Memorandum submitted by Professor S A
May (Vet 28)
1. Whether the provisions of the 1966 Act
are out of step with the developments in the veterinary surgeon
and related professions
The Veterinary Surgeons Act (1966) is arguably
the most important animal welfare legislation of the twentieth
century. It defined "the act of veterinary surgery",
and, in the interests of animals, their owners and the general
public, reserved the right to undertake acts of veterinary surgery
to appropriately qualified persons, namely veterinary surgeons.
It recognised and admitted to the supplementary register created
under the 1948 Act the last group of veterinary practitioners,
those employed in charitable institutions providing free treatment
to those who could not otherwise afford veterinary care. This
completed the progressive upgrading of the control of those treating
animals through the Acts of 1881, 1920 and 1948.
In 1966, the one person qualified to act on
behalf of sick animals and their owners, and to advise on preventive
medicine aimed at avoiding animal suffering, was the veterinary
surgeon. Therefore, it was logical, at that time, to legislate
to that effect, and 85 years (1881-1966) of successive pieces
of legislation should be seen in that context. The fact that the
1966 Act has remained until today also testifies to its "fitness
for purpose". However, both society and the veterinary profession
(like all professions) have moved on, and in two important areas
modernisation is required: recognition of the "veterinary
team", and appropriate regulation of all individuals in this
team, including veterinary surgeons themselves.
2. Whether there ought to be regulation of
providers of veterinary care other than veterinary surgeons
One of the main developments in the last 41
years has been the emergence of the "veterinary team",
analogous to the medical team we all encounter when we visit our
general practitioners or are referred to hospital consultants.
Veterinary surgeons work with veterinary nurses and other paraprofessional
groups as a routine, and animal owners can be reassured that those
employed by veterinary practices are working legally, under the
direction of veterinary surgeons, in the interests of their animals.
However, the situation is less clear with those who are self-employed
working at the boundary between "acts of veterinary surgery"
and procedures which are not controlled under the 1966 Act.
The logical development of all our thinking
in the last 125 years is to extend regulation to the whole veterinary
team to ensure that this country's high standards of animal welfare,
and the public expectations in this regard, are maintained. No
longer is it the case that there are only the qualified and the
unqualified. The emergence and maturation of veterinary nursing
as a proud profession alongside veterinary surgery demonstrates
how those with complementary education and qualifications can
not only contribute well in their areas of expertise, but also
develop specific expertise which adds value to the veterinary
team. However, the developing range of veterinary paraprofessional
groups has the potential to add to confusion which already exists
over who is qualified, in terms of his or her competence (never
mind who is legally qualified!) to safely carry out a procedure
on an animal. Therefore, it is essential that scrutiny of education
and experience, and regulation of conduct, is extended to all
who aspire to be a part of the veterinary team in the same way
as it applies to veterinary surgeons.
3. Whether the delivery of veterinary services
ought to be regulated through a mandatory practice standards scheme,
with a professional code of ethics, rather than the RCVS regulating
practitioners on an individual basis
Historically, the regulation of individuals
has worked well, although the structures (Preliminary Investigation
Committee, and Disciplinary Committee), their composition (drawn
from members of RCVS Council), and procedures need review and
change in the near future. This would broaden the sanctions available,
broaden the membership to include veterinary paraprofessionals,
members of other professional groups and lay members, and ensure
alignment with modern legislation in areas such as human rights.
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.
It is appropriate (and important) for the profession to define
threshold standards for facilities so that it can recognise misconduct
when an individual has chosen to work in a completely inadequate
environment, and the operation of a voluntary scheme will provide
the public (and the practitioners themselves) with reassurance
that a facility has met the threshold standards.
The situation will be complicated by the regulation
of paraprofessional groups. The model for regulation of individuals
is clear, and it can be seen how any regulator could work to an
outline of equipment and premises necessary for safe practice.
However, the replication of mandatory standards schemes for every
context in which veterinary services were provided would be completely
impractical and once more emphasise facilities over people—who
are the most important part of this discussion.
4. Whether the RCVS and VNC should be given
the power to require continuing professional development and revalidation
The last 40 years have seen a rapid acceleration
in the rate of accumulation of knowledge and the development of
new technologies. The veterinary curriculum of 2007 is very different
from that of 1966, with new approaches to diagnosis, much more
sophisticated techniques in surgery (for instance, fracture fixation
and colic surgery in horses, arthroscopy and laparoscopy) and
a range of modern medicines. Members of the veterinary team must
be constantly updating themselves, through lifelong learning,
in the same way as members of all other professions.
Attendance at courses would be the bare minimum
requirement, but, of course, this does not guarantee competence.
A better option is periodic revalidation, based on a judgement
of continued ability to practice, which could include peer and
client feedback, in addition to attendance of CPD courses.
5. Whether the governing body of the RCVS
and VNS ought to include appointed lay persons as well as veterinary
professionals
The precise composition of the RCVS and VNC
should depend on the eventual structure for governance of the
veterinary team and the role of each college/council/board.
All colleges/councils/boards will need an appropriate
balance of members selected from amongst veterinary surgeons,
veterinary nurses, other paraprofessionals and lay persons. An
overarching disciplinary board for the veterinary team would require
a membership made up of representatives from all four groups.
However, a college/council more focused on education and specialisation
within a professional group might only require an appropriate
ratio of members of that group and lay persons.
6. 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
Policing of professional conduct is the one
area where there seems to be unanimous agreement on the need for
change! There is concern within the profession about the fairness
and consistency in decision-making of the existing structures,
and suspicion from members of the public that the conduct committees
which some veterinary surgeons see as too harsh are actually too
lenient. There is a need, in a separate conduct committee, for
a broader membership (not just drawn from RCVS Council), more
transparency of the processes (without breaching confidences in
individual cases), greater understanding of decisions, and a range
of sanctions matched more closely to the level of misconduct.
The question is incomplete in just mentioning
the RCVS and VNC. Clearly, this committee will need to deal with
all members of the veterinary team, and should, therefore, have
a membership which reflects that. This will allow it to deal with
problems occurring at the boundaries of responsibilities of different
groups, as increasingly cases involve several professional persons.
Crucially, to the public, it will also act as a single body dealing
with their complaint about the way their animal was handled by
the veterinary team.
7. Whether the RCVS ought to have the power
to delegate specified procedures to people holding qualifications
recognised by the RCVS Council
As has already been mentioned, in relation to
CPD, the last 40 years has seen a huge increase in the required
knowledge and skills of the veterinary surgeon. This means that
even with regular attendance at CPD courses, no veterinary surgeon
can be up-to-date in every area of practice. While it is essential
that veterinary surgeons should have a basic knowledge of public
health, first aid and generic diagnostic and therapeutic skills
for all species, all will only be at the "cutting edge"
in more restricted spheres of surgery or medicine. In addition,
paraprofessional groups, such as nurses and physiotherapists,
are often more proficient in areas of their practice than veterinary
surgeons, who may be less frequently involved in specialised areas
of veterinary nursing or rehabilitation of convalescent animals.
There is no doubt that there would be a justifiable
public outcry if this generation betrayed previous generations
in compromising the internationally-recognised high standards
of animal welfare which have been achieved in this country through
successive legislation relating to animal care. However, the Veterinary
Surgeons Act (1966) neither recognises specialisation within the
profession, nor the development of the veterinary team made up
of experts in a range of relevant skills whose contribution is
greater than the sum of the individual parts. Therefore, the RCVS,
or any successor coordinating body for the veterinary team, needs
to be able to licence and periodically revalidate all professionals
at different levels. This includes specialists within the veterinary
profession, as well as nurses, physiotherapists and any other
paraprofessional groups under the authority of any new veterinary
services legislation. It is as unacceptable for inexperienced
surgeons to be undertaking laparoscopy in an animal as it was
for untrained human surgeons to be undertaking laparoscopy in
women. Similarly, it is not acceptable for members of unregulated
paraprofessional groups, as a result of deficient knowledge and
skills, to inflict unnecessary suffering on animals and their
owners.
SUMMARY
1. The Veterinary Surgeons Act is out of
step in two main areas:
— recognition of the whole "veterinary
team";
— regulation of all individuals,
including better and more transparent regulation of veterinary
surgeons themselves.
2. To avoid undermining all the progress
made in animal welfare over the last 100-200 years, all professions
within the veterinary team must be regulated.
3. Regulation should focus on individuals,
but all professional bodies should be encouraged to set standards
for conduct, expertise and facilities which will determine judgements
made on the fitness of individuals to practice. Clearly, professionals
whose premises are able to satisfy voluntary practice standards
schemes will be reassured that their facilities are considered
appropriate.
4. The one guarantee we have in life is
that change will take place. Knowledge increases and technical
skills improve at sometimes frightening rates. Therefore, mandatory
CPD and revalidation of all members of the veterinary team are
essential to animal welfare and the interests of their owners.
5. The precise composition of the RCVS and
VNC should depend on the eventual governance structure for the
veterinary team. Individual colleges/councils/boards will need
appropriate and balanced representation of veterinary surgeons,
veterinary nurses, other paraprofessional groups and the public,
through lay appointees.
6. The professional conduct committee needs
to be modernised in terms of its composition, transparency of
its processes, and range of sanctions, so the latter are seen
as fair and proportionate to the level of misconduct, by members
of the veterinary team and the public alike.
7. In the interests of animal welfare and
the public, the RCVS or other "umbrella" organisation
needs to be able to licence and revalidate all members of the
veterinary team at levels appropriate to their education, knowledge,
skills and experience. This includes different levels of specialist
within the veterinary profession itself, and veterinary nurses
and other paraprofessional persons involved in the treatment of
animals.
September 2007
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