Examination of Witnesses (Questions 106-119)
MR CHRIS
BARKER, MRCVS
18 FEBRUARY 2008
Q106 Chairman: Thank you very much for
coming down from Carlisle today. It is kind of you to spare the
time to come out of a busy practice. Thank you very much for your
pithy, interesting and indeed entertaining evidence, which I read.
I could almost sum it up that you are saying: "Status quo;
no need to change anything; Royal College's proposals far too
bureaucratic, far too expensive and we can get on and do it by
other means." Is that a fair summary of where you come from?
Mr Barker: Do things need to change?
I am totally convinced that our disciplinary system does not match
the human rights requirement and that has got to change. What
I cannot comment on is whether that has to be done through primary
legislation; that is for the people like yourselves to work out.
I have a major problem with a ruling body that expects a lot of
the profession and expects a lot of the profession and makes various
demands without what I feel is an adequate understanding of how
the hell we are meant to comply. This is a profession under some
pressure. There is a lot of depression within the profession.
The documented rate of suicide in the profession is double that
of the medical profession and four times that of people in the
general public. This is a profession that feels a lot of stress.
I am not saying that there should not be change, but I want to
be sure that the change is warranted, that it is evidence-based
and not just a good idea of a committee based in London; that
if it is genuinely required, it has been thought through how the
profession can comply and put it into action, and also that they
have put some thought into what costs are going to be involved
for the profession. At the moment I am unconvinced of most of
those points.
Q107 Chairman: Given the work that
the Royal College has currently undertaken on legislative change,
do you feel in any way, shape or form, as a member, that you have
been consulted or involved in this process?
Mr Barker: Time and again the
Royal College will remind members we are declared members. However,
our input to the profession tends to repay our registration fee
every year. We certainly get quite a few bits of paper through,
and we are asked for consultation on various items. By the time
we are asked for consultation you generally find that the policy
has already been decided; it has been through Advisory committee
and has been to Council; and they have been through various ideas
of what they might do, and then they put it out to consultation—"do
you like the final result?" I do not really consider that
consultation. At the moment there are something like 13,500 practising
vets in the country, and to that final consultation paper—I
cannot remember—it is well below a hundred that bothered
to write in. There is a gulf between the profession and the ruling
body. The ruling body seems to go its own way. There are no routes
through which individual members of the profession are able to
influence policy.
Q108 Chairman: Do you have any feedback?
I am not certain whether there is a kind of "opposed change"
group within the Royal College that is formulated in any way,
where you can meet with fellow professionals to talk about these
matters.
Mr Barker: I am not a member of
enough groups to comment too much. At the moment there is quite
an active group, a web-based group of the Society of Practising
Veterinary Surgeons, which tends to involve a lot of people who
own practices, and also a lot of assistants, and there is a lot
of discussion on that group. The President of the Royal College
is actually a member of that group. I have to say he is rather
selective of when he pops his head up to answer a question.
Q109 Chairman: Most of that kind
of activity is, by definition, self-selecting in terms of—
Mr Barker: I do not deny that
at all, but I think this is quite a representative group of practice
owners.
Q110 Chairman: In relation to the
majority of Council members, we were asking about the composition,
as to whether they should all be elected or whether there should
be this combination of elected and appointed. What is your view
about that?
Mr Barker: Eight-five per cent
of the profession is in practice. There is no way 85% of the seats
on Council are practitioners. I have been privy to the discussion
paper put forward by Defra and they even raised the idea of there
being no elected members of the committee, because they are worried
that an elected member may carry with him the thoughts of the
profession behind him, and therefore would not be truly independent
in setting standards. I find that terrifying. It is difficult
enough to nominate people and get them on to the Council of the
Royal College as it is. You asked earlier about had they got a
breadth of the profession: blatantly, no. Twelve members go to
the universities, and there is a new university of Nottingham
started in the last 18 months. The Privy Council—they get
the people who have the time to dedicate to it, and I am afraid
that is not the practitioners out there doing the actual work.
You may end up with people who have been in practice but they
have retired or they are in a situation where they have contributed
to the practice, but not to the most damaging workload, which
can be the provision of out-of-hours. Therefore, you are getting
a view from practitioners or former practitioners but I am afraid
they are one step removed from providing the service that we do
nowadays.
Q111 Mr Drew: You raised the issue
of out-of-hours practice. Can you give us a feel for other issues
where you feel that the Royal College is either not representing
the profession or could do much more, maybe with the help of legislative
change, to bring up to date some of the problems that arise? I
am always raising the issue of what is happening to large animal
practices. That is in decline, and it has not been addressed,
certainly by Defra, and maybe it is a criticism of the Royal College.
Mr Barker: First of all, let us
clarify the situation. The Royal College does not represent the
practising vet. It is very clear in everything it does and all
the meetings it holds: it will stand there and beat the drum:
"We are not here to represent you; we are here to represent
the public"; and I understand that situation, but it rather
undermines your question because they do not see that they do
represent the profession at all. In terms of out-of-hours—and
this is an illustration of how we have so little communication
with them—we have a situation where we are the only country
that provides 24/7 cover. It is not asked of us under the Veterinary
Surgeons Act; it has been instituted through the Guide to Professional
Conduct. At the moment there is a major crisis, which the Royal
College will not admit to. Basically, we cannot serve two masters.
We have working time regulations specifying the length of time
that people can work, and most especially we have to have a compulsory
11-hour break between working days. This actually is impossible
to comply with if your practice is below a certain size, and that
size is five. I have a practice where we have five part-timers.
We work as an equivalent of a three full-time vet equivalents,
but because there are five of us we just about comply—just—but
there are nights I get called out where I am expected at work
at nine the next morning. I am breaking the law! The Royal College
has been closing its eyes and will not enter into proper discussions
with the profession about this. It is basically saying that we
need to provide 24-hour cover, and I am saying that if you get
down to the many practices of only three people—that is
the average practice size in Britain—you cannot comply with
the law and with the Guide to Professional Conduct. The Royal
College is digging in its heels and will not talk to us. Basically,
it is relying on us either to break the law or relying on practice
owners, who they argue are self-employed and therefore the working
time regulations do not apply. They will not talk to us about
it; they just keep spouting, "it is possible". In June
last year, in the communication that comes round, we were promised
an advice note to show us how we could all comply with ease: it
has not been published yet. Apparently, they have taken—
Q112 Chairman: Mr Barker, to bring
us back to what we are discussing, which is the potential changes
that the Royal College would like to see in the Act, what you
have just been talking about is a disagreement, frustration, about
the advice given to the profession about what is good practice
and its compatibility with a piece of European law. I did not
get the impression that the Royal College wanted to put into law
the type of framework that is currently causing you a problem.
By all means put me right if I have misunderstood that.
Mr Barker: We have a lot within
their proposals that is not spelt out. They are talking about
validation with no idea of how they would apply it, but—"it
is a good idea; trust us, we will do it right". As a professional
I do not see how we can do it. I do not know where the manpower
is going to come to apply this. There may be a whole string of
subjects which we do not have time to go into here, which their
expectations are just not realistic for the profession to deliver.
Q113 David Taylor: You complained
a moment or two ago that the Royal College did not represent the
veterinary profession. Parallel to this debate in this room, in
the Commons there is a major piece of legislation just looking
at the regulation of the various professions within the Health
Service. The medical profession, the 60 million people in the
UK, is split in terms of the BMA, which you can say represents
the profession—
Mr Barker: As our BVA would, yes.
Q114 David Taylor: Which deals with
the regulation. Is that the line and direction of travel that
you would like to see, with at least some body, some organisation,
charged with the responsibility of "representing the profession"?
Mr Barker: I think if it was given
the ability to communicate with us and charge us about the real
problems, then there may be some strength in that idea. The Defra
submission talks about regulation. It talks that it should be
risk-based and it should be proportionate. I think there is a
lot of real importance here. Proportionality: 85% of the profession
are working in practice, a total of under 15,000 vets. Add to
that, 7,500 nurses. We are a small profession. We may only have
23,000 there, but Defra has been prepared to find parliamentary
time to re-jig this. Compare that with 200,000 doctors, 400,000
nurses and midwifes: even on the lawyer side there are over 140,000.
To find parliamentary time, one has to ask why Defra—and
Defra is suggesting a White Paper—is finding time for what
is actually a very small profession. Money—proportionality:
it is only those practising vets that have got the money to pay
for any new layers of regulation. These three new bodies that
are going to be set up—I am sorry, I do not believe that
that is going to be less expensive than it is now. These costs
are going to be put on to the profession. One final thing is that
it is a proportionality of whether we are an equivalent to the
medical profession and should we be regulated in the same way?
I do not believe we should. The difference between the veterinary
profession—I am not going to deride what we do as veterinary
surgeons because we have standards as high as anywhere in the
medical profession—and general practice—the practice,
in terms of being able to things, is probably better equipped
than the GP. In terms of what we do—does it require the
same level of regulation that Shipman has ended up being brought
down on to the medical profession? I doubt that it does. Say I
am doing an operation, a basic operation, and, sadly, for whatever
reason, an animal under an anaesthetic dies: I am going to regret
that. I, as a professional, will re-examine what happened in the
theatre and try and work out what happened. I will sympathise
and I will share the loss that the owner has of losing that pet:
but it does not begin to compare with the tragedy involved if
a human dies under an anaesthetic.
Q115 David Taylor: Of course not.
Mr Barker: The responsibility
is an order of magnitude different, and yet the Royal College
is arguing that on this small profession, this self-financing
profession, it should bring down all of the regulations that have
been brought forward and which the BMA and everyone else is trying
to think, "Does this work for medics?" You have a huge
profession being supported by the NHS. To bring the same level
of regulation down on the vets, I think, would be financially
crippling.
Q116 David Taylor: You are dealing
with tens of millions of sentient beings. You said right at the
very start of your evidence that the Royal College was blatantly
not representative—paraphrasing slightly—
Mr Barker: It is their words,
not mine; these are their words. They make it quite clear that
they are not there to represent us; they assume that the BVA is
the body that should—
Q117 David Taylor: Which important
strands of opinion do you believe are not getting a proper hearing
in the councils of the Royal College? Which attitudes within the
profession are not being given any great weight or—
Mr Barker: I fear that the BVA
is very representative of the large animal side of the profession.
That may be quite right because that is the only way it gets presented
to the Government. Defra, indeed—one has to say, what is
the interest of Defra in the small animal side of our profession?
Q118 David Taylor: But you were complaining
that the RCVS was not representative of the profession. Which
parts of the profession is it not representative of, and what
are the effects of that disproportionality?
Mr Barker: My main complaint is
that they will create policies which, on the surface are good
ideas; but because they do not have sufficient representation
from the practising side of the body, they do not recognise the
law of unforeseen consequence. I put in my evidence that they
tried to consider that veterinary nurses—they are desperate
to recognise veterinary nurses, and, yes, veterinary nurses need
to be applauded for their knowledge and contribution; but the
Council got as far as almost putting a date of 2010 beyond which
it would be illegal in veterinary practice for anybody to monitor
an anaesthetic other than a qualified veterinary nurse. There
are insufficient qualified veterinary nurses in this country to
satisfy that need; and it was not until the practice deluged the
Advisory Committee with letter after letter that they finally
went, "oops"! The intention still lies on the books
as an aspiration, and this is the problem. We are faced with something
that is completely unmanageable for the profession, and it got
that close to becoming the policy of the Royal College of Veterinary
Surgeons, even though it was completely impractical. They had
no idea how it had been put into operation and they had no idea
of the costs or the way it would disrupt emergency work. You would
say, "we have a veterinary nurse—oh, she is off sick
today, we cannot operate; it is illegal". These things were
not being put through Advisory and put to Council, and there were
insufficient practitioners on the Council to say, "Wait a
minute, guys, this will not work". It only got out to the
profession through the forum of the website I mentioned, at which
point everybody went, "Wow, let us move"! But because
of the way the Royal College works—minutes are not circulated
early enough; there is no way for practitioners to input—we
got that close to having an impossible situation foisted on the
profession.
Q119 Chairman: Just before we go,
because I am conscious there may be a vote, I want to press you
on an area where in your evidence you feel very strongly over
this question of a mandatory requirement for continuous professional
development. You feel that the existing arrangements can work
perfectly satisfactorily. You said that the guide to professional
conduct has more than adequately kept up with clinical developments
in the veterinary field, and you go on to develop this point later
in your evidence. Tell us why you do not think that is a good
idea.
Mr Barker: I believe keeping up
to date is vital to the profession; there is no doubt about that.
I am not sure that making it mandatory will make anybody obey
it more than they are at the moment. Any vet worth his salt will
be keeping up to date as it is. The Royal College makes great
play that science is bounding forward. In reality, practice is
not bounding forward at the same speed. It is not a gradual process.
Occasionally, we get leaps forward where new ideas come in and
are applied. Therefore, I am not denying that keeping up to date
is right but I am not sure that making it mandatory will make
people obey it any better.
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