Standard of Proof

RE: Standard of Proof

Anthony Todd — Sat, 08 Feb 2020 12:04:25 GMT

[quote userid="4181" url="~/001/nonclinical/f/life-in-practice-discussions/28818/standard-of-proof/219315"]I trust this will inform what needs improvement?[/quote]

Some redacted examples of communications would save many words, be so helpful and possibly confirmatory.

Also some analysis of complaints to give members an idea of the scale of this concern. Are we thinking of five cases a year or five hundred?

RE: Standard of Proof

Rob Loxley — Fri, 07 Feb 2020 19:47:00 GMT

Luckily the RCVS has commissioned and published a stakeholder survey. Choice snippets for reflection include

inappropriate tone of interactions, lack of proactive and timely communications and slow speed of resolution were raised as issues by some in relation to the disciplinary process

would continue to benefit from greater communication and engagement
further improvement could still be made in terms of antiquated processes, proactivity and communication

Considerations moving forward: Centre attention on ...
Improving communications, particularly in relation to - Those going through the disciplinary process (N.B. speed, frequency & tone)
Improving the disciplinary process experience for professionals - Keeping at the heart of all interactions: Innocent until proven guilty of gross misconduct -
Increasing speed of resolution of cases brought

Disciplinary process •Inappropriate tone of written correspondence to vets at the initial stage of an investigation •“officious and upsetting…the language used is there to appease the complainant…without recognising or taking into account the upset that that language will cause the veterinary surgeon who in fact is not being found guilty of any professional misconduct.” •Low frequency of communication during the process •Slow speed of process to resolution

I trust this will inform what needs improvement?

RE: Standard of Proof

Bob Russell — Fri, 07 Feb 2020 14:08:31 GMT

I have no doubt that they are aware and following this discussion.

I also suspect they may not be very good at determining what discussions should be in secret and what should be open.

If the impact is on the whole profession then it should be in the open. If it is regarding individuals with repercussions then it should be done quietly until such time as it has to be made public.

RE: Standard of Proof

Richard Stephenson — Thu, 06 Feb 2020 16:47:33 GMT

[quote userid="7638" url="~/001/nonclinical/f/life-in-practice-discussions/28818/standard-of-proof/219287"](And this new quote feature on the website is so brilliant and easy to use i'm going completely overboard replying to bits of your post, apologies!)[/quote]

Mark, thanks for your comments - hopefully Belgravia House has switched its listening ears on!!

RE: Standard of Proof

Mark Hedberg — Thu, 06 Feb 2020 13:23:32 GMT

[quote userid="3233" url="~/001/nonclinical/f/life-in-practice-discussions/28818/standard-of-proof/219278"]Mark - absolutely agree - you will recall that when I was a member of Council I spent many hours on this forum explaining the decisions of Council (not all of which I agreed with).[/quote]

Absolutely, and it's one of the reasons I'm a card carrying member of the Richard Stephenson Fan Club. :) I very much appreciated you taking the effort to keep people in the loop.

[quote userid="3233" url="~/001/nonclinical/f/life-in-practice-discussions/28818/standard-of-proof/219278"]This is one of those ideas - I couldn't begin to count how often it has been rejected in the past - which is what makes me so anxious that it has resurfaced in an 'advanced' state AND that it continues to be discussed in secret sessions of Council. This idea has been 'tried' convicted and consigned to exile many times before - we have now reached double jeopardy[/quote]

And this, I honestly confess I did not know! What a great point. I did not know it had been discussed previously. I did not like the idea to begin with, and i like it even less now.

[quote userid="3233" url="~/001/nonclinical/f/life-in-practice-discussions/28818/standard-of-proof/219278"]but if you are steering the oil tanker its best to avoid the ice bergs!!![/quote]

Truer words were never said! Albeit, based on a reading of the Charter and the VSA (I'm a very sad person), I am admittedly uncertain how fast the steering response is on the HMS RCVS.

(And this new quote feature on the website is so brilliant and easy to use i'm going completely overboard replying to bits of your post, apologies!)

RE: Standard of Proof

Alastair Welch — Wed, 05 Feb 2020 23:02:56 GMT

Richard,

Is that the same department which run the preliminary part of the concerns procedure (stage 1 with CEG)?

RE: Standard of Proof

Richard Stephenson — Wed, 05 Feb 2020 22:54:43 GMT

[quote userid="11493" url="~/001/nonclinical/f/life-in-practice-discussions/28818/standard-of-proof/219279"]Who are those lobbies in this case specifically? [/quote]

Francisco - that's a really good question. I doubt the idea emanates from the public as they would have to be an expert in the RCVS disciplinary process to even know that such a thing exists. In short I cannot see the idea originating from anywhere other than the legal Services dept of the RCVS itself.

RE: Standard of Proof

Francisco Gomez — Wed, 05 Feb 2020 22:24:21 GMT

[quote userid="3233" url="~/001/nonclinical/f/life-in-practice-discussions/28818/standard-of-proof/219278"]some 'ideas' have the habit of coming back with tedious monotony because powerful lobbies[/quote]

Who are those lobbies in this case specifically?

RE: Standard of Proof

Richard Stephenson — Wed, 05 Feb 2020 22:01:25 GMT

[quote userid="7638" url="~/001/nonclinical/f/life-in-practice-discussions/28818/standard-of-proof/219274"]Ideas, like veterinary surgeons, should get a fair and impartial hearing, should they not?[/quote]

Mark - absolutely agree - you will recall that when I was a member of Council I spent many hours on this forum explaining the decisions of Council (not all of which I agreed with). However some 'ideas' have the habit of coming back with tedious monotony because powerful lobbies know that if you try try and try again you can get want you want simply by persistence and with any luck because eventually it slips by with no one noticing. This is one of those ideas - I couldn't begin to count how often it has been rejected in the past - which is what makes me so anxious that it has resurfaced in an 'advanced' state AND that it continues to be discussed in secret sessions of Council. This idea has been 'tried' convicted and consigned to exile many times before - we have now reached double jeopardy

Very much appreciate that the President sometimes has to front bad policy (he / she may disagree with), but if you are steering the oil tanker its best to avoid the ice bergs!!!

RE: Standard of Proof

Mark Hedberg — Wed, 05 Feb 2020 18:25:34 GMT

[quote userid="3233" url="~/001/nonclinical/f/life-in-practice-discussions/28818/standard-of-proof/219235"]Mark - yes I am being a tad harsh there and I have no doubt about Niall's good nature! - but I think in truth that the gross UNFAIRNESS is towards hard working vets who if the RCVS proposals (and they were discussed by Council in secret session last Thursday) will have less rights than the most heinous of criminals i.e. to be granted a fair impartial hearing (that is to the standard of beyond reasonable doubt).[/quote]

As it happens, I agree with you on the burden of proof change - and I certainly understand the oil tanker metaphor - Abilene syndrome was another variation on it I heard. ;)

And I absolutely respect that criticism goes with the job, no question there. Niall as president may well not like the idea (I do not know this and have not discussed this with him) but as president it is his duty to ensure that good or bad ideas presented to Council get an impartial review.

Insinuations (on the other thread, not here) that he was somehow improper or cowardly were completely unfair.

Ideas, like veterinary surgeons, should get a fair and impartial hearing, should they not?

RE: Standard of Proof

Alastair Welch — Tue, 04 Feb 2020 17:30:03 GMT

Richard,

The CEO and the Registrar are our servants, we pay their salary, they work for us. It would be good if someone reminded them of that form time to time.

RE: Standard of Proof

Richard Stephenson — Tue, 04 Feb 2020 17:15:11 GMT

[quote userid="7638" url="~/001/nonclinical/f/life-in-practice-discussions/28818/standard-of-proof/219220"]

Richard Stephenson said:
It would not have been hard for Niall to say 'not on my watch'

That's a little unfair,

[/quote]

Mark - yes I am being a tad harsh there and I have no doubt about Niall's good nature! - but I think in truth that the gross UNFAIRNESS is towards hard working vets who if the RCVS proposals (and they were discussed by Council in secret session last Thursday) will have less rights than the most heinous of criminals i.e. to be granted a fair impartial hearing (that is to the standard of beyond reasonable doubt).

I have been involved long enough with the RCVS to know that when a subject keeps on being resurrected from the dead AND it gets as far as a concept paper for proposed 'consultation' it is very rare indeed that the oil tanker can be stopped.

Whilst I appreciate that Niall's open letter will have been written for him by (probably) the Registrar or CEO it is his name that appears under it. He is no doubt constrained to represent the views of the CEO / Registrar as the face of the College - but I do think that he cannot expect immunity from criticism - it goes with the turf of holding such high office.

The whole episode which has only come to light because of excellent investigative journalism by the Vet Record highlights the dangers of official organisations becoming secretive and introverted. Despite the fact that the whole world now knows what is afoot the RCVS has not thought to publish the Concept paper nor despite that fact the the Vet Record reports that senior Council members raised the issue of important matters being discussed in secret did they practice openness and transparency and debate the paper in the open.

One thing Niall could immediately do is place into the public domain all the documents relating to the legislative working party and the concept paper - after all we the members pay for this work to be done - why shouldn't we be allowed to see it and judge for ourselves.

RE: Standard of Proof

Richard Stephenson — Tue, 04 Feb 2020 16:59:41 GMT

[quote userid="4367" url="~/001/nonclinical/f/life-in-practice-discussions/28818/standard-of-proof/219224"] "VDS won't support you" do not help reassure the new members of the profession[/quote]

I think what the VDS has always meant by this is that they will SETTLE any claim brought against you if you do x y or z because they cannot defend certain actions in court - I'm sure that they will still 'support' their members - but sometimes support means paying up at the earliest.

The VDS newsletter had a really good section about VDS myths at some point this year that dispelled the idea that they would leave members high and dry.

RE: Standard of Proof

Mark Hedberg — Tue, 04 Feb 2020 15:34:08 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/28818/standard-of-proof/219223"]Mark Hedberg and everyone else ... just so you know, you can 'quote' from anywhere in the thread in the same reply - ie no need to reply twice, you can click any post to reply, and then quote from other posts too[/quote]

Apologies, my bad!

RE: Standard of Proof

Sarah Keir — Tue, 04 Feb 2020 12:31:40 GMT

[quote userid="4367" url="~/001/nonclinical/f/life-in-practice-discussions/28818/standard-of-proof/219224"]tour the vet schools[/quote]

I hope it has changed from when I graduated when they definitely acted as if they were the hand of God, and the VDS similar scared the shot out of us.

RE: Standard of Proof

Iain Richards — Tue, 04 Feb 2020 10:16:07 GMT

And, in absolute fariness to the college, they do tour the vet schools and they did give presentations at Lancaster explaining all this.

The mantras of. "gold standard" and "VDS won't support you" do not help reassure the new members of the profession

RE: Standard of Proof

Arlo Guthrie — Tue, 04 Feb 2020 09:58:07 GMT

Mark Hedberg and everyone else ... just so you know, you can 'quote' from anywhere in the thread in the same reply - ie no need to reply twice, you can click any post to reply, and then quote from other posts too.

RE: Standard of Proof

Mark Hedberg — Tue, 04 Feb 2020 09:07:56 GMT

[quote userid="4367" url="~/001/nonclinical/f/life-in-practice-discussions/28818/standard-of-proof/219112"] NOt least in showing young vets that you don't get struck off that easily[/quote]

I used to do this when talking to students - once they saw a few things people had gotten struck off for, everyone was much more relaxed.) It's pretty difficult to get struck off, although I completely concede that the process is far too long. Speedy justice is a human right, so I do understand why people are making efforts to get things concluded more quickly.

(Also UK tradition - Magna Carta in 1215 ("To no one will we sell, to no one will we refuse or delay, right or justice.")

RE: Standard of Proof

Mark Hedberg — Tue, 04 Feb 2020 09:00:16 GMT

[quote userid="3233" url="~/001/nonclinical/f/life-in-practice-discussions/28818/standard-of-proof/219098"]It would not have been hard for Niall to say 'not on my watch' [/quote]

That's a little unfair, Niall's term is up in July 2020, so such a statement would be meaningless, wouldn't it? The letter lays out some background on why they are looking at things, and some of the ideas. Ok, we don't like it? We're feeding back that we don't like it.

Personally, I respect that Niall didn't try to promise anything that he couldn't prove or couldn't be held to.

(Declaration - Niall is a friend.)

RE: Standard of Proof

David Mills — Mon, 03 Feb 2020 23:21:32 GMT

I've been chewing over this for a little while.

The RCVS dead hand reaches ever further, under the veil of mind matters and other nonsense.

Most new graduates are supported through the first few years by battle hardened, thicker skimmed colleagues, who are there to prevent or pick up the pieces. Experience, perspective. I suspect these people, who criticise an interfering and overbearing regulator from a position of reasonableness and some element of decency, are going to rapidly die out.

There are innovations possible. Rcvs to subsidise cctv in veterinary practice. Imagine the savings on dc cases! Christ a whole industry kneecapped. Record, visually and verbally. Yes initial capital cost. The sale or rental of the White horse of horseferry Road should cover it. Reductions in retention fees for those practices that do. Pss even.

Next, a rigorous survey of why there is a small amount of distrust of the public towards vets. I hypothesise this mainly revolves around fees and their perception. We see it daily, animals treated according to some "gold standard" taught by out of touch cpd and universities, run out of money and they come to us and have their problem solved quickly and by that outdated notion of first principles and clinical reasoning. I don't blame the individual vets, but their subjugation by corporate protocols and "ways of treating". The very same corporates disproportionately represented on council. The RCVS should take the full blame for the commidification of the profession, but it's a runaway train. Instead they dead hand the individual. Spread fear, and paper over with more fear and increase the chances of being sanctioned.

In the past, the rcvs kind of left vets alone. But there are political and financial pressures at work these days. First rate regulator of a tiny profession of 20k. Looking to the heavens rather than the coalface. A continuous and growing push towards standardisation that sees an ever more expensive and client-blaming and shaming culture. Where be the first opinion practitioners as experts at dc hearings? Never did this seem further from reality. Instead we get self aggrandised experts who haven't sullied their hands with uninsured animals for decades, opinion as fact and gospel.

The RCVS needs caution here. You increase public protection and trust by engagement of vets and buy in to an inclusive regulator who listens, and responds, and understands. Hell, even teamwork. The opacity of any management structure eventually leads to its downfall. Change or be changed.

RE: Standard of Proof

grumpyoldman — Mon, 03 Feb 2020 22:18:03 GMT

Oh dear oh dear oh dear , and i thought ADR was a bad idea and just a back door whingers charter. If people spend 5-6 years getting something plus post grad skills and qualifications chances are that most of the time they are not going to be terrible at it . If the RCVS is going to find other ways of damaging peoples lives they need to make sure they are 100% right not reduce it to a 75-80% likelihood. Particularly if there are bad decisions which cannot then be overturned without an enormous financial commitment. Graduate attrition is a problem and a growing one , talking to a friend recently who is a senior human surgeon married to an Anesthesiologist ,they knew personally of 4 veterinarians who had recently left the profession because they felt unable to live up to the demands and expectations of the public. We have CCTV in all our practices and consult rooms now and we use it in all manner of dispute situations , One thing it had highlighted is that the public lie and directly bend the truth to suit themselves as well as deliberately omit vital bits of information if it suits their purpose . its impossible to write everything down with every client. it is great proving them wrong and exposing them as liars, but that is the only satisfaction, you still often as not don't get paid as they swan off down the road to CVS or V4P .

An over fussy regulatory system does impinge itself on your life decisions in all sorts of ways. The other day I was walking my own dogs ( both on leads ) along a country lane. Suddenly without warning 2 Border terriers appeared one grabbed my jack russell by the throat ,the other bit through her body wall , my collie was unharmed . I did push them away and pulled one off her , the owner then appeared yelling and screaming at me for "kicking " his dog. His dogs eventually disengaged and returned home. I received a torrent of abuse for basically walking my dogs peacefully along a public highway and minding my own business ,before returning to the practice to repair Bettys Body wall hernia. Twenty years ago i may well have put my foot through his dog and possibly knocked several of the rude arrogant arseholes teeth out. However these days we have social media where I doubtless would have been portrayed as a serious dog beating villain and public enemy number 1 , and then of course up steps the regulator, who decides it was not suitably professional conduct and off we go. So the idiot wins and nice hard working people who play by the rules get crapped on.

I see Keele is opening another new school on our doorstep, has anyone stopped to think for a second that maybe we wouldn't need more and more new grads from more and more new schools ,if we could just keep the ones we already make from leaving the job after 5-10 years ?.

RE: Standard of Proof

Evelyn Barbour-Hill — Mon, 03 Feb 2020 17:51:02 GMT

Excellent article, Sarah.

However it's worth pointing out yet again that negligence is NOT within the jurisdiction of the RCVS, unless it's been severe and persistent, or you've lied about it or in some other manner turned it into disgraceful conduct.

Against that, I have no doubt that some at least of the RCVS establishment would like to bring negligence under RCVS jurisdiction,. The "alternative dispute resolution" initiative has certainly blurred the distinctions.

RE: Standard of Proof

Sarah Keir — Mon, 03 Feb 2020 13:35:44 GMT

For those of you following this discussion thread, I have written an article on defensive medicine - a very topical subject and I cannot see how the proposed changes will do anything but increase the fear increasing defensive medicine.

https://www.sarahthevet.com/2020/01/30/defensive-medicine-a-symptom-of-fear/

RE: Standard of Proof

Eamon McAllister — Fri, 31 Jan 2020 23:11:26 GMT

I’m of the same opinion. I think that the RCVS is a self important, self serving and unaccountable entity scooping up retention fees whilst hoarding enormous financial resources; strong enough to impose on the individual but too weak to resist the corporate lobby or Government edict. The council has always been peppered with ambitious careerists promoting agenda which erode the confidence and undermine the wellbeing of the ordinary member.

RE: Standard of Proof

Alastair Welch — Fri, 31 Jan 2020 21:28:20 GMT

Dear Niall,

Thank you for the link to your letter, although I am not going to thank you for its contents, which I find quite frankly deeply disturbing. If we ignore the padding for the time being and focus on the issue at hand what you seem to be saying is (and I struggle to believe that you have the brass neck to use this as an excuse) that whilst you recognise that veterinary surgeons have a very high level of trust amongst the public the same cannot be said of the regulator of veterinary surgeons. In order to improve the standing of the regulator with the public you are seeking to discipline more of the (aforementioned highly trusted) veterinary surgeons. Put it another way is that in order to ensure that the college continues to look good in the public's eyes you are quite happy to ruin the careers and lives of innocent veterinary surgeons. It is shameful and you should be ashamed of yourself.

I recognise that that it is important that the college needs to be trusted but perhaps before you sacrifice innocent veterinary surgeons you should look a little closer to home. A quick glance through the council papers reveals that the concerns department regularly fails to meet its own (very modest) KPI targets. In December it only managed to meet the 16 week target in 60% of cases (the target is 90%, so you are an awful long way away from getting it right). The excuse provided is the usual one that you a member of staff short. This is simply not good enough. This target is regularly missed and what it tells me is that whoever is in charge of the concerns department is not capable of doing their job and should be replaced. It is not as if the college is short of money: you are a cash rich, property rich organisation but not content with the big pile of gold that you are hoarding we are stung with a fee increase at multiple times inflation. What excuse can you possibly have for doing such a poor job?

It is impossible to go one month to the next without seeing some new initiative or the from the college aiming to improve the 'well being' of veterinary surgeons, Is this all just lip service? If you genuinely care about the health and well being of VS then you will recognise the immense harm your proposal will do and withdraw it forthwith.

What a terrible legacy of your presidency.