Memorandum submitted by the Royal College
of Veterinary Surgeons (Vet 11)
INTRODUCTION
1. The Royal College of Veterinary Surgeons
seeks to promote and sustain public confidence in veterinary medicine.
We welcome the Committee's decision to undertake the inquiry.
2. The Veterinary Surgeons Act gives the
College the task of regulating veterinary surgeons. Regulation
is a form of quality assurance and involves managing the interface
between a profession and its clients or patients. In the case
of the veterinary profession there are both clients and patients
and a general public interest arising from veterinary work in
relation to food safety and disease control. Our overriding objectives
are:
— To safeguard the health and
welfare of animals committed to veterinary care through the regulation
of the educational, ethical and clinical standards of the veterinary
profession, thereby protecting the interests of those dependent
on animals and assuring public health.
— To act as an impartial source
of informed opinion on animal health and welfare issues and their
interaction with human health.
3. The first objective relates to the role
of the College under the Act. The second concerns the exercise
of the College's powers under its Royal Charter.
4. RCVS consulted veterinary surgeons, veterinary
nurses and other interested bodies in 2003 and 2005 on possible
improvements to the Veterinary Surgeons Act 1966, and in November
2005 adopted firm proposals for the main areas where changes are
needed.
EXECUTIVE SUMMARY
5. The College seeks new legislation because
the present Act does not measure up to present-day expectations
for the regulation of a profession. Currently RCVS keeps the register
of qualified veterinary surgeons and intervenes when things go
wrong, by looking into complaints about the professional conduct
of veterinary surgeons. We cannot take preventative action to
ensure that proper standards are being met and can only take action
when a complaint is made against an individual veterinary surgeon.
This may mean that an animal has to suffer before the College
can do anything. This is not satisfactory, especially in the light
of the new animal welfare legislation.
6. The College's proposals are designed
to address the following main shortcomings in the Veterinary Surgeons
Act:
— It allows veterinary surgeons,
once registered, to practise with no means of ensuring that their
professional skills and knowledge are kept up to date. This does
not fit with a modern regulator's role of prevention rather than
prosecution.
— The Act does not allow a proper
separation between the Council which sets the standards for professional
conduct, the Preliminary Investigation Committee which looks into
allegations of misconduct and the Disciplinary Committee which
adjudicates.
— The Disciplinary Committee has
no direct jurisdiction in cases where a veterinary surgeon's competence
or medical fitness to practise is at issue rather than their conduct.
— The Act deals with the regulation
of individual practitioners and gives no power to collect information
about the businesses in which veterinary surgeons work. Most veterinary
care is provided by practices, and the standards they observe
need to be assured. Veterinary practices are not always controlled
by veterinary surgeons.
— The Act deals only with veterinary
surgeons. It does not recognise veterinary nurses as a profession
or give statutory powers to regulate them.
7. The College's answers to the questions
posed by the Select Committee are below.
Are the provisions of the 1966 Act out of step
with developments in the veterinary surgeon and related professions?
8. The Act focusses on the qualifications
and conduct of individual veterinary surgeons. These days, however,
care is generally provided through teamwork between veterinary
surgeons, veterinary nurses and lay staff. There has also been
a change in the legal character of veterinary practices. Traditionally
veterinary surgeons worked as sole practitioners or in partnerships,
but a growing number of practices are now owned by companies or
other corporate entities (nearly a fifth of the practice premises
known to RCVS appear to be in corporate ownership). Veterinary
surgeons who direct or are employed by such practices are answerable
to RCVS for their conduct, but the College has no jurisdiction
over the actions or omissions of managers or practice owners who
are not veterinary surgeons.
9. In response to these changes we are seeking
power to introduce mandatory regulation of practice standards,
building on the existing voluntary RCVS Practice Standards Scheme
which covers about half of all practice premises. This would mean
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.
10. There have been other developments which
go wider than the veterinary profession. The changes we propose
are in line with the modernisation of the regulatory arrangements
of the human health professions in recent years, and with the
Government's further decisions as set out in the recent White
Paper, Trust, Assurance and Safety—The Regulation of
Health Professionals in the 21st Century, Cm 7013. Our proposals
for a new structure to deal with complaints against veterinary
surgeons and veterinary nurses also take particular account of
the Human Rights Act 1998.
Ought there to be regulation of providers of veterinary
care other than veterinary surgeons?
11. Veterinary nurses work closely with
veterinary surgeons as an integral part of the veterinary team,
and we believe they are ready to be recognised as a profession
in their own right. The College keeps a list of qualified veterinary
nurses, but there is no power to regulate their conduct. Pending
legislation we are introducing such regulation under powers in
the RCVS Royal Charter. Veterinary nurses whose names have been
entered in the list from 1 January 2003, and other listed veterinary
nurses who volunteer, are now registered and subject to a code
of professional conduct and a requirement to undertake continuing
professional development. In due course complaints will be investigated
and appropriate disciplinary action taken, but statutory powers
are necessary to require all veterinary nurses to be registered
and for the regulation to be effective.
12. The College's proposals concern the
regulation of veterinary surgeons and veterinary nurses. Other
providers of veterinary care ought also to be regulated, under
arrangements which are appropriate to the assessed risks.
13. There is an issue over enforcement of
the legislation. The Act makes it unlawful for anyone other than
a veterinary surgeon to practise veterinary surgery, unless they
fall within the terms of certain specific exceptions. There is
anecdotal evidence, however, of an increasing numbers of animals
being treated with alternative and complementary therapies by
non-veterinarians. Whatever view may be taken of the efficacy
of the therapies in question, animal health and welfare is at
risk if people without veterinary training diagnose illness and
prescribe treatment. Veterinary surgeons are free to use complementary
therapies, but they are qualified to diagnose what is wrong with
the animal, can judge whether or not the treatment is working,
and can be called to account if it goes wrong. It is therefore
a matter of concern when non-veterinarians practise veterinary
surgery except within the limits set by the Act. We do not, however,
think it appropriate for the College to seek to police such activities,
because this could give the impression that we wish to protect
the veterinary profession from competition.
Ought the delivery of veterinary services 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?
14. We propose both. The public still needs
to be assured that individual practitioners are properly qualified,
up to date and answerable for their professional conduct and competence.
For the reasons mentioned in paragraph 9 above, though, we think
that the framework of statutory regulation should encompass practice
standards and extend to 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 public increasingly expect the College to address complaints
which do not relate to individual veterinary surgeons. In order
to deliver risk-based regulation in accordance with current good
practice it is necessary to look beyond individual practitioners
to take account of other members of the team and the environment
(including equipment, systems and protocols) in which they all
work. The regulation of the veterinary team should be pro-active
in setting standards and in ensuring compliance by means of advice
and visits. This approach would also make it easier to monitor
the activities of individual practitioners in context and identify
and address abnormalities and irregularities.
15. Such regulation already exists for human
healthcare service providers, primarily through the Healthcare
Commission. It is worth noting also that the Veterinary Medicines
Directorate of DEFRA propose to introduce a register of premises
from which veterinary surgeons supply medicines. The specific
object is to assist the enforcement of the medicines legislation,
but the new register, to be maintained by RCVS, will also incidentally
serve to identify most of the points where veterinary services
are delivered.
16. The voluntary RCVS Practice Standards
Scheme has paved the way for statutory regulation of practices,
but we do not suggest that new legislation should simply make
the present scheme mandatory. In line with the Government's better
regulation policies any regulatory scheme needs to be risk-based
so as to minimise the costs and focus attention where it is most
needed. The present scheme is providing the information which
will be needed in order to set the benchmarks for risk-based regulation
of practice standards under new legislation.
Should the RCVS and Veterinary Nurses Council
(VNC) be given the power to require continuing professional development
and revalidation?
17. Veterinary surgeons and registered veterinary
nurses are already under a professional obligation to undertake
continuing professional development, and we think the RCVS and
Veterinary Nurses Councils should have power to require this under
new legislation. The public has a right to expect that any professional
is devoting time to keeping abreast of new developments. Science
moves forward at a rapid pace, and what was suitable as treatment
twenty years ago may no longer be so. Keeping up to date is vital
in order to maintain public confidence and maintaining a licence
to practise should be subject to such a requirement.
18. Revalidation or reaccreditation would
provide a positive assurance of continuing competence. That would
go well beyond checking that practitioners had taken steps to
keep up to date. What form revalidation might take in the medical
profession has been under debate for several years. Cm 7013 announced
the Government's decision that it should be introduced but left
much of the detail for further discussion.
19. The veterinary and veterinary nursing
professions have yet to begin a formal consideration of what form
revalidation might take, although some thought has been given
to it by RCVS committees. There is of course no veterinary equivalent
of the National Health Service, and veterinary care is predominantly
provided by small independent businesses. Practical arrangements
for revalidation would have to take realistic account of the likely
costs and logistics. There would be little benefit in introducing
Rolls Royce arrangements to assure the public of the competence
of veterinary surgeons and veterinary nurses if their services
became prohibitively expensive. Nevertheless, it seems right for
the legislation to provide the necessary powers for the future.
With the passage of time what may now seem idealistic can come
to be seen as overdue, and it is worth bearing in mind that the
present legislation has already been in place for over 40 years.
Ought the governing body of the RCVS and VNC to
include appointed lay persons as well as veterinary professionals?
20. Yes. The RCVS and VN Councils already
include lay members who make an important contribution. Any professional
regulatory body needs lay members to represent the public interest
and to ensure that self-regulation is not self-serving. We also
propose that the Councils should include appointed veterinary
surgeons and veterinary nurses.
21. Cm 7013, published after the RCVS Council
adopted its proposals, announced the Government's decision that
the regulators of the human health professions should be wholly
appointed bodies. Our proposals envisage retaining elected veterinary
surgeons and veterinary nurses on the two Councils. Otherwise
there would be a loss of accountability, particularly for expenditure
(which has to be met from the registration and retention fees
paid by individual members of the professions).
Ought the RCVS and VNC to have a separate conduct
committee with the powers to investigate complaints, give warnings
and to make interim orders pending proceedings?
22. We think the Conduct and Competence
Committee needs to be separate from the RCVS and VN Councils so
that rule-making and adjudication are kept at arm's length. If
those who sit in judgment are involved in writing the rules, they
are liable to have regard to what they intended rather than what
the rules actually say. The public is also likely to have more
confidence in the impartiality of an independent tribunal.
23. We do not propose that the Conduct and
Competence Committee should investigate complaints: that job would
be given to a different body, which we refer to as the "board",
in order to keep standard-setting, prosecution and adjudication
separate. The board would set up its own arrangements for sifting
and investigating complaints and deciding which of them ought
to be referred to the Conduct and Competence Committee.
24. Both the board and the Conduct and Competence
Committee would have the option of disposing of a complaint by
giving a formal warning. The board could also give formal advice,
and the Conduct and Competence Committee would be able to impose
conditions or restrictions as an alternative to suspension or
removal from the register. There was general support for such
powers in the responses to the RCVS consultations of 2003 and
2005.
25. By contrast there was sharp controversy
on the question whether the Conduct and Competence Committee should
be able to make interim orders pending proceedings to suspend
respondents or to allow them to practise only subject to conditions
or restrictions. This is certainly a difficult area. The circumstances
would have to be quite exceptional to justify stopping someone
practising their profession without a full hearing of the allegations
against them and their response, particularly where this could
lead to serious loss of income. (Suspension by a professional
regulator is a very different matter from suspension by an employer
on full or even partial pay.) Circumstances can, however, arise
from time to time where intervention is necessary, particularly
where a practitioner suffers severe health problems. In such cases
it seems right to have power to take action in the public interest,
subject to the same safeguards as apply under the human health
legislation (see, for example, article 31 of the Health Professions
Order 2001, SI 2002/254).
Ought the RCVS to have the power to delegate specified
procedures to people holding qualifications recognised by the
RCVS Council?
26. We think this would be helpful. As noted
above, the current legislation allows non-veterinarians to practise
veterinary surgery within certain limits—for example farmers
can give their animals medical treatment and carry out minor surgery,
and trained technicians can take blood samples—but there
is a problem in keeping pace with developments. Ministers can
make exemption orders allowing non-veterinarians to carry out
specified procedures, but the order-making process has proved
slow and laborious and the powers do not extend to full regulation
of conduct. That is why we suggest that veterinary surgeons should
have power to delegate appropriate procedures to people holding
qualifications recognised by RCVS, provided the animal remains
under the care of the veterinary surgeon. This could offer a quicker
way forward when new disciplines emerge and encourage team working
between veterinary surgeons and other trained providers of veterinary
services.
CONCLUSION
27. We believe that new legislation is necessary
in order to set in place a regulatory structure which will meet
the proper expectations of Parliament and the public. Over the
years we have found ways of working round some of the constraints
in the present aging Act—notably by introducing a voluntary
Practice Standards Scheme and non-statutory regulation of veterinary
nurses—but there are limits to what we can do without a
modern legislative framework. We hope that the Committee will
endorse the need for new legislation, and we look forward to hearing
whether or not the Committee agrees with the specific proposals
which we have put forward.
September 2007
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