Memorandum submitted by the Ashlea Veterinary
Centre Ltd (Vet 04)
PREAMBLE
The Council and Officers of the Royal College
of Veterinary Surgeons have, for several years, made it abundantly
clear that they believe that the welfare of those animals entrusted
to the care of members of the veterinary profession would be better
served if the Royal College were granted more powers to regulate
and control the profession than are currently available under
the Veterinary Surgeons Act 1966.
However, as Council's plans have become ever
more complex the interest of the Membership has dwindled. When
the first consultation paper was published (February 2003) there
were 475 responses from individual members of the profession,
but in June 2005 a second consultation paper elicited but 86 replies
from the Membership. So while the RCVS may rightly claim that
it has "consulted" the profession, whether its proposals
are supported by the majority of the profession is open to doubt.
Indeed any review of the future governance of
the veterinary profession should consider the growing disengagement
between the practising profession and its governing body, a schism
which has seen less than 18% of the "electorate" bothering
to vote in either of the last two RCVS Council elections. While
the RCVS may seek to represent this simply as "voter apathy",
I would suggest that it more properly reflects the growing frustration
of vets in practice who have found that there very few routes
by which they can influence policy discussions within either the
Advisory Committee or RCVS Council itself.
With notable exceptions, RCVS Council remains
dominated by University nominees and by veterinary surgeons that
are no longer active in clinical work. The track record of RCVS
Council on practical issues is poor, with a tendency for decisions
to be made without adequate thought as to how the practising arm
of the profession might comply. For example, it took a rearguard
action by practitioners, deluging the Advisory Committee with
letters of complaint, to dissuade Council from insisting that
qualified veterinary nurses must monitor all general anaesthetic
procedures performed in practice. The recommendation was being
made despite there being an under-supply of such qualified staff
and with no apparent regard for the cost implications, to both
practices and clients, of the implementation of such a requirement.
Before the announcement of the EFRA Committee
enquiry, the impression given to the profession was that there
was little prospect of parliamentary time being made available
for discussion of a new Veterinary Surgeons Act. Consequently
RCVS Council has investigated various ways of extending its control
of the Profession beyond those areas allowed by the 1966 Act (eg
by encouraging practices to join the voluntary Practice Standards
Scheme and by altering bye-laws to impose additional control over
recently qualified veterinary nurses).
Now RCVS Council is formally seeking additional
powers by asking for revision of the VSA. It is clear that Council's
proposals form the core of the enquiry by EFRACOM. In assessing
Council's requests it is vital that EFRACOM should consider:
— whether the requested changes
will truly improve the welfare of animals entrusted to the care
of veterinary surgeons;
— whether any changes deemed right
and proper could be achieved without invoking the need for a completely
fresh Act; and
— whether the costs incurred by
the changes (be they costs of compliance, of regulation or of
enforcement) risk damaging animal welfare by increasing the cost
of veterinary attention and thereby putting the care of certain
animals beyond the financial reach of their owners.
RESPONSES TO
SPECIFIC POINTS
RAISED IN
THE INQUIRY
ANNOUNCEMENT
1. Whether the provisions of the 1966 Act
are out of step with developments in the veterinary surgeon and
related professions
1a. In the wake of events such as Shipman
it is evident that there is a growing distrust of the principle
of self-regulation. And consequently there is the prospect of
more regulation being heaped upon the veterinary profession.
1b. There is the danger that in seeking
a new VSA to satisfy perceived "public expectations"
our ruling body is becoming too precious. Other professions are
facing increased regulation in order to protect the end-user—the
public. The end-user for the veterinary profession is the animal-patient,
not the human-owner. The ethical requirements are entirely different.
It is not the job of the RCVS to protect the public from veterinary
surgeons in terms of any relevant financial transaction—this
is a straightforward business situation, adequately governed by
the current law of the land.
1c. In terms of the vet-patient relationship
I fail to see that there have been any significant changes which
require a new VSA; the Guide to Professional Conduct has more
than adequately kept up with clinical developments within the
veterinary field.
2. Whether there ought to be regulation of
providers of veterinary care other than veterinary surgeons
2a. The RCVS seems inordinately worried
by the rise of corporate ownership of practices. I believe their
fears are misplaced.
2b. The RCVS seems to believe that employed
veterinary surgeons may act in ways which may be considered "not
in the best interests of the animals entrusted to their care"
in order to protect their continued employment. It was always
so—I fail to see what has changed.
2c. If a practice owner, corporate or otherwise,
were to make unethical demands of their veterinary staff it remains
the employee's responsibility to make the owner/manager aware
that business policy compromises their professional duty under
the RCVS Guide to Professional Conduct. To seek to regulate providers
rather than veterinary surgeons simply adds another layer of bureaucracy
and complexity—if enacted I foresee some very expensive
test cases!
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
3a. Before any such change is made it is
for the RCVS to demonstrate that the present system is putting
animal welfare at risk. I do not believe that such evidence exists.
3b. There may indeed be veterinary surgeons
operating out of premises which other vets would consider substandard.
But animal welfare is protected by ensuring the standard of care
offered across the consulting table, not by the size of the consulting
room, the standard of the flooring or the number of gadgets available
in an adjacent room. Unless animal welfare is being compromised
it is not the job of the RCVS to insist that premises be upgraded
at massive expense to satisfy arbitrary standards.
3c. I am unconvinced that defining practice
standards will have any significant effect on the quality of care
offered to patient animals. The current Practice Standards Scheme
concentrates far too heavily on the building involved and the
equipment used. However, outline proposals to assess and improve
the standards of clinical care seem to rely far too heavily on
a proposed system of clinical audit. For small, independent businesses
this would be massively wasteful in terms of time and money, resources
that would be far better spent on providing clinical services.
And of itself clinical audit would be a meaningless exercise as
there are no set levels of expected clinical outcome for the profession
against which the practising vets might compare themselves.
4. Whether the RCVS and Veterinary Nurses
Council should be given the power to require continuing professional
development and revalidation
4a. There is no doubt that both veterinary
surgeons and nurses need to keep their clinical knowledge up-to-date.
And most do this quite satisfactorily at present through the ready
availability of a plethora of journals and CPD courses. But in
order to be seen to be dealing with the few individuals that fail
in their current professional responsibility, the RCVS proposes
compulsion on the whole profession.
4b. To date the RCVS has tried to achieve
its wishes in several ways:
— It has declared that continuing
professional development "should be considered mandatory"—this
despite it having no legal responsibility for post-graduate education.
— It has established the voluntary
practice standards scheme. By subscribing to this scheme practices
have, in effect, allowed the RCVS more stringent controls over
the professional lives of veterinary surgeons employed by participating
practices than is allowed under the 1966 Act (eg with regard to
CPD requirements).
4c. While it is clearly a nonsense that
the profession's governing body has no means of ensuring that
veterinary surgeons "keep up to date" I would suggest
that compulsion is a large sledge hammer to crack a very small
nut.
4d. As yet I have seen no evidence that
the principle of compulsion has been adequately thought through.
The current requirements are simple—as vets we are expected
to complete a stated number of hours of self-chosen study each
year. However, even now there is no accommodation made for part-timers
or for those on career breaks—people for which the financial
cost is significant having part-time incomes yet full-time CPD
requirements. Responsibility for personal CPD currently lies with
the individual vet and already responsibility is clouded somewhat
for those employed by practices subscribing to the PSS. Other
issues that need to be faced include:
— What happens to the principle
of professional indemnity insurance if a vet has not performed
"sufficient" CPD?
— For practices employing locums—who
is to monitor the CPD carried out by such temporary employees?
4e. The current situation serves the profession
perfectly adequately—should you be called before the Disciplinary
Committee and your level of CPD be found wanting then it can be
taken into consideration by the Committee.
4f. Those that shirk their professional
responsibility currently will do so in the future—even in
the face of compulsion!
5. Whether the governing body of the RCVS
and VNC ought to include appointed lay persons as well as veterinary
professionals
5a. The performance of lay observers on
the RCVS Disciplinary Committee has drawn nothing but praise from
those members of the profession who have witnessed their work
first-hand. I see no objection whatsoever to the principle of
independent appointees similarly sitting on RCVS Council.
5b. I would simply ask the question "who
appoints the appointees?". It is important that any appointees
are truly independent and that we avoid the appointment to RCVS
Council of interested parties (governmental or otherwise) with
their own agenda.
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
6a. I understand that the disciplinary process
within the RCVS needs to change to comply with Human Rights legislation.
I feel unqualified to comment on the structure required to satisfy
the changed circumstances. However, the ability to "make
interim orders pending proceedings" smacks of sentence before
trial and should be strongly resisted.
7. Whether the RCVS ought to have the power
to delegate specified procedures to people holding qualifications
recognised by the RCVS Council
7a. I would be in general agreement with
this. It would certainly be an improvement on the current situation
where the Government is considering the delegation of a procedure
currently regarded as an act of veterinary surgery (TB testing)
to lay persons despite the stated opposition from RCVS Council.
CLOSING COMMENTS
— For all its expressed desire
to increase its control over the practising profession the RCVS
still demonstrates a considerable reluctance in becoming involved
with judging a fellow professional's "clinical performance".
Consequently the public is bemused as to why it has to pursue
cases of incompetence and negligence through the courts while
the RCVS will only act on issues of "professional behaviour".
— The cost to individual practices
of running a professional service are rising inexorably—rates,
salaries, national insurance, waste disposal regulations, medicine
regulations, health and safety regulations... the list is seemingly
endless. Each new layer of bureaucracy adds to the costs that
must inevitably passed on to the client. If the new proposals
from the RCVS add further to the cost of providing veterinary
attention then they will damage rather than promote animal welfare.
August 2007
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