditions, and this raises
the matter of statutory definitions. If such rights are to be
granted or delegated to non-veterinarians (and we strongly support
such a concept), it is vital that there should be re-definitions
of the terms "animal" and "veterinary surgery",
which appear in the interpretation section of the 1966 Act, but
have proved inadequate in the past.
14. The definition of the word "animal"
in the 1966 Act specifically included birds and reptiles but not
fish. However the Animal Welfare Act 2006 (and the equivalent
Animal Health and Welfare (Scotland) Act) define "animal"
as "a vertebrate other than man" on the grounds that
those species are sentient. Central considers that the definition
should be revised to the more modern one used in the welfare legislation.
15. The existing definition of an act of
veterinary surgery has led, in several instances to uncertainty
as to whether a particular action or procedure falls within the
definition. The definition is frequently misconstrued as offering
a good degree of detail, when, in fact, the lettered paragraphs
of the section are specific about four areas only which do not
affect the generality of the definition. For example, the question
as to whether the ascertainment of pregnancy in an animal was
an act of veterinary surgery was a contentious issue, since pregnancy
is neither a disease nor injury and does not fall naturally within
the wording of the section. The use of behaviour therapy is also
contentious. Central considers that redefinition should include
the mental and physical health of the animal as is also used in
the welfare legislation
16. Additionally, if it were to be the case
that veterinarians could delegate specific acts of veterinary
surgery to qualified paraprofessionals, the term "animals
under their care", would require statutory definition.
17. If certain paraprofessionals are to
be given the right to carry out limited acts of veterinary surgery,
Central considers that they ought to be subject to some kind of
regulation and control to ensure that they confine themselves
to their permitted role. Additionally there should be some measure
of their competence at the time of qualification and of ensuring
they undertake appropriate CPD to maintain this competence. In
view of the current self-regulation climate, it is possible this
could be achieved by a body other than RCVS.
Whether the delivery of veterinary services ought
to be regulated through a mandatory practice standards scheme,
with a professional code of ethics
18. The 1948 Veterinary Surgeons Act (section
5) provided that no unqualified person should be permitted to
practise veterinary surgery. In law, the word "person"
covers both a natural person and an artificial person ie a collection
of natural persons formed into a corporate body eg a company.
In the 1966 Act (section 19) however this ban on unqualified practice
was reworded to prohibit such practice by unqualified individuals
and companies were therefore not covered. It is assumed that this
change was made ex improviso since the Act contained no
provision for the registration of corporate bodies
19. We have already referred to the introduction
of corporate practices and the inability of RCVS to regulate their
corporate activities. The introduction of a mandatory practice
standards scheme would provide a significant level of protection
for the general public and the welfare of their animals in such
practices. Furthermore, the Veterinary Medicines Directorate has
stated their intention to introduce a practice registration scheme
as an element of medicines control legislation. It would therefore
seem an anachronism not have formal regulation of practice standards
by RCVS.
20. However, Central considers that regulating
practices alone would not provide adequate protection of animals'
welfare as the accountability of an individual veterinary surgeon
would be too remote. We therefore consider that there should be
continuing direct regulation of individual veterinary surgeons
by RCVS in addition to regulation of practice standards.
Whether the RCVS and Veterinary Nurses Council
(VNC) should be given the power to require continuing professional
development and revalidation
21. There is no doubt that the pace of change
in the veterinary profession is as great as it is in other technical
sectors and Central therefore considers CPD to be a professional
responsibility. Current RCVS advice lays down an acceptable minimum
with which Central concurs.
22. However, provisions for mandatory CPD
are relatively simple to draft, but exceedingly difficult to enforce,
as other professions have discovered, unless one goes so far as
to require members of the profession to sit a revalidation examination
periodically. If there were to be such provisions, which we consider
unwise, Central considers that care would have to be taken to
consider their sustainability in the light of European legislation
affecting the freedom of movement and rights of practice of veterinarians
from other Member States.
23. In relation to veterinary nurses and
other paraprofessionals, there would be even greater complications
in the European context, not only in regard to CPD but also the
recognition of qualifications of those trained elsewhere, their
competence relative to VNs trained here, and their eligibility
to carry out permitted acts of minor veterinary surgery.
Whether the governing body of the RCVS and VNC
ought to include appointed lay persons as well as veterinary professionals
24. The present legislation empowers the
Privy Council to appoint four members of RCVS Council. Although
currently one of these is the CVO of DEFRA, all four appointees
could be lay persons. It is also open to each of the universities
with veterinary schools to appoint a non-veterinarian as one of
its representatives. If such possibilities were made requirements,
or like numbers were to be appointed by other means, the membership
of the RCVS Council would have 25% lay membership. Central considers
that would strike an acceptable balance between satisfying public
perceptions of the need for greater transparency and accountability,
and reducing the number of veterinary Council members to the point
where the profession would no longer be self regulating.
25. However, Central considers there may
be confusion between membership of the Council per se and
membership of the Disciplinary and Preliminary Investigation Committees.
There are undoubtedly some real public concerns about the Council
"managing the affairs of the profession", as per the
long title of the 1966 Act. The pressure appears to be for self-governing
professions to demonstrate that they are not self protectionist
bodies which close ranks in the face of any complaints, and it
would be at the level of these two Committees that the case could
be made for greater lay involvement. There must, however, continue
to be sufficient numbers of veterinarians on the Committees to
ensure that they have a full understanding of the science and
the context of the matters under scrutiny, if they are not to
lose the trust of the profession in return for public approval.
26. There have also been suggestions that
the burden of proof in disciplinary cases should be reduced to
the balance of probabilities. Central considers that, where there
is the possibility of a veterinary surgeon being deprived of their
livelihood, it would be entirely inappropriate for the burden
of proof to be anything less than beyond reasonable doubt. Similar
proposals have been made for regulation of the medical profession
and opinion there is concurrent with our own.
27. Whether the RCVS and VNC ought to have
a separate conduct committee with the powers to investigate complaints,
give warnings and to make interim orders pending proceedings
28. The implications of this question are
not entirely clear. The RCVS already has a Preliminary Investigation
Committee (PIC) with the statutory obligation to investigate any
complaints which might lead to disciplinary proceedings, and although
statutory authority to issue warnings may be absent, warnings
and advice have been given in the past, although these have not
been made public. If it is suggested that the Committee's powers
should be extended to make warnings a matter of record and to
issue interim orders, careful and extensive drafting of the appropriate
provisions would be required.
29. The Disciplinary Committee, unlike the
PIC, does not report to RCVS Council to ensure its impartiality.
Central considers that the independence of the Committee is essential
and recommend that no change is instituted that might adversely
affect the Committee's impartiality.
30. If, however, the question was intended
to inquire about the need for both a Professional Conduct Committee
and a Health Committee, with the former considering broadly the
cases now heard by the Disciplinary Committee, and the latter
adjudicating upon allegations that the ability to practise of
a veterinarian is seriously impaired by reason of his physical
or mental condition, this would reflect provisions in other comparable
legislation.
Whether the RCVS ought to have the power to delegate
specified procedures to people holding qualifications recognised
by RCVS Council
31. In our responses above Central have
indicated that provisions for the delegation of specified procedures
would be a much more complex matter than the simplicity of this
question might suggest. Without any detail regarding the types
or extent of procedures which might be delegated and subject to
what conditions and control, it may be wise to reserve judgment
on such a proposal. If, as is believed, the purpose of the current
and previous Veterinary Surgeons Acts was to protect the public
and their animals against unqualified and/or incompetent treatment,
Central questions how far it is possible to delegate to paraprofessionals
without jeopardising the gold standard of veterinary care and
expertise expected by the public for their animals. Clearly the
mechanism by which the competence of paraprofessionals is measured
is pivotal, but no body other than RCVS has the technical ability
to assess that. We therefore consider that the authority to delegate
should rest with RCVS.
32. Delegation of certain procedures or
minor acts of veterinary surgery to non-veterinarians would, in
certain circumstances, raise issues of certification, particularly
in relation to the export of animals and foodstuffs of animal
origin. The certificate for the importing country will normally
require the assurance of the signature of a veterinary surgeon
(and always does in the EU), but if the veterinarian has not personally
carried out the necessary work or was not present when it was
carried out by a paraprofessional, Central considers he could
not legally or ethically sign the certificate. We also consider
it unlikely that the importing country would consider any such
certificate acceptable.
ADDITIONAL MATTERS
33. The final question that arises is of
the form which any new legislation should take. If the current
Act were to be replaced root and branch by a new Veterinary Surgeons
Act, Parliamentary time is a significant obstacle to which must
be added the considerable additional resources that would have
to be provided by DEFRA. A Bill simply to make amendments to the
existing Act would be shorter and less consuming of Parliamentary
time but would still have to contend for a place with other Bills
which may be considered of more importance. The other option currently
being canvassed is the amendment of certain sections of the current
Act by Regulatory Reform Orders. While this may seem an attractive
means of making essential changes without having to bid for Parliamentary
time, there is a danger that only a few matters will be selected,
without full appreciation of the effect upon the remainder of
the fabric of the Act. Central can envisage, for example, an Order
being made which would make provision for veterinary surgeons
to delegate minor acts of veterinary surgery to trained paraprofessionals
without amendments being made to the interpretation section of
the Act in regard to the meaning of the terms "animal",
"animals under their care" or "veterinary surgery".
It is submitted that, if Government considers that there are good
and compelling reasons to replace the 1966 Act, it should accept
the responsibility of making the necessary Parliamentary time
available, and draft a Bill so that words can be tested against
ideas and proposals.
September 2007
| 
