Vet Legislation Reform: 4: Fitness to Practise

RE: Vet Legislation Reform: 4: Fitness to Practise

Bob Russell — Fri, 23 Apr 2021 13:30:08 GMT

I may not know the majority of vets within a 50 mile radius but I am pretty sure I would know if there were any really dangerous ones!

An example of a solution looking for a problem.

RE: Vet Legislation Reform: 4: Fitness to Practise

Richard Carter — Fri, 23 Apr 2021 08:49:59 GMT

On the practicalities of revalidation- it is over 30 years since I last touched a horse and rest been mostly companion practice, first opinion in a rural part of the country- so how to I revalidate - someone dreams up some general questions or someone checks I know how to scrub my hands or some specialist asks some obscure condition to see if you can develop a plan?

RE: Vet Legislation Reform: 4: Fitness to Practise

Arlo Guthrie — Tue, 20 Apr 2021 15:25:32 GMT

Hmm - just got to the end of the consultation and found that there was a separate opportunity to address the standard of proof thing there, which means I was wrong about it being buried, just not well signposted.

Anyway, there again I found this reference to the change to Fitness to Practise being predicated on the lower, civil standard of proof. Again, the first time I have heard this argument being put forward is during the survey part of the consultation, and the fact that it was added after the initial concerns people raised makes me think it has been created to justify the change. Maybe that's unfair, but that's how it seems.

I added this to my response: Incidentally, I see here that again it is stated without qualification that: "The civil standard of proof is an integral aspect of a Fitness to Practise regime." This was not stated in the original working party report: www.rcvs.org.uk/.../, which makes it seem like this justification has been added by the College at a later date purely because its first justification (that other professions use this standard of proof) is unsound.

RE: Vet Legislation Reform: 4: Fitness to Practise

Arlo Guthrie — Tue, 20 Apr 2021 14:33:28 GMT

Update. I have replied to the consultation representing VetSurgeon.org. This was an interesting one. Contains the most controversial recommendation (standard of proof) which I found was somewhat 'buried' in the consultation.

Also, for the first time, I saw a new explanation for the need to change the standard of proof, which is that the change to fitness to practise (which seems a better system to me) is contingent upon it.

"In addition, The Fitness to Practise model would be contingent on changing the standard of proof used by the disciplinary process from the criminal to the civil standard; an explanation of the implications of this change is set out"

My question is WHY? SAYS WHO? It is not explained anywhere I can see.

Here is what I wrote WRT to section 4

Whilst 'current impairment' seems like a sensible, fairer concept, this section contains one of the most controversial proposals in this consultation, which the College is apparently trying to slip in unnoticed, as there is no opportunity to address it directly.

I refer to the proposed change to the standard of proof used in DC hearings, from criminal to civil.

To justify this recommendation, the College states:

"the Law Commission explained in its 2014 report on the regulation of health and social care professionals in England, ‘it is not acceptable that a registrant who is more likely than not to be a danger to the public should be allowed to continue practising because a panel is not certain that he or she is such a danger’."

However, does this provide a sound rationale for applying the lower standard of proof to veterinary hearings.

NO. ABSOLUTELY NOT.

Health and social care professionals treat humans directly, so if they are incompetent or, for want of a better way of putting it, a 'groper', then they represent a clear and obvious danger to the public.

Veterinary surgeons treat animals and therefore present a vanishingly small risk to members of the public.

It may also be true that veterinary surgeons are at greater risk of a vexatious complaint from a member of the public than healthcare professionals, both because there is a greater risk of a failure in communication between a medic and an intermediary (the pet owner), and a medic and their patient. In simple terms, you are more likely to remember instructions relating to your own health than your pet's. Also, some (perhaps lots of) owners blame their own failure of care on others, and the vet is an easy target.

Against this, you have to consider the impact of disciplinary hearings and sanctions (and the threat of sanctions) on veterinary surgeons. In particular, the glacial speed of disciplinary proceedings are, in my opinion, inhumane. Then there is the fact that there is rarely (if ever) exoneration for the vet at the end, but rather an instruction as to how they should have done better. So there is no closure for the vet, just a stain on their career.

Is it fair, proportionate and reasonable for human to go through the protracted mental pain and suffering of all this and of losing their career over a dog, without the very highest standard of proof?

Is a lower standard of proof needed in order to protect the public from veterinary surgeons (who do not treat members of the public)?

NO is the answer to both these two question.

And will lowering the standard of proof, along with suspensions and more intrusive regulation lead to more vets leaving the profession, or preferring to work in another country?

Recommendation 4.2: Widening the grounds for investigation

No comment

Recommendation 4.3: Introducing powers to impose interim orders

Just one question about this recommendation, which is: "Who is going to pay for it?"

Presumably all VSs and VNs will need to carry insurance to protect their salaries in the event of an interim order (because unlike in the human world, suspended vets will not keep their job on full pay).

Given vets are not generally paid excessively well, the costs of insurance will surely be passed to owners. Along with the costs of more practice regulation, etc.

And what happens in the case of a successful appeal? Will the RCVS pay compensation for lost earnings / job?

Recommendation 4.4: Introduce reviews of suspension orders

No comment

Recommendation 4.5: Introduce a wider range of sanctions

No comment

Recommendation 4.6: Introduce the power to require disclosure of information

No comment

Recommendation 4.7: Formalise role of Case Examiners and allow them to conclude cases

Comment made on Vetsurgeon was that whilst Case Examiner model might speed up the disciplinary process, it might lead to less scrutiny. What steps would be taken to make sure it doesn't, especially if Case Examiners are given the power to sanction (will they?)

RE: Vet Legislation Reform: 4: Fitness to Practise

David Shepherd — Thu, 11 Mar 2021 15:48:29 GMT

[quote userid="16318" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228897#228897"] I assume revalidation will be a multiple choice questionnaire much like the Improve / OVS training.[/quote]

I hope that shower of charlatans would have nothing to do with it. I’ve recently done their OVS training - poorly designed, not updated to take Brexit into account, ambiguous multiple choice questions, several covering material not mentioned on the course, and grossly overpriced. (I did a very similar RYA/MCA yacht master course recently and it was £40).

RE: Vet Legislation Reform: 4: Fitness to Practise

Sarah Keir — Wed, 10 Mar 2021 16:24:37 GMT

[quote userid="16318" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228897#228897"]I assume revalidation will be a multiple choice questionnaire much like the Improve / OVS training.[/quote]

THE GMC revalidation is far more involved than this - annual whole practise appraisals then a recommendation from a senior doctor based on appraisals and evidence.

RE: Vet Legislation Reform: 4: Fitness to Practise

Julie Lavis — Thu, 04 Mar 2021 07:57:01 GMT

Hi Clive, I am a locum too. I assume revalidation will be a multiple choice questionnaire much like the Improve / OVS training. The fascinating part will be what standards they will apply, it's such a can of worms.

RE: Vet Legislation Reform: 4: Fitness to Practise

Clive Ansell — Wed, 03 Mar 2021 17:07:50 GMT

[quote userid="16318" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228884#228884"]Will it be gold?[/quote]

Whatever that is?

Will it be Bull?

[quote userid="16318" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228884#228884"]which means that the RCVS will need to define the standard to which we all practice.[/quote]

How could that be policed, enforced or regulated in the case of a roving locum like me?

RE: Vet Legislation Reform: 4: Fitness to Practise

Julie Lavis — Wed, 03 Mar 2021 15:34:34 GMT

Perhaps at a bit of a tangent, but as part of fitness to practice we may be required to revalidate our qualification every 5 years - which means that the RCVS will need to define the standard to which we all practice. Will it be gold?

RE: Vet Legislation Reform: 4: Fitness to Practise

Arlo Guthrie — Mon, 01 Mar 2021 09:04:29 GMT

Incidentally, one concept I've heard floated before is 'Evidence-based government'. One thing that strikes me about the proposals in this consultation is the lack of evidence for any of the problems which the proposals seek to solve, or evidence to suggest that the proposed solutions may be effective.

Take the change in the standard of proof used in disciplinary proceedings. It is said that other regulators use civil (as a justification). How many? Which professions? What evidence for a problem in the vet profession which would suggest that a civil standard is needed? As I said earlier, my understanding is that it's because there's a fear that criminal may not stand up in court in the future, when other regulators use civil. But if that's true, who says so?

I have a feeling it's the nature of the beast that all regulators will always look for more and different ways to regulate, rather than less. Perhaps on the basis that if you are not always looking for more or better (in their view) ways to regulate, you're not doing a very good job.

Wouldn't it be a good thing if, before introducing changes to regulation, regulators had to provide evidence of the need for it, or the likelihood of it providing a benefit? Evelyn Barbour-Hill I think it was you that made the point in a different thread about what checks and balances would be in place to prevent the RCVS allowing further delegation of tasks. Perhaps a requirement for the RCVS to show evidence of need / likely benefit would give you some reassurance.

RE: Vet Legislation Reform: 4: Fitness to Practise

Arlo Guthrie — Mon, 01 Mar 2021 08:28:30 GMT

[quote userid="2131" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228826#228826"]So if it has been thought through in very great detail, why does the consultation dicument not clearly state "the RCVS will fully compensate the accused if he is subsequently acquiited" (or even "the RCVS will not pay a penny to compensate the accused if he is subsequently acquitted, cos we don't give a t*ss")[/quote]

Well, for one it may have been thought through in great detail but less well explained. I suspect that may be a common problem, actually.

RE: Vet Legislation Reform: 4: Fitness to Practise

Evelyn Barbour-Hill — Mon, 01 Mar 2021 00:17:43 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228580#228580"]

Bob Russell said:
This really has not been thought out at all.

I very much doubt that. Probably it has been thought through in very great detail, but they reached a different conclusion. I only say that because it is such a common accusation and in my experience, usually unfair!

[/quote]

So if it has been thought through in very great detail, why does the consultation dicument not clearly state "the RCVS will fully compensate the accused if he is subsequently acquiited" (or even "the RCVS will not pay a penny to compensate the accused if he is subsequently acquitted, cos we don't give a t*ss")

[quote userid="9515" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228576#228576"]

I just finished reading a book last night and one of the paragraphs got me thinking on this. 'Unnatural Causes' by Dr Richard Shepherd.

"In the Crown Court, a mother charged with manslaughter would be convicted only if her guilt is beyond reasonable doubt. The Family Court, which hears the local authority's request to remove her next child from her, must reconsider her case all over again - but apply a different level of proof. The Family Court applies the lower standard of proof - the balance of probabilities - to reach its conclusions. That can be defined as a 50.1per cent chance of guilt - a 'lower' standard of proof that the standard of proof that is beyond reasonable doubt. So, different courts can reach different conclusions based on the different levels of proof they require, and it often happens that the Crown Court does not have enough evidence to convict for the death of a child but the Family court feels there is sufficient evidence to remove the living sibling of that child. And so, truth, that elastic commodity I once thought so immutable, becomes a question not of fact but of definition.' (my bold)

[/quote]

Thank you for that, Sarah.

Let's be clear here and cut through the waffle of "standard of proof". Proof means proof. Balance of probabilities is not proof. We're talking about a change from "you have been proved guilty beyond any reasonable doubt" to "we think you're probably guilty, so you're guilty"

RE: Vet Legislation Reform: 4: Fitness to Practise

Bob Russell — Sun, 21 Feb 2021 11:59:28 GMT

In what way do we present a real and immediate risk to the public? We treat animals and whilst we may be a real and immediate risk to them it is not comparable to a Shipman injecting his patients with morphine.

Mimicking medical regulation is arrogant nonsense.

RE: Vet Legislation Reform: 4: Fitness to Practise

Minnie — Sat, 20 Feb 2021 18:09:48 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228574#228574"]Veterinary professionals do NOT represent that same danger to the public as a duff doctor, both because there are no opportunities for a 'groper'[/quote]

little danger to the public perhaps , but I wouldn't be saying this too loudly in front of some of the nurses

RE: Vet Legislation Reform: 4: Fitness to Practise

patrick murphy — Sat, 20 Feb 2021 15:44:30 GMT

they are always trying to compare us with other professions yet many of my legal and in particular medical friends have given up work primarily because of the onerous requirements for CPD and legislation. some comparison

RE: Vet Legislation Reform: 4: Fitness to Practise

Cool — Sat, 20 Feb 2021 13:57:59 GMT

While I am not anti-legislation, I am beginning to think that the RCVS wants to do this because other regulators do so. I think we need to stop for a second to consider the impact of these changes on the veterinarians the RCVS sees to regulate. Are we putting more strain on the vets who are leaving the profession in large numbers?

RE: Vet Legislation Reform: 4: Fitness to Practise

Arlo Guthrie — Fri, 19 Feb 2021 17:44:55 GMT

[quote userid="12892" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228650#228650"]I disagree that the college should have more power on us as it already has.[/quote]

Andrea Susanna Andrea, hi, a first time poster after being a member for a long time! A very warm welcome and I hope you'll come and join in more often!

[quote userid="12892" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228650#228650"] nobody should be suspended before a final decision from the dc[/quote]

So I take it you believe the risk to the public in the meantime (whilst outcome is pending) is minimal? It would be very interesting to know how many times in the past that someone has continued to practise whilst awaiting an outcome which went against them, and which you might assume they were a danger to the public in the meantime.

[quote userid="12892" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228650#228650"]I can only imagine the length of it is as it is for lack of funds or manpower and I don’t know if it would ever improve.
[/quote]

I've always been operating under the understanding that it is is because it takes a long time to investigate. Ie to get the slot in the diary for the investigator to visit all the different people, and gather all the evidence and then you've got the lawyers and the committee to meet up.

All things which presumably more manpower would solve, or reduce.

Or perhaps technology, and the ease with which one can now zoom witnesses etc, should start making things easier. Not to mention the use of case examiners, which I understand might move things along a bit faster.

[quote userid="5012" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228652#228652"]My question would be to that - who's paying?[/quote]

That is THE question, isn't it. Presumably it would have to be insurance, so your premiums will go up.

RE: Vet Legislation Reform: 4: Fitness to Practise

Clive Ansell — Fri, 19 Feb 2021 16:27:05 GMT

[quote userid="12892" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228650#228650"]especially considering the vet/vet nurse may be suspended without pay only to find out later he/she was not guilty.[/quote]

My question would be to that - who's paying?

RE: Vet Legislation Reform: 4: Fitness to Practise

Andrea Susanna — Fri, 19 Feb 2021 16:12:26 GMT

I feel that the standard of proof must be unquestionably high and nobody should be suspended before a final decision from the dc especially considering the vet/vet nurse may be suspended without pay only to find out later he/she was not guilty.

the whole process is already very thorough and especially long and stressful and anybody who had gone through it would most likely agree.
I can only imagine the length of it is as it is for lack of funds or manpower and I don’t know if it would ever improve.

I disagree that the college should have more power on us as it already has.

andrea

RE: Vet Legislation Reform: 4: Fitness to Practise

Nick Jackson — Mon, 15 Feb 2021 15:34:51 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228580#228580"]criminal in line with other regulators, it may not stand up in court in the future.[/quote]

If this is the concern, why not say it clearly? This is one of the things that has frustrated me here, so many vague statements meaning one is inclined to read between the lines.

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228580#228580"] slow progression of cases is probably the single most important thing about the system that needs to be fixed before anything else[/quote]

Couldnt agree more, I think the case examiner situation may help this. Though I do find it interesting that at the same time as wanting to be able to reassure the public further with all these other measures, the case examiner situation is essentially 2 people in a room with the power to throw out or continue any case. Unfortunately to me this will reduce scrutiny rather than improve it. I would also be interested to know if 'dispose' of cases as they put it just means there will be no case or if these case examiners will also have powers to issue sanctions.

RE: Vet Legislation Reform: 4: Fitness to Practise

Arlo Guthrie — Mon, 15 Feb 2021 15:18:46 GMT

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228575#228575"]This really has not been thought out at all.[/quote]

[quote userid="18277" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228577#228577"]So much of this review is based on mirroring various human healthcare regulators, with pretty shaky justification, taking the view of we should copy unless we really REALLY cant. Very lazy approach.[/quote]

My understanding, which may be wrong, is that unless the burden of proof is changed to criminal in line with other regulators, it may not stand up in court in the future. I am not a lawyer so I do not know whether this is a valid concern or not.

[quote userid="18277" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228577#228577"]

Arlo Guthrie said:
Introduce powers to impose interim orders (ie suspension of vet before final decision by DC)

This really worries me when coupled with the slow progression of cases

[/quote]

As an outside observer with no axe to grind, it strikes me that the slow progression of cases is probably the single most important thing about the system that needs to be fixed before anything else. I think it would be considered fairer if the system also judged 'guilty' or 'not guilty' and not the current system, which is "'not guilty', but you need to improve here and here, because actually, we think you are a little bit guilty".

RE: Vet Legislation Reform: 4: Fitness to Practise

Bob Russell — Mon, 15 Feb 2021 14:04:02 GMT

One reason why the Family court is so secretive. Privacy is one important element of course but lack of scrutiny and injustice result.

It is very difficult to prove 'balance of probabilities' because it is not a mathematical formula, more an imbalance between the powers of sometimes dodgy social workers and the weight of the state against individuals and their often inexperienced legal advisors. The scales of justice are not in balance and it is not legal to complain in public.

Reasonable doubt relies on reasonable people making the decisions! We have seen what happens when people are not reasonable (Chikosi rearing its head once more).

RE: Vet Legislation Reform: 4: Fitness to Practise

Nick Jackson — Mon, 15 Feb 2021 13:32:52 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228574#228574"]

Is it reasonable to make a comparison between the veterinary profession and health and social care professionals?

[/quote]

Nope - it really isnt, for all the points you have listed. So much of this review is based on mirroring various human healthcare regulators, with pretty shaky justification, taking the view of we should copy unless we really REALLY cant. Very lazy approach.

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228574#228574"] rather than being seen and trusted as scrupulously fair[/quote]

If only we could feel this way. Which certainly for a profession to 'self-regulate' we need to be able to have a collective conscience and trust that that is held equally against all. Rather than feeling like we are being monitored for a slip by those in ivory towers.

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29665/vet-legislation-reform-4-fitness-to-practise/228574#228574"]Introduce powers to impose interim orders (ie suspension of vet before final decision by DC)[/quote]

This really worries me when coupled with the slow progression of cases, as Bob says, in medicine in the UK since most are public employees they are likely to be on full pay where as this is vanishingly unlikely in veterinary medicine. Even those not publicly employed in healthcare in the UK are likely to have been on substantially higher take homes than we are!

RE: Vet Legislation Reform: 4: Fitness to Practise

Sarah Keir — Mon, 15 Feb 2021 13:29:04 GMT

I just finished reading a book last night and one of the paragraphs got me thinking on this. 'Unnatural Causes' by Dr Richard Shepherd.

When we are talking about safeguarding animals, animal welfare matters but we are not talking about human life protection. In the eyes of the law pets are property.

RE: Vet Legislation Reform: 4: Fitness to Practise

Bob Russell — Mon, 15 Feb 2021 12:47:27 GMT

The risks to the general public are minimal compared to a member of the medical profession. Consulting rooms tend to be rather public places as well.

Suspended human medics are likely to be on full pay whereas suspended vets are likely to be at the mercy of the benefits system! If this is introduced then some form of additional insurance would be required to cover this possibility. Will the RCVS pay compensation in cases of not guilty?

This really has not been thought out at all. Ivory towers etc.