Examination of Witnesses (Questions 140-149)
MS EMMA
ROBERTS, MR
IVAN STOCKDALE,
MS GILL
SPINNEY AND
MR STUART
HUDSON
3 MARCH 2008
Q140 Paddy Tipping: What are the
costs to your members of doing that?
Mr Stockdale: You would be looking
in terms of costs at probably close to £3,500 and all of
this is done voluntarily because we see this as the proper way
to go.
Q141 Paddy Tipping: Mr Hudson, you
told us earlier on that to be a chiropractor you had to pay £1,000.
Presumably that is for insurance?
Mr Hudson: No. I was involved
with the introduction of statutory regulation. There was a King's
Fund working party report etc., but because chiropractic was a
small profession we had to give a commitment to pay £1,000
a year to get things up and running as there were so few practitioners.
We still pay £1,000 a year. That basically allows us to call
ourselves chiropractors. In my opinion, this is where regulation
can go wrong. If I can draw a parallel with the treatment of humans.
Much of the regulation of health care on humans is really by title.
There is statutory regulation of chiropractic and osteopathy and
I think the Health Professions Council governs another 13 disciplines,
but it does not govern what people do. It governs people by what
they call themselves. You could have a situation where two people
go through a chiropractic college. They qualify at the end with
a chiropractic award and they set up next door to each other in
the high street. Person A decides he is going to call himself
a chiropractor. He pays £1,000 and then he is subject to
a great deal of procedural things he has to do. Person B sets
up next door and decides he is not going to call himself a chiropractor.
He is going to call himself a spinal specialist and he is outside
of regulation. They are doing the same thing but only one is regulated.
I was talking earlier on about the issue of red flags. I really
believe that this is important and I am sure that people in the
veterinary world and veterinary surgeons will agree. People come
to somebody like me with back pain and I have to go through all
sorts of things to diagnose what they have. What I have to rule
out is a red flag. It is not rocket science. Have they got unremitting
back pain? Is it waking them up at night? Are they losing weight?
Are they tired all the time? All of those suggest to me I need
to refer that person to somebody else. The same person could go
to a massage therapist with his back pain where there is no regulation
at all. He could undertake a treatment of massage for 12 months
and not get any better and wonder why. It does not really make
sense and this is why I think you have to look at what people
do, but when it comes to risk the gentleman was asking about selective
procedure and how you select. What criteria do you use? If you
are going to look at risk, you have to look at all aspects of
risk, not just the treatment. What could happen to this animal,
this horse, this dog or this cat if this is done? The worst case
scenario for me as a healthcare professional that treats humans
is that I miss something that needs urgent referral elsewhere.
That is why I ask as many questions as I do and examine people
as I do. There are not the same examination procedures on an animal
as there are on a human. I have to do an orthopaedic assessment,
a neurological exam and check the vital signs of the patient,
their blood pressure and their temperature. I take a comprehensive
history, do a systems review and then I do all my examination
procedures on top. If you go into an academic book shop and look
for texts on the orthopaedic examination of a human, there is
a multitude. The challenge is to find a comprehensive text on
the orthopaedic examination of a horse. There is not a lot of
information out there. Also, you have a situation where people
come to me in my clinic. But some people ask if I do home visits.
I prefer not to because I cannot do the job properly. I need my
controlled environment to do that. Somebody who is treating a
horse is going to that horse at somebody's stable yard. My concern
is if there is going to be regulation and standards are to be
set they have to be set to reality, not to the wishes of people
who think you should be doing X, Y and Z when they are not being
done by people in the field because you just cannot do them.[1]
Q142 Paddy Tipping: Ms Roberts, what
are the costs involved to your colleagues of being a practitioner?
Ms Roberts: To join the Association
it is £100 a year currently and insurance normally costs,
for animal practitioners, around £120 a year so the costs
are fairly low. A lot of our members do work part time. The human
costs are different. I am a chiropractor. I do pay £1,000
a year for my registration to treat people , but in terms of this
Association, the animal practitioners are a separate profession
and their membership costs are a lot lower.
Q143 Paddy Tipping: If things go
wrong, what are the recourses?
Ms Roberts: We have only had one
disciplinary action so far, to date, and that was a conduct issue
between one professional and another professional. However, we
are aware of animal welfare being the primary issue and, in terms
of changing the Act, we are in agreement with regulation for that
reason. However we do currently regulate ourselves. We want to
make that point. Yes, we agree that all the organisations should
join a voluntary register as opposed to it being the gypsy who
is out there practising and who cannot join the register. If he
is practising in a safe manner, then we have no problem with him
joining a voluntary register during the transitional period but
ultimately we would much prefer to see people working who are
qualified and insured.
Q144 Mr Drew: Have you any idea at
all how many complaints there are out there? One of the issues
we pick up as MPs is that this is an area where people do feel
very strongly. Is it that there are not many complaints and we
are probably getting a disproportionate amount of interest or
are there complaints and people have nowhere to go to complain
if they feel that they are getting bad treatment or whatever?
Ms Roberts: It is difficult for
me to say because I hear complaints from my animal clients and
from vets in my practice but I have to view them as gossip because
they are outside the remit of this Association because they are
not complaining about members of the Association.
Q145 Mr Drew: What do they do about
their complaint? Can they do anything? Can they physically take
legal action if they feel so disposed?
Ms Roberts: At the moment some
people do feel that there is not enough regulation and legislation.
Q146 Mr Drew: They have to go for
an individual court case?
Ms Roberts: They do if the animal
is injured and certainly if there is financial loss involved.
Mr Hudson: I think there is a
misunderstanding amongst a lot of practitioners in the field about
what a voluntary association is and what statutory regulation
means. The associations are just collective groups of people who
set their own standards. They have no teeth in reality because
the only leverage they have is, "If you want to stay in our
association you have to do this". They cannot legally stop
somebody from doing what they do, so the recourse is not there.
An association can only go so far. I guess it would come down
to financial compensation if the animal was injured. I do not
know what else there would be.
Q147 Miss McIntosh: You are talking
about the cost of joining in each case, the cost of joining a
professional body. What would the cost of continuing, ongoing
and professional development be?
Mr Hudson: In chiropractic we
have to do 30 hours a year and 15 hours of that has to be in a
group learning environment. I am talking here as a chiropractor
who treats humans. The costs can vary because it depends on what
the seminars are that you go to. I do not think CPD is a cure
all. The good thing about our work as complementary practitioners
is it has a very long learning curve. You do not get to the top
of the learning curve. If you think you have, you are in the wrong
job. There is always another thing to learn. People who are enthusiastic
about what they do will do CPD anyway. Enforcing CPD does not
make people learn. It makes them go to seminars. I would support
that CPD ought to be mandatory. I think it is the only way of
doing it, but it is not a magic bullet to solve the problem and
keep people up to date. Costs can be significant. It just depends
on the course you go on and how you do it. It can be hundreds
of pounds.
Q148 Miss McIntosh: When you say
it should be manageable, which you did say in your written submission,
in terms of content and time spent and it should be realistic—
Mr Hudson: That is right. It has
to be sensible. You need quite a lot of latitude in the allowable
content of CPD because of the diversity of people in the field
doing what they do. You should not be too prescriptive. It has
to be manageable for people out there. In all likelihood, there
are a lot of people doing pretty good work who are not earning
an awful lot of money but who are doing no harm and are very competent.
You can make things extremely difficult for them to carry on doing
what they do if you set something that is unattainable for them.
Q149 Mr Williams: Even though, as
you said, the complaints that you come across are anecdotal rather
than substantiated, are they in general complaints that treatment
given was ineffective and therefore a waste of money or that it
was positively harming an animal and therefore dangerous, or a
bit of everything?
Ms Roberts: It is the first mainly.
I have heard complaints of the pain being increased in animals
to a level that was not necessary. It was not necessarily a healing
process; it was a worsening due to the treatment. There is a difference.
Sometimes you get a reaction after treatment anyway. Also, the
key issue is that animals may need pain killers. They may need
to have pain relief and that is something that someone unqualified
would not have been trained to recognise.
Chairman: Thank you all very much indeed.
I wish we could have longer but we do have the benefit of your
written evidence. Again, many thanks for your contribution and
thank you for joining us this afternoon.
1 Note by witness: Mr Hudson acknowledges that there
are many competent and well qualified massage therapists who will
recognise red flags and refer for further medical opinion if indicated.
Mr Hudson would also like to point out that whilst person B in
the above example would hold a chiropractic award, they would
be prohibited from in any way implying that they were a `chiropractor'
unless they were registered with the General Chiropractic Council. Back
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