Examination of Witnesses (Questions 124-139)
MS EMMA
ROBERTS, MR
IVAN STOCKDALE,
MS GILL
SPINNEY AND
MR STUART
HUDSON
3 MARCH 2008
Q124 Chairman: Good afternoon, ladies
and gentlemen. Can I welcome you to the second and final evidence
session on the Committee's inquiry into the need for change of
the Veterinary Surgeons Act 1966? Can I formally welcome from
the Association of McTimoney-Corley Spinal Therapists Emma Roberts,
who is their public relations representative; from the British
Association of Equine Dental Technicians Ivan Stockdale, who is
their chairman, and Gill Spinney, the secretary and council member;
and from the Oxford College of Equine Physical Therapy Stuart
Hudson, their director. Thank you for your written evidence and
advice to the Committee. That was much appreciated. Perhaps all
three of you, in terms of your respective organisations, could
give us the benefit of your views about the wider question of
how para-professionals should be regulated.
Mr Stockdale: What I am going
to discuss is how the British Association of Equine Dental Technicians
set about self-regulating and how we feel. This is a very good
model for regulation in terms of the Veterinary Surgeons Act.
All our members are examined and have past examinations set out
by the British Equestrian Veterinary Association and the British
Veterinary Dental Association. These take on average about three
and a half to four years to get to a decent standard in order
to pass these exams. Once the examinations have been passed—they
are over a two day period—all members are then subject to
a code of conduct and mandatory CPDs so they have to perform three
days of CPD that is monitored each year in order to renew their
membership. They also have to have full indemnity insurance and
professional indemnity insurance in order to be members of the
Association. Once they agree to be members of the Association,
also there are certain codes of ethics and practice involving
procedures, their length of expertise and when to involve veterinary
surgeons in that. Also, there are certain procedures where you
would be involved with the veterinary surgeon from the word go.
It is a self-regulatory body, if you like, but it is something
all our members have voluntarily joined in order to push equine
dentistry forward.
Q125 Chairman: So that we understand
a little bit about the work of the dental technician in this field,
I do not know a great deal for example about the dental needs
of horses but, like humans, perhaps there are occasions when somebody
has to take a tooth out. Who does that and where do you come into
the process?
Mr Stockdale: This is a bit of
a grey area with the present Veterinary Surgeons Act in respect
of where the procedures start and stop. If you are looking at
a tooth removal, that can range from literally a loose tooth that
can be removed with the fingers to full sedation, nerve blocking
by a veterinary surgeon and possibly even a couple of hours of
procedure. That would be done under veterinary supervision in
an environment such as an equine hospital or something like that.
It is a very broad spectrum of tooth removal.
Q126 Chairman: In other words, there
are times when your members work with fully qualified vets and
times when you will be called in because that is what you do?
Mr Stockdale: That is correct.
On a daily basis our members would be used in conjunction with
present veterinary practices, equine practices, hospitals. I for
instance am involved in a clinic at Liverpool Vets' School where
we do dental procedures and are referred horses for lengthy and
necessary treatment. We have the expertise and the equipment and
training to carry out these procedures.
Q127 Chairman: Ms Roberts, do you
want to give us the benefit of your views on this question? I
was intrigued when I was learning about what your therapists do
to understand that in addition to horses you also look after human
beings. Perhaps you could explain, for those of us who might have
the odd bad back, whether it is something you could help us with.
Ms Roberts: Our members are graduates
from the Oxford College of Equine Physical Therapy and the Original
Oxford College of Chiropractic and have for many years provided
a competent and responsible manipulative therapy service working
alongside veterinary surgeons. A lot of the practitioners who
are members are human and animal trained although obviously I
have just prepared this today based on the veterinary side. It
crosses over because obviously the mammalian skeleton has similarities
and in terms of manipulation it is possible to help the range
of movement to mobilise and to speed up the recovery rate after
injury in both an animal and a human being via manipulative care.
Q128 Chairman: Do you only do spinal
activity or do you do other things?
Ms Roberts: We do treat the whole
spinal column but we also look at the extremities. If there is
a lower limb injury, we are trained to pick that up and diagnose
it.
Q129 Chairman: You have covered what
you do but what about the central question about regulation of
your members? What do you think is the appropriate approach?
Ms Roberts: In terms of regulation
I do feel that we are adequately regulating our own membership.
We have disciplinary procedures. We have a CPD criterion which
they have to meet annually. We have an annual general meeting
after which there is an open forum for discussion about any disciplinary
matters that may have arisen in that annual period. Everybody
has to provide proof of their insurance annually in order to maintain
their membership and there is a fee of course as well.
Q130 Chairman: Mr Hudson, you are
the director of the Oxford College of Equine Physical Therapy
and it would be very helpful to us if you could perhaps add your
observations to the question about how para-professionals should
be regulated.
Mr Hudson: First of all, I am
talking from the perspective of somebody who is regulated because
I am a chiropractor so I understand what is involved. It is reasonable
to say that if you view this from the perspective of the animal
and the owner regulation is sensible. Regulation is not a cure
all or a magic bullet as there are negatives to regulation. First
of all, costs. As a registered chiropractor I pay £1,000
annually just to be a chiropractor. Secondly, it can make people
very defensive. If you make any regulation too onerous people
can be overly-concerned about trying to cover their backsides
rather than concentrating on the work they are doing. Thirdly,
if it is too onerous, you could end up with a reduction in practitioners
in the field. I have a proposal for how it should be done. I am
concerned slightly with the Defra proposal that there should be
some kind of selective regulation based on risk. There are four
components to risk. There are risk components to competence and
conduct. If the treatment is administered incorrectly, is there
potential for danger to the animal? Second, there are risks associated
with the administration of that treatment in the presence of contra-indications.
These two are the things that I think people are going to focus
on if they try to select particular groups for regulation. There
are two other areas that are very important. If you do not apply
regulation to everybody, you are going to miss these and they
are applicable. A competence risk is associated with failing to
recognise red flags, red flags being basically things that need
to go on to somebody else; the failure constantly to review diagnosis
or progress and the failure to refer when appropriate. If you
do not cover every practitioner in the field, you are going to
miss people out. Secondly, conduct is very important. If I can
cite as an example, confidentiality. There can be a racing yard
with race horses. The trainer calls a practitioner in to treat
an animal that has a perceived problem, the practitioner treats
the horse, then goes to the pub and talks to the landlord about
the horse he has treated. There are implications here. This is
the same for everybody, whether you are a vet, a veterinary nurse,
an acupuncturist or a massage therapist. This is an important
point. I am concerned that if you only regulate certain people
on perceived risk you are going to miss out people who are going
to be guilty of these things as well. Perceived risk is a difficult
one for manipulative therapists. You are going to get different
people arguing from different perspectives. Some people do not
want any regulation and they are going to say there is absolutely
no risk whatsoever in what they do. Some people are going to inflate
the risks because they will say they are the gold standard in
education and everybody needs to do exactly what they do. The
truth probably sits somewhere between the two, I feel. I think
the solution for how to regulate people has to make sense to the
public, to the third party observing this. It does not have to
make sense only to the practitioner. First of all, there should
be a committee to govern all complementary therapists. I do not
know how that ought to be formed or who should be on it but there
should be a committee. There should be a voluntary register produced
and people should apply to go onto the register. They have to
provide evidence of a qualification in their field, a written
statement to the effect that they are aware of contra-indications
to what they do and evidence of insurance. All applicants, I feel,
should be mandated to attend a seminar run by the RCVS to cover
issues of red flags and referral procedures so that everyone has
a level playing field. I think all applicants should also have
to sign up to a common code of conduct which should be applicable
to every single person who treats an animal, whether they are
a complementary practitioner or a veterinary surgeon, because
these issues are common. Having done that, there should be a unified
effort to promote a culture change within the UK by getting practitioners,
the RCVS, the government, whoever to promote the message that
people should go to practitioners on that register. There should
be a means of regulating those people and maybe striking them
off the register or whatever. My concern is, if you go down the
route of trying to have accreditation of particular courses, there
is going to be a bloodbath. You will never reach a consensus of
opinion. You will have people who will be polarised at the gold
standard and people who do not want to do anything at all.
Q131 Chairman: That was a very interesting
contribution. Thank you for it. What none of you have said is
that there should not be any unqualified activity in the field.
You have all placed particular emphasis on the qualifications
of your respective members, the high standards that you currently
operate to, the question of insurance indemnity and all the key
things that, if you were looking for a top quality professional,
somebody who understood the service they were buying may well
look for. What about people who do what you do but who are not
as well qualified? Should we be legislating to legislate them
out or legislating, if legislation be necessary, to pick out the
people who adhere to the high standards that you have just talked
about?
Mr Stockdale: When we mentioned
the BAEDT, this is voluntary. All these things that we do are
voluntary in the hope that it is not set up for an exemption order.
We would be wanting to be regulated in a new VSA. That would be
something we would welcome. As far as the equine industry goes,
we proposed and put forward a paper to Defra where we would be
allowing certain grandfather rights for people who are unqualified,
giving them time to register an interest because, at this moment
in time, there is nothing to stop anybody in this room buying
a set of rasps and calling themselves a horse dentist. As long
as they do not claim to be qualified, they have not broken any
law and that clearly cannot be right for the animal or the consumer.
What we propose with Defra is allowing a registration of probably
12 months where people could register an interest—i.e.,
that they are unqualified or deemed by the law to be unqualified—and
then a register of interest in order to make themselves known.
Then we would give them a time limit of possibly four years in
order to pass their exams or at least to take their exams. Once
they have taken their exams, they then get a further exemption
of two years in order to pass those exams. That gives them a five
or six year window to get their qualifications and be in the regulatory
body. At the moment there is nothing to stop anybody from buying
rasps and calling themselves a dentist. That cannot carry on.
That is how we would envisage encompassing people who are out
there at the moment. There is an estimation of close to 600 people
which is quite a serious problem. That is how we would envisage
encompassing these people. We are not trying to stop people from
making a living. All we are asking is that if they are going to
charge people money and treat horses they do it professionally
and are regulated so that there is some accountability.
Q132 Mr Gray: Is there not another
way of doing this which would be to say obviously any sensible
horse owner—and I am one—would use someone who was
on or other of the registers that you describe? I use a chiropractor
and there is no way in the world he would get himself qualified.
He is an absolutely brilliant fellow, a gypsy guy and a fantastic
worker. We use him for our horses and it would be very difficult
for him to register. That would become a matter for the market.
I, as a horse owner, can choose to use a gypsy who is not on the
register but I think what the Chairman was asking a moment ago
was: should we go one stage further and say, "Okay, gypsy.
You are not on the register. You are never going to be on the
register and therefore you are not allowed to touch a horse. If
we catch you touching a horse, you are in trouble with the law."
I wonder how far down that spectrum you reckon we should go.
Mr Stockdale: I can see exactly
where you are going but I must admit that my view is if somebody
wants to be a doctor they have to pass medical exams. If somebody
wants to be a human dentist they would have to pass dentistry
exams. I am afraid to say that if they are putting themselves
forward to pass on treatment to an animal, then they have to show
they are up to the standard or stop.
Q133 Mr Gray: Would that apply to
chiropractic as well?
Mr Hudson: Yes. But the reason
I mentioned perhaps having a register on a voluntary basis is
it will be pretty much impossible to stop people doing things
out there in reality.
Q134 Mr Gray: You could make it against
the law. You could say that treating a horse when you are not
on the register is breaking the law.
Mr Hudson: Sure, but enforcing
it might be difficult. You could have your chap who is a gypsy
who is extremely competent at what he does, and there is nothing
wrong with that, because we are talking about things that are
vocational. This is why training and education issues need to
be looked at with regard to the end product. It is so easy to
get caught up in academia and things like this and kind of miss
the point in a way. The issue here is accountability, is it not,
and recourse for the owner of the animal or the animal itself
in the event that there is a problem. Again, I am saying that
regulation as viewed from the perspective of the animal or the
owner seems sensible but I do not know in reality how many problems
there have been. I do not know if anyone has asked the insurance
industry about claims for competence-based injuries to animals.
I would doubt that there have been any but I do not know. In terms
of risk, if a manipulative therapist puts their hands on a horse
and does things, if you compare the forces on that skeletal structure
from an engineering perspective with the dynamic loads on that
animal as it is going through its activities of daily living,
as it is rolling around in a field or trotting down the road,
the forces applied by the practitioner are probably fairly small.
Some people will say it is hugely risky if you do not do this
or that. I would say try and look at it from a sensible perspective
but again it is about accountability and a means of recourse which
is why I mentioned having a voluntary register. But somebody has
to show evidence of insurance. You cannot get insured to do the
work we do if you do not have a qualification. Insurers will not
insure you unless you can present evidence of this so that would
take those people out of the register anyway.
Q135 Mr Cox: Surely the owner would
know if he goes to the gypsy that he is not going to be insured
or registered and it is his risk.
Mr Hudson: Absolutely. That is
why I am saying it should be a voluntary register and there should
be freedom of choice for the owner to choose but the regulatory
body should encourage the public to use people who are on the
register.
Mr Stockdale: We have been involved
in this in the dentistry world for about five or six years now
and in reality it does not happen. There are people out there
who would give themselves not bogus qualifications but dress up
their business cards so that they do look highly qualified. The
Trading Standards say that you only break the law if you intimate
qualifications so as long as you do not put down a qualification
that actually exists you are fine. You find EQDT after lots of
names. That indicates that they are qualified but in reality they
are not. I take your point about the chiropractor. In dentistry
things have moved on an awful lot. We also are dealing with a
lot of problems in the mouth. The horse does not show initial
signs but if it is left it can show quite serious signs. Of course
by that time it is too late. People say that the guy is okay but
it is not until five years down the line that you are presented
with a problem that cannot be fixed or requires veterinary intervention
to remove the tooth and so on. It could quite easily have been
fixed if it was sorted earlier on. I still go back to the same
point that if you are charging people for a service I think the
least anybody can expect is that they pass a level of examination
to be adjudged on their expertise.
Q136 Mr Cox: Can that not to be dealt
with by simply reserving certain procedures for those who are
on the register and other procedures can be left to the market?
Mr Stockdale: The problem in reality
with that is that you are talking about hand floating which is
not a government procedure. People say, "I just want to hand
float a horse's teeth". They go along and charge the money.
People have presented their horses for treatment and everything
is okay. The problem is that there is a major cavity that is starting
to form or a fracture of the tooth and so on that has not been
picked up, or even slight misalignments. Because that practitioner
cannot do that procedure as it would involve power tool work for
instance or over-correction of the tooth, it then gets left and
that is the problem.
Q137 Mr Cox: That may be an argument
for having dentistry as one of the reserved procedures only for
those on the register.
Mr Stockdale: Are you talking
about a register only for dentists? That is something we want
to push for.
Q138 Mr Cox: I am sure you would
but we are looking much more broadly across dentistry and other
things as well. One issue is what should be regulated and what
should not be.
Mr Stockdale: If you get into
the regulation of certain procedures—again, this is something
we have been working with in the last five or six years—what
it has done is allow a proliferation of people who have taken
no examinations to put themselves out there as horse dentists.
In reality, they are saying, "I am not breaking the law because
I am only doing a category one procedure." Also, you have
dentistry schools starting up with no qualifications at all but
charging people money in order to give them category one status.
Everybody has category one status because it is not governed.
Q139 Paddy Tipping: You have a practice
standards scheme at the moment which is voluntary but you are
advocating that over a period of years it should become mandatory?
Mr Stockdale: That is correct,
but not necessarily to the BAEDT. There are other people who want
to provide dentistry in their own associations out there. As long
as they get to the same standard as the BAEDT or the BEVA examinations,
we have no problem at all with 20 associations starting up. The
degree of accountability comes into play here. The consumer needs
to be satisfied that people who work on horses' mouths are up
to a recognised standard. This is something that needs veterinary
involvement. You need a degree of knowledge about it and at the
moment it is not working in respect of having categorisation of
those.
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