3. MINUTES OF THE MEETING HELD ON 26 JANUARY 2010 Paper attached Including the relevant section of the draft minutes from Council in March 2010

Transcription

1 Advisory 20 April 2010 ADVISORY COMMITTEE 20 APRIL AT AM AGENDA 1. APOLOGIES FOR ABSENCE 2. DECLARATIONS OF INTEREST 3. MINUTES OF THE MEETING HELD ON 26 JANUARY 2010 Paper attached Including the relevant section of the draft minutes from Council in March MATTERS ARISING a. Kennel Club Correspondence with the Kennel Paper attached Club is attached which indicates that very few notifications are made to the Kennel Club about alterations to natural conformation. b. Health Marking a short paper is attached to Paper attached explain the end of this discussion and the RCVS approval to health marking in this case in advance of receiving the test results. c. Small Animal Surveillance Project Copies of Paper attached the project information as amended following advice from the RCVS is attached. d. Named Veterinary Surgeons revised annex The revised advice is now available on the RCVS website and this has been confirmed to the BUAV. e. Equine Pre-Purchase Examinations - a copy of the Paper attached and final advice agreed by the Chairman of the PPE Working Party and Council is attached. f. Hurlingham Polo Association copies of Paper attached recent correspondence with the HPA are attached 5. RCVS HEALTH PROTOCOL Paper attached 6. BATESON INQUIRY Paper attached 1

2 Advisory 20 April CONSENT AND COMMUNICATION Paper attached 8. THE ROLE OF VNS AND EPIDURAL INJECTIONS, THECAL SAC PUNCTURE (CSF SAMPLING AND MYELOGRAPHY) AND THE COLLECTION OF SYNOVIAL FLUID Paper attached 9. RSPCA EUTHANASIA RULES AND GUIDELINES Paper attached 10. BRITISH HORSERACING AUTHORITY RULES OF RACING - GUIDE CHANGE Paper attached 11. CRIMINAL RECORDS BUREAU ADVICE NOTE Paper attached 12. GUIDE REVIEW 2010 Paper attached MATTERS FOR REPORT 13. CERTIFICATON SUB COMMITTEE Report attached 14. RECOGNISED VETERINARY PRACTICE SUB COMMITTEE Report attached 15. PRACTICE STANDARDS GROUP Report attached 16. RIDNG ESTABLISHMENTS SUB COMMITTEE No report HOUR EMERGENCY COVER MEETING WITH SPVS VPMA Oral report 18. TRIPARTITE MEETING WITH HOME OFFICE; VETERINARY MEDICINES DIRECTORATE AND RCVS ON 1 ST APRIL Report to follow 19. ANIMALS (SCIENTIFIC PROCEDURES) DIVISION AND INSPECTORATE HAMPTON IMPLEMENTATION REVIEW Report attached 20. RESEARCH REVIEW ANIMAL ABUSE, CHILD ABUSE AND DOMESTIC VIOLENCE Report attached 21. DISCIPLINARY COMMITTEE HEARING REPORTS SINCE THE LAST MEETING MR LESLIE HIGGOTT In January, the Disciplinary Committee rejected Mr Leslie Higgott s application for restoration to the Register. Mr Higgott s name was removed from the Register in September 2008 for failing to provide adequate clinical care to a patient. At his application for restoration, Mr Higgot gave evidence that he had undergone 35 hours of CPD since his removal from the Register, but the Committee did not consider this 2

3 Advisory 20 April 2010 training was sufficient to put right the deficiencies in clinical competence identified when his name was removed from the Register. MR JAMES LOCKYEAR In February 2010, the Committee heard an Inquiry into Mr James Lockyear, who was charged with dishonestly attempting to obtain prescription only medication and for inappropriate and unprofessional behaviour. The Committee found Mr Lockyear guilty of Disgraceful Conduct in a Professional Respect in relation to the medicines charge and ordered that his name be removed from the Register. MR RUSSELL OAKES Also in February, the Committee resumed a hearing into Mr Russell Oakes. The Committee had first heard this case in April Mr Oakes was charged with fraudulent entry onto the Register of Veterinary Surgeons, and in April 2008, the committee adjourned their decision pending completion of the criminal investigation into this and other matters. Recently, Mr Oakes was convicted and sentenced to two years imprisonment and the Committee directed that his name be removed from the RCVS Register for fraudulent registration. CONFIDENTIAL AND PRIVATE ITEMS 22. There are no confidential papers ANY OTHER BUSINESS DATE OF THE NEXT MEETING SEPTEMBER 2010 AT A.M. Gordon Hockey Assistant Registrar/Head of Professional Conduct 23 March 2010 g.hockey@rcvs.org.uk Lucy Evans Professional Conduct Department 3

4 AC April 10 AI 03 MEETING Advisory Committee DATE 10 April 2010 TITLE CLASSIFICATION SUMMARY DECISIONS REQUIRED ATTACHMENTS AUTHOR Advisory Committee Minutes Unclassified Advisory Committee is asked to approve the Minutes of the Advisory Committee meeting held on 26 January 2010 (without attachments). Also attached, as Annex A, is the relevant section of the Council minutes from March 2010 To approve the minutes Annex A - relevant section of the Council minutes from March 2010 Gordon Hockey Head of Professional Conduct/Assistant Registrar 1

5 AC April 10 AI 03 2

6 AC April 10 AI 03 ADVISORY COMMITTEE MINUTES OF THE MEETING HELD AT RCVS ON 26 JANUARY 2010 AT AM Members: Dr Bob Moore - Chairman Mrs Kathy Kissick* - VN Council Dr Jerry Davies Dr Bertie Ellis Mr Chris Gray* Mr Bob Partridge Mrs Clare Tapsfield-Wright - Vice Chair Mrs Lynn Turner (paragraphs 1 55) Mr John Walmsley * Absent In attendance: Prof Sandy Trees President Miss Jane Hern Registrar Mr Gordon Hockey Assistant Registrar/Head of Professional Conduct Mr Jamie Hollis Secretary, Advisory Committee, Professional Conduct Mrs Sue Whall Solicitor APOLOGIES 1. Apologies were received from Kathy Kissick and Chris Gray; comments were received from Richard Stephenson and Chris Gray. 2. Mr Partridge raised the issue of late papers, indicating that a motion was raised at the last Council meeting requesting that there be 10 working days notice of papers, except in emergency situations. He said that none of the papers for this meeting had been provided with 10 working days to consider the papers. He said the substantial papers on the Guide review had been provided with only two working days to consider them and one document had arrived the day before. Mr Partridge indicated that he considered if Council s decision was being ignored then this was not only discourteous to Council but also a personal discourtesy to President as he had accepted the motion to Council. 3. The President indicated that he was present as an observer and was not a member of the Committee. He explained that the Council motion was to look at procedures 3

7 AC April 10 AI 03 and operating processes in order to set standards and these had not yet been agreed and Officers were to consider a paper later in the week. He agreed that normally papers were provided earlier. 4. The Chairman indicated he intended to discuss these issues in the afternoon, when considering agenda item It was proposed and seconded that discussion on the Guide should be adjourned until the afternoon of the next meeting in April. There was support from other members of the Committee. The Committee therefore agreed to set aside a whole day for the next Advisory Committee meeting. 6. Mr Partridge raised one additional item and said that while he was in favour of electronic papers they should be provided in consistent form as pdf documents. 7. The Chairman informed the Committee that Mr Jamie Hollis would be leaving the College at the end of the week and thanked him for all his work. DECLARATIONS OF INTEREST 8. Copies of completed declarations of interest forms were available. There were no updates or any additional declarations of interest. MINUTES 9. The minutes of the meeting held on 10 September 2009 were accepted. MATTERS ARISING 10. The Committee noted the following: a. Council s approval of Advice Note 29 about reporting information to the Kennel Club; Advice Note 30 in relation to whistle blowing and Advice Note 31 in relation to veterinary surgeons and pet insurance matters. b. The 2010 edition of the Guide to Professional Conduct was being sent out by the end of January. c. That 24-hour emergency cover was to be considered further by the Communications Board meeting later in the week. d. That a further paper on arbitration, mediation and conciliation was to be considered by Officers later in the week. 4

8 AC April 10 AI The Committee also raised the matter of RCVS guidance on health marking of carcasses which had been considered by the Certification Sub Committee and Advisory Committee. The Chairman indicated that although veterinary surgeons retained overall responsibility, it was not necessary for them to seal the chiller personally. 12. Members of the Committee expressed concerns and referred to the minutes of the last meeting. It was reported that, after the meeting, the Senior Vice President, who had experience of such matters, had said it was impractical for veterinary surgeons to seal the chiller personally as they were responsible for the entire abattoir. This view was supported by the Junior Vice President. 13. It was commented that obligations covering professional certification demanded that a certificate was provided after relevant results were received and the guidance being proposed was at odds with this. 14. It was stated that the RCVS must be consistent and in one situation signing a certificate before the results were received had led to removal from the register by the Disciplinary Committee. 15. The veterinary surgeon is responsible for the security of the carcasses until the results are received and is responsible for disposal of the carcasses if the results are negative. After discussion it was agreed this could be achieved by the veterinary surgeon applying the seal and recording the number and later personally breaking the seal before signing any relevant paperwork. 16. It was agreed that this pragmatic procedure was sufficiently robust to protect the public. MATTERS FOR DECISION BY COUNCIL Guide Revision It was agreed to postpone this matter until the next meeting due to late circulation of the papers to Committee members. Guide Annex Responsibilities of Named Veterinary Surgeons working under the Animals (Scientific Procedures) Act 1986 A(SP)A 18. The Committee was asked to consider certain provisions in the annex to the Guide for named veterinary surgeons (NVSs) under the Animals (Scientific Procedures) Act, 5

9 AC April 10 AI 03 following concerns expressed by the British Union for the Abolition of Vivisection and changes to the laws relating to medicines. 19. The Committee considered whether paragraph 21 of the annex and the recent footnote to clarify the NVS role, in particular that NVSs are not responsible for staffing at research establishments. The Committee took into account the views of the Home Office and solicitors instructed by the RCVS. 20. The Committee considered that staffing was a matter for the research establishments, as owners of the animals, with advice from NVSs as appropriate. The Committee considered it was the responsibility of the establishment and the certificate holder in particular, to determine general staffing levels. The terms of the footnote to paragraph 21 of the annex were endorsed. 21. It was noted that if issues arose, the NVS could discuss any concerns with the personal or project licence holder, as appropriate, and could also discuss issues with the Home Office inspector or certificate holder. 22. It was agreed that clarification of the existing guidance was useful and that it should be made clear that the RCVS does not stipulate that veterinary surgeons or staff at designated establishments must be on site at all times. It was agreed that paragraph 21 should be amended to the following: 21) The NVS should ensure there are appropriate arrangements for the provision of veterinary services, including 24-hour emergency cover (see RCVS Guide to Professional Conduct for details). The NVS may delegate these duties to suitably competent deputies. The certificate holder is responsible for providing the necessary resources for the provision of such cover and services. Staff at the designated establishment are expected to contact the NVS or delegated deputy, to seek veterinary advice or assistance, as appropriate; but the RCVS Guide does not stipulate that staff of the designated establishment must be on site 24 hours a day. 23. The Committee also agreed that the Guidance should state that it has been issued after consultation with the Home Office and the Laboratory Animals Veterinary Association and taking into account the 1986 Act and associated statutory guidance, rather than in conjunction with those organisations. The Committee considered this emphasised that the guidance was issued by the RCVS to its members and was not intended to be Home Office guidance issues in accordance with A(SP)A. 24. There was also an amendment to paragraphs 28 to 32, to update these paragraphs following changes to legislation. It was agreed these should now state the following: Prescription only medicines and controlled drugs 6

10 AC April 10 AI 03 28) The NVS is responsible for the appropriate storage, administration and safe disposal of prescription only medicines and controlled drugs obtained by him or her (including by prescription) for therapeutic purposes. 29) The Veterinary Medicines Regulations 2009 do not apply in relation to a product intended for administration in the course of a procedure licensed under the Animals (Scientific Procedure) Act 1986, except that, if the animals are to be put into the human food chain, the only products that may be administered to the animals are (a) authorised veterinary medicinal products administered in accordance with their marketing authorisation, or (b) products administered in accordance with an animal test certificate granted under paragraph 9 of Schedule 4. 30) The NVS is expected to give guidance on the use of anaesthesia and analgesia. 31) Where carcasses of treated animals may be destined for the food chain, due regard must be paid to laws relating to tissue residues. If substances with no Maximum Residue Limit (MRL) have been used, at any stage in the procedures, the animal should not be allowed to enter the food chain. 32) Council Regulation (EEC) 2377/90 provides that no animal can enter the food chain if it has been administered a substance that is not listed in Annexes I, II or III of the Regulation. (The annexes are to be replaced in due course by Table I of a new Regulation of European Parliament and of the Council.) Where a Maximum Residue Limit (MRL) has been set, any residue must be at concentrations below the MRL. 25. Copies of the current guidance are available on the RCVS website or from the Professional Conduct Department. 26. Council is asked to approve the proposed changes to the annex to the RCVS Guide to Professional Conduct. 27. It was agreed that the impact of the changes to medicines legislation could be discussed at the next tripartite meeting between the RCVS, Veterinary Medicines Directorate and the Home Office. Equine Pre Purchase Examinations (PPEs) 7

11 AC April 10 AI The Committee noted the most recent draft of the advice note on equine prepurchase examinations. The Committee asked that drafts of documents should be numbered in such a way to identify the most recent version. 29. The revised advice note also proposed changes to the advice on PPEs in the RCVS Guide to Professional Conduct. 30. The Guide currently states: 13. In the case of examination of a horse before purchase, it is advisable that the vendor's veterinary surgeon does not carry out the 'Examination on Behalf of a Purchaser' but it may be that for reasons of distance, particular expertise, or because both vendor and prospective purchaser are clients, the vendor's veterinary surgeon may be asked to carry out the examination. Any danger of conflict of interest must therefore be avoided by ensuring that: a. the purchaser is made aware that the vendor is also a client and has no objection b. the vendor agrees to permit the disclosure of anything relevant in the case history (If permission cannot be obtained then the vendor's veterinary surgeon should not act) c. it is made clear to both parties that in this instance the veterinary surgeon is acting on behalf of the purchaser and that information derived from the examination is confidential to the purchaser alone. 31. The proposed change to the advice in the RCVS Guide to Professional Conduct sought to clarify that the vendor s veterinary surgeon may properly carry out a PPE on behalf of a purchaser, provided that certain safeguards are in place. The revised text of the Guide was agreed as: Pre Purchase Examinations (PPEs) Pre-purchase examinations ( PPEs ) of horses are carried out at the request of a potential purchaser (or agent), to determine, so far as is possible by clinical examination, whether the animal is suitable for the intended use. It is preferable that the vendor's veterinary surgeon does not carry out the 'Examination on Behalf of a Purchaser' because of the conflict of interest. However, it may be that for valid reasons the vendor's veterinary surgeon is asked to carry out the examination. Valid reasons include, for example: (i) (ii) logistical problems including the possible distance and expense incurred in employing another veterinary surgeon to examine the horse; the particular expertise of the vendor s veterinary surgeon 8

12 AC April 10 AI 03 The RCVS accepts that the vendor's veterinary surgeon may carry out the examination if the following additional safeguards are taken to ensure the examination is not only fair, but perceived to be fair by the client requesting it: a. the veterinary surgeon makes the purchaser aware that the vendor is also a client and the potential purchaser has no objection. If there is an objection, the vendor's veterinary surgeon should not act. b. the vendor agrees to permit full disclosure of the clinical records. If permission cannot be obtained then the vendor's veterinary surgeon should not act. If the records reveal a factor which is likely to be prejudicial to the purchaser s intended use, the purchaser should be informed with the vendor s permission in advance of the examination. b. it is made clear to both parties that in this instance the veterinary surgeon is acting on behalf of the purchaser. 32. Council is asked to approve the proposed changes to the RCVS Guide to Professional Conduct. 33. The Committee approved the advice note, subject to minor amendments; a copy is attached as annex A. 34. The Committee was informed that Working Party would begin on amending the equine pre-purchase certificate. MATTERS FOR DECISION BY THE COMMITTEE Small Animal Disease Surveillance Project 35. This agenda item was taken first and the Committee was provided with a presentation on small animal disease surveillance by Dr Allan Redford and Ms Aine Tierny of Liverpool University. Dr Redford indicated that there were several phases. He said that phase one of the project had involved information provided by commercial laboratories and the confidentiality issues were not so significant. Project two had involved the collection of real time data from veterinary practices across the country. He said that the project was not possible without Vet Solutions, a computer software data company, which was used by approximately 20% of practices and it was from these practices that data was collected. 36. The four types of data to be collected would be basic information of the animal and the owner s postcode; the veterinary surgeon s free text field for information about 9

13 AC April 10 AI 03 the consultation; the treatment field such as the name of the antibiotic; and a protocol or questionnaire appended to the consultation, which usually involved a single question, for example, did the animal present with a particular symptom. There could be further questions. 37. Dr Redford indicated that it was probably possible to identify people from all the information that was received by Liverpool University, but that the data would be presented only in relation to the first part of the postcode from which, generally, people could not be identified. He said the project had strict rules for processing of the data and did not provide it to anybody. 38. The Committee was informed that clients were asked to consent to the provision of Data to the project on an opt-out basis. He said that the data was not Liverpool University s. He said the University s ethics committee had approved the opt-out, because the data was low risk and for a reasonable purpose: he said that even if somebody was identified from the data, the data was not sensitive data or data that was particularly personal to the individual. 39. Dr Redford said that from the veterinary surgeon s perspective, it was important to make participation as simple as possible. It was also important for clients of practices to understand exactly what was involved. Dr Redford said that posters explaining the project would be put up in waiting rooms. Also the questionnaire included an option to opt-out, in which case the project would receive no data other than that the consultation took place and somebody had opted out. He said that if a person accompanying the animal is not the owner the default is the opt-out. The Committee was informed that in the pilot, 3 premises were involved with 500 consults and only 4-5 opt-outs. Veterinary surgeons had said they found it easy to take part in the project. 40. Dr Redford said that a list of FAQs for veterinary surgeons had been developed and these explained how the opt-out works. In the information, the RCVS name was used to confirm that what was being done was professional and the aims of the project were supported by RCVS. It was asked if this support could be more explicit in the future. 41. It was asked why the full postcode was collected if it was not used. Dr Redford indicated that the full postcode could be used to get detailed spatial information about cases, for example, average distances travelled by clients and clusters of diseases; and reiterated the postcode would not be used for presentation purposes or on mapping software. 42. It was asked whether rare breeds could be identified to a particular area. Dr Redford explained that members of the public will be able to look at the information column by column and look at a map on the first part of the postcode. No further information would be available to them; the full postcode would be used internally only. He said that only the project would have information about the 10

14 AC April 10 AI 03 particular animals. He accepted that rare breed owners might be identifiable, from information perhaps known within those breed societies, but all that would be known is that they had had a consultation, not what the consultation was about. 43. It was asked whether owners were asked to read the poster, because consent to any degree depended on this. Dr Redford said this was assumed and the consulting veterinary surgeon was not required to ask the client if he or she had read the poster, but this could be considered. 44. It was asked whether the data collected related only to the project questions or general clinical data on the records. Dr Redford confirmed that certain general data was collected. 45. In answer to the question why an opt-in was not used, it was reported that practices had indicated that this would be too onerous and they would not join the scheme. It was suggested an opt-in might be used for those with rare breeds. 46. It was commented that the free text could include owners financial information and there were concerns with the collection of this information. It was asked whether they had access to all past clinical information and it was said no, but all new free text information was collected. There was discussion on the free text and Dr Redford indicated that the clinical value of the information was significant. It was questioned whether local information and styles of note-taking would make the free text information difficult to interpret. It was suggested that buzz words could be picked up on the free text so that the information could be received, Dr Redford agreed with such practices, but said that they needed to receive the information first. 47. A booklet of FAQs is made available to those who take part and was distributed to the Committee. 48. There was discussion about what clinical information was the personal data of the client and the Assistant Registrar indicated that the Data Protection Act applied to all the information on the clinical record and not just the information about the owner or client. 49. It was checked whether practices needed to register with the Information Commissioner and the Assistant Registrar indicated that individual registration was not necessary for normal practice work. It was suggested that if the RCVS approved the project this could indicate it was within normal veterinary work. 50. The Bateson Inquiry was referred to in relation to its encouragement to collect prevalence data. Dr Redford indicated that they would only deal with a proportion of veterinary surgeons but it was a start and they would only be looking for approval for the next phase of the pilot. 51. The Committee considered the issues in the absence of Dr Redford and Ms Aine Tierny. 11

15 AC April 10 AI It was suggested that the RCVS should encourage the development of the project because of the welfare benefits of the scheme, but it was complicated and the information for animal owners should be simplified; with a better protocol for asking owners if they had read the relevant information/poster. It was also suggested that the next trial period should be used to fine tune the soft ware to strip out the relevant parts of the free text, not least because the free text would include local abbreviations etc. that might be difficult to understand. 53. It was agreed that client consent could be on an opt out basis in order to attract a high rate of involvement, otherwise there would be insufficient information collected. It was agreed that the next project phase should be encouraged; there should be greater clarity of information to animal owners and with regard to the role of the RCVS; it was agreed the opt- out should continue, albeit with reservations. The Committee advised that during the next phase consideration should be given to retaining only relevant data and to the practicalities of using codes for clinical information. The possibility of identifying clients with rare breeds should also be considered. 54. It was questioned whether the prevalence data was scientifically robust and refereed and it was agreed that Dr Redford should be asked to ensure this. Reporting to the Kennel Club 55. The Committee considered the current provisions of the RCVS Guide to Professional Conduct which provide that Registration with the Kennel Club permits a veterinary surgeon who carries out surgery to alter the natural conformation of a dog, to report this to the Kennel Club. It was noted that veterinary surgeons had discretion to report in such cases, but no obligation to do so and were usually reliant on the client disclosing the Kennel Club registration. Nevertheless, the Committee sought to encourage veterinary surgeons to report to the Kennel Club to improve the health and welfare of pedigree dogs. 56. There was discussion on what amounted to alteration of the natural conformation of a dog and after discussion of a proposed list of examples, it was agreed that no list should be provided with the Advice Note, because it might be misunderstood by third parties, such as insurers, and veterinary surgeons should use discretion and common sense to identify alterations to the natural conformation, for example, cosmetic surgery. 57. The Committee also discussed the Kennel Club s desire that all caesarean sections carried out on Kennel Club registered animals should be reported to the Kennel Club. The purpose of the proposal was to ensure that the Kennel Club is in possession of sufficient information to ensure that applications for the registration of litters will not be accepted where dams have already had two litters delivered by 12

16 AC April 10 AI 03 caesarean section, save for scientifically proven welfare reasons and normally provided the application is made prior to the mating. (KC Regulation B22c(5)). 58. The Committee noted that the Kennel Club and the British Veterinary Association had been custodians of Canine Health Schemes, such as the Eye Scheme and the Hip Scheme for over 30 years. However, the Committee considered that a scheme to report all caesarean sections was unworkable until there was proper and accurate identification of dogs, by, for example, microchipping. The Committee noted that from January 2010 the Eye Scheme and the Hip Scheme require the dog to be permanently identified. The Committee indicated its support for the microchipping of dogs and routine scanning by veterinary surgeons. 59. The Committee asked that information about current reports of alterations to natural conformation is sought from the Kennel Club to ascertain if the scheme worked in practice. It was agreed the Advice Note on reporting to the Kennel Club should remain unchanged. MATTERS FOR REPORT Certification Sub Committee Report 60. The Committee noted the report. Practice Standards Group 61. The Committee noted the report and comment was made on the Practice Standards Group s endorsement of Practice Standards Scheme (PSS) inspectors also undertaking the role of Preliminary Investigation Committee (PIC) investigators. It was suggested that since there were approximately 50 PSS inspectors and 4 PIC investigators, an overlap between the two roles was not only undesirable but also unnecessary. It was suggested that the profession would be likely to prefer the two groups to be separate: the regulatory role of the RCVS and the voluntary practice standards scheme to be clearly separate. Against this, it was commented that the profession was represented within the Practice Standards Group, which had endorsed the current arrangements. Also, that there was already overlap between the voluntary scheme and the RCVS regulatory role, because any information obtained through the scheme was accessible to the Professional Conduct Department conducting investigations, and this was made clear in the Scheme rules. 62. There was further discussion on the issue and it was suggested that in the current climate of transparency, the two groups should be separated. It was suggested that this might only be a matter of perception, but was still important. 63. It was reported that the PIC investigators manual dealt with the potential overlap between PIC and PSS duties and provided that PIC investigators should not be 13

17 AC April 10 AI 03 involved in investigations where they had prior knowledge of a practice through the PSS. 64. It was noted that PIC investigators had been sought and appointed from the PSS inspectors and it was commented that ongoing involvement with the PSS allowed the PIC investigators to be best qualified and experienced for their role. It was commented that PSS inspectors came from a variety of backgrounds including, for example, the Veterinary Defence Society and there may be perception and potential conflict of interest issues with other PSS inspectors. However, it was suggested that the RCVS deal initially with the PIC and PSS overlap and the wider issue in due course. 65. The general feeling of the Committee was that the two roles should be separate and it was agreed that the issue should be referred back to the Practice Standards Group for reconsideration to ensure there was no conflict of interest within the Practice Standards Scheme. It was agreed that the Planning and Resources Committee should seek to reconcile the different views on this matter. Sir Patrick Bateson s Inquiry into Dog Breeding 66. The Committee noted the Bateson report and considered in particular the two recommendations relating to the RCVS, that: a. To support the collection of anonymised diagnosis from veterinary surgeries to provide statistically significant prevalence data b. And with the profession and BVA to lead a shift in emphasis towards preventative veterinary medicine rather than simply focus on the correction of problems after they have occurred. 67. With regard to the first recommendation, the Committee referred to the pilot studies considered earlier in the meeting noting that the proposal currently only had the potential to cover only 20% of veterinary practices in the UK. It was agreed these issues should be explored further and involve the group from the RVC referred to by Sir Patrick Bateson. Also, it was considered that permanent identification of dogs (e.g. microchipping or tattooing) to ensure accurate identification was essential to the accurate collection of information about dogs. 68. With regard to the second point, the Committee noted the recommendation and considered that good veterinary practice included preventative veterinary medicine. Riding Establishments Sub Committee 69. The Committee noted the report and that the discussion on self funding was for the Planning and Resources Committee. 14

18 AC April 10 AI 03 Consent and Communication Working Party 70. The Committee noted the report and agreed that relevant advice should be drafted for the profession. It was noted that comment had been made about the responsibilities of a referring veterinary surgeon and it was agreed that paragraph 27 of the report was ambiguous. It was agreed if an animal is transferred to another practice (e.g. a dedicated OOH provider) the transferring practice must obtain the necessary consent from the client, but once the animal has been transferred to the second practice, consent for procedures subsequently carried out was a matter for that practice. 71. With regard to whether a client had the mental capacity to give consent, it was agreed this was a sensitive and difficult issue and veterinary surgeons should not be criticised if they had made all reasonable efforts in such difficult circumstances. RCVS and VMD Meeting on 10 Nov The Committee noted the report of the meeting and it was acknowledged that medicines should be disposed of safely. It was commented that occasionally safety for the veterinary surgeon meant the disposal of controlled drugs in carcasses of animals, although this was a sensitive issue due to the associated consent issues and it was for this reason that the Veterinary Medicines Directorate had removed from its literature this method of disposal as an example. 73. The Committee reiterated that the register of veterinary practice premises should not be published. BVA:AWF Dog Breeding Stakeholders Meeting held on 12 Nov The Committee noted the report. RSPCA on 25 Nov The Committee noted the report and endorsed further liaison with the RSPCA to seek to clarify the role of veterinary surgeons involved in RSPCA investigations. The Committee indicated that while veterinary surgeons were able to give opinions, the facts on which those opinions are given should be clear, so that later in an investigation, or at court, it is clear if an opinion has been given on the basis of the veterinary surgeon s examination of the animal alone (where the veterinary surgeon is sometimes referred to as a professional witness) or where the opinion is given (usually later) on the basis of all relevant information in the case including, for example, any subsequent post-mortem reports of the accused responses to the allegations. 15

19 AC April 10 AI 03 Association of British Insurers Meeting on 1 December The Committee noted the report with approval, but suggested that at future meetings with insurers, RCVS Officers should represent the RCVS. VMD Authorisations for Manufacturers (Guidance Note 17) 77. The Committee noted revised guidance for blood banks included in the Guidance Note. BEVA Position Statement on permitted drugs in FEI competitions 78. The Committee noted the report and encouraged the RCVS to become more involved with such general welfare issues. Draft RSPCA Press Statement on punitive dog training techniques 79. The Committee noted the report and indicated its disapproval of punitive training methods. Alterations to the financial loss allowance for Non-Council members of the Advisory Committee 80. The Committee noted the information. Reports of Disciplinary Committee Hearings 81. The Committee noted the hearings CONFIDENTIAL AND PRIVATE ITEMS Recognised Veterinary Practice Sub Committee 82. The Committee noted the report. Concern was expressed about RCVS acceptance of the lay use of surface electromyography and micro-thermography involving hand held probes; taking place in conjunction with veterinary diagnosis and advice. It was noted that conventional electromyography involved the insertion of recording needles. [It has since been confirmed that for surface electromyography, the insertion of needles is not involved and, furthermore the work, when carried out by a lay person, is performed under veterinary supervision. The lay person concerned has been informed that diagnosis and advice based on any diagnosis is the practice of veterinary surgery that should be carried out by a veterinary surgeon.] 16

20 AC April 10 AI With regard to the use of a pulsed magnetic field in a trial, it was suggested that the Research Sub Committee be involved to assist with any advice that might need to be drafted. OTHER BUSINESS 84. The Committee considered whether to appoint an additional non-council member, but agreed instead to invite relevant veterinary experts to meetings as necessary and keep under review the expertise around the table. 85. There was discussion on the composition of the Guide Working Party and it was suggested that it should include two Advisory Committee or Council members who are veterinary surgeons, a non veterinary surgeon, who could be from Council or a former Lay Observer with the Preliminary Investigation Committee; a registered veterinary nurse; a veterinary surgeon who is not a Council member; with the Chairman of the Advisory Committee to attend meetings, as appropriate. There was also discussion about appointing a representative of a consumer group to the working party. It was noted that these matters were for Officers to determine in consultation with the Chairman. 86. There was discussion of the appropriate consultation with the profession and the public that should be undertaken, although there was no decision sought. DATE OF THE NEXT MEETING 87. The date and time of the next meeting is 20 th April 2010 at 10:30 a.m. The Committee was advised the meeting would last all day. 17

21 AC April 10 AI 03 18

22 AC April 10 AI 03 Annex A RCVS Council March 2010 Draft minutes of Council relating to: Advisory Committee Dr Bobby Moore, Chairman of the Advisory Committee, introduced the minutes of the Advisory Committee to Council, indicating that he sought Council approval to changes to the advice on pre-purchase examinations in the RCVS Guide to Professional Conduct and changes to the annex to the Guide giving advice to Named Veterinary Surgeons (NVSs). He said that there was a tabled paper setting out two paragraphs in the minutes that had partially corrupted when the word document had been converted to a pdf document. Dr Moore said that under matters arising, the discussions on the health marking of carcasses was still ongoing and he therefore wished to withdraw paragraph 15 of the minutes from the present discussion. He said that the matter would be reported subsequently. Under the heading Guide Review, Dr Moore indicated that discussion on the Guide review had been postponed until the Committee s next meeting in April, because the papers, which were significant, had been provided late and could not have been given proper consideration by the whole Committee in January. Referring to the proposed changes to the Guide giving advice to NVSs, Dr Moore said that the changes to paragraph 21 of the advice to NVSs were set out in paragraph 22 of the Committee minutes; and the changes to paragraphs 28 to 32 of the advice was set out in paragraph 24 of the Committee minutes. He said that since the Committee meeting there had been changes to the relevant European legislation and the changes would be made and reported. [The change was to paragraph 32 of the advice to NVSs and the Veterinary Medicines Directorate has confirmed its accuracy. The paragraph now states: European Parliament Directive 2001/82, as amended, provides that no animal may enter the food chain if it has been administered a substance that is not listed in the Table of allowed substances in Commission Regulation 37/2010 (this table replaces Annexes I, II or III of Council Regulation (EEC) 2377/90). Where a Maximum Residue Limit (MRL) has been set, any residue must be at concentrations lower than or equal to the MRL. ] Referring to the RCVS advice on pre-purchase examinations, Dr Moore said that the existing and revised guidance was set out in the minutes at paragraphs 28 to 34 and had been drafted and agreed with the British Veterinary Equine Association. He indicated that the revised guidance emphasised that a veterinary surgeon may carry out a pre-purchase examination where the vendor was a client provided that certain safeguards were met. He said that the next step for the working party dealing with this issue was to make changes to the pre-purchase examination certificate used by veterinary surgeons to record the results of the examination and advice provided to the prospective purchase, the client for the purposes of the examination. 19

23 AC April 10 AI 03 Annex A Dr Moore indicated that the Committee had discussed the overlap between the RCVS Practice Standards Scheme Inspectors and the Preliminary Investigation Committee s Investigators and concluded that the two roles ought to be separate, but had referred the matter back to the Practice Standards Group for further consideration of the issues. Dr Moore said that there would be further discussion of the Bateson Report at the Committee s next meeting; that the Committee continued to take the view that the register of veterinary practice premises held by the RCVS should not be published; and, that the Committee had made suggestions about the composition of the Guide Review Working Party. Dr Moore invited questions from Council members. Comments from Council members included: Non-veterinary surgeon Council members appointed to the Disciplinary Committee might not be in a position to be appointed to the Guide Review Working Party (paragraph 85 of the minutes. It was suggested that there might be former members of the Disciplinary Committee who could participate in the Guide review or, as the Committee had indicated, the appointment of a representative of a relevant consumer group was an option. It was suggested that the Committee s support for microchipping of dogs and routine scanning by veterinary surgeons might be at odds with other Committee views and this tension would need to be resolved (paragraph 58 of the minutes). Responding, Dr Moore indicated this was a sensitive issue, but identification of animals was important for proper reporting of information. With regard to identification, it was also said that microchip numbers are not always accurately recorded on Kennel Club (KC) documentation, due to transposition errors and, therefore, there was not always correlation between data from the KC and Petlog, also associated with the KC where the microchip information was stored. It was suggested that the Committee s insistence on microchipping of dogs before endorsing the Kennel Club s collection of information about caesarean sections was inconsistent with the support of existing schemes (also paragraph 58). Responding, Dr Moore indicated that this was a new reporting structure proposed by the Kennel Club and the RCVS would support it only after the Kennel Club had changed its agreement with its members. He said that once it was clear that its members gave their consent to the reporting of such information then the RCVS would support the scheme in the same way as the altering the conformation of a dog; and encourage veterinary surgeons to report. The response was accepted with disappointment that this was not set out in the minutes. Concern was expressed that the minutes on the Committee s brief consideration of the Bateson Report had implied that preventative veterinary medicine was a new idea (paragraph 68). It was suggested the minute could have been better phrased, with a view to promotion of the profession, to emphasis that the profession had long recognised the importance of preventative medicine and this was not something the RCVS had picked up for the first time from the report. It was asked for what purpose the RCVS had considered Liverpool University s small animal veterinary surveillance Network (SAVSNET) (paragraphs 35 54) as such issues could equally apply to similar projects in other institutions. Dr Moore indicated that discussion at Committee had involved the issue of client consent to use of the information and whether 20

24 AC April 10 AI 03 Annex A in these circumstances consent given by an opt-out system was acceptable. He said the Committee had considered that it was acceptable, at least at this initial second pilot phase. There was a proposal, which was seconded, that the revised advice on pre-purchase examinations should be revised from: the veterinary surgeon makes the purchaser aware that the vendor is also a client and the potential purchaser has no objection. If there is an objection, the vendor's veterinary surgeon should not act. to the veterinary surgeon makes the purchaser aware that the vendor is also a client and the potential purchaser has no objection. If there is an objection, the vendor's veterinary surgeon must not act. There was discussion about the proposed change and it was suggested that the wording should be mandatory, because the veterinary surgeon must not act for the potential purchaser if he or she does not want a veterinary surgeon carrying out the examination who has an ongoing professional relationship with the vendor. It was suggested that the change did not materially alter the advice and that the problem was theoretical only. It was suggested that it could not occur in practice, because if the potential purchaser objected to the vendor s veterinary surgeon carrying out the examination, he or she would not ask him to do so. It was suggested that the advice be referred back to the Working Party and Advisory Committee for consideration and on this basis the proposal was withdrawn. It was then commented that it was unfortunate the revised advice had been referred back when the majority in Council might have approved it as drafted by the Working Party. However, it was argued that if the advice had been changed and approved, it would have been done without any consideration by those who understood the issues best; although later, the President accepted the point that the advice as drafted might have been agreed by Council and suggested that the suggested revisions be dealt with electronically in order to avoid any undue delay in finalising the advice. Also, it was suggested that the revised advice on pre-purchase examinations might better describe the full disclosure of client records, rather than clinical records, because it might be argued that certain communications with clients and third parties, such as insurers and other relevant information was not part of the clinical record, but was part of the client record (paragraph 31 of the minutes). 21

25 AC April 2010 AI 04a MEETING Advisory Committee DATE 20 April 2010 TITLE CLASSIFICATION SUMMARY DECISIONS REQUIRED ATTACHMENTS AUTHOR Kennel Club Unclassified To inform the Committee of correspondence with the Kennel Club, to show that very few notifications on alteration to natural conformation are made to the Kennel Club None required None Gordon Hockey Head of Professional Conduct/Assistant Registrar 1

26 AC April 2010 AI 04a 2

27 AC April 2010 AI 04a From: Caroline Kisko [] Sent: 19 March :23 To: Lucy Evans Cc: Gordon Hockey Subject: RE: Kennel club issues Dear Lucy Many thanks for this and we are pleased to hear that the RCVS is happy to welcome our commitment to increasing the monitoring of pedigree dog health. In answer to your question regarding reporting by vets we receive hardly any nowadays reporting is almost entirely limited to owners letting us know that they have had an operation carried out. Regarding microchipping I think that the vast majority of organisations are now in favour of compulsory microchipping (including the Kennel Club) but while it remains voluntary we are not prepared to require it of all those registering dogs with us. However members of our accredited Breeder Scheme (who have volunteered to be bound by certain conditions of registration) are required to have all their breeding stock permanently identified. The permission to report caesars will automatically follow once we have agreement from all the veterinary bodies as the appropriate wording will be added to registration documents thereby ensuring that breeders agree to this as part of the registration process. We are currently still in discussion with both BVA and BSAVA on this matter. I will come back to you as soon as this is resolved and hope that we can then agree a joint approach to promote both matters to the profession. With kind regards Caroline From: Lucy Evans [mailto:] Sent: 18 March :54 To: Caroline Kisko Cc: Gordon Hockey Subject: Kennel club issues Dear Caroline, I am writing following RCVS Advisory Committee s consideration of the reporting of altertion of the natural confirmation of dogs. I have taken over this issue as Jamie Hollis has now left the College. The Advisory Committee welcomed the Kennel Club s commitment to increasing monitoring, to ensure the health and welfare of pedigree dogs. The Committee considered a definition of alteration of natural conformation, and a list of procedures that would be altering the natural conformation, to assist the profession and 3

28 AC April 2010 AI 04a public in the understanding of the term, but decided they should not be included in the advice note because of the potential for misunderstanding; particularly by pet insurers. The Committee also discussed RCVS support for the Kennel Club initiative to refuse the registration of litters where the dam has already had two litters by caesarean, and will encourage the reporting of caesareans, similar to the reporting of alterations of natural confirmation, once Kennel Club members have given their consent to the reporting of such information. The Advisory Committee has also asked me to request information from you on the numbers of reports you have received from veterinary surgeons under the existing scheme (alterations of natural conformation) and I will be grateful if you could let me know this, and any other relevant information about reports by veterinary surgeons. There was concern that without permanent identification of animals, for example, by microchipping, veterinary surgeons may find it difficult to make accurate reports. I hope that this clarifies matters, and please contact me if I can help further. Yours sincerely, Lucy Evans ******************** THE KENNEL CLUB The primary objective of the Kennel Club is to promote, in every way, the general improvement of dogs and furthermore to protect and promote the dog's varied roles in society. Visit the Kennel Club website for all your canine needs. If you register with our new website you will have access to enewsletters relating to different disciplines, be able to respond to online polls and collect articles of interest in your 'My Articles' area. Please register at today! ******************** DISCLAIMER The views or opinions in this are entirely those of the sender and do not necessarily represent the views or position of the Kennel Club; the information contained within this is confidential and may be legally or otherwise privileged. It is intended solely for the addressee. If you are not the intended recipient you are hereby notified that any disclosure, copying, distribution or taking any action in relation of this information is strictly prohibited and may be unlawful. Neither the sender nor the represented institution is liable for the correct and complete transmission of the contents of an , or for its timely receipt. If you have received this in error, please notify us as soon as possible. 4

29 AC April 2010 AI 04b MEETING Advisory Committee DATE 20 April 2010 TITLE CLASSIFICATION SUMMARY DECISIONS REQUIRED ATTACHMENTS AUTHOR Health Marking Unclassified To confirm the outcome of further discussions with the Food Standards Agency None required None Lucy Evans Professional Conduct Department Gordon Hockey Head of Professional Conduct/Assistant Registrar 1

30 AC April 2010 AI 04b 2

31 AC April 2010 AI 04b BACKGROUND 1. The issue of health marking certificates was first considered by the Certification Sub- Committee in July 2009 following correspondence from the Food Standards Agency (FSA). The issue related to planned changes to the BSE control regimes in the UK to allow a health marking to be applied at the point of carcass inspection, before the BSE test results are received, so long as carcasses remain under official control until the test results were received. 2. The Certification Sub Committee was content with the proposals from the Meet Hygiene Service (MHS), but the Advisory Committee expressed concern, noting that veterinary surgeons had been removed from the register after reckless certification before results of tests had been received. 3. The issue continued after the last Advisory Committee meeting and a number of answers were sought from the MHS; What paperwork does the vet sign? Answer: There is no additional paperwork to be signed for the MHS or FSA the veterinary signature is in effect the stamp applied to the carcass. Why does the stamp need to be applied early on in the process? Answer: Because the dye used works much better on warm surfaces and there are also HSE implications of trying to do this later in the chiller when the carcasses on [sic] usually hanging from lines or rails in the ceiling. How are the carcasses identified later down the line? Answer: Usually by a labelling system. Why is this work different to other veterinary work where a vet might be held to account for applying a veterinary signature before the results are received? Answer: Because in this context the vet still retains control over the stamped carcasses and can stop them leaving the plant and dispose of them; and the RCVS will have approved this as an exception. Is this system safe in such a tough environment as a plant where many overseas vets are known to practise? Answer: There are checks in place by involving a LV [lead veterinary surgeon] (usually a contractor) and a veterinary manager (MHS); the latter is informed of a positive even before the FBO (Food Business Operator). Also all veterinary surgeons are professionals and there are seniors to go to for advice if an OV can ensure food safety. 3

32 AC April 2010 AI 04b 4. It was agreed by the Committee that a) the Official Veterinary Surgeon (OV) must have responsibility for the security of stamped carcasses and must personally seal any chiller in which they are stored until the test result confirms the health mark; b) if the test results are negative, the chiller may be opened by a MHI (Meat Hygiene Inspector), but only under the express direction of the OV (Official Veterinarian); but, if the test results are anything other than negative (e.g. a positive, no test and inconclusive), the chiller must be opened by the OV, who must ensure disposal of the relevant carcasses. 5. The MHS gave assurances about the assistance and support given to OVs, particularly those who were young and from overseas. These were that: The OV can liaise with the LV who in turn can liaise with the VM at MHS HQ. In addition, records would be maintained at plant level to indicate that disposal of carcases and related procedures had occurred. In addition: When a positive result occurs, the following happens : The lab. rings the MHS HQ VM (Veterinary Manager) responsible for this subject area. This call is made before the plant operator (FBO/Food Business Operator) is made aware of the result. The VM contacts the LV who then contacts the OV. This occurs within the same morning. The LV will attend the plant the same day. The OV will be involved in unsealing of the chiller(s) and disposal of the carcase(s) and any other parts of the carcase(s) thereof. The test results for all carcases will be accessible by the FBO who can access lab results by logging onto the lab s website using their own log-in details. The test results for all carcases will be accessible by the OV/MHI who can access lab results by logging onto the lab s website using their own log-in details. Where the lab does not operate a system which provides access as above, it will instead the results separately to the FBO, the MHS at the premises and the MHS, HQ VM responsible for this subject area. In instances where a non-negative result i.e. one other than a positive but which is not a true negative, occurs the following happens: 4

33 AC April 2010 AI 04b The lab. will the results to the MHS HQ VM responsible for this subject area at the same time as an is sent to the plant operator/mhs staff at the premises. The test results for all carcases will be accessible by the FBO who can access lab results by logging onto the lab s website using their own log-in details. The test results for all carcases will be accessible by the OV/MHI who can access lab results by logging onto the lab s website using their own log-in details. Where the lab does not operate a system which provides access as above, it will instead the results separately to the FBO, the MHS at the premises and the MHS, HQ VM responsible for this subject area. The OV will be involved in unsealing of the chiller(s) and disposal of the carcase(s) and any other parts of the carcase(s) thereof. Monthly checks On a monthly basis, all non-negative (and positive) results are ed from the labs to MHS HQ. MHS HQ request MHS staff at each premises and the LVs responsible for those premises to confirm that the carcases and the parts of the carcase(s) thereof have been disposed of correctly. 6. The Committee also suggested that informally, the Chairman could consider whether relevant training could be given to OVs on the induction course. The Professional Conduct Department has asked the Food Standards Agency to confirm this and received the following reply: The MHS have informed LVs, OVs and SMHIs of the requirements regarding health-marking of bovine carcases awaiting BSE test results by means of a comprehensive Communications Plan. This covered: Instructions in the Manual of Official Controls (MOC) the instruction manual for all MHS field staff Operational Briefing Notes Q&As Teleconferences with LVs, OVs & SMHIs to explain the new instructions and answer any queries. The above is intended to ensure that all relevant veterinary staff and SMHIs are aware of both the related requirements and their responsibilities. 5

34 AC April 2010 AI 04c MEETING Advisory Committee DATE 20 April 2010 TITLE CLASSIFICATION SUMMARY DECISIONS REQUIRED ATTACHMENTS AUTHOR Small Animal Veterinary Surveillance Network (SAVSNET) Unclassified To note the amended project information following RCVS advice None Required SAVSNET Project Information Gordon Hockey Professional Conduct Department

35 AC April 2010 AI 04c 2

36 AC April 2010 AI 04c Small Animal Veterinary Surveillance Network -Frequently Asked Questions for Vets- Thank you for taking the time to read this document and for thinking about taking part in SAVSNET. Without participating vets, SAVNSET would not be possible. Contents 1. What is SAVSNET? What is scanning surveillance? Why am I being asked to take part? What information is SAVSNET hoping to collect? How will the data be presented? Can veterinarians be identified from the information collected? Will the information collected by SAVSNET be kept safe? As a participating practice, what data can I get access to? Who will have access to the entire database? How does a client opt out? How can individual premises opt out? Who is funding SAVSNET? Who manages SAVSNET? Has data collection been reviewed and approved? How will SAVSNET improve the health of the UK small animal population? What are our responsibilities if our practice takes part in SAVSNET? Can I find out more information on the diseases affecting our small animals? What do I do if I want to complain? Where can I go to get further information? WHAT IS SAVSNET? SAVSNET is the Small Animal Veterinary Surveillance Network. It is a national programme of scanning disease surveillance, set up at the University of Liverpool s vet school in conjunction with one of the UK s leading practice management 3

37 AC April 2010 AI 04c software providers Veterinary Solutions Ltd. SAVSNET is designed to help veterinary professionals by establishing what diseases are being faced by our small animal populations across the UK. The aim is to ultimately help you, and your clients, by providing up-to-date disease information for your area. 2. WHAT IS SCANNING SURVEILLANCE? Scanning disease surveillance is a means to characterise the current disease situation within a given population, identify changes in prevalence of both known and emerging diseases, and determine when measures such as targeted investigation are necessary. It relies on capturing clinically relevant data that is already recorded for other purposes. DEFRA and the AHT have national programmes of scanning surveillance in place in the UK for farmed livestock and birds 1 and the equine population 2 respectively. In contrast, little data is available for the small animal population. 3. WHY AM I BEING ASKED TO TAKE PART? You have been asked because your premises uses practice management software produced by Veterinary Solutions Ltd. This software is being used in ~700 premises across the UK. Ultimately the aim is to recruit as many premises as possible to give as true a representation of the current national prevalence of disease across the whole country. Currently we are recruiting 30 premises to take place in a three month pilot. 4. WHAT INFORMATION IS SAVSNET HOPING TO COLLECT? SAVSNET will collect two types of information from each consultation with an MRCVS. It is broken down as follows: Type 1: Routine information. This is the information that you already have recorded on the patient s record and so requires no additional effort on your behalf. An example is given below: Treatment Date Surgery I.D. Geographic s Species Breed DOB Animal Sex Gender Description Treatment Dispensed: 1 x Frontline Combo Spot-on Cat 3's Instructions: use as directed 12-Jan CH64 9DX Feline Domestic Short Hair 01- Apr-96 Female Neutered Dispensed: 1 x Milbemax Cat 2-8kg Apart from the postcode, we are not collecting any of the owner s personal information. The postcode is required to allow us to search for hotspots (local

38 AC April 2010 AI 04c epidemics) of disease. The full postcode will never be made publically available (see FAQ 5 which illustrates how the data will be presented). We are also aware that certain breeds are considered rare and owners of such breeds may be concerned about being identified. In order to address this we will make all reasonable efforts when producing reports, to lower the reporting resolution for rare breeds or animals, such that they cannot be identified. 5

39 AC April 2010 AI 04c Type 2: Simple, but specific additional question(s) At the end of each consultation, you will be prompted to answer a single question relating to the reason for the animal s visit. For example, did this animal present with diarrhoea? There will be three options for you to choose from namely No, Owner opt out, and Yes, and each will lead to a different outcome: No: that concludes the string of questions. SAVSNET will collect the Type 1 Routine information as indicated above and will also register that the animals has not presented with the syndrome in question. Owner opt out: No further questions will be asked. SAVSNET will not receive any information from this particular consultation except an empty line to indicate a consultation took place (for further information on opting-out, please see FAQ 10). Yes: In order to clarify the case, a few simple, targeted questions will follow to give further information on the consultation. An example of the type and format of the questions is shown below. These will be changed on a regular basis, so that we can collect information on a wide range of diseases. 5. HOW WILL THE DATA BE PRESENTED? Reports of the summarised data will be produced at regular intervals and will be freely available on the SAVSNET website ( Data will be 6

40 AC April 2010 AI 04c anonymised, to protect both practice and client identity. Full post code data will not be published. Instead, geographical distributions of disease will be presented at the level of the first half of the postcode. These. The following charts are examples of how the results should look. Please note, they were created using made-up information. 7

41 AC April 2010 AI 04c c/o Corda Technology Maps like these will show the relative amount of disease being seen by vets in different parts of the country (based on made up data). Proportion of animals neutered nationally by species Age (years) 8

42 AC April 2010 AI 04c Data collected by SAVSNET is only for use in the SAVSNET project and will not be used for any other reasons other than for the purpose of establishing a network for disease surveillance. As SAVSNET develops we hope to introduce an interactive functionality which would allow you, as a contributing veterinary practice, to access your own disease statistics, and see how they compare to other national averages. This would allow you to see how your practice varies from national statistics in a way not previously possible. 6. CAN VETERINARIANS BE IDENTIFIED FROM THE INFORMATION COLLECTED? We will not collect information on any individual vet or veterinary premises, only information relating to the animals seen with consenting owners. The information gathered from the practices will be anonymous; therefore names of the consulting veterinarians, practice names and practice addresses will not be collected. However, Vet solutions will organise the secure transfer of information from your local server. This will be tagged with a code such that Vet solutions can identify its origin. This tagging system is for quality control, so that in cases where files become corrupted, we will be able to arrange the resending of information with Vet solutions. This tagging system will not allow us to identify the origin of the contributing premises. We are collecting the owner s postcode for each consenting consultation. This data will be used to identify local prevalence of disease, and will only be published at the level of the first half of the postcode. In some instances, if a veterinary practice is the only one in a given postcode area (denoted by the first half of the postcode), then it may be possible through published maps, to determine that a particular practice was contributing data to SAVSNET. If you would like us to, we will supply a link to your practice homepage directly from the SAVSNET website. 7. WILL THE INFORMATION COLLECTED BY SAVSNET BE KEPT SAFE? Yes. SAVSNET has a responsibility under the Data Protection Act 1998 to protect you and your clients personal information. The information collected will be stored on a secure data server. Unless encrypted, data in its raw form will not be permitted to be saved by SAVNET onto other devices including laptops, portable external hard-drives or USB pens in order to maintain a high level of security to protect this data. 9

43 AC April 2010 AI 04c The data collected will not contain any personal information of the owner or the vet; the only potential identifier collected will be the owner s postcode to enable spatial analysis to be performed. However, to maintain owner and pet anonymity, this will only be presented spatially at the resolution identifying the post-town, such as CH64 or L AS A PARTICIPATING PRACTICE, WHAT DATA CAN I GET ACCESS TO? Like members of the public, you will be able to access simple charts like the ones above. You will not be able to see the entire database in its raw (unedited) format. This is to protect your clients privacy because it will contain their full postcode. As SAVSNET develops we hope to introduce an interactive functionality which would allow you, as a contributing veterinary practice, to access your own disease statistics, and see how they compare to other national averages. This would allow you to see how your practice varies from national statistics in a way not previously possible. 9. WHO WILL HAVE ACCESS TO THE ENTIRE DATABASE? Access to the entire SAVSNET database containing all the raw data will be protected by an encrypted log-in to keep it safe. Access is granted only to the SAVSNET team and approved scientists. Approved scientists will need to be from a recognised research centre, have a proven record, have developed an important question that has clear benefit to our pet animals welfare and they will need to be formally approved by the SAVSNET management team (see FAQ 12). Results of these analyses would be expected to be available publically in scientific journals and / or the SAVSNET website and /or presented at scientific meetings. 10. HOW DOES A CLIENT OPT OUT? Taking part in the SAVSNET project is completely optional for clients. Their consent is being obtained by opt out. i.e. their data will be included unless they stipulate they want to be excluded. This process has been approved by an independent ethical review panel. Clients are made aware of the project by a poster which must be clearly displayed in all waiting areas. If they don t want to take part, they just need to inform their vet in the consultation. At the end of each consultation, their vet will be provided with an opportunity to indicate that this client has decided to opt out. Clearly, vets should also exclude data from consultations by selecting the opt-out option where, in the opinion of the attending MRCVS, the owner/person accompanying the animal is either, not in a position to understand the information, or under 18 years of age, or did not have an opportunity to read the poster e.g. home visit. 10

44 AC April 2010 AI 04c If an owner opts out, we will receive no information other than the fact that a consultation has taken place in the form of a blank entry on our records. Clients will still be able to look at the SAVSNET website and benefit from the information collected, even if they personally did not participate in the study. 11. HOW CAN INDIVIDUAL PREMISES OPT OUT? Participation in SAVSNET at the premises level is on an all vets-in/all vets-out basis. If at any time, you as a premises decide you do not want to take part in SAVSNET, then just let us know. This should be done through the vet in your premises that is the SAVSNET contact. If you do not know who this is, then feel free to contact us and we can let you know (see FAQ 18). Withdrawing from the project is very easy the agreement can be terminated immediately. We would however, appreciate feedback on the reasoning behind such a decision so that we can aim to improve the SAVSNET product over time. If you do decide to withdraw from the project, you will still be able to access publically available data through the SAVSNET website. 12. WHO IS FUNDING SAVSNET? SAVSNET is currently supported by a partnership with Vet solutions; and a consortium of pharmaceutical companies and Defra (Department for the Environment, Food and Rural Affairs) and the University of Liverpool. The Animal Health Trust and the British Small Animal Veterinary Association are also actively involved. Thus no one body has ownership of the SAVNET data collected. The pharmaceutical companies involved are as follows (in alphabetical order): Dechra, Fort Dodge, Intervet-Schering Plough, Merial, Novartis, Pfizer and Virbac. 13. WHO MANAGES SAVSNET? The day-to-day running of SAVSNET is managed by researchers at the University of Liverpool. Annually, there is a formal management meeting to which all the SAVSNET funders and supporters s, including the Animal Health Trust, the British Small Animal Veterinary Association, Defra, are invited. Everyone attending the management meeting has voting rights. 14. HAS DATA COLLECTION BEEN REVIEWED AND APPROVED? SAVSNET has ethical approval from the University of Liverpool and the RCVS to collect and analyse data so that veterinary surgeons caring for animals can be provided with statistically significant information about diagnosis and disease surveillance. An opt-out consent is accepted by the RCVS in this particular scheme for these purposes in the public interest and animal welfare interests. 15. HOW WILL SAVSNET IMPROVE THE HEALTH OF THE UK SMALL ANIMAL POPULATION? The reports produced by SAVSNET on its website, will build up into a comprehensive picture of the types and amount of diseases experienced by our 11

45 AC April 2010 AI 04c pets. This will help us understand why animals get disease. For example is it their age, or their breed, or perhaps where they live, that might contribute to why they are affected. This knowledge and understanding generated by SAVSNET on diseases in UK small animals will help pet owners understand the importance of a range of diseases identify new diseases early in their development inform vets of the diseases that are of particular concern in their local area facilitate the training of new vets and postgraduate vets 16. WHAT ARE OUR RESPONSIBILITIES IF OUR PRACTICE TAKES PART IN SAVSNET? We have designed and piloted SAVSNET with vets in practice to ensure it has minimal impact on your already busy working lives. However, each practice that does take part has to agree to certain responsibilities listed below. These are a requirement of SAVSNETs ethical approval. Ensure a SAVSNET information poster is always displayed in the waiting area of your practice in a position where it can easily be seen and read by your clients, and to always make available to your clients the SAVSNET booklet. When writing to your clients, consideration should be given to informing clients of the practice participation in SAVSNET. You agree that all information provided to the University for SAVSNET should only be provided by a Member of the Royal College of Veterinary Surgeon s ( MRCVS ). To ensure that Data will not be provided to the University in the following circumstances: o The owner informs you that they wish to opt-out and not participate in the study; o The person accompanying the animal is not the owner of the pet; o The owner/person accompanying the animal is, IN THE OPINION OF THE ATTENDING MRCVS, EITHER not in a position to understand the information, OR under 18 years of age, OR did not have an opportunity to read the poster e.g. home visit. SAVSNET would value feedback from both you and your clients. We may occasionally contact you during pilot, and once it has been completed, to find out how you are finding it. Clearly, if you have any comments or suggestions, then please feel free to contact us directly (see FAQ 19). 17. CAN I FIND OUT MORE INFORMATION ON THE DISEASES AFFECTING OUR SMALL ANIMALS? Yes, SAVSNET has launched its website which is available at Here you can find some information on a selection of different diseases with reviews of the diseases currently of interest. This is designed to be a continually 12

46 AC April 2010 AI 04c expanding section which develops over time. If you would like to contribute to this website, please us at As the study progresses, the website will carry detailed reports based on the findings of the study. This will combine historical and current data, thus enabling us to look at disease trends over time and also geographic (spatial) patterns of disease. Such information will be useful for both veterinary professionals and the animal-owning public, and will lead to a better understanding of the diseases of small animals, which ultimately will help improve diagnosis, treatment, prevention, and control. 18. WHAT DO I DO IF I WANT TO COMPLAIN? If you (or your clients) are unhappy with any aspect of the SAVSNET initiative, please feel free to let us know by ing us at savsnet@liv.ac.uk or phoning stating the nature of the complaint and we will get back to you and try to help. If you remain unhappy or have a complaint which you feel you cannot come to us with then you should contact the Research Governance Officer on (ethics@liv.ac.uk), stating the name of the project (SAVSNET), and the details of the complaint or concerns you wish to make. 19. WHERE CAN I GO TO GET FURTHER INFORMATION? Further information can be found on the SAVSNET website Should you require further details, you can call us on and leaving your name and contact details, along with a description of your query. Alternatively, you can us at savsnet@liv.ac.uk or write to SAVSNET, University of Liverpool, Leahurst campus, Chester High Road, Neston, CH64 7TE Thank you for taking the time to read this information sheet. Best wishes Miss Áine Tierney SAVSNET co-ordinator Dr Alan Radford Senior Lecturer in Infectious Diseases. 13

47 AC April 2010 AI 04c Small Animal Veterinary Surveillance Network -Frequently Asked Questions (FAQs) for Animal Owners- Thank you for taking the time to read this information sheet. Contents 1. What is SAVSNET? 2. Why am I being asked to take part? 3. What information is SAVSNET collecting? 4. Why is it important for me to take part? 5. How will SAVSNET improve the health of the UK small animal population? 6. Can I be identified from the information collected? 7. Is my information safe? 8. What do I have to do if I want to take part? 9. What if I do not wish to take part? 10. How will the information be presented? 11. Will I have access to any of the information? 12. Who will have access to the information in the basic form in which it is collected? 13. Who is funding SAVSNET? 14. Who manages SAVSNET? 15. Has data collection been approved? 16. What do I do if I want to complain? 17. Where can I go to get further information? 14

48 AC April 2010 AI 04c 1. WHAT IS SAVSNET? SAVSNET stands for the Small Animal Veterinary Surveillance Network. This is a national project designed to find out the most common reasons for our pets to visit the vet. We want to see if there is anything which makes some animals more likely to get ill. The aim is to use this information to try and improve the health of our pets. SAVSNET has been set up by the University of Liverpool as a nonprofit making organisation. We are working with small animal vets like yours from around the country. SAVSNET is seeking your permission to collect information from your vet about why you have come to see them today. If you would prefer not to take part, all you need do is tell your vet. You will not be personally identifiable from the information we collect. 2. WHY AM I BEING ASKED TO TAKE PART? We are currently collecting information from up to 30 vets from across the UK. Your vet has kindly agreed to take part in SAVSNET because they have recognised the benefit this type of information could provide to their patients. Taking part in SAVSNET is quick and easy, it will not require any of your time. 3. WHAT INFORMATION IS SAVSNET COLLECTING? The information we want to collect is about the pets who visit their vet. We are NOT collecting the owner s name, house number, street name, or town, the name or address of their vet, or any financial information about how owners pay for their pet s consultation. We aim to collect two types of information about pets each time they are brought to the vet. 15

49 AC April 2010 AI 04c Type 1: Routine information: This is information that is already recorded by your vet and includes: The pet s species (e.g. cat, dog, rabbit) The pet s breed The pet s date/year of birth The pet s sex (male/female) The nature of the condition. Any treatments given to the vet The postcode - this information will help us to see where in the country there is more disease appearing. An example of what this information may look like is shown below. Treatment Date Surgery I.D. Postcode Species Breed Date/Year of birth Sex Gender Description Treatment 12 Jan CH64 9DX Feline Domestic Short Hair 01 Apr 1996 Female Neutered Dispensed: 1 x Frontline Combo Spoton Dispensed: 1 x Milbemax Cat 2-8kg Type 2: Simple, but specific additional question(s): At the end of each consultation, your vet will be asked a few questions about the reason for the visit. Your vet will not need to ask their owners anything extra, the questions will be very simple. 16

50 AC April 2010 AI 04c An example of the type of questions we will ask is below. Was this pet brought to the vets today because it has diarrhoea? Option 1. Yes Option 2. No Option 3. Owner wishes not to take part in this study Option 1: If the answer is yes, this will be followed by a few simple questions to tell us how severe the diarrhoea may be. For example, how long has the diarrhoea been going on for? or is there any blood in the diarrhoea? These are simple questions which will give meaningful results, but that we will not unnecessarily delay owners or vets. Option 2: If the answer is no, then your vet will not be asked any further questions. Option 3: Alternatively, if an owner does not wish not to take part, this is the point at which your vet can exclude all related information from the project (see also FAQ 5). These questions will be changed on a regular basis, so that we can collect information on a wide range of diseases; for example coughing, lameness, etc. 4. WHY IS IT IMPORTANT FOR ME TO TAKE PART? Without the support of pet owners like you, this project would not be possible. There is little information available on how common diseases are for our pet animals. The information will only be used to improve the health of our pets. 5. HOW WILL SAVSNET IMPROVE THE HEALTH OF THE UK SMALL ANIMAL POPULATION? The information collected by SAVSNET will start to build a picture of the type of diseases experienced by our pets and where they appear in the country. This may also help us understand why some animals get ill and others do not. For example, is it their age, or their breed, or perhaps where in the country they live that might contribute to why a 17

51 AC April 2010 AI 04c particular pet gets poorly? The aim is to create a computer based system for the collection of anonymised diagnosis from veterinary premises in order to provide statistically significant prevalence data (as per the Bateson report). This information will help to: produce reports which will help pet owners understand, prevent and control a range of diseases. identify new diseases early in their development. inform vets of the diseases that are of particular concern in their local area. 6. CAN I BE IDENTIFIED FROM THE INFORMATION COLLECTED? Information collected will be anonymous. For example we will not collect your name, your pets name or your postal address. However, we are collecting the full postcode of where the animal lives. This will only be available to the SAVSNET team and approved scientists (see FAQ 12). It is important for us to collect this information to allow us to identify the location of where disease is occurring in the UK. For the vast majority of households, the postcode is not unique, so individual houses cannot be identified. However, we are aware that in rare cases, there may be some postcodes with only one residence. In order to further protect your privacy, SAVSNET will only indicate where diseases are occurring at the level of the first half of the postcode. For example, our postcode is CH64 7TE, but we will only present it as being in the CH64 area. In this way, it will never be possible for others to identify who has contributed to SAVSNET. We are also aware that certain breeds are considered rare and owners of such breeds may be concerned about being identified. In order to address this we will make all reasonable efforts when producing reports, to lower the reporting resolution for rare breeds or animals, such that they cannot be identified. 7. IS MY INFORMATION SAFE? Yes. SAVSNET has a responsibility under the Data Protection Act 1998 to protect your personal information and that of your pet. All 18

52 AC April 2010 AI 04c information collected by us will be stored on a secure passwordprotected data storage system. In addition, in order to maintain a high level of security, information in its raw form will not be allowed to be saved by SAVNET onto other devices including laptop computers, portable external hard-drives or USB pens, unless it is encrypted. 8. WHAT DO I HAVE TO DO IF I WANT TO TAKE PART? You do not need to do anything to take part in SAVSNET. Your vet should not need to ask you for any additional information. All the information we collect will be recorded at the end of your consultation, so it should not unnecessarily delay your stay. 9. WHAT IF I DO NOT WISH TO TAKE PART? Taking part in SAVSNET is entirely up to you. If for whatever reason you decide you do not wish to take part, all you need to do is tell your vet during each consultation that you do not want to be part of the SAVSNET project. We call this opting-out. They will then exclude all of your data relating to the current consultation from the project (please read FAQ 3 for further information). Please also be assured that you will not be treated any differently by us or your vet if you decide to opt out. 10. HOW WILL THE INFORMATION BE PRESENTED? Data collected as part of the SAVSNET project will be anonymised, analysed and summarised on the SAVSNET web site. We also hope to put reports in this folder that you are reading now, and to publish them in the veterinary press. The following charts are examples of how the results should look in the future. Please note, they were created using made-up information. Maps like these will show the relative amount of disease being seen by vets in different parts of the country. 19

53 AC April 2010 AI 04c Proportion of animals neutered nationally by species Age (years) 11. WILL I HAVE ACCESS TO ANY OF THE INFORMATION? Nobody outside of the SAVSNET team and approved scientists (see FAQ 12) will be allowed to see the information in the raw form we collect it. However, anonymised, summaries of the information we collect will be available on the SAVSNET website and will include charts and graphs that allow you to see what is happening in the UK. See FAQ 10 for examples of what this will look like. These will be available for everyone to see and we hope they will build up into a comprehensive picture of small animal diseases across the UK. To reiterate, owners or animals will never be identifiable. 20

54 AC April 2010 AI 04c 12. WHO WILL HAVE ACCESS TO THE INFORMATION IN THE BASIC FORM IN WHICH IT IS COLLECTED? The information SAVSNET collects in its most basic, un-summarised form, contains postcodes. Access to information in this form is strictly limited to SAVSNET-approved scientists, and protected by a secure log-in to keep it completely safe. Approval of scientists is overseen by the SAVSNET management committee (see FAQ 14). Approved scientists will need to be from a recognised research centre, have a proven record, and have proposed an important question, the answer to which would have clear benefit to our pet animals and / or their owners. 13. WHO IS FUNDING SAVSNET? SAVSNET is currently supported by several organisations. This way, no individual company owns the information SAVSNET collects. These organisations and companies are as follows (in alphabetical order): BSAVA (British Small Animal Veterinary Association; exists to promote high scientific and educational standards of small animal medicine and surgery) Dechra Defra (Department for the Environment, Food and Rural Affairs; representing the UK Government) Fort Dodge Intervet-Schering Plough Merial Novartis Pfizer University of Liverpool Virbac We are extremely grateful to these organisations and companies for supporting this project as without them, SAVSNET would not be possible. 14. WHO MANAGES SAVSNET? The day-to-day running of SAVSNET is managed by researchers at the University of Liverpool. 21

55 AC April 2010 AI 04c Once a year, there is a formal management meeting attended by all the SAVSNET supporters listed in FAQ 13. In addition, there are representatives of other organisations including the Animal Health Trust; they run a similar surveillance project for horses, and Vet solutions; the computer company who have developed the computer system (software) that your vet practice uses. 15. HAS DATA COLLECTION BEEN APPROVED? Yes. SAVSNET has ethical approval from the University of Liverpool and the Royal College of Veterinary Surgeons, professional regulators of UK vets. This allows us to collect and analyse data so that veterinary surgeons caring for animals can be provided with important information about diagnosis and disease surveillance. 16. WHAT DO I DO IF I WANT TO COMPLAIN? If you are unhappy with any aspect of this project, please feel free to let us know by contacting us on and we will try to help. If you remain unhappy, or have a complaint which you feel you cannot come to us with, then you should contact the Research Governance Officer on (ethics@liv.ac.uk), stating the name of the project (SAVSNET), and the details of the complaint or concerns you wish to make. 17. WHERE CAN I GO TO GET FURTHER INFORMATION? Further information can be found on the SAVSNET website Should you wish to have a personal copy of this brochure then you can: download it from our website. Please see us at savsnet@liv.ac.uk Write to us at SAVSNET, University of Liverpool, Leahurst campus, Chester High Road, Neston, S. Wirral, CH64 7TE 22

56 AC April 2010 AI 04c Call us on Tel: [24-hour recorded message] and request the practice information sheet for owners. Please leave your name and address and we will send you a copy in the post. Thank you for taking the time to read this information sheet. Best wishes Miss Áine Tierney SAVSNET co-ordinator Dr Alan Radford Senior Lecturer in Infectious Diseases. 23

57 AC April 2010 AI 04c Dr Alan Radford SAVSNET University of Liverpool, Leahurst Campus Chester High Road, Neston, S. Wirral CH64 7TE T: E: 15 March 2010 Dear Sir / Madam The Small Animal Veterinary Surveillance Network ( SAVSNET ) agreement with participating veterinary practices The University of Liverpool (the University ) invites you to participate in SAVSNET, a national programme of surveillance on the UK s small animal population co-ordinated by the University through its School of Veterinary Sciences. SAVSNET is supported by a number of public and commercial entities including the British Small Animal Veterinary Association ( BSAVA ) and the Department of Environment, Food and Rural Affairs ( Defra ). The aim of SAVSNET is to capture information on incidence of disease in the UK small animal population. The University has entered into an agreement with Vet Solutions Ltd., the company which currently provides you with veterinary practice management software, to assist it in obtaining existing data from your practice management system and also new data by including brief survey questions onto your current practice management system. Should you choose to engage in SAVSNET, it is a condition of the ethical approval received by the University that you prominently display a poster in your surgery and make available a booklet in your reception area explaining SAVSNET to your clients (the poster and the booklet will be provided). This is part of the procedure for obtaining consent from your clients, allowing them to opt-out from the project if they so choose. Further details of how the University proposes you should alert and inform your clients about SAVSNET are provided in the Frequently Asked Questions ( FAQ s ) attached. If you wish to engage in SAVSNET please confirm your acceptance of the standard terms and conditions attached by signing in the box below and returning one copy of this letter to us at the address above. Yours sincerely Dr Alan Radford BSc, BVSc, PhD, MRCVS SAVSNET Principle Investigator 24

58 AC April 2010 AI 04c Accepted by (signature):...(mrcvs) Name (capitals):... Role in practice:... contact:...phone contact:... Date:... For and on behalf of: If you would like to be acknowledged as contributing to SAVSNET, please indicate this by ticking this box. We can then put the name of your premises on the SAVSNET web site and can also provide a link to your own homepage, if you wish. Indicate the name of your premise, as you would like it to appear on the SAVSNET website.... If you would like us to link to your premises homepage, please write it clearly below.... SAVSNET standard terms and conditions 1. Use of the Data 1.1. Data means information currently existing on your practice management system in relation to species, breed, age, sex, free-text clinical information, treatment given and the postcode of where the animal is kept. Data shall also mean the responses you provide to all survey questions. Data will only be received from consenting clients (see FAQ 11) Data provided by you will be used by the University for the purpose of SAVSNET (see FAQ 7 & 10). Any other use of the Data by the University is strictly prohibited and shall constitute a fundamental breach of the Agreement. 2. Confidential Information 2.2 Confidential Information means other information provided by you and shall include, without limitation, financial information, all information relating to the 25

59 AC April 2010 AI 04c name and address of your practice, the names of your employees, and any information which may directly identify your clients. 2.3 All your Confidential Information shall be maintained in confidence by the University and shall not be disclosed or displayed by the University. 2.4 The University shall apply no lesser security and degree of care to your Confidential Information than that which you apply to your own confidential or proprietary information. 2.5 The obligations of confidentiality under this clause shall not apply where the Confidential Information is disclosed with your prior written consent, or it is required by law or by court or administrative order to be disclosed. 3. Your Responsibilities 3.1 Ensure the SAVSNET poster is always displayed in the waiting area of your practice in a position where it can easily be seen and read by your clients. 3.2 Ensure the small SAVSNET display stand is positioned near to / at reception. 3.3 To make available to your clients the SAVSNET FAQ booklet. 3.4 You agree that all information provided to the University for SAVSNET should only be provided by a Member of the Royal College of Veterinary Surgeon s ( MRCVS ). 3.5 To ensure that Data will not be provided to the University in the following circumstances: The owner informs you that they wish to opt-out and not participate in the study; The person accompanying the animal is not the owner of the pet; The owner/person accompanying the animal is, IN THE OPINION OF THE ATTENDING MRCVS, EITHER not in a position to understand the information, OR under 18 years of age, OR did not have an opportunity to read the poster e.g. home visit. 4. Publication 4.1. The University will analyse the Data and publish its analysis and interpretation in an anonymised form on the SAVSNET website (see FAQ 7 / Your practice name is deemed confidential (section 2.2). However if you wish, the University can acknowledge you as a contributor to SAVSNET, if you give us express permission to do so, by ticking the appropriate box at the end of this agreement. 5. Indemnity and Liability 26

60 AC April 2010 AI 04c 5.1. There is no representation, condition or warranty given by you that the Data, Confidential Information or any information you provide will be fit for the particular purpose required by the University In the event that a claim is brought against you from your involvement in SAVSNET, the University shall hold you harmless and will indemnify you from any such claims as well as for any losses you may suffer (save for indirect, economic and/or consequential losses) which result from the University s possession, use or storage of the Data except to the extent that any such liability is caused or contributed to by your negligence (see FAQ 4). 6. General 6.1. The University has been granted ethical approval for SAVSNET by its Research Ethics Sub-Committee for Physical Interventions (Ref. RETH000263) (FAQ 4) The Royal College of Veterinary Surgeons, professional regulators of UK veterinary surgeons, support the aims of this project and the collection of data for the purposes of this project This Agreement shall come into force on the date of the last signature to the Agreement, and shall expire 3 years from that date Either party may terminate this Agreement immediately upon written notice for convenience If any provision of this Agreement is declared void or unenforceable by a Court of competent jurisdiction it shall be severed from the Agreement and the remaining provisions shall continue to the fullest extent permitted by law Nothing in this Agreement creates a relationship of employment, agency or partnership between the parties You shall not be entitled to assign this Agreement to any other party without the express written permission of the University This Agreement contains the entire agreement between the parties. No amendments or modifications to this agreement will be of any effect unless in writing signed by authorised representatives of both parties This Agreement is subject to the laws of England and both parties hereby submit to the exclusive jurisdiction of the English Courts. 27

61 AC April 2010 AI 04c YOUR CHANCE TO HELP PETS IN THE UK Why do we need your help? Working with vets like yours, we are trying to find out more about the diseases that make our pet animals unwell. This project is being run at the Veterinary School at the University of Liverpool, and is called SAVSNET, the Small Animal Veterinary Surveillance Network. How will you and your pet benefit? We hope to find out the most common reasons for owners to bring their pet to the vet. In addition, we will find out more about why animals become unwell, for example are they more likely to get a particular disease because of their age, their breed, or their location. This will build up over time into a detailed picture of the health of our UK pets, and ultimately may allow vets and other professionals to reduce the amount of disease seen in our pets. SAVSNET also has a website where you can find out more information on some of these important diseases. What information do we wish to collect about your pet? We are collecting the following types of information from each consultation: 1. Species (for example dog, cat, rabbit) 2. Breed, age, sex 3. Why your pet was brought to the vet 4. A few simple questions (for example did this pet have diarrhoea? ) 5. Treatment given 6. Postcode You cannot be identified from the information you provide. We will not record your name, or the rest of your address, or any payment details. How will information be collected? If you are happy to take part in SAVSNET, you don t need to do anything. We will collect the above information from your vet at the end of your pet s consultation. What if I don t want to take part? You do not have to take part in SAVSNET. If you would prefer not to, all you have to do is tell your vet before or during your pets consultation. What will SAVSNET do with your information? All the information we collect will be stored securely at the University of Liverpool. We will use this anonymous information to write summary reports which will be published on the SAVSNET website. You and your pet will never be individually or publically identifiable from these reports. Protecting your Privacy SAVSNET has a responsibility under the Data Protection Act 1998 to protect your personal information; your pet s and vet s information will be protected in the same way. SAVSNET has ethical approval from the University of Liverpool and the Royal College of Veterinary Surgeons. Further information is available in a pet owners handbook at your practice reception or... Web: 28

62 AC April 2010 AI 04c Tel: (24 hour messaging service to request further information) By writing to us at SAVSNET, University of Liverpool, Leahurst campus, Chester High Road, Neston, S. Wirral, CH64 7TE You can also contact the University of Liverpool Research Governance Officer if you have any further concerns (for details see SAVSNET handbook at your practice reception). Working together towards a brighter future for the UK s small animals 29

63 Please look at the SAVSNET poster BEFORE you see your vet Working together towards a brighter future for the UK s small animals 30

64 AC April 2010 AI 04e MEETING Advisory Committee DATE 20 April 2010 TITLE CLASSIFICATION SUMMARY DECISIONS REQUIRED ATTACHMENTS AUTHOR Equine Pre Purchase Examinations Unclassified To note the and final advice agreed by the Chairman of the PPE Working Party and Council None required None Gordon Hockey Head of Professional Conduct/Assistant Registrar 1

65 AC April 2010 AI 04e 2

66 AC April 2010 AI 04e From: Gordon Hockey Sent: 19 March :54 To: Cc: Laura McClintock; Jane Hern Subject: Equine PPE and draft RCVS health protocol Dear All Thank you for your comments and discussion, from which I have concluded that the suggested amendment, with a tweak, has been agreed, as attached. The amended sentences are: If there is an objection, the vendor's veterinary surgeon must not act. the vendor agrees to permit disclosure of relevant clinical/case records. Helpfully, the amended version is definitely clearly than the earlier version. Thank you for your help with this. Yours sincerely Gordon Gordon Hockey Head of Professional Conduct / Assistant Registrar Royal College of Veterinary Surgeons Horseferry Road London SW1P 2AF Tel Direct Line Original Message----- From: 3

67 AC April 2010 AI 04e Sent: 19 March :18 To: Gordon Hockey Subject: Re: Equine PPE I too am content with what is coming out of this rapid-fire 'debate', with Lynne's/ Chris T's amendments. As to 'must' this comes not from pedantry 'an over-educated person parading his knowledge' (Chambers) but from spending many hours in camera at DC hearings wrestling with the precise wording of charges and of the Guide to Professional Conduct, in respect of a VS whose professional career hangs in the balance, where, like my colleagues in the room, I must make a personal decision on the future of that career. Such a question may indeed never come up, but when it does... I honestly thought the point would cause little debate and be sorted on the day, but, clearly, it fell over some sensitivities. I regret that, but not the end result. CJC Gordon Hockey wrote: > > Dear All > > Arising from Council, attached is the revised guidance on Pre Purchase > Examinations. > > I am hopeful that everybody will feel they were right. The suggested > changes have been agreed by the Working Party and the Working Party > considered the changes were unnecessary. > > I have explained the confusion at Council and that because of this > (and because the points were minor), it was decided this advice could > be agreed by . > > Nevertheless, I have been asked to say that there were feelings of > exasperation and disappointment from the Working Party with what they > considered to be pedantic points. > > I am assuming the changes will be agreed but it would be helpful to > have two or three Council members confirm agreement. I hope that by > early next week the revised advice will be on the RCVS website. > > Thanks > > Gordon > > Gordon Hockey > > 4

68 AC April 2010 AI 04e ADVICE NOTE 26 EQUINE PRE-PURCHASE EXAMINATIONS 1. Pre-purchase examinations ( PPEs ) of horses are carried out at the request of a potential purchaser (or agent), to determine, so far as is possible by clinical examination, whether the animal is suitable for the intended use. Examining a horse on behalf of a vendor is not generally advisable except in the special circumstances of an auction of horses. 2. The PPE is an assessment of the horse based on a recognised examination, carried out in two or five stages (although all stages may not be completed if the horse fails the examination at one of the early stages). Generally, the examination is carried out by a veterinary surgeon with no prior knowledge of the horse s clinical condition and who has no access to the horse s clinical records. Some information about a horse may be made available by the vendor. The PPE provides an assessment of the horse at the time of examination, to assist the decision to purchase, or not, and is an indication, not a guarantee, of a horse s suitability for intended use. 3. Generally a person intending to purchase a horse will seek a PPE by a veterinary surgeon and for this purpose becomes that veterinary surgeon s client. 4. Detailed guidance is available for veterinary surgeons on how to carry out prepurchase examinations from the British Equine Veterinary Association (BEVA). The purpose of this advice note is to set out the advice from the RCVS within the RCVS Guide to Professional Conduct and explore the professional conduct issues that may arise from PPEs, particularly those arising where both the vendor and the person seeking the PPE are clients of the same veterinary surgeon or practice. 5. The RCVS Guide to Professional Conduct provides guidance at Part 2, E, Examinations on behalf of a third party which states; Pre Purchase Examinations (PPEs) Pre-purchase examinations ( PPEs ) of horses are carried out at the request of a potential purchaser (or agent), to determine, so far as is possible by clinical examination, whether the animal is suitable for the intended use. It is preferable that the vendor's veterinary surgeon does not carry out the 'Examination on 5

69 AC April 2010 AI 04e Behalf of a Purchaser' because of the conflict of interest. However, it may be that for valid reasons the vendor's veterinary surgeon is asked to carry out the examination. Valid reasons include, for example: (i) (ii) logistical problems including the possible distance and expense incurred in employing another veterinary surgeon to examine the horse; the particular expertise of the vendor s veterinary surgeon The RCVS accepts that the vendor's veterinary surgeon may carry out the examination if the following additional safeguards are taken to ensure the examination is not only fair, but perceived to be fair by the client requesting it: a. the veterinary surgeon makes the purchaser aware that the vendor is also a client and the potential purchaser has no objection. If there is an objection, the vendor's veterinary surgeon must not act. b. the vendor agrees to permit disclosure of relevant clinical/case records. If permission cannot be obtained then the vendor's veterinary surgeon should not act. If the records reveal a factor which is likely to be prejudicial to the purchaser s intended use, the purchaser should be informed with the vendor s permission in advance of the examination. c. it is made clear to both parties that in this instance the veterinary surgeon is acting on behalf of the purchaser. 6. While having regard to the usual constraints of client confidentiality, there may be occasions when the examining veterinary surgeon considers it appropriate, for reasons of animal welfare (including good husbandry) or public interest, to advise the vendor of relevant findings. In these circumstances, common sense and courtesy should prevail. 7. All clinical findings and clinical information within the documents which are relied upon, and that are relevant to the opinion must be stated in the certificate. 8. It is advisable to retain copies of all relevant information considered as part of the examination and which are referred to in the certificate. Conclusion 9. Ideally, veterinary surgeons should not carry out PPEs where the vendor is a client. However, if, for practical or other reasons, veterinary surgeons do, they must follow the safeguards outlined in the RCVS Guide to Professional Conduct, to ensure the examination is not only fair, but perceived to be fair by the client requesting the PPE. Professional Conduct Department revised February

70 AC April 10 AI 05 MEETING Advisory Committee DATE 20 April 2010 TITLE Draft Health Protocol Procedures where a veterinary surgeon s fitness to practise may be impaired by reasons of adverse physical or mental health CLASSIFICATION SUMMARY Unclassified Following written advice from Counsel, the Preliminary Investigation Committee has proposed an RCVS health protocol. The Advisory Committee is asked to consider proposed additions to the RCVS Guide to Professional Conduct, which underpin the proposed health protocol. DECISIONS REQUIRED To decide on additions to the RCVS Guide to Professional Conduct (and Veterinary Nurses Guide) to underpin the proposed RCVS Health Protocol; recommending to Council as appropriate. ATTACHMENTS AUTHOR Annex A Counsel s advice Annex B - Draft RCVS Health Protocol Gordon Hockey Head of Professional Conduct/Assistant Registrar Laura McClintock Professional Conduct Department l.mcclintock@rcvs.org.uk 1

71 AC April 10 AI 05 2

72 AC April 10 AI 05 Background Jurisdiction 1. The Veterinary Surgeons Act 1966 gives the RCVS jurisdiction to deal with (i) criminal convictions that may render registrants unfit to practise and (ii) disgraceful conduct in a professional respect that may affect registration, but no express statutory provision to manage the impairment of fitness to practise due to ill health. 2. It has not been clear whether the RCVS has jurisdiction to act against veterinary surgeons where there have been no complaints, even those whose ill health may be adversely affecting their fitness to practise or where they may be a risk to the public or animals. For example, where a medical practitioner considers a veterinary surgeon is unfit to practise due to ill health, but no animals have been harmed. Procedures 3. Currently, the Preliminary Investigation Committee (PIC) manages informally health related complaints and convictions, with monitoring of the veterinary surgeon. In appropriate circumstances complaints are referred to the Disciplinary Committee (DC) where they are managed with undertakings by the veterinary surgeon, postponement of Judgment and, if appropriate, suspension or removal from the register. The aim in every case has been to help the veterinary surgeons get treatment for any ill health while protecting animals and the public interest. 4. It has been understood that where the is a realistic prospect of proving charges against a veterinary surgeon (in accordance with the RCVS jurisdiction), the complaint or conviction must be referred to the DC; subject always to the public interest. This has meant that the PIC has considered it is obliged to refer complaints to the DC where the evidence exists, but has been reluctant to do so in certain cases, for example, where an owner practitioner has misused his or her own controlled drugs, but has subsequently overcome the addiction. Proposed Health Protocol 5. With little prospect of a new Veterinary Surgeons Act to provide an express health jurisdiction, the PIC and its Lay Observers were keen to clarify and formalise the current jurisdiction and procedures, so that veterinary surgeons affected by ill health 3

73 AC April 10 AI 05 who are a risk to animals and the public (including themselves) can be managed compassionately and consistently, under the current Act. 6. The proposed health protocol has been developed with advice from the Veterinary Surgeons Health Support Programme and those involved in the General Medical Council s health procedures, which has an express health jurisdiction. 7. In May 2009, the PIC agreed in principle that it should manage health complaints and concerns, with referral to DC as a last resort if necessary to protect animals or the public interest. The DC has endorsed this proposed health protocol. 8. The PIC agreed that legal advice should be sought on what was in effect a widening of perceived RCVS jurisdiction, under the current Act. Legal Advice on the proposed RCVS health protocol 9. Legal advice was sought on the extent to which the PIC could manage such complaints, whether complaints had to be referred to the DC, the extent to which undertakings to PIC by a veterinary surgeon could be enforced, and whether the RCVS had jurisdiction over veterinary surgeons with ill health who were a risk to animal health and the public interest, including those who may be a suicide risk. 10. On the 25 August 2009, the College s external solicitors instructed Mr Nicholas Peacock of Hailsham Chambers to advise in relation to the proposed health protocol. 11. On 12 October 2009, College s representatives including the RCVS President, external solicitors, together with Mr Rory O Connor of the Veterinary Surgeons Health Support Programme (VSHSP) met with Counsel. There was discussion of a draft protocol for managing veterinary surgeons with health issues that may adversely affect their fitness to practise and discussion of the RCVS health jurisdiction. 12. Counsel advised that regulators can lead from the front and that their purpose is to set standards for their members and advise the profession as a whole; and that in principle he had no difficulty with the proposals set out by the College, although the protocol and guidance should be clarified. In addition, Counsel considered that any 4

74 AC April 10 AI 05 health protocol should be underpinned by appropriate additions to the RCVS Guide to Professional Conduct to explain and clarify the new requirements to the profession. A copy of Counsel s advice is attached as annex A and it provides that ill health which poses a risk to animals and the public interest can amount to disgraceful conduct in a professional respect where a veterinary surgeon does not take steps to address the issue. 13. The PIC considered Counsel s advice at its annual training in December 2009, together with representatives from the VSHSP, the Veterinary Benevolent Fund and the Veterinary Defence Society. 14. Subsequently, the PIC, in consultation with DC, has approved an RCVS health protocol RCVS Health Protocol- Procedures where a veterinary surgeon s fitness to practise may be impaired by reasons of adverse physical or mental health which is attached at annex B. RCVS Statutory Jurisdiction 15. The RCVS has a statutory duty to regulate the profession to the full extent of its jurisdiction, express and implied. The legal advice went further than anticipated and has indicated that not only is a health protocol a reasonable proposal, but also that the RCVS has full jurisdiction in such matters if there is relevant advice in the RCVS Guide to Professional Conduct so that veterinary surgeons are aware of what is expected. 16. The recent review of the RCVS complaints and disciplinary procedures has endorsed the RCVS review of its jurisdiction. The review was agreed as part of Council s discussion in March 2008 to ensure the robustness of the RCVS complaints and disciplinary procedures. Additions to the RCVS Guide to Professional Conduct to support the Health Protocol 17. The additions to the RCVS Guide to Professional Conduct are necessary to confirm the full extent of the RCVS jurisdiction and set out exactly what might amount to disgraceful professional conduct in this context. 5

75 AC April 10 AI The proposed changes or additions to the RCVS Guide to Professional Conduct (Part 1, E, Your responsibilities to the general public) to support the RCVS health protocol are the following: RCVS Health Protocol The RCVS health protocol aims to protect animals and the public interest by helping veterinary surgeons whose fitness to practise is impaired by reason of adverse physical or mental health, for example, addiction to alcohol or drugs. Veterinary surgeons whose fitness to practise is impaired are invited to agree undertakings which may, for example, limit the extent to which they may practise. The protocol provides that those whose cases are not referred to the Disciplinary Committee for a formal hearing are monitored by the RCVS through both a workplace and medical supervisor. The RCVS Health Protocol is an annex to the Guide. Underpinning the protocol are the following provisions of the Guide: (i) The RCVS has jurisdiction to take action with regard to a veterinary surgeon's health where: (a) the veterinary surgeon's physical or mental health has resulted in or was a contributing cause of or is directly relevant to a criminal conviction; and that conviction potentially renders him/her unfit to practise; and (b) the veterinary surgeon's physical or mental health has resulted in or was a contributing cause of or is directly relevant to conduct on his/her part; and that conduct is potentially such as to amount to disgraceful conduct in a professional respect. (ii) Disgraceful conduct in a professional respect may include: a) A refusal (or failure) by a registrant to take (or demonstrate) reasonable steps to address adverse physical or mental health where there is harm to (or a risk of harm to) animal health or welfare and/or public health and/or the public interest; 6

76 AC April 10 AI 05 b) A refusal to accede to a regulator s reasonable request (for example to undergo medical examination and/or to accept undertakings); c) Breach of undertakings. (iii) (iv) (v) All those who meet practising veterinary surgeons, including members of staff, veterinary surgeons, veterinary nurses, clients, and healthcare professionals, for example, medical practitioners, who have concerns that a veterinary surgeon's physical or mental health may make him/her unfit to practise are asked to report those concerns to the RCVS as soon as is reasonably practicable. Veterinary surgeons who are concerned that a colleague s physical or mental health may make him/her unfit to practise must take steps to ensure that animals are not put at risk and that the public (including the colleague) is protected. The full health protocol is attached as an annex to the Guide. 19. Paragraph 18 (i) sets out the express statutory jurisdiction of the RCVS. 20. Paragraph 18 (ii) a), b) and c) are recommended by Counsel in paragraph 27 of his advice, to clarify that these are included within the interpretation of disgraceful conduct in a professional respect: the express statutory jurisdiction. Counsel advises that such conduct - practising where adverse physical or mental health presents a risk to animals and the public interest, without taking steps to address this is capable of amounting to disgraceful conduct in a professional respect. Paragraphs b) and c) provide that a veterinary surgeon must assist the RCVS in its investigation of such concerns by agreeing to reasonable requests by the RCVS in relation to medical examinations and tests and undertakings. It is unlikely that a case will be referred to DC on the basis of a failure to agree to undertakings, because the substantive case can be referred to DC. A case referred to DC because of a veterinary surgeon s failure to agree to reasonable requests for a medical examination is perhaps more likely, because without this cooperation, the RCVS will be unable to investigate complaints and concerns relating to veterinary surgeons ill health. However, veterinary surgeons need only comply with reasonable requests. 7

77 AC April 10 AI Paragraph 18 (iii) encourages veterinary surgeons and others to report concerns so that the RCVS can seek to ensure that such persons are safe to practise. There is no obligation to report created by paragraph (iii). 22. Paragraph 18 (iv) places an obligation on veterinary surgeons. If veterinary surgeons are concerned that a colleague s ill health makes him, or her, a risk to animals or the public interest, they must act to protect animals and the public interest. 23. Paragraph 18 (v) provides that the full health protocol (agreed by PIC) is attached as an annex to the Guide. Veterinary Nurses 24. Currently, the Veterinary Nurses Guide to Professional Conduct mirrors the veterinary surgeons RCVS Guide to Professional Conduct; and the proposed regulation of veterinary nurses is similar to that of veterinary surgeons and is based on disgraceful conduct in a professional respect. Therefore, it is suggested that the proposed additions to the RCVS Guide to Professional Conduct should be added to the Veterinary Nurses Guide as well, with suitably amended wording. 25. The regulation of registered veterinary nurses will lead to application of these provisions. Issues 26. Counsel was asked why the RCVS could implement a health jurisdiction now (one not expressed in legislation), when approximately 10 years ago the General Medical Council considered that legislation was necessary to achieve virtually the same thing. Counsel indicated that the understanding of disgraceful conduct in a professional respect or serious professional conduct has moved on in the intervening years and what was then impossible, or more difficult, is reasonable now based on the modern understanding of a regulator s function. 8

78 AC April 10 AI The proposed additions to the Guide (paragraph 18 (ii) a), b) and c)) do not make physical or mental ill health disgraceful conduct in a professional respect, but where a veterinary surgeon s physical or mental ill health is causing harm or a risk of harm to animals or the public interest (is adversely affecting his or her fitness to practise) and he or she does not take reasonable steps to address this, that is, or can be, disgraceful conduct in a professional respect. 28. The proposed addition to the Guide in paragraph 18 (ii) a) articulates what has been recognised in decisions of the PIC and DC, that the risk of harm to animals and the public (in the future) is a factor to be considered when deciding if a veterinary surgeon s (sometimes ongoing) actions could be, or are, disgraceful and a failure to reduce the risk of future problems can make disgraceful something that otherwise is not sufficiently serious on its own to be disgraceful. 29. The proposed additions to the Guide in paragraph 18 (ii) b) require a veterinary surgeon to cooperate with an RCVS investigation reasonable requests of the RCVS to enable the RCVS to investigate properly, relevant concerns and complaints. The provision is similar to the need for a car driver to give a sample when stopped for driving and there is a reasonable suspicion that she or he has been drinking. Failure to provide a sample is an offence in itself. It is similar, also, to the requirement that veterinary surgeons must provide the RCVS with relevant client/clinical/case records even if these tend to incriminate them. Professionals have a responsibility to cooperate with their regulator. The requirement to agree to reasonable undertakings is relevant where otherwise animals and the public would be put at risk. 30. The proposed addition to the Guide in paragraph 18 (ii) c) confirms the enforcement of undertakings given by veterinary surgeons to PIC (and DC). Undertakings enable a veterinary surgeon to continue in practice rather than be referred to the Disciplinary Committee, because animals and the public interest are protected by the undertakings. Undertakings may, for example, limit the extent of a veterinary surgeon s practice. It is envisaged that some undertakings will be a matter for negotiation with the RCVS, particularly as a veterinary surgeon s health improves. 31. The proposed addition to the Guide in paragraph 18 (iii) is a request to all who come across practising veterinary surgeons to provide the RCVS with relevant information to enable it to act as regulator. This is not drafted as an obligation or 9

79 AC April 10 AI 05 requirement, rather as encouragement for those concerned to act as responsible citizens. 32. The proposed addition to the Guide in paragraph 18 (iv) gives a responsibility or obligation to veterinary surgeons to act in the interests of animals and the public. Initially, this could be to contact the VSHSP or the senior veterinary surgeon in the practice at which the veterinary surgeon works; where the veterinary surgeon s ill health may adversely affect his or her fitness to practise. If a veterinary surgeon is unwilling to address his or her ill health and to seek help, and animals and the public interest are put at risk, there is an obligation to report him or her to the RCVS. The profession may find this acceptable where there is a health protocol and the RCVS is not seeking to refer such veterinary surgeons to the DC. 33. Although the proposed health protocol seeks to avoid referring a veterinary surgeon with health problems to the DC, this may be unavoidable in some cases, if referral is necessary to protect animals and the public interest. For example, if convictions against a veterinary surgeon are such that removal from the register is necessary to protect the reputation of the profession, or if a veterinary surgeon repeatedly breaks undertakings given to the PIC, such that there is no confidence future undertakings will be honoured. Recommendations 34. The Advisory Committee is asked to approve/ recommend to Council the proposed additions to the RCVS Guide to Professional Conduct set out in paragraph 18, including the addition of the health protocol (as approved by PIC) as an annex to the Guide. 35. The Committee is also asked to confirm the addition of the Guide provisions, suitably amended, to the Veterinary Nurses Guide. 10

80 AC April 10 AI 05 Annex A THE ROYAL COLLEGE OF VETERINARY SURGEONS A PROPOSED HEALTH PROTOCOL ADVICE 1. I am asked to advise the Royal College of Veterinary Surgeons (RCVS) in respect of a proposed health protocol. 2. For the purposes of this Advice I have considered in particular: (i) a paper dated 23 rd June 2009 from Gordon Hockey, Assistant Registrar and Head of Professional Conduct; (ii) slides from a paper by David Bartram, Mental Health Group, Division of Clinical Neurosciences, University of Southampton School of Medicine; (iii) minutes of the meeting of the Preliminary Investigation Committee (PIC) on 20 th May In particular I am asked to consider five specific issues, which I summarise as: 3.1 The extent to which the RCVS may implement a health protocol consistent with its statutory powers and duties; 3.2 The extent to which the PIC may manage health related cases; 11

81 AC April 10 AI 05 Annex A 3.3 The extent to which the PIC may seek and enforce undertakings from a veterinary surgeon; 3.4 Whether free-standing health conditions may be considered by the PIC as part of a health protocol; 3.5 Whether amendments are required to the RCVS s documentation and guidance. 4. I gave preliminary consideration to these issues and took instructions in conference on 12 th October Jurisdiction and legal framework 5. The role of the RCVS is (quoting from its website): To safeguard the health and welfare of animals committed to veterinary care through the regulation of the educational, ethical and clinical standards of the veterinary profession, thereby protecting the interests of those dependent on animals and assuring public health. To act as an impartial source of informed opinion on animal health and welfare issues and their interaction with human health. 12

82 AC April 10 AI 05 Annex A 6. The Royal College of Veterinary Surgeons was established by Royal Charter in 1844 (revised by Supplemental Royal Charter in 1967). The RCVS currently comprises three principal organisations and functions. First, in its capacity as a Royal College, according to the RCVS website, it: exercise[es] powers to award Fellowships, Diplomas and Certificates to veterinary surgeons, veterinary nurses and others, and to act as an informed and impartial source of opinion on veterinary matters. 7. Second, the RCVS also acts as a statutory regulator of the veterinary profession. Its powers to that end are contained in the Veterinary Surgeons Act 1966, as amended (the 1966 Act). In its regulatory capacity, again quoting from the RCVS website, it exercises its statutory duties: to maintain a register of veterinary surgeons eligible to practise in the UK; to regulate veterinary education and to regulate professional conduct. 8. Third, the RCVS comprises the RCVS Trust, a charity established: to promote and advance the study and practice of the art and science of veterinary surgery and medicine - by providing the RCVS Library and Information Service and a range of grants largely to support educational and research activities. 9. This advice principally concerns the regulatory function of the RCVS, in particular the regulation of professional conduct. 13

83 AC April 10 AI 05 Annex A 10. The statutory jurisdiction to regulate professional conduct is set out at sections 15 and 16 of the 1966 Act: Disciplinary and similar proceedings 15 Preliminary investigation and disciplinary committees (1) The Council shall set up a committee of the Council to be known as the preliminary investigation committee which shall be charged with the duty of conducting a preliminary investigation into every disciplinary case (that is to say, a case in which it is alleged that a person is liable to have his name removed from the register or to have his registration suspended under the next following section) and of deciding whether the case should be referred to the disciplinary committee. (2) There shall continue to be a committee of the Council known as the disciplinary committee charged with the duty of considering and determining (a) any disciplinary case referred to them by the preliminary investigation committee; and (b) any other case of which the disciplinary committee has cognizance under section 18 of this Act. (3) The provisions of Part I of Schedule 2 to this Act shall have effect with respect to the constitution of the preliminary investigation and disciplinary committees, and the provisions of Part II of that Schedule shall have effect with respect to the procedure of the disciplinary committee. 16 Removal of names from register for crime or disgraceful conduct (1) If (a) a person registered in the register is convicted in the United Kingdom or elsewhere of a criminal offence which, in the opinion of the disciplinary committee, renders him unfit to practise veterinary surgery; or (b) any such person is judged by the disciplinary committee to have been guilty of disgraceful conduct in any professional respect; or (c) the disciplinary committee is satisfied that the name of any such person has been fraudulently entered in the [register; or (d) a person registered in the register otherwise than under Schedule 1B misconducts himself in a professional respect, and as a result (i) ceases, in any relevant European State other than the United Kingdom, to be registered or recognised as a veterinary surgeon; or (ii) is prohibited, in any relevant European State other than the 14

84 AC April 10 AI 05 Annex A United Kingdom, from practising (whether on a permanent or temporary basis) as a veterinary surgeon,] the committee may, if they think fit, direct that his name shall be removed from the register or (except in a case falling within paragraph (c) of this subsection) that his registration therein shall be suspended, that is to say, it shall not have effect during a period specified in the direction. (2) Where the disciplinary committee direct that a person s name shall be removed from the register or that his registration shall be suspended under this section, the registrar shall serve a notice of the direction on him. (3) This section shall apply in relation to the supplementary veterinary register and persons registered in that register as it applies in relation to the register of veterinary surgeons and registered veterinary surgeons. 11. In common with other healthcare regulators, the College issues guidance in various forms. For the purposes of this Advice, the principal guidance comprises: 11.1 The Guide to Professional Conduct (currently the 2008 edition); 11.2 Processing a complaint, a guide to the complaints procedure; 11.3 Advice Notes, including Advice Note 3 Serious Professional Misconduct; 11.4 Disciplinary Committee Guidance and the Disciplinary Committee Manual. 12. In summary, in its regulatory capacity the RCVS inter alia: 12.1 Maintains a register of veterinary professionals; 15

85 AC April 10 AI 05 Annex A 12.2 Sets the standards of professional competence and conduct; 12.3 Promotes high standards in education and training and; 12.4 Investigates, prosecutes and adjudicates upon complaints concerning professional conduct. Discussion 13. In general terms I am asked to consider whether, if at all, the RCVS can implement a health protocol. I should make clear that, consistent with the position adopted by other healthcare regulators, I take health cases to comprise cases of adverse physical or mental health. 14. In addressing this issue, I note first the role of the RCVS as set out at Paragraph 5 below. In exercising its role, in my opinion the RCVS clearly has an express (and/or implied) duty to act in the public interest. Consistent with the views expressed in The Shipman Inquiry and set out, for example, in the GMC s Indicative Sanctions Guidance at paragraph 19 (as endorsed, for example, by the High Court in Harry v GMC [2006] EWHC 3050 (Admin)), in my opinion the public interest comprises three principal elements for these purposes: 16

86 AC April 10 AI 05 Annex A a. Protection of members of the public; b. Maintenance of public confidence in the profession; c. Declaring and upholding proper standards of conduct and behaviour. 15. The two bases for disciplinary action at present by the RCVS are contained in section 16(1)(a) and (b) of the 1966 Act above. The first is where: a person registered in the register is convicted in the United Kingdom or elsewhere of a criminal offence which, in the opinion of the disciplinary committee, renders him unfit to practise veterinary surgery 16. This provision mirrors the powers of most healthcare regulators (including, for example, the General Medical Council (GMC), the General Dental Council (GDC) and the Nursing and Midwifery Council (NMC)). (I note that the RCVS was some years in advance of those other regulators in expressly referring to the notion of fitness to practise.) 17. The second basis for disciplinary action is where: any such person is judged by the disciplinary committee to have been guilty of disgraceful conduct in any professional respect 18. This formulation echoes inter alia the GMC s former test for disciplinary action, namely whether a registrant was guilty of serious professional misconduct. I note that the RCVS expressly adopts the alternative definition, serious professional 17

87 AC April 10 AI 05 Annex A misconduct, in its Advice Note 3, referred to above. In my opinion the two formulations are interchangeable. 19. The classic definition of serious professional misconduct can be found in Roylance v GMC (No 2) [2000] AC 311, PC, where Lord Clyde stated: The expression serious professional misconduct is not defined in the legislation and it is inappropriate to attempt any exhaustive definition. It is the successor of the earlier phrase used in the Medical Act 1858 (21 & 22 Vict. c. 90) infamous conduct in a professional respect, but it was not suggested that any real difference of meaning is intended by the change of words. This is not an area in which an absolute precision can be looked for. The booklet which the General Medical Council have prepared, Professional Conduct and Discipline: Fitness to Practice (December 1993), indeed recognises the impossibility in changing circumstances and new eventualities of prescribing a complete catalogue of the forms of professional misconduct which may lead to disciplinary action. Counsel for the doctor argued that there must be some certainty in the definition so that it can be known in advance what conduct will and what will not qualify as serious professional misconduct. But while many examples can be given the list cannot be regarded as exhaustive. Moreover the Professional Conduct Committee are well placed in the light of their own experience, whether lay or professional, to decide where precisely the line falls to be drawn in the circumstances of particular cases and their skill and knowledge requires to be respected. However the essential elements of the concept can be identified. Serious professional misconduct is presented as a distinct matter from a conviction in the British Islands of a criminal offence, which is dealt with as a separate basis for a direction by the committee in section 36(1) of the Medical Act Analysis of what is essentially a single concept requires to be undertaken with caution, but it may be useful at least to recognise the elements which the respective words contribute to it. Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a medical practitioner in the particular circumstances. The misconduct is qualified in two respects. First, it is qualified by the word professional which links the misconduct to the profession of medicine. Secondly, the misconduct is qualified by the word serious. It is not any professional misconduct which will qualify. The professional misconduct must be serious. The whole matter was summarised in the context of serious professional misconduct on the part of a registered dentist 18

88 AC April 10 AI 05 Annex A by Lord Mackay of Clashfern in Doughty v. General Dental Council [1988] A.C. 164, 173: In the light of these considerations in their Lordships view what is now required is that the General Dental Council should establish conduct connected with his profession in which the dentist concerned has fallen short, by omission or commission, of the standards of conduct expected among dentists and that such falling short as is established should be serious. On an appeal to this Board, the Board has the responsibility of deciding whether the committee were entitled to take the view that the evidence established that there had been a falling short of these standards and also entitled to take the view that such falling short as was established was serious. 20. There are in my opinion two important notions in the above formulation: (i) what constitutes misconduct will change over time and; (ii) in determining whether conduct amounts to serious professional misconduct, regard should be had to the standards ordinarily required to be followed. 21. One source of such standards is clearly the guidance which the regulator itself sets. In setting standards, a regulator is not in my opinion confined to following standards which have already become accepted over time by the profession. In my opinion a regulator may, pursuant to its role and acting in the public interest, take the lead in setting standards where appropriate. 22. Other healthcare regulators have in recent years amended their disciplinary jurisdiction and moved from the old serious professional misconduct system to what might be called a new fitness to practise system. By way of example, the Medical Act 1983 as amended gives the GMC jurisdiction to inquire into whether 19

89 AC April 10 AI 05 Annex A a doctor s fitness to practise is impaired in the circumstances set out by section 35D: (2) A person s fitness to practise shall be regarded as impaired for the purposes of this Act by reason only of - (a) misconduct; (b) deficient professional performance; (c) a conviction or caution in the British Islands for a criminal offence, or a conviction elsewhere for an offence which, if committed in England and Wales, would constitute a criminal offence; (d) adverse physical or mental health; (e) a determination by a body in the United Kingdom responsible under any enactment for the regulation of a health or social care profession to the effect that his fitness to practise as a member of that profession is impaired, or a determination by a regulatory body elsewhere to the same effect. f) the Independent Barring Board including the person in a barred list (within the meaning of the Safeguarding Vulnerable Groups Act 2006(21) or the Safeguarding Vulnerable Groups (Northern Ireland) Order 2007(22)); or (g) the Scottish Ministers including the person in the children's list or the adults list (within the meaning of the Protection of Vulnerable Groups (Scotland) Act 2007(23)) 23. As an example of a separate health jurisdiction, the GMC s health jurisdiction was first introduced in the late 1980s. The (now superseded) GMC Health Committee (Procedure) Rules Order of Council 1987 can be found on the GMC website at The GMC s health jurisdiction was comprehensively considered by Dame Janet Smith in The Shipman Inquiry s Fifth Report at Chapter 22. See 20

90 AC April 10 AI 05 Annex A 24. Like the GMC, most healthcare regulators expressly include adverse physical or mental health as a separate basis for disciplinary action. The RCVS has no separate health jurisdiction. In advising the RCVS in this matter, it is important to consider the extent to which, if at all, adverse physical or mental health can be a ground for intervention at present. In my opinion there are already two circumstances in which the RCVS has jurisdiction to intervene where there are concerns about a registrant s adverse physical or mental health: 24.1 Where the adverse physical or mental health leads to a criminal conviction which renders him or her unfit to practise. This formulation is derived from section 16(1)(a) of the 1966 Act as amended; 24.2 Where the conduct complained of (caused as it may be by adverse physical or mental health) is serious enough and there is evidence that it could amount to serious professional misconduct. This formulation is derived from section 16(1)(b) of the 1966 Act and the discussion above and is mirrored in Paragraph B2 of the RCVS guidance document Processing a complaint, which states: neither can we deal with performance (competence) or health complaints unless they are serious enough and there is evidence that they could amount to serious professional misconduct. (my emphasis) 21

91 AC April 10 AI 05 Annex A 25. I understand that these two bases are reasonably well accepted and adopted by the RCVS. Indeed I understand that the Disciplinary Committee (DC) has on various occasions in what might be considered a health case exercised its jurisdiction to adjourn a case for up to two years pending compliance with conditions before final determination. [In my opinion this demonstrates the flexibility of regulatory proceedings very well. The GDC used to adopt the same method of disposal, so far as I am aware without complaint or being overturned, until its new fitness to practise procedures were introduced recently.] 26. In my opinion it is consistent with (i) the role of the RCVS as set out in Paragraph 5 above (as explained by Paragraph 14 above) and/or; (ii) modern notions of acceptable professional standards and/or; (iii) the role of the RCVS in setting standards, to consider the current scope of the notion of serious professional misconduct, or the alternative formulation disgraceful conduct in any professional respect. 27. In my opinion, in the particular context of health cases, the notion is already capable of comprising the following examples of conduct: 27.1 A refusal (or failure) by a registrant to take (or demonstrate) reasonable steps to address adverse physical or mental health where there is harm to (or a risk of harm to) animal health or welfare and/or public health and/or the public interest; 22

92 AC April 10 AI 05 Annex A 27.2 A refusal to accede to a regulator s reasonable request (for example to undergo medical examination and/or to accept undertakings); 27.3 Breach of undertakings. 28. In my opinion it is not necessary (though it may be considered desirable) to implement an express statutory health jurisdiction in order to consider the types of behaviour set out above. The implementation of an express health scheme might avoid any argument about the interpretation of the notion of serious professional misconduct. However, in my opinion, for the reasons set out above, the notion is sufficiently flexible to include the types of behaviour above in any event. Given the apparent lack of parliamentary time for statutory amendments, it is in my opinion appropriate for the RCVS to proceed on the basis I have set out above in the meantime. Specific questions 29. In the light of the discussion above, I address the specific questions asked of me in my instructions. 30. Q1. By what means and to what extent may the College implement a health protocol to deal with cases where there is alleged to be, or following 23

93 AC April 10 AI 05 Annex A investigation found to be, an underlying health issue on the part of the veterinary surgeon concerned, within the framework created by the Veterinary Surgeons Act 1966 and in line with the College s responsibilities as a statutory regulator? Counsel is asked to consider in this regard the draft Health Protocol at Annex A of Mr Hockey s paper, including the proposed policies on, for example, misuse of drugs. 31. In my opinion the RCVS is entitled to consider all cases which raise issues of adverse physical or mental health where such cases fall within Paragraph 24.1 and Paragraph 24.2 (as amplified in Paragraph 27 above). The implementation of such a policy is in my opinion already undertaken by RCVS to some extent in any event and is consistent both with the role of the RCVS and with the statutory framework of the 1966 Act. For the avoidance of doubt, the RCVS has no jurisdiction to consider health (or any other) cases which do not fall within Paragraphs 24.1 and/or 24.2 (as amplified) above. Cases (including health cases) which do not meet the relevant threshold should continue to be screened out. 32. In my opinion the most appropriate mechanism for implementing such a policy is by the adoption of a written protocol (equivalent to a set of rules) and associated policies and/or guidance (to explain how the protocol is interpreted and operated). I recommend that the RCVS formulates a written protocol which is as close as possible to the set of rules which it would wish to implement if parliamentary time were available. In particular I recommend that health be defined to include 24

94 AC April 10 AI 05 Annex A adverse physical and/or mental health. I further recommend the inclusion of a common provision amongst other regulators, perhaps best reflected in the GMC s Fitness to Practise Rules 2004 ( as follows: (6) When determining whether a practitioner s fitness to practise is impaired by reason of adverse physical or mental health, the FTP Panel may take into account- (a) the practitioner s current physical or mental condition; (b) any continuing or episodic condition suffered by the practitioner; and (c) a condition suffered by the practitioner which, although currently in remission, may be expected to cause a recurrence of impairment of the practitioner s fitness to practise. 33. In my opinion the draft protocol produced by Mr Hockey might reasonably be expanded. I suggest that some consideration is given to the detail which might be required in a set of rules and refer by way of example to the GMC s previous health rules (see Paragraph 23 above), which might be helpfully modified to suit the RCVS s needs. 34. In conference I advised, and for the purposes of this Advice I repeat, that the RCVS needs to have an impact assessment carried out in respect of any proposed changes. By this I do not mean a full public consultation, rather that the RCVS needs (whether by means of an internal evaluation in committee, alternatively with the assistance of external service providers) to consider the impact of the proposed changes on registrants (in particular in this instance disability, gender and ethnic minority issues). 25

95 AC April 10 AI 05 Annex A 35. In conference I considered changes which should be made to RCVS documentation. I will consider this in detail below under Question 5, together with the issue of publicity and consultation. 36. Q2. To what extent may the PIC manage health related cases? Does the PIC have the jurisdiction to consider the wider public interest, to the extent that they are not obliged to forward a complaint to the Disciplinary Committee, if, due to the practitioner s health, it is not in the public interest to do so (for example, if the veterinary surgeon has health issues which can be managed with undertakings or if the veterinary surgeon is at risk of suicide), notwithstanding the fact that there is a realistic prospect of proving serious professional misconduct? 37. Pursuant to section 15 of the 1966 Act, the PIC is charged with conducting a preliminary investigation into every disciplinary case and of deciding whether the case should be referred to the DC. 38. Unlike some regulators, the PIC is not required to send all cases to the DC where there is a realistic prospect of proving a conviction or serious professional misconduct. In my opinion the wording of the 1966 Act gives the PIC a degree of flexibility in the approach it may take to all cases, including health cases. 26

96 AC April 10 AI 05 Annex A 39. In my opinion, in light of the flexibility inherent in the statutory duty, it is appropriate for the PIC to manage certain health cases (as properly understood) by way of inviting undertakings from the registrant without referral in every case to the DC. The PIC may in my opinion also invite the registrant to disclose details of (or undergo) medical examination in appropriate cases. Such an approach is in my opinion consistent with and proportionate to the role and duties of the RCVS. Subject to the development of a protocol in more detail, such management can be achieved in practice by inviting the registrant to accept undertakings and adjourning the case from time to time pending compliance with undertakings. Undertakings should be appropriate, proportionate, workable and measurable. I should make clear that in my opinion the power to adjourn is inherent in all such proceedings whether or not an express statutory power exists. In the event of a refusal to accept undertakings and/or a breach of undertakings, the PIC should notify the registrant that s/he is liable to be referred to the DC for the underlying matter and in respect of the refusal/breach. 40. In deciding whether or not to refer a case to the DC, the PIC is required in my opinion to have regard to its role as set out in Paragraphs 5 and 14 above and, to that extent, it must consider the public interest (as should all committees of the RCVS). Any regulator may set out policies setting out the action it will usually take in respect of certain types of behaviour (eg misuse of drugs), provided that any such policy is consistent with its role. Accordingly the PIC can (and in my opinion should) formulate a written policy, reviewable from time to time, in 27

97 AC April 10 AI 05 Annex A respect of those health cases which it proposes to manage without referral to the DC. In formulating a referral/management policy, the PIC should be careful not to be seen to usurp the function (in particular the adjudicatory function) of the DC. Further, relevant factors in the management of health cases by the PIC might include but are not limited to: (i) the overall efficient allocation of RCVS resources; (ii) the inability of the DC to adjourn for more than a set period overall once a case has been referred to it. 41. I was asked in conference to consider the position of suicidal registrants in particular, noting that one (though by no means the only one) of the motives for implementing a health protocol along the lines suggested is because of the disproportionate numbers of suicides amongst veterinary surgeons. I recognise, however, that the vast bulk of health cases are likely to comprise registrants with alcohol- or medication-related problems. In so far as rare cases of suicidal registrants are concerned, a regulator, including for these purposes the PIC, is in my opinion entitled to have regard to the registrant s interests in deciding what action to take. (Arguably, the registrant being a member of the public as well, this forms part of the regulator s duty to act in the public interest.) However, the RCVS must not lose sight of its principal role, applying to all registrants whether suicidal or not, as per Paragraphs 5 and 14 above. The PIC is not required to refer every case which may result in suspension or erasure to the DC (see section 16 of the 1966 Act and my paragraph 38 above). The PIC can properly manage certain cases without the need for referral to the DC, for the reasons and in the 28

98 AC April 10 AI 05 Annex A circumstances discussed in this Advice. However, there are clearly some cases which are such that, in light of its role, the PIC should refer to the DC in any event, whatever the health issues and whether the registrant is suicidal or not, because they are so serious. (A possible example of this philosophy, though under a different rule structure, is Crabbie v GMC [2002] 1 WLR 3104, PC). Deciding where to draw the line is a matter for the RCVS to determine, and to formulate guidance on, over time and will in each case be a matter for the PIC to reach a judgment on, based on the facts of that case. 42. Q3. To what extent may the PIC seek and enforce undertakings from a veterinary surgeon? 43. In my opinion undertakings on the part of a registrant are an appropriate and sensible way in which the PIC can manage health cases, in the circumstances set out above, without the need to refer to the DC. An undertaking is a common form of expressing a promise, the breach of which is punishable in its own right. It follows that a registrant must be informed at the time that undertakings are offered that breach of any undertaking may be actioned (by referral to the DC) in its own right. Healthcare regulators have traditionally determined and monitored health cases in private. Accordingly, in my opinion such cases should be managed in private (and the protocol should make clear that they will be managed in private). I note that this power exists in respect of proceedings before the DC: see rule 21.2 of the DC Rules

99 AC April 10 AI 05 Annex A 44. I repeat that undertakings should be appropriate, proportionate, workable and measurable. They should not amount to suspension by the back door, in that they cannot realistically be complied with: see Udom v GMC [2009] EWHC 3242 (Admin). In my opinion it is important that a bank of draft undertakings is developed (as per the set which I have seen for the purposes of these instructions, which follows closely the GMC s undertakings bank), which may be tailored to suit the needs of the individual case, but which should be published and freely available on the RCVS website. 45. As explained above, healthcare regulators have traditionally determined and monitored health cases in private. In my opinion such undertakings as are clearly referable to a registrant s health should not be disclosed or be made publicly available. 46. Q4. Could free-standing health conditions (ie without any specific complaint, misconduct allegation, conviction or other incident) of themselves be considered by the PIC, particularly where a medical practitioner is concerned that a veterinary surgeon is not fit to practise by reason of health and may be a suicide risk? 47. The short answer to the question as framed is that, as the RCVS jurisdiction is presently framed, free-standing or pure health cases could not be considered. 30

100 AC April 10 AI 05 Annex A However, for the reasons set out below, pure health cases are probably something of a misconception in any event, as the sorts of health cases to be considered by RCVS will only be those which have a consequential impact on fitness to practise issues. 48. In the GMC jurisdiction for example, pure health cases cannot be considered either; there must be some consequential impairment of fitness to practise. In my opinion the same philosophy would apply to the RCVS. A case which includes health aspects may be considered by the PIC if it is capable of constituting serious professional misconduct as I have sought to explain that notion above. 49. There will clearly be grey areas about the definition of serious professional misconduct and it is impossible to draft an Advice which predicts all the types of behaviour which might come to the attention of the RCVS. A suicidal veterinary surgeon whose conduct harms animal welfare can in my opinion be considered by the RCVS under its present jurisdiction. Likewise, in my opinion, where animal welfare is put at risk but without any actual harm. The full ambit of the notion serious professional misconduct in this context is a matter for (i) the profession at large, (ii) the RCVS in setting a lead and (iii) ultimately, the DC to determine in the event of any dispute (alternatively the Court on any appeal). 31

101 AC April 10 AI 05 Annex A 50. Does Counsel consider it appropriate to propose amendments to the College s Guide to Professional Conduct in order to provide support to the proposed Protocol for health related cases? 51. As discussed in conference, in my opinion it is essential for the changes which are sought to be reflected in the relevant guidance documents. The extent to which such changes should be consulted on is a matter for the RCVS, though there should in my opinion be at least a high degree of publicity about them. 52. The starting-point for any amendments to any documentation is in my opinion the Guide to Professional Conduct. This is the reference point for assessing whether conduct complained of falls below the relevant standard. As I have already indicated, a regulator may take the lead in setting and/or changing standards. In my opinion the instances of misconduct which I have identified at Paragraph 27 above are capable of being adjudicated upon without any change in existing guidance. However, it would in my opinion be sensible and fair to registrants that such an interpretation, if accepted by RCVS, is heralded and then set out in the Guide. The three aspects of Paragraph 27 should in my opinion be included; the obvious place is in what is currently section H3 of the Guide. 53. Considering the position adopted by other healthcare regulators, I note the following in the GMC s section in Good Medical Practice in the section entitled Health ( 32

102 AC April 10 AI 05 Annex A 77. You should be registered with a general practitioner outside your family to ensure that you have access to independent and objective medical care. You should not treat yourself. 78. You should protect your patients, your colleagues and yourself by being immunised against common serious communicable diseases where vaccines are available. 79. If you know that you have, or think that you might have, a serious condition that you could pass on to patients, or if your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague. You must ask for and follow their advice about investigations, treatment and changes to your practice that they consider necessary. You must not rely on your own assessment of the risk you pose to patients. 54. Clearly Paragraph 79 addresses, at least in part, the same sort of mischief which I have sought to address in this Advice, namely where adverse physical or mental health puts patients at risk. 55. The current NMC Code ( does not have a particular section on health. However, it states under Managing Risk : You must act without delay if you believe that you, a colleague or anyone else may be putting someone at risk You must inform someone in authority if you experience problems that prevent you working within this Code or other nationally agreed standards 56. As above, in my opinion this formulation is capable of addressing the mischief to which my Paragraph 27 above is addressed. 33

103 AC April 10 AI 05 Annex A 57. By way of final example, the GDC states in Standards for Dental Professionals ( A2DB7F3254DC/0/StandardsforDentalProfessionals.pdf): 1.3 Work within your knowledge, professional competence and physical abilities 1.7 If you believe that patients might be at risk because of your health, behaviour or professional performance, or that of a colleague, or because of any aspect of the clinical environment, you should take action. You can get advice from appropriate colleagues, a professional organisation or your defence organisation. If at any time you are not sure how to continue, contact us. 58. Clearly there are many ways in which the standard can be expressed. In my view all the above regulators have sought in their central guidance document to state the obligation which I have set out in Paragraph 27.1 above. In particular I note that two of the regulators above set out the obligation in sections of their relevant guidance documents other than a section dedicated to health. 59. Processing a complaint (a guide to the complaints procedure) should be amended to make clear that health cases will be considered in accordance with such protocol as the RCVS adopts and the circumstances which I have set out above. 34

104 AC April 10 AI 05 Annex A 60. Advice note 3 (serious professional misconduct) needs some fairly wholesale redrafting in order to bring it into line with (i) Roylance (supra) and (ii) this Advice. 61. The Disciplinary Committee Guidance and the Disciplinary Committee Manual may need some amendments, though the changes which are proposed are principally intended to affect the PIC rather than the DC. However, the DC may decide, for example, to issue guidance about the stance it will take in the event of breach of an undertaking given to the PIC. 62. The crucial aspect of any change in policy or approach, and in any amendments to documentation, is that such changes should be widely publicised and all documentation (including protocols) should be freely available on the RCVS website. Such transparency was regarded by Dame Janet Smith in The Shipman Inquiry as fundamental to the duties of a regulator. 63. I understand that changes to the Guide to Professional Conduct are consulted upon generally and endorse that approach in respect of the changes to reflect my Paragraph 27 above. Conclusion 35

105 AC April 10 AI 05 Annex A 64. If I can be of any further assistance in this matter, or if I can clarify any part of this Advice, my Instructing Solicitor should not hesitate to contact me on Nicholas A. Peacock Hailsham Chambers 9 th December

106 AC April 10 AI 05 Annex A THE ROYAL COLLEGE OF VETERINARY SURGEONS A PROPOSED HEALTH PROTOCOL ADVICE PENNINGTONS SOLICITORS LLP ABACUS HOUSE 33 GUTTER LANE LONDON EC2V 8AR Tel: Ref: NXC/ /

107 38

108 AC April 10 AI 05 Annex B ROYAL COLLEGE OF VETERINARY SURGEONS HEALTH PROTOCOL PROCEDURES WHERE A VETERINARY SURGEON S FITNESS TO PRACTISE MAY BE IMPAIRED BY REASON OF ADVERSE PHYSICAL OR MENTAL HEALTH The RCVS health protocol aims to protect animals and the public interest by helping veterinary surgeons whose fitness to practise is impaired by reason of adverse physical or mental health, for example, addiction to alcohol or drugs. Veterinary surgeons whose fitness to practise is impaired are invited to agree undertakings which may, for example, limit the extent to which they may practise. The protocol provides that those whose cases are not referred to the Disciplinary Committee for a formal hearing are monitored by the RCVS through both a workplace and medical supervisor. When can the Royal College of Veterinary Surgeons take action in relation to a veterinary surgeon's health? 1. In exercising its statutory role, the Royal College of Veterinary Surgeons (RCVS) has an express duty to act in the public interest. This includes protecting members of the public, maintaining public confidence in the profession, promoting animal welfare and declaring and upholding proper standards of conduct and behaviour amongst veterinary surgeons. 2. The RCVS jurisdiction in relation to its regulatory role is set out in the Veterinary Surgeons Act 1966 (Act). The Act gives the RCVS its powers in relation to the action it can take regarding veterinary surgeons (those registered with the RCVS). The RCVS can only take action regarding the health of a veterinary surgeon in circumstances in which it has jurisdiction to do so under the Act. 3. The RCVS has jurisdiction to take action with regard to a veterinary surgeon's health where: b) the veterinary surgeon's physical or mental health has resulted in or was a contributing cause of or is directly relevant to a criminal conviction; and that conviction potentially renders him/her unfit to practise; and c) the veterinary surgeon's physical or mental health has resulted in or was a contributing cause of or is directly relevant to conduct on his/her part; and that conduct is potentially such as to amount to disgraceful conduct in a professional respect. 4. A veterinary surgeon s conduct is capable of amounting to disgraceful conduct in a professional respect if he/she either does not take, or does not demonstrate that he/she has taken, reasonable steps to address his/her adverse physical or mental health, where his/her fitness to practise is potentially impaired as a result, or where there is harm, or risk of harm, to animal health or welfare and/or public health and/or the public interest as a result. 39

109 AC April 10 AI 05 Annex B 5. In summary, the RCVS can only take action regarding a veterinary surgeon s health where this is relevant to his/her fitness to practise 1. In this context being unfit to practise is taken to include disgraceful conduct in a professional respect. 6. When considering whether a veterinary surgeon's fitness to practise is impaired by reason of adverse physical or mental health, the following factors may be taken into account: (a) the veterinary surgeon's current physical or mental condition; (b) any continuing or episodic condition suffered by the veterinary surgeon; and (c) any condition suffered by the veterinary surgeon which, although currently in remission, may be expected to recur. 7. Circumstances where the RCVS may take action regarding the veterinary surgeon's health include (but are not limited to): a) health problems which have compromised the veterinary surgeon's perception or cognition or impaired his/her insight in a manner linked to his/her fitness to practise. Often such adverse effects lead from health conditions relating to addiction to alcohol or to drugs; b) misuse of medicines/drugs for the veterinary surgeon's own purposes, as a result of health problems (often addiction to such drugs); and, c) the veterinary surgeon has deliberately self-harmed or attempted suicide using practice medicines, drugs or equipment. The RCVS takes the view that its duty to protect members of the public includes protection of the veterinary surgeon him or herself 2. When should concerns about a veterinary surgeon's health be reported to the RCVS? 8. The RCVS has a duty to act in the public interest and will investigate sympathetically any concerns brought to its attention. 9. All those who meet practising veterinary surgeons, including members of staff, veterinary surgeons, veterinary nurses, clients, and healthcare professionals, for example, medical practitioners, who have concerns that a veterinary surgeon's physical or mental health may make him/her unfit to practise are asked to report those concerns to the RCVS as soon as is reasonably practicable. 10. Veterinary surgeons who are concerned that a colleague s physical or mental health may make him/her unfit to practise must take steps to ensure that animals are not put at risk and that the public (including the colleague) is protected. 1 This has been confirmed with regard to other healthcare regulators by the report of the Council for Healthcare Regulatory Excellence in June 2009 in response to the report by the Disciplinary Rights Commission ("Maintaining Standards: Promoting Equality" September 2007). 2 The RCVS Preliminary Investigation Committee has taken the view that although, in theory, use of practice drugs for such a purpose could potentially amount to misconduct such as to warrant the intervention of the RCVS, it would very rarely (if ever) be appropriate for such a matter to be forwarded to the Disciplinary Committee, given the public interest considerations involved. 40

110 AC April 10 AI 05 Annex B How does the RCVS deal with concerns that a veterinary surgeon s fitness to practise may be impaired by reason of adverse physical or mental health? 11. The Veterinary Surgeons Act gives the RCVS Preliminary Investigation Committee ("PIC") the duty of conducting a preliminary investigation into every case in which it is alleged that a person is liable to have his/her name removed from the Register or to have his/her registration suspended; and of deciding whether the case should be referred to the Disciplinary Committee. 12. The PIC, in accordance with that duty, assesses complaints brought before it and decides whether (i) there is a realistic prospect of a finding of disgraceful conduct in a professional respect or that a conviction renders the veterinary surgeon unfit to practise as the case may be; and, if so, (ii) whether it is in the public interest to forward the complaint to the Disciplinary Committee for a full hearing. When undertaking both elements of this assessment, the PIC may take into account the health of the veterinary surgeon as one of the relevant factors. 13. Once the PIC has investigated a complaint, the PIC may take the view that the matter is so serious that referral to the Disciplinary Committee is necessary in the public interest notwithstanding any issues surrounding the veterinary surgeon's health In circumstances other than those described in paragraph 13, once the PIC has investigated a complaint, it may take the view that, in light of all relevant circumstances, including the veterinary surgeon's health, it is in the public interest not to forward the matter to the Disciplinary Committee, at least at that time. 15. Where the PIC takes the view that it would not be in the public interest to forward the matter to the Disciplinary Committee, it may: a) hold the matter open for a specified period of time; or, b) adjourn consideration of the complaint for a specified period of time. 16. Where the PIC has decided to hold a matter open for a period of time or adjourn consideration of the complaint for a period of time, it may also decide to take such steps as it deems appropriate in all the circumstances, to protect the public interest, for example, it may: a) invite the veterinary surgeon to undergo medical, examinations, assessments, tests or reports; b) invite the veterinary surgeon to agree to a visit from and interview with representatives of the RCVS, for example the Senior Case Manager and a veterinary investigator; c) invite the veterinary surgeon to provide medical reports to the PIC; and/or 3 Section 15 4 see Crabbie v GMC WLR 3104 PC 41

111 AC April 10 AI 05 Annex B d) invite the veterinary surgeon to embark on a course of treatment recommended by the veterinary surgeon s medical practitioners (in-patient or outpatient); and e) invite the veterinary surgeon to give undertakings to the PIC. 17. An undertaking is a formal promise, the breach of which is punishable in its own right. If the PIC decides to invite the veterinary surgeon to give undertakings, it must ensure that any such undertakings are proportionate, targeted, workable and measurable. 18. The PIC may refer to and draw from (but are not limited to) the undertakings set out in the RCVS's document entitled "Bank of Undertakings", attached as annex A to this protocol. Undertakings may include (but are not limited to) the following: d) undergoing treatment from the veterinary surgeon's medical practitioner at his/her cost; e) supervision from a medical supervisor appointed by the RCVS. The medical supervisor will not be the veterinary surgeon's own treating medical practitioner; f) supervision from a workplace supervisor appointed by the RCVS, who may be a suitable colleague in the same practice; g) specific undertakings to address concerns identified by the RCVS or the medical supervisor, for example, relating to the veterinary surgeon s practice or the specific facts relating to the complaint; h) undertakings (similar to those in relation to the RCVS model undertakings) regarding the sharing of information between relevant persons, for example the veterinary surgeon's medical practitioner, employer, medical supervisor; workplace supervisor and the RCVS; and, i) submitting to blood, urine or other tests. 19. If the PIC considers that undertakings would be appropriate, it will inform the veterinary surgeon at the time of inviting him/her to give the undertaking(s) that he/she will be liable to be referred to the Disciplinary Committee for breach of an undertaking. The veterinary surgeon will also be informed that, if he/she breaches an undertaking, the underlying complaint/matter which led to consideration by the PIC in the first place may also be referred to the Disciplinary Committee. 20. Undertakings are given in writing and signed by the veterinary surgeon. Undertakings are not made public by the PIC, unless there is an overriding public interest in disclosure. Similarly, once undertakings have been given to the PIC, the management of those undertakings takes place in private, unless there are overriding public interest reasons for disclosure. 21. When monitoring and supervising a held-open or adjourned case, the PIC and the RCVS adopts a pro-active approach to ensure compliance with undertakings. This involves regular liaison between the RCVS, usually the Senior Case Manager, and the relevant individuals such as the medical supervisor, workplace supervisor and employer as the case may be. The PIC may direct, as it deems appropriate, that any reports, test results or similar documents should be submitted to and considered by a case examiner or case manager or the Chair of PIC or a full meeting of the PIC. 42

112 AC April 10 AI 05 Annex B 22. It is open to the PIC to invite the medical supervisor, workplace supervisor or other relevant individual to attend at its meeting and to report to the PIC in relation to the veterinary surgeon. In such circumstances, the veterinary surgeon should be informed that the individual concerned has been asked to attend the PIC meeting and should be invited to comment on the attendance by that individual; and a written note of the individual's report to the PIC should be made available to the veterinary surgeon after the PIC meeting. PIC meetings are held in private. 23. A held-open or adjourned case may be further held open or adjourned from time to time and in any event until such time as the PIC considers that the case may be closed or that it should be referred to the Disciplinary Committee. Monitoring and supervision will be carried out for as long as it is considered to be necessary by the PIC in the public interest. 5 What happens if a veterinary surgeon does not co-operate with PIC in relation to consideration of his/her health or where undertakings are breached or where further matters arise? 24. The following may be treated as disgraceful conduct in a professional respect and may therefore be forwarded to the Disciplinary Committee by the PIC as allegations in their own right (with or without the original complaint/matter that led to PIC considering the veterinary surgeon in the first place being also forwarded): j) refusal or failure by the veterinary surgeon to take or demonstrate reasonable steps to address his/her adverse, physical or mental health, where his/her fitness to practise is potentially impaired as a result, or where there is harm, or a risk of a harm, to animal health or welfare and/or public health and/or the public interest as a result; k) refusal to accede to reasonable requests by the PIC or RCVS, for example to undergo a medical examination or provide medical reports or give undertakings; and l) breach of an undertaking (whether or not the veterinary surgeon accepts that he/she has been in breach of the undertaking). 25. If additional information (for example, information provided in compliance with undertakings), or a further complaint comes to the attention of the PIC during the course of its management of a held-open or adjourned case, the PIC may, having regard to that further information or complaint, decide to refer all or any matters to the Disciplinary Committee, following any additional investigation, if any is considered necessary. 26. Concerns are investigated as complaints and the RCVS will deal with concerns in similar timelines to complaints. What if the public interest requires a veterinary surgeon s name to be removed from the register? 27. The PIC may refer a matter/complaint to the Disciplinary Committee if it considers it to be appropriate and just, having regard to its duties under the Act. Last revised: 29 March The General Medical Council has indicated that, on average, health cases are held open for 5 years. 43

113 AC April 10 AI 06 MEETING Advisory Committee DATE 20 April 2010 TITLE CLASSIFICATION SUMMARY DECISIONS REQUIRED ATTACHMENTS Dog breeding: Professor Bateson's report Unclassified The paper considers, briefly, the issues and recommendations within the Independent Inquiry into Dog Breeding that are particularly relevant to the RCVS. Advise the Public Affairs Committee on the five main issues set out in the paper. Annex A: Extracts from the report Annex B: Extract from PAC minutes February 2010 Annex C: RCVS annex to the Guide on microchipping Annex D: Letter from the BVA AWF Dog Breeding Stakeholder Group Annex E : Draft paper for Public Affairs Committee and position statement on microchipping AUTHOR Gordon Hockey Head of Professional Conduct/ Assistant Registrar g.hockey@rcvs.org.uk 1

114 AC April 10 AI 06 2

115 AC April 10 AI 06 Background 1. The report of Professor Patrick Bateson's Independent Inquiry Into Dog Breeding was published on 14 January The Inquiry was commissioned by the Kennel Club and the Dogs Trust following the BBC documentary "Pedigree Dogs Exposed"; the preface to the Report, which is included in the extracts at annex A gives a fuller account of the origins of the exercise. Recommendations relevant to the RCVS and the veterinary profession 2. The report recommended a role for the profession in: a) collecting anonymised data, particularly data on diagnoses, from veterinary surgeries, to provide statistically significant prevalence data for each breed; building upon work already started by RVC. The RCVS is urged to give full support to this; b) leading a shift in emphasis towards preventative veterinary medicine rather than concentrating on the correction of problems. 3. When considering the roles of the profession, the report mentions the significance of providing assistance and information to help reduce the incidence of specific conditions. (This issue seems to be one of prevalence within the profession at the moment with the Head of the Canine Genetics Research Group at the AHT giving a lecture at the upcoming BSAVA conference on the powers of veterinary practitioners to tackle welfare problems caused by inherited diseases in pedigree dogs.) 4. The report also considers the role of the profession in providing expert support for the enforcement of dog breeding and sales legislation. (The BVA is invited to provide local authorities with a list of practitioners willing to carry out and/or support inspections of licensed breeding premises.) 5. The report also notes the widely expressed view that all dogs should be microchipped, preferably by the breeder. Consideration RCVS 6. In January, the Advisory Committee noted the report and commented on it briefly and in February the Public Affairs Committee considered the report. The PAC will consider the issues further with advice from the Advisory Committee. Issues General 7. The Report suggests that there is a conflict for the profession in perception and potentially reality between the income derived from clients for correcting faults in breeds and their duty to advise against breeding practices that cause faults to proliferate; and a conflict between what clients are advised to do and what they want to do. The Report recognises that appropriate veterinary advice is often sought too late by clients to avoid welfare problems. 3

116 AC April 10 AI The conflict for individual veterinary surgeons between advice and personal gain should be theoretical rather than actual. As professionals, veterinary surgeons advise on the basis of their veterinary knowledge, putting animals and animal welfare before any personal advantage or gain, as provided in the RCVS Guide to Professional Conduct; to do otherwise is contrary to the ethos of the profession and risks censure by the RCVS. As with all professionals, veterinary surgeons put their clients interests before their own, and therefore clients will be the main drivers for veterinary care and treatment, subject to overriding welfare and public interest concerns. 9. Clients will want what society considers appropriate and acceptable, or tolerates, ranging from experimentation on animals, intensive farming and breeding of animals. Action by the profession to insist on specific welfare practices which are not accepted by a significant number of those whom they affect, are unlikely to be successful; if the RCVS enforcement of its advice that puppies tails should not be docked for cosmetic reasons is any example. This was difficult to enforce because the RCVS uses a complaints based system of regulation and without the support of those who would be complainants, it can be ineffective. Where enforcement is based on other systems, for example, routine inspection or audit, the problem is less significant. 10. If the problem for the profession is one of perception, the profession and the RCVS need to make clear that animal welfare is paramount. This relates to recent discussions in the RCVS about the wider scientific role of the RCVS. Collecting anonymised data, particularly data on diagnoses, from veterinary surgeries 11. The Report suggests in paragraph 8.2 that there should be a pilot scheme with priority given to collecting data, with respect to the conditions creating the greatest welfare challenges in terms of pain, impact on quality of life, capacity for correction and onset of early age. Also, that the data collected should relate both to the incidence of inherited disease and to the incidence of veterinary procedures necessary to correct faults due to selection for extreme morphologies (e.g. caesarean sections, corrections for entropion, soft palate resections, etc). 12. The Report also suggests in paragraph 8.2 that this work should build upon the work started by the Royal Veterinary College; in addition there is ongoing work associated with promoting standard nomenclature, which would assist the collection of relevant data; this is by a group known as VENOM. 13. At its last meeting, the Advisory Committee considered a project to collect clinical data from veterinary practices (SAVSNET); the project is in conjunction with a computer software company and based on the number of veterinary practices using the software, those responsible for the project estimate that it could cover approximately 20% of veterinary practices in the UK. 14. The Committee has encouraged the SAVSNET project in a number of ways, including the collection of data on diagnoses and statistically significant prevalence data. Also, the Committee has approved the collection of data on an opt out basis, subject to a number of safeguards, which makes the data easier to collect. Arguably this is not true consent to the collection of clients personal data, but the Committee considered the animal welfare and public interest considerations in this case justified an opt-out approach. 15. SAVSNET are proposing to collect data about the geographical location of the animal using the postcode and have indicated they will publish data with reference to only the 4

117 AC April 10 AI 06 first part of the postcode, to avoid identifying individuals. Potentially, this could show regional variations of disease in breeds, which, according to the Report, are likely when a sire carrying a disease has been used in a particular locality. 16. There may be other groups involved in collecting relevant data and the RCVS should aim to meet all such groups. It may also be worth discussing with the corporate practices. It is suggested the overall aim should be to obtain national data. 17. The RCVS may also wish to include pet insurers in discussion about the collection of relevant data. The Report suggests that a useful source of relevant data in Sweden was Agria, a Swedish Insurance company. But the Report states that despite being asked by Professor Bateson, UK pet insurance companies, which must hold a considerable amount of relevant data, did not make this available. 18. It is suggested that a way forward would be to meet with those involved in the various groups, potentially in one meeting, so that the RCVS can support and facilitate the ongoing work within the profession and encourage the various groups undertaking work to liaise and agree a strategy to ensure the data can be shared and used properly; and will be statistically significant and relevant and also useful as envisaged in the Report. 19. A related issue is taking samples, for example, blood samples, for testing. In paragraph 5.10 of the Report it states that taking blood samples for disease surveillance purposes is prohibited under the Animal (Scientific Procedures) Act 1986 (A(SP)A), unless part of a clinical procedure. In farming, sampling of the national herd is considered to be recognised veterinary practice and it may be that this would be the same for pet animals, if carried out as part of a recognised scheme. This would need further consideration and discussion with the Home Office. The RCVS and BVA are urged to lead a shift in emphasis towards preventative veterinary medicine rather than focussing on the correction of problems 20. The Advisory Committee minutes recorded that the Report recommended the RCVS with the profession and BVA.. lead a shift in emphasis towards preventative veterinary medicine rather than simply focus on the correction of problems after they have occurred. Also that the Committee noted the recommendation and considered that good veterinary practice included preventative veterinary medicine. 21. The draft minutes of Council record the objection to the phrasing in the minutes stating that: Concern was expressed that the minutes on the Committee's brief consideration of the Bateson Report had implied that preventative veterinary medicine was a new idea (paragraph 68). It was suggested the minute could have been better phrased, with a view to promotion of the profession, to emphasis that the profession had long recognised the importance of preventative medicine and this was not something the RCVS had picked up for the first time from the report. 22. On the basis of the comment made at Council and the issue of perception raised in the Report, it may be that the profession has not managed to gets its views across to the public on preventative medicine. It may be that this is not so much a problem of emphasis, as a need to step up publicity and the provision of information to the public. The question is how this should be achieved. 5

118 AC April 10 AI 06 Providing assistance and information to help reduce the incidence of specific conditions 23. The recommendation is found in paragraph 7.37 of the Report and it is not entirely clear how the assistance and information might be provided, although the next part of the report deals with the education of purchasers and welcomes the preparation by the British Veterinary Association (BVA) of a draft contract between breeder and purchaser of a puppy. If provided by the profession, such information would also be likely to improve the perception of the profession. 24. This issue of RCVS information on issues related to clinical practice could be linked to developments of the RCVS Charter role, the emergence of clinical governance and the ongoing development of the RCVS Practice Standards Scheme; however, such work would need to be resourced and agreement on who or which Committee made final decisions or recommendations to Council and the extent of consultation envisaged with the profession and/or professional organisations; or whether the RCVS role is one of liaison only. Providing expert support for the enforcement of dog breeding and sales legislation 25. Within the executive summary is stated that the British Veterinary Association (BVA) should compile, and provide to Local Authorities, a list of veterinary practitioners willing to carry out and/or support inspections of licensed breeding premises. This will be helpful for one aspect of the legislation s enforcement. 26. Another aspect of enforcement is having relevant experts to assist the prosecution of offenders. The RCVS provides advice on appearing in court, particularly as an expert (and it is not something that should be undertaken without relevant veterinary knowledge and understanding of the responsibilities of an expert witness), but what prosecutors need is a list of relevant experts. This can be encouraged through relevant professional organisations such as the Expert Witness Institute, but it is questionable whether they would hold a list for such a specialised purpose. Alternatively, it may be appropriate to look back to the introduction of the Dangerous Dogs Act, when it is understood there was a list of known experts in the profession who were able to assist the courts with the relevant issues. The report notes the widely expressed view that all dogs should be microchipped, preferably by the breeder 27. Attached as annex B are the details of Mr Viner s presentation before the Public Affairs Committee, as recorded in the minutes of the meeting. At its meeting in January, the Advisory Committee considered scanning all animals for microchips would not cause the profession undue difficulties and this was raised by Mr Viner in Council as something that needed to be considered. 28. The position of the RCVS in the past has been broadly, that microchipping is recommended and supported by the profession; and in keeping with the expectation of owners who have their animals microchipped; the profession should assist the return of animals to their owners. This may be necessary where a microchip is scanned and found to have a name listed that is not the current client or person presenting the animal. In many cases the animals are strays and all concerned want the animals returned to the original owner. In some cases, however, ownership may be disputed. The RCVS has provided advice in an annex to the Guide, which is attached as annex C. 6

119 AC April 10 AI The Report s recommendation (paragraph 8.8) is that all puppies should be indelibly identified, by implantation of microchip or such other equivalent system as may be developed, prior to sale; and that the ID number of the microchip or equivalent should be recorded on the contract of sale, all relevant health test certificates and registration documents and a central database and.. create such offences as seem appropriate. 30. There is a need that records of animals microchip numbers on other registration papers and official documents are accurate and that databases for such microchip numbers and registrations, for example with the Kennel Club are consistent. This issue was raised at Council in March this year. 31. It is suggested that this recommendation, as stated in the Report, relates to puppies and those who sell puppies, breeders. Therefore, it will apply to the approximately 1,000 breeders in the UK. It is not clear whether such rules would be easy to apply against those who import puppies from Ireland and sell them in the UK. Also, it is not clear whether this recommendation will become a recommendation to microchip all dogs sold or owned, with much greater implications. 32. There is no recommendation that veterinary surgeons must scan all dogs, although this is likely to become increasingly common, even good practice, if all puppies must be microchipped before sale. Increasing this may be expected by the public and the Committee should consider the effect this may have on practising veterinary surgeons. Views could be canvassed from appropriate groups in the profession. Another issue is the extent to which the profession may be expected to report those who sell puppies that are not microchipped. It is not clear whether practising veterinary surgeons will be aware of such sales, but it is difficult to report a client because this may mean the end of the vetclient relationship, for obvious reasons. 33. If there is legislation that all dogs must be microchipped, it is suggested that while veterinary surgeons may have discretion to report alleged criminal offences, to report minor offences, particularly where they applied to large numbers of clients, would undermine the concept of client confidentiality. The RCVS has guidance on reporting offences and generally there is discretion, but no obligation to report. It is suggested the RCVS needs to make clear that the profession is not an alternative to proper enforcement by a responsible authority; although, the public relations issues may be more complicated if the profession is expected to enforce any legislation by default. 34. The RCVS President has confirmed to Council that: a) The RCVS welcomes the principle of compulsory microchipping of all dogs. b) Such legislation would require policing. c) The RCVS does not feel that veterinary surgeons should be expected to be the instruments of policing such a policy. That would have negative effects on vet/client relations and potentially on animal welfare. d) There are a number of other issues that need thinking through such as the welfare implications of microchipping very young dogs. 35. The issue has moved on and attached as annex E is a draft paper for the Public Affairs Committee with a draft position statement for the RCVS. 7

120 AC April 10 AI 06 BVA AWF Dog Breeding Stakeholder Group 36. Attached as annex D is a letter from the BVA AWF Dog Breeding Stakeholder Group, which seeks the RCVS views on the continuation of the Group. The RCVS is only an observer to the Group and therefore, arguably it is not for the RCVS to determine its future, but it may be appropriate to suggest that the group should continue until the new independent Advisory Council is established. Conclusion 37. The Committee is asked to advise the Public Affairs Committee on the relevant issues: a) Collection of Data it is suggested the RCVS support the profession s initiatives to provide relevant statistically significant data; b) Available experts should the RCVS consider having a list of relevant experts to assist prosecutions to complement the proposed BVA list; c) Preventative medicine How can RCVS and the profession get across to the public and dog owners the message of preventative veterinary medicine; d) Microchipping are there suggested amendments to the proposed position statement; e) BVA AWF Dog Breeding Stakeholder Group it is suggested the Group should continue until the new independent Advisory Council is established. Professional Conduct Department 8

121 AC April 10 AI 06 Annex A EXTRACTS FROM REPORT OF INDEPENDENT INQUIRY INTO DOG BREEDING The full report is available at: Preface The structure of the report is as follows. After an introduction to the dog and its domestication, the second chapter discusses scientific advances in the assessment of animal welfare. The third chapter deals in general terms with the genetics of inbreeding. The fourth chapter summarises the response to my call for evidence and the fifth summarises what was learned from the interviews conducted over the summer. The sixth chapter deals with the central problem of poor welfare that has arisen in the course of breeding dogs and the seventh chapter discusses ways forward in order to improve matters. The eighth chapter gives my recommendations. The background to the Inquiry was a showing by the BBC on 19 August 2008 of a television documentary called Pedigree Dogs Exposed. It was a hard-hitting piece of journalism written and directed by Jemima Harrison. It was aimed at those breeders of pedigree dogs who had ignored the adverse effects of inbreeding and particularly those who were breeding for extreme conformations. The United Kingdom s premiere dog club, the Kennel Club, felt that it had been unfairly treated and complained to OfCom, the regulator of the UK Communications industry. At the time of writing, this dispute has not been settled. Nevertheless, the BBC pulled out of its long-standing arrangement to televise Crufts dog show. Moreover, the public reaction was such that Dogs Trust, the Royal Society for the Prevention of Cruelty to Animals and the People s Dispensary for Sick Animals ended their support; and Pedigree Petfoods and Hills Pet Nutrition cancelled their sponsorship of the show. The Associate Parliamentary Group on Animal Welfare (APGAW) announced that it would hold hearings on the breeding of pedigree dogs. At the same time the Kennel Club combined forces with a leading dog charity, Dogs Trust, and announced an independent Inquiry into the breeding of all dogs. I was first telephoned in December 2008 by Mr Henry Hoppe, a senior official of the Department for the Environment, Food and Rural Affairs (Defra), and asked whether I would be prepared to lead an Inquiry into the breeding of dogs. I said that I would. On 9 January 2009 I duly met Mr Hoppe, Mrs Clarissa Baldwin, who is Chief Executive of Dogs Trust, Mrs Caroline Kisko, who is Secretary of the Kennel Club, some staff members of both organizations and some additional officials from Defra. I told them that I had not kept a dog in recent years, had no experience of dog breeding though I did breed pedigree cats in a small way (Russian Blues and Egyptian Maus), that I was not uncontroversial after I had led an Inquiry for the National Trust into the hunting of red deer with hounds, and that I had already made many unalterable commitments in The Kennel Club and Dogs Trust were content, nevertheless, that I should lead the Inquiry. My remit as stated for a review board is given in Appendix 1. The funders of the Inquiry agreed that I should be helped by a senior person who had experience of drafting minutes of meetings and drafting text for the report. I duly appointed Mrs Heather Peck who had led the Animal Welfare Section of Defra before her retirement. Our biographies are given in Appendix 2. Heather Peck has proved an excellent colleague and, even though this report is written in the first person, its preparation has emphatically been a collaborative effort between us both. After 9

122 AC April 10 AI 06 Annex A consultation, I appointed an Advisory Committee consisting of two geneticists, two animal welfare experts, three clinical veterinarians and a practicing veterinary surgeon. One of the geneticists was also a dog-breeder of long-standing. Details of the Advisory Committee are given in Appendix 3. On 29 January 2009 I met Eric Martlew MP, Chairman of APGAW. Although the remit for his inquiry was narrower than mine (see Appendix 4), we agreed to exchange evidence. It was important that we should do so, since the two inquiries overlapped and were both triggered by the same BBC programme. On 12 February I issued a call for evidence, details of which are given in Appendix 5. A substantial period of time was allowed for evidence to be prepared and the deadline for submission was set for 15 May The evidence was distilled and presented to the Advisory Group which met for the first time on 1 June. The Group worked well together and recommended people that Heather Peck and I should interview. The rest of the summer was devoted to interviews, visiting dog shows and dog breeders. We began to formulate conclusions that we presented to the Advisory Group when it met again on 10 September. At the end of October a draft of the report was distributed to the funders of the Inquiry, Defra officials, the members of the Advisory Group, and five anonymous referees nominated independently by the Association for the Study of Animal Behaviour, the British Veterinary Association and the Genetics Society. This draft did not include the recommendations in Chapter 8 or the Executive Summary. Comments on the draft report were received by the end of November and the report was completed in December, its format was designed by me and delivered to the printer after Christmas. The funders were shown the final report 72 hours before its official publication on 14 January Otherwise, nobody (apart from Heather Peck) has seen my firm recommendations given at the end of the published version of this report. Patrick Bateson Cambridge January 2010 Executive Summary The Inquiry into dog breeding was headed by Professor Sir Patrick Bateson FRS. It was funded by Dogs Trust and the Kennel Club but was conducted independently of both organisations. The Inquiry received the advice of dog breeders as well as experts in genetics, animal welfare, and veterinary surgery and the report was anonymously peer reviewed by five experts in the three scientific fields. Throughout the Inquiry Professor Bateson was greatly assisted by Mrs Heather Peck. The report opens with an account of the domestication of dogs and the astonishing variety of forms and behaviour that have been generated by artificial selection. It also considers the wide variety of ways in which dogs assist humans and are used by them. As background to the Inquiry, the science of animal welfare and the freedoms that should be granted to sentient animals are reviewed. The observations and assessments that can be utilised to measure welfare include: any physical damage to the animal, physiological and behavioural states that would be found in suffering humans, the extent to which the animal has been required chronically to operate homeostatic mechanisms that would normally operate acutely, 10

123 AC April 10 AI 06 Annex A the extent to which it behaves abnormally, and the animal s preferences when given a choice. Consideration is also given to the ecological conditions to which the animal is adapted, its normal social structure and whether or not it can express patterns of behaviour to which it accords high priority. The genetics of inbreeding are reviewed. Animals that are inbred are less likely than optimally outbred animals to survive and less likely to reproduce. Inbreeding can result in reduced fertility both in litter size and sperm viability, developmental disruption, lower birth rate, higher infant mortality, shorter life span, reduction of immune system function, and increased frequency of genetic disorders. A call for evidence by Professor Bateson received 135 written responses including 58 from breed clubs, 21 from breeders, 16 from veterinary surgeons, other scientists or academic institutions, 13 from dog or animal welfare charities and 10 from pet owners. Widespread concern was expressed about dogs that are farmed and bred for profit, sometimes on a large scale. The need for statistically significant and robust prevalence data of inherited disorders was listed as the key research need by everyone who addressed the topic. The balance of opinion was strongly in favour of action to resolve the worst abuses of current breeding practices, provided both that controls or standards apply equally to all dogs (not just pedigree or purebreeds) and that the details of breeding strategies are breed or cross-breed specific. Professor Bateson and Mrs Peck visited four dog shows and interviewed 50 individuals including politicians, civil and public servants, scientists, veterinary surgeons, dog breeders, and representatives of animal care charities. The subjects of the interviews covered existing academic research and the challenges that needed addressing in terms of prevalence of disorders and corrective surgery. Views on the current welfare problems and potential solutions to them were obtained from breeders and breeder organisations, pet nutrition and marketing businesses, and dog rescue and re-homing charities. Advice was also given on legal and enforcement challenges. A draft report was prepared at the end of October and independently peer-reviewed by five anonymous experts in genetics, animal welfare and veterinary surgery. Their comments were received by the end of November and incorporated into the final report. Many breeders exercise the highest standards of welfare, are passionate about caring for their dogs properly and take great trouble to ensure that their puppies go to good homes. Nevertheless, current dog breeding practices do in many cases impose welfare costs on individual dogs from a variety of causes including the following: negligent or incompetent management with a particular impact on breeding bitches but also including failure to socialise puppies appropriately; use of closely related breeding pairs such that already high levels of inbreeding are worsened; use of breeding pairs carrying inherited disorders such that inherited disease is transmitted to offspring; artificial selection for extreme characteristics that are directly responsible for failure to meet one or more welfare criteria; and the sale of dogs that are unsuited to the conditions in which they will be kept by their owners. Improving the situation will require cooperation and action at many different levels and by many different people: research scientists, the specialist dog breeders and the clubs to which they belong, the veterinary profession, the dog protection and re-homing charities, the members of the public who buy dogs, Local Authorities, Central Government and Devolved Administrations, when breaches of the law persist. The means for effecting change are those that encourage, guide and (where necessary as a last resort) enforce beneficial changes in the behaviour of those connected with the breeding of dogs. 11

124 AC April 10 AI 06 Annex A The best available science and advice should be provided to breeders to guide their efforts, together with harnessing the knowledge, skill and commitment to welfare that already exists within the dog breeding community. Those breeders who deliver genuinely high welfare standards should be rewarded and recognised for their efforts, both in the show ring and in the market place. Prospective dog owners should be advised on what constitutes good welfare in dogs, how to identify a dog breed or type suitable for their personal circumstances, and how to find a dog breeder or other source that will reliably provide a fit, healthy and appropriately socialised dog plus necessary documentation covering identification and guidance. A non-statutory Advisory Council on Dog Breeding should be established. The key role of the Council should be to develop evidence-based breeding strategies that address the issues of poor conformation, inherited disease and inbreeding, as appropriate to the specific breed, and to provide advice on the priorities for research and development in this area. High priority should be given to the creation of a computer-based system for the collection of anonymised diagnoses from veterinary surgeries in order to provide statistically significant prevalence data for each breed. Initially, priority should be given to collecting data with respect to the conditions creating the greatest welfare challenges in terms of pain, impact on quality of life, capacity for correction, and early age of onset. The data collected should relate both to the incidence of inherited disease and to the incidence of veterinary procedures necessary to correct faults due to selection for extreme morphologies. Those drafting Breed Standards should have regard to the need to avoid the selection for extreme morphologies that can damage the health and welfare of the dog and to the guidance of the Advisory Council on Dog Breeding when available. Where a problem within a breed already exists, the Breed Standard should be amended specifically to encourage the selection for morphologies that will improve the welfare status of the breed. An upgraded Accredited Breeder Scheme should be implemented guaranteeing among other matters that all pre-mating tests for inherited disease appropriate to the breed or breeds are undertaken on both parents, that no mating takes place if the tests indicate that it would be inadvisable, any prospective purchaser is able to view the puppies with their mother, every puppy is identified by microchip prior to sale and all pre-sale tests on the puppy that are appropriate to the breed have been carried out; and that the duty of care which every dog breeder owes to the parent dogs and puppies for which they are responsible is fully met with regard to both health and welfare. Irrespective of whether they are members of an Accredited Breeder scheme, all breeders should have their puppies microchipped before they are sold. Prospective purchasers should expect that this has been done before buying a puppy. When inspecting the premises of breeders that require licences, Local Authorities should address all welfare issues covered by the Animal Welfare Act 2006, especially those relating to dog behaviour. In issuing a licence Local Authorities should specify and inspect the staffing levels necessary to ensure appropriate health and welfare, including exercise of parents and socialisation of the puppies. Breeders records should be inspected to ensure that breedappropriate pre-mating tests and screening programmes have been carried out with regard to both parents. Regulations should be established under the Animal Welfare Act 2006 in order, among other matters, to require that all puppies should be indelibly identified before sale and that any person 12

125 AC April 10 AI 06 Annex A breeding dogs should have regard to the health and welfare of both the parents and the offspring of the mating. A statutory Code of Practice on the Breeding of Dogs should be established under the Animal Welfare Act Regulations should be made under the Animal Welfare Act 2006 to replace the various Breeding and Sales of Dogs Acts. The British Veterinary Association (BVA) should compile, and provide to Local Authorities, a list of veterinary practitioners willing to carry out and/or support inspections of licensed breeding premises. The Royal College of Veterinary Surgeons and the BVA, working with the profession as a whole, should lead a shift in emphasis to preventative veterinary medicine rather than simply the correction of problems after they have occurred. Complementing all existing schemes, a public awareness and education campaign should be designed by expert practitioners, in order to persuade the general dog-buying public to change its behaviour in specific key respects and to provide readily comprehensible information on what questions to ask and what to look for when buying a dog. This should be supported and run by as many as possible of the dog and animal welfare organisations acting jointly and in unanimity. When available, the buying public should be encouraged to purchase only from breeders participating in a robust and audited accreditation scheme. Chapter 7 - Ways Forward The Veterinary Profession 7.35 The veterinary profession faces a dilemma with regard to small animal welfare in general and dogs in particular. Many of the conditions facing dogs as a result of selective breeding are subject to surgical correction. It is only the ready availability of modern veterinary medicine that has permitted some conditions such as the inability to give birth without surgical intervention to become widespread. Veterinary surgeons, both in perception and potentially in reality, face two conflicts of interest: a. The conflict between the income they derive from correcting faults and their duty to advise against breeding practices that cause such faults to proliferate. b. The conflict between what they should advise their client to do and what their client wants to do. The latter is most starkly exposed in the non-reporting of dogs with poor hip scores I acknowledge that in many cases the individual veterinary surgeon has little or no opportunity to provide timely advice to a client considering either breeding from a bitch or purchasing a puppy. In most instances the client is already committed before advice is sought In some areas, however, the profession could take a lead where it would be both practicable and reasonable for it to do so. These include: a. Collection of anonymised data from veterinary surgeries. b. Provision of assistance and information in support of moves to reduce the incidence of specific conditions. 13

126 AC April 10 AI 06 Annex A c. Provision of expert support for the enforcement of dog breeding and sales legislation, perhaps at pro bono rates (as do the legal profession when working in the public interest). The Legal Framework and Enforcement 7.48 In many quarters the view is strongly expressed that each dog in the United Kingdom should be microchipped, preferably by the breeder. One argument for doing so is that microchipping would greatly facilitate those whose job it is to control abuses of dog welfare by making it much easier to trace animals back to the owner and breeder. It would enable owners of errant pets to get them back more easily and also make dog owners more responsible. It would be a deterrent against dog theft and possibly lead to savings to Local Authorities by reducing kenneling costs. Discussion 7.57 The flaws and shortcomings in the currently available data are clear and remedying these gaps in knowledge should be given high priority. I do not accept that nothing needs to be done until more data are available. In considering how to address the issue of improving welfare for dogs, it is helpful to characterise the desired end result. Ultimately, the aim is for a society in which: a. Sound scientific data is available to guide decisions and advice. b. The primary and overriding objective for all dog breeders and show judges is the welfare of the individual dogs and of the breed as a whole, to which all cosmetic and breed specific criteria are subordinate. c. Breeders are able and willing to use available scientific data to guide their breeding decisions in order to achieve their welfare objectives and reduce levels of inbreeding. d. The veterinary profession, collectively and individually, combine preventative medicine with their curative and remedial work through the provision of screening programmes and science driven advice. e. Purchasers are educated and informed in their approach to selecting a breed and an individual dog; they are aware of health and welfare risks with regard to particular breeds or crosses, know how to find a breeder who can deliver genuinely high welfare status puppies, and take advantage of specialist screening and advice in order to ensure that when they invest in a dog they find one that is fit for their home environment in terms of type, temperament, health and socialisation Achieving the shift from where we are now to the desired end state is primarily an issue of behavioural change on the part of breeders, owners, veterinary surgeons, purchasers and all those bodies with an interest in dog welfare. However, all initiatives for change should be 14

127 AC April 10 AI 06 Annex A evidence-based. As a matter of high priority, a health and welfare recording system should be established enabling data on the prevalence of specific disorders, by breed or cross-breed, to be collected from veterinary surgeries and elsewhere. 8.5 Working with the profession as a whole, the RCVS and the BVA should lead a shift in emphasis towards preventative veterinary medicine rather than simply focus on the correction of problems after they have occurred. Addressing poor or negligent management in the care of breeding dogs 8.11 The British Veterinary Association should compile, and provide to Local Authorities, a list of veterinary practitioners willing to carry out and/or support inspections of licensed breeding premises. Chapter 8 - Recommendations Addressing inbreeding, inherited disease and selection for extreme morphologies 8.1 A non-statutory Advisory Council on Dog Breeding should be established. The key role of the Council should be to develop evidence-based breeding strategies that address the issues of poor conformation, inherited disease and inbreeding as appropriate to the specific breed and to provide advice on the priorities for research and development in these areas. I recommend that the Advisory Council members and Chairman should be appointed by open competition according to Nolan Principles. Defra should manage the selection process, drawing appropriately upon the advice of the devolved authorities and experts. Members should be selected on the basis of their personal expertise and not with regard to any personal affiliation or membership. Draft terms of reference and proposals for funding the Council are given at Appendix High priority should be given to the creation of a computer-based system for the collection of anonymised diagnoses from veterinary surgeries in order to provide statistically significant prevalence data for each breed. This should build upon the work already started by the Royal Veterinary College. It is important that this scheme is fully supported by the Royal College of Veterinary Surgeons. In a pilot scheme, priority should be given to collecting data with respect to the conditions creating the greatest welfare challenges in terms of pain, impact on quality of life, capacity for correction, and early age of onset. The data collected should relate both to the incidence of inherited disease and to the incidence of veterinary procedures necessary to correct faults due to selection for extreme morphologies (e.g. Caesarean sections, corrections for entropion, soft palate resections, etc). 15

128 AC April 10 AI 06 Annex A Appendix 3 Advisory Group to the Inquiry Chairman: Members: Professor Sir Patrick Bateson MA PhD ScD FRS Emeritus Professor of Ethology, University of Cambridge Professor William Amos BA PhD Professor of Evolutionary Genetics, Cambridge University Andrew Ash BVet Med, MRCVS Junior Vice-President BSAVA, Grove Lodge Veterinary Group Ltd Dr Brian Catchpole BVetMed PhD MRCVS Senior Lecturer in Veterinary Immunology, Royal Veterinary College Dr Bruce M Cattanach BSc PhD DSc FRS Emeritus scientist, MRC Mammalian Genetics Unit, Harwell Professor Sheila Crispin PhD FRCVS University of Bristol Professor Ian McConnell BVMS MA PhD MRCVS Emeritus Professor, University of Cambridge Dr Roger Mugford PhD Company of Animals Professor Christine Nicol MA DPhil Professor of Animal Welfare, University of Bristol Secretary: Mrs Heather Peck BSc FCIPD 16

129 AC April 10 AI 06 Annex B 1. Dr Viner's presentation, on microchipping, covered the following ground: - there was currently no RCVS line on whether the microchipping of dogs should be made compulsory; - the College took the view that veterinary surgeons were not responsible for routinely scanning animals presented in practices to see whether or not the client was the registered owner; - the microchipping of companion animals entailed the subcutaneous injection of a small chip, rather larger than a grain of rice, using a syringe rather larger than that required for normal injections. The College took the view that, as a general rule, subcutaneous implantation in cats and dogs did not amount to the practice of veterinary surgery; - the technology had moved on, with increasingly reliable hardware, growing standardisation across Europe and the development of other functions than identification (eg using the chip to read temperatures and potentially other clinical indicators); - there was growing public acceptance of microchipping, partly as result of the PETS scheme, and BVA and the Kennel Club had made identification by microchipping or tattooing a requirement of the health schemes. Compulsory microchipping was likely to feature in the manifestos of all three major parties; - the benefits of microchipping included reuniting lost animals with their owners, pinning responsibility for animals on to the registered owner, and identifying animals unequivocally for health schemes; - the disadvantages included the need to implant chips in very small, young animals (the Bateson report recommended that puppies should be microchipped before sale by the breeder); cost, though this was modest (typically for implantation in a veterinary practice); occasional failure or migration of chips; problems of confidentiality if practices discovered that the client's details did not match the entry on the database; and objections to the infringement of individual liberty which any compulsory scheme would entail. 2. Dr Viner suggested that the RCVS ought to have a policy on compulsory microchipping. In his view the College ought to support this for dogs, and perhaps for cats. If that was agreed, the policy would need to be communicated, and the particular issue of implantation in very young animals would need to be addressed. Looking at the criteria listed in paragraph 2 of the paper, Dr Viner suggested that it would indeed be possible to reach agreement on a College line, that pursuing the topic would be compatible with the statutory role, that action was feasible, and that the subject did engage the public interest. There would, however, probably be no ill consequences if action were not taken. 3. The following points were made in discussion: - compulsory microchipping of most horses was being phased in, and sheep would soon have to be identified electronically; 17

130 AC April 10 AI 06 Annex B - the established practice of microchipping laboratory mice suggested that implantation in small animals was not a real problem, though some unease over this was understandable; - scanning in veterinary practices was bound to cause difficulties from time to time when owners failed to register a change of details, and veterinary surgeons would also need to know what to do if an animal was presented with no chip; - statutory dog licensing had been abandoned as being unenforceable and expensive, with the licence fees not covering the costs of administration. Compulsory microchipping would shift the costs on to the owner of the animal, but it would still be necessary to demonstrate a public benefit. The issues would be different for companion animals, food animals and competition animals; - further factors in the argument were the Bateson recommendations on dog breeding, the prospect of a rise in certain zoonotic diseases of dogs as a result of climate change extending the range of the invertebrate vectors, and the evidential value of microchipping in disciplinary proceedings where individual animals needed to be identified. The reporting of the correction of certain defects to the Kennel Club made little sense without microchipping to identify the dog; - it was argued that the College should not be seen to advocate compulsory microchipping of companion animals or push veterinary surgeons into playing policeman by carrying out routine scanning. The RCVS was liable to be seen as trying to drum up business for veterinary practices if it favoured compulsion. That should be left to the BVA and breed societies; - it was urged that the College should support the principle of microchipping but not compulsion. The owners whose dogs most needed to be identified were those least likely to comply with compulsory microchipping, and there was a danger that they would refrain from taking their dogs to a veterinary surgeon in order not to be found out. The requirements for horse passports were still widely ignored; - there was indeed an issue over implantation in very small animals, and fatal injuries had been reported following implantation of microchips by nonveterinary surgeons; - in the BVA/KC health schemes tattooing was accepted as an alternative to microchipping and was very satisfactory when modern methods were used; - it should be born in mind that policy on compulsory microchipping would not be the sole preserve of the UK Government. The Welsh Assembly had launched its own review of the question. It was also noted that microchipping was already compulsory in many EU member states, and that identification and traceability were to be the themes of the European veterinary week in June. 4. It was agreed that a paper considering the issues further would be put to the Committee for its next meeting. In the light of the discussion it seemed that there was unlikely to be a consensus within the RCVS for compulsory microchipping, primarily because of the effect enforcement might have upon the relationship between veterinary surgeons and 18

131 AC April 10 AI 06 Annex B their clients, but the benefits were recognised and the College would be unlikely to wish actively to oppose it. Further actions would be to: - formulate a response to issues about implantation in puppies and kittens less than nine weeks old, seeking welfare advice as appropriate; - ensure policy makers were aware of the issues that would arise, particularly relating to enforcement; - be prepared to review RCVS guidance to members should compulsory microchipping become a reality. 19

132 AC April 10 AI 06 Annex B 20

133 AC April 10 AI 06 Annex C j. Microchipping Using microchips to help reunite animals with their owners 1. Microchips are implanted in companion animals to assist with their return if lost or stolen and veterinary surgeons are frequently the first point of contact for those owners whose animals are missing. 2. A microchip may be scanned in circumstances where, for example: the animal has been lost or is a stray, it is suspected that the animal has been stolen, or where a client is unaware that the animal has been microchipped. 3. Veterinary surgeons are encouraged to take appropriate steps to reunite the animal with the owner and if necessary contact the relevant database, for example, the PetLog Reunification Service (Tel petlogadmin@the-kennel-club.org.uk). 4. If it is suspected that the animal is stolen, veterinary surgeons or the owner may involve the police. Ownership Dispute 5. An ownership dispute may arise where a client presents an animal with a microchip registered in another person's name. With their consent, both parties to the dispute can be put in touch with each other. 6. If a client declines to consent to the release of his or her name and contact details and details of the animal and microchip, a veterinary surgeon should breach client confidentiality to pass the necessary information to the PetLog Reunification Service. * [If the registered owner declines to consent to the release of his or her name and contact details these should be known to the Petlog Reunification Service.] 7. PetLog Reunification Service will then seek to reunite the animal with the registered owner or update the relevant database. *The Petlog Reunification Service provides a standard form for veterinary surgeons to provide information to the service. The Petlog Reunification Service indicates: 'In the unlikely event that the Carer [client] is not willing for their details to be released or refuses to agree to return the animal they will be informed that the Registered Owner will be advised to seek legal advice. On instruction from a Solicitor or the Police PetLog can release details.' Professional Conduct Department 13 Feb February

134 AC April 10 AI 06 Annex D 22

135 AC April 10 AI 06 Annex D Dear BVA AWF DOG BREEDING STAKEHOLDER GROUP I am writing to you as a member of the stakeholder group as there has been a considerable amount of activity since we last met on 12 November Specifically, the Bateson report has been published and launched and the recommendations contained therein are now known. Additionally, the Kennel Club has held a number of stakeholder meetings at which they reported on their proposals in response to the Bateson, APGAW and RSPCA reports. One of those proposals included for the establishment of an Advisory Council; The Dog Health Group, to be chaired by Professor Sheila Crispin. The longevity of that group is, at this stage unknown and it might meet once or several times. It is known that The Dog Health Group will consider the Accredited Breeder Scheme, genetics and health screening and breed standards and conformation. Membership of the group will be drawn from a more diverse range of backgrounds than the membership of the BVA AWF group. Additionally, the Dogs Trust is looking to convene a meeting of interested parties over the next few weeks to discuss some of the wider implications arising out of the Bateson review. There are a number of unresolved/outstanding items arising from our last meeting and the question in light of all the above is therefore, is it your view that the BVA AWF stakeholder group should continue:- as is with revised terms of reference (eg to feed into the proposed Dog Health Group) with an extended membership (permanent or co-opted) or disband. One of the potential significant differences between the BVA led group and those proposed is that our group has the potential to consider the breeding and associated issues of other species as part of its remit. For example, there has been considerable media and other interest in the issue of the breeding of cats. I would be most grateful for your views with regard to the future of the BVA AWF stakeholder group which once known, will enable us to determine a way forward and ensure that either as a group or individually, we have the opportunity to have an ongoing input into the debate. Yours sincerely Steve Goody Secretary BVA AWF Dog Breeding Stakeholder Group 23

136 AC April 10 AI 06 Annex D 24

137 AC April 10 AI 06 Annex E COMPULSORY MICROCHIPPING OF DOGS RELEVANCE OF ISSUE TO THE RCVS: 1. Compulsory microchipping is an animal welfare issue that directly affects the veterinary profession. Furthermore, compulsory microchipping is developing significant political backing and forms one of the key proposals in the recent Defra consultation on the control of dangerous dogs. BACKGROUND: ISSUES: 2. Following discussions in the meeting of the RCVS Public Affairs Committee (PAC) on 14 October 2009, the Committee identified the compulsory microchipping of dogs as being an issue of high priority. As a consequence, Dr Bradley Viner was asked to present on the issue at the PAC meeting on 10 February Dr Viner addressed the advantages of compulsory microchipping and the potential issues, and proposed that the Committee should recommend to Council that the RCVS should support the compulsory identification by microchipping of all dogs in the UK on the grounds of animal welfare. 3. In the light of the discussion following Dr Viner s presentation it seemed unlikely that a consensus within the RCVS for compulsory microchipping could be found, primarily because of the effect enforcement might have upon the relationship between veterinary surgeons and their clients. The Committee, however, recognised the benefits of microchipping and considered that the College would be unlikely to wish actively to oppose it. 4. It was agreed that the issue should remain on the Committee s agenda for future meetings and that a paper on compulsory microchipping should be put before PAC at the meeting on 12 May It was also agreed that future actions would be to formulate a response to issues surrounding the implantation of chips in puppies and kittens, to ensure policy makers are aware of the issues relating to enforcement, and to review RCVS guidance should microchipping become compulsory. 5. Following the meeting, on 9 March 2010, Defra released a public consultation on dangerous dogs. A key policy proposal in the consultation is the imposition of legislation requiring the compulsory microchipping. The consultation closes on 1 June This consultation has received significant media coverage and the RCVS has been asked for its position on compulsory microchipping. 6. Microchipping is widely regarded as a safe, painless and reliable method for permanently identifying dogs. Such identification offers many benefits in the promotion of animal health and welfare, and the control of dangerous dogs. There are significant concerns, however, regarding the enforcement of such legislation. If veterinary surgeons were expected to police any policy of compulsory microchipping this could have a negative effect on animal health and welfare, by adversely affecting the client vet relationship. There are also issues surrounding animal welfare where chips are implanted in puppies and small breeds of dogs, and concerns about developing appropriate training for those implanting chips in order to ensure that animals do not suffer from adverse reactions to poorly implanted microchips. A full discussion of the issues surrounding microchipping is available in Annex A. 25

138 AC April 10 AI 06 Annex E SUMMARY: 7. The issue of compulsory microchipping is gaining considerable support and whatever the outcome of the forthcoming election, legislation on microchipping seems probable. It could be argued that by publicly supporting the principle of compulsory microchipping on the grounds that it is an accurate and reliable form of permanent identification and as such can assist in improving animal health and welfare, the RCVS would be in a strong position to present the issues surrounding such a policy, and to educate and advise the public, media and legislators as to how any law should be implemented and the protocols that will need to be developed. This could therefore ensure that any legislation that is passed will have the maximum possible benefit for animal health and welfare. ISSUES FOR CONSIDERATION: 8. The Committee is invited to consider supporting the draft position statement on microchipping and to recommend its adoption to Council. SUMMARY OF ISSUES AND POLITICAL CONTEXT Annex A The following Annex summarises the principal advantages and disadvantages of the compulsory microchipping of dogs and seeks to provide political context to the issue. Whilst other forms of permanent identification exist, such as tattooing, this paper exclusively considers the issues surrounding microchipping. 1. The compulsory microchipping of dogs potentially has many advantages for the welfare of dogs and for the control of dangerous dogs. These include: a. Legal responsibility i. If all dogs were microchipped then it could assist in providing clear and accurate information as to who owns a particular dog. Such identification may be of assistance when attempting to secure prosecutions relating to dangerous dogs. Consequently, microchipping could serve to improve the enforcement of the legislation surrounding dangerous dogs. b. Recovery of lost pets i. According to the Dogs Trust, in 2008, 97,000 stray dogs were picked up by local authorities. As a permanent form of identification, microchipping, unlike collar and tag identification systems, could provide a much more accurate and efficient means of identify the owner of a stray and returning the stray home. It is also maintained that microchipping discourages the abandonment of dogs and could significant reduce incidents of dog theft. c. Inherited defects 26

139 AC April 10 AI 06 Annex E i. One of the recommendations of the Independent Inquiry into Dog Breeding (2010) led by Professor Sir Patrick Bateson was that all puppies should be indelibly identified, by the implantation of microchip or such other equivalent system as may be developed. It is argued that this would assist in identifying where dogs were bred and thus aid in reducing incidents of inherited defects by addressing bad practices such as in-breeding. d. Pet insurance i. The use of microchips may help to ensure that the animal presented for treatment is the same animal that is covered by a pet health or insurance scheme, thus potentially reducing incidents of insurance fraud. e. Improved diagnostics i. Microchip technology is constantly developing and new chips may be able to assist veterinary surgeons in the clinical evaluation of animals. Microchips are available that can store clinically relevant information about the chipped animal and new advanced chips can measure the body temperature of animals without the need for invasive procedures other than the implantation of the chip itself. 2. Whilst there are many advantages to the compulsory microchipping of dogs there are a number of disadvantages and potential pitfalls including: a. Chip reliability b. Cost i. It is generally accepted that microchips have excellent reliability and are regarded as one of the best ways to permanently identify an animal. Nevertheless, there are instances of chip failure and scanning equipment is not always 100% accurate. Scanners may not find the chip or even in very rare cases have been shown to pick up the wrong code from the chip (Lord, L. et al., 2008, Sensitivity of commercial scanners to microchips of various frequencies implanted in dogs and cats in JAVMA, Vol 233, No.11, December 1, 2008). i. Compulsory microchipping would place an additional financial burden on dog owners. The Dogs Trust maintains that the average cost of microchipping a dog is 25, but acknowledges that welfare organisations may do this at a lower cost or sometimes free of charge. The Defra consultation paper raises concerns that compulsory microchipping may place an extra burden on animal welfare charities as they may not only have to pay for the microchipping of dogs, but also take more dogs in as people refuse to cover the cost of chipping. Others argue, however, that as microchipping may help animals to be returned to their owners more quickly it could reduce the burden on animal welfare charities. c. Animal Welfare 27

140 AC April 10 AI 06 Annex E i. Microchips are, as the name suggests, small and the procedure of implanting the chip is generally considered to be safe and painless, nevertheless animal welfare concerns have been raised regarding the implantation of the chips in young puppies and especially in the puppies of small breeds of dog. ii. iii. Poorly implanted chips can lead to severe injuries during implantation, increased risks of microchip migration and may have adverse effects on diagnostic techniques such as MRI scanning. Appropriate training and qualifications for the person responsible for implanting the microchip could help to address this issue. Currently there is no legislation as to who can implant microchips in the UK, RCVS guidance however states that microchipping should only be undertaken by a veterinary surgeon when it is via a method other than the subcutaneous route, eartags or bolus. As dogs are microchipped subcutaneously there is no requirement for a veterinary surgeon to perform the procedure. In other European countries only veterinarians are allowed to implant microchips (Swift, S., 2000, Microchip adverse reactions in Journal of Small Animal Practice, May 2000, Vol 41 p232,). Microchipping dogs is generally considered to be a safe procedure, but concerns have been expressed regarding potential adverse reactions to the implantation of microchips. Between 1997 and 1999 the British Small Animal Veterinary Association s (BSAVA) Microchip Adverse Reaction Scheme received reports of 61 reports of adverse reactions representing a rate of one per 19,869 implanted chips. Out of fifty-six dogs and three cats with reported reactions to microchipping, there were 47 chip migrations, one complete chip loss, four chip failures and three reports of abscesses (Swift, S., 2000, Microchip adverse reactions in Journal of Small Animal Practice, Vol 41 p232, May 2000). In what appear to be extremely rare cases, however, there have been reports of tumours occurring at the site of the implanted chip (see Vascellari, M., 2003, Liposarcoma at the site of an implanted microchip in a dog in The Veterinary Journal, 168, (2004), pp ). d. Role of the veterinary surgeon i. Legislation requiring the compulsory microchipping of dogs would need to be policed, if veterinary surgeons had a role in ensuring that legislation was enforced it is argued that this could have a detrimental effect on animal welfare. If, for example, it were widely known that veterinary surgeons routinely scan all dogs coming into their practices to check for the presence of a microchip, it might deter those with something to hide from visiting. This could have a negative impact on animal health and welfare. Moreover if a dog were found to be registered with a different owner from the one presenting the animal this would raise the question of whose responsibility it would be to sort out the problem and whether a vet would be required to report this to the authorities. If veterinary surgeons were required to act as 28

141 AC April 10 AI 06 Annex E policemen it could adversely affect the relationship between vet and client. POLITICAL CONTEXT e. UK political support i. There currently appears to be significant political support for the compulsory microchipping of dogs, with both the Labour and Conservative parties expressing support for such legislation. Moreover, the issue of the control of dangerous dogs is receiving growing interest in parliament and the media. Further attention has been drawn to this topic following the attack on Betty Williams MP by a Rottweiler - and the recent publication (9 March) of the Defra consultation on dangerous dogs. f. Wider support for compulsory microchipping i. The BSAVA, RSPCA and the Dogs Trust have all publicly expressed support for the compulsory microchipping of dogs. g. European context i. In a number of European Countries (Austria, Belgium, Bulgaria, Czech Republic, Denmark, Finland, France, Germany, Luxembourg, Portugal, Sweden, Slovenia and Switzerland) permanent identification in the form of either a tattoo or more commonly by microchipping is obligatory. h. Defra consultation i. A key policy proposal in the Defra Consultation on dangerous dogs is the imposition of legislation requiring the compulsory microchipping. The publication of this consultation has led to considerable media coverage of the issue of the control of dangerous dogs, compulsory microchipping and compulsory third-party insurance for all dogs, dubbed Labour s Dog Tax. Given the timing of the Consultation (published immediately before an election, with a closing date around a month after the expected election date) and the relatively concise nature of the document, it could be argued the consultation exercise is an attempt to show that the Government is tackling the issue of dangerous dogs rather than a true consultation on the future policy surrounding the control of dangerous dogs. Whilst proposals in the consultation may not be implemented, the consultation has brought significant media attention to the issue of the control of dangerous dogs and compulsory microchipping, and the RCVS has been asked for comment by various trade publications. 29

142 AC April 10 AI 06 Annex E Annex B RCVS DRAFT POSITION STATEMENT March 2010 COMPULSORY MICROCHIPPING OF DOGS 1. The Royal College of Veterinary Surgeons (RCVS) accepts the benefits of compulsory microchipping of all dogs, on the grounds that the permanent and accurate identification of a dog has a positive impact on animal welfare and may assist in the control of dangerous dogs, but has some reservations about its implementation. The RCVS also acknowledges that other forms of permanent identification such as tattooing exist and are effective. REASONS FOR SUPPORTING COMPULSORY MICROCHIPPING 2. Microchipping is widely regarded as a safe, painless and reliable method for permanently identifying dogs. Such identification offers many benefits in the promotion of animal health and welfare. a. Microchip identification provides an accurate and efficient means of returning stray dogs to their owners and may also serve to reduce incidents of the abandonment or theft of dogs. b. Microchipping can assist veterinary surgeons by helping them to identify the animal being presented, retrieve clinically relevant details and establish whether it is covered by pet insurance. c. Microchipping puppies prior to sale could assist in identifying where dogs were bred and help to reduce the poor breeding practices that can lead to inherited defects and diseases. The indelible identification of all puppies by microchip or other such equivalent system as may be developed was one of the recommendations of the Independent Inquiry into Dog Breeding (2010) led by Professor Sir Patrick Bateson. d. Permanent identification, such as microchipping, has an important role to play in the control of potentially dangerous dogs as the accurate identification of animal and owner is crucial to the enforcement of legislation and to achieving successful prosecutions. CONCERNS 3. Whilst in principle supporting the compulsory microchipping of dogs, the RCVS considers that there are certain issues that should be addressed before the implementation of legislation. a. In order to be effective, any legislation requiring the compulsory microchipping of dogs would need to be enforced. The RCVS does not consider that veterinary surgeons should be expected to police any policy of compulsory microchipping as this could have a negative effect on animal health and welfare. If, for example, it were widely known that veterinary surgeons routinely scan all dogs coming into their practices to check for the presence of a microchip, it might deter those with something to hide from visiting. Moreover, if a dog is found to be registered with a different owner from the one presenting the animal this would raise the question of whose responsibility it would be to sort out the problem and whether a vet would be required to report this to the 30

143 AC April 10 AI 06 Annex E authorities - it is not the role of a veterinary surgeon to act as police officer and to do so could adversely affect the relationship between vet and client. b. Microchips are, as the name suggests, very small (about the size of a large grain of rice) and the procedure of implanting the chip is generally considered to be safe and painless, nevertheless animal welfare concerns have been raised regarding the implantation of the chips in young puppies and especially in small breeds of dog. It is imperative that the veterinary profession is involved in the development of any legislation concerning the compulsory microchipping of dogs, in order to determine protocols for the age at which microchipping performed. c. Poorly implanted chips can lead to severe injuries during implantation, increased risks of microchip migration and may have adverse effects on diagnostic techniques such as MRI scanning. Appropriate standards of training for those charged with implanting microchips must be developed, through a process of thorough consultation with the veterinary profession. For further information please contact: Anthony Roberts RCVS Policy and Public Affairs Officer T: F: E: a.roberts@rcvs.org.uk 31

144 AC April 10 AI 07 MEETING Advisory Committee DATE 20 April 2010 TITLE CLASSIFICATION SUMMARY DECISIONS REQUIRED Communication and Consent Unclassified To consider a new advice note giving advice on communication and consent issues in relation to sample use and re-use. To approve the draft Advice Note on Sample Use and Reuse To approve the changes to the current annex on postmortem examinations ATTACHMENTS AUTHOR Annex A Note of the Communication and Consent Working Party meeting December 2009 Annex B Current annex to the Guide on Communication and Consent Annex C Proposed advice note on Sample Use and Reuse, Post Mortems and Disposal Annex D current annex to the Guide on advice on postmortem examinations Lucy Evans Professional Conduct Department lucy@rcvs.org.uk 1

145 AC April 10 AI 07 2

146 AC April 10 AI 07 BACKGROUND 1. The Communication and Consent Working Party met in December 2009 and recommended alterations and additions to the advice on Communication and Consent. The note of this meeting was reported to Advisory Committee in January 2010 and a copy of the note of this meeting is attached as annex A. 2. The Working Party suggested further advice on blood, tissue, body part and cadaver: use, retention and re-use. The Working Party suggested that the annex to the Guide on Communication and Consent could be altered to take into account their recommendations. 3. Many of the concerns of the Working Party have already been addressed in the communication and consent annex to the Guide to Professional Conduct, agreed by the Working Party. These are detailed below. Therefore, it is proposed that the annex on communication and consent will remain in its current form; this is attached as annex B. 4. The remaining issues are dealt with in a new RCVS Advice Note on the Use and re-use of samples, post mortems and disposal of cadavers ; (attached as annex C) to replace the existing annex to the Guide on post mortems (attached as annex D). DISCUSSION/ ISSUES 5. The issues considered already in the current Annex to the Guide on Communication and Consent include: a) that consent forms should include confirmation that the signatory is over 18 years of age: this is included in the sample consent forms for anaesthesia and surgical procedures, and euthanasia. b) that the forms should include the relationship of the signatory to the owner of the animal. The current sample forms contain a declaration by the person that he or she has authority to act on behalf of the animal owner. If a veterinary surgeon doubts a signatory s capacity, full enquiries should be made and an objective opinion formed before proceeding. It was suggested that such enquiries should include ascertaining whether a power of attorney or some other authority to act on behalf of an owner exists. This guidance is contained in the current annex at paragraphs 24 and 25 which deal with mental incapacity. c) specific wording to be included in the sample forms which has been included. These are detailed in paragraph 29. a. and b. in the minutes from the Working Party meeting of December d) that potentially difficult situations should be highlighted in the guidance to provoke thought, such as when an animal is not accompanied by the client, for instance when a client s neighbour presents the animal on his/her behalf. This 3

147 AC April 10 AI 07 is included in the current guidance at paragraphs 13 and 14 Who is the Client? which provides that care should be taken when consent is given by a client who is not the owner of the animal and lists general matters to consider when dealing with circumstances of this nature. e) that generic information should be included on the relevant form to acknowledge the inherent risks of surgery as well as anaesthesia. This is covered in the current specimen form, which states; I understand that there are some risks involved in all anaesthetic techniques and surgical procedures. f) that generic examples of common circumstances in which consent should be sought, but when this may not be sought. The current annex on Communication and Consent gives examples, through a quote from the Practice Standards Scheme Manual of situations in which consent should be sought in General Practice for all procedures including diagnostics, medical treatments, surgery, euthanasia and when a patient is admitted to the care of a veterinary surgeon. g) that advice should be drafted with certain religious positions in mind. This issue has been considered by Advisory Committee in the past, when it considered support of a DEFRA religious protocol in September It was decided then that it was not appropriate for the RCVS to be named in the protocol. 6. Those issues which were not covered in the current Communication and Consent annex have been addressed in the new advice note which the Committee is asked to consider and approve. 7. The Working Party suggested that an extra guidance point should be added to the second page of the sample form in relation to taking samples. This has not been dealt with in the new advice note. 8. The Working Party also highlighted the need to change the annex to the Guide to Professional Conduct on post-mortem examinations. The Working Party agreed the general principle that consent for a post-mortem must be recorded on a relevant consent form; however, this consent may be obtained over the telephone where necessary and that veterinary surgeons should be mindful that owners may be in a delicate state at this time. The current annex to the Guide on post-mortems has been revised and included in the new advice note. 9. The Working Party also discussed whether guidance should be given on the disposal of animals after euthanasia and whether the consent should include further options for disposal such as home burial or cremation with ashes returned or not returned. This issue has also been covered in the new advice note which suggests that consent should be sought for disposal and that veterinary surgeons should ensure third party contractors are appropriately licensed. The advice note also sets out the guidance on disposal contained in the new draft of the Practice Standards (PSS) Manual. 4

148 AC April 10 AI 07 CONCLUSIONS 10. The Advisory Committee is asked to approve the draft advice note and recommend this to Council; as a replacement to the current annex to the Guide to Professional Conduct on post-mortem examinations. 5

149 AC April 10 AI 07 Annex A 6

150 AC April 10 AI 07 Annex A ROYAL COLLEGE OF VETERINARY SURGEONS CONSENT AND COMMUNICATIONS WORKING PARTY NOTE OF MEETING HELD AT BELGRAVIA HOUSE ON 7 DECEMBER 2009 AT 10 AM Present: Mr Peter Jinman, Chair and Council Member Mrs Diane Mark, former Lay Observer, Preliminary Investigation Committee Ms Barbara Saunders, Council Member (until 12:30) Mr Fred McKeating, Technical Director, Veterinary Defence Society Mr Harvey Locke, President Elect, British Veterinary Association Ms Adrienne Conroy, independent In attendance: Mr Jamie Hollis, Advisory Manager, Professional Conduct Department Apologies 1. Apologies were received from Professor Alistair Barr, Council Member. 2. Mr Jinman welcomed everyone to the meeting and asked those present to introduce themselves. Consent and Communications Advice 3. The group considered the provision of consent and communications advice generally, and it was noted that the desire of the group was to produce sound advice to assist the Advisory Committee in relation to what was a fundamental issue. The group were mindful to ensure that any advice highlighted responsibilities or areas for veterinary surgeons to consider without being overly prescriptive. 4. The discussion turned to the paper produced by Defra advisory group, The England Implementation Group of the Animal Health and Welfare Strategy for Great Britain, (EIG paper) in relation to using veterinary samples for more than their original purpose. 5. It was noted that it can be difficult for national campaigns involving disease surveillance in light of restrictions on the reuse of samples. It was further noted that this, in addition to questions raised by the profession, and concern following the events at Alder Hey have led to the current discussion. In particular, the group need to consider consent in the context of the use or reuse of samples in another sphere from that originally intended. It was acknowledged that the EIG paper contained useful background to the discussion. 6. It was however noted that while there seemed to be an emphasis on the retention of materials, there was little mention of the retention of body parts in the paper, and that 7

151 AC April 10 AI 07 Annex A this would be a particularly important issue in the case of domestic pets in that it may attract a significant amount of public interest. It was suggested that both the EIG paper, and the profession generally tended to look to human medicine for a lead in this area, when that may not always be relevant. Distinctions could be drawn between certain aspects of veterinary practice, and a holistic view should be taken. 7. It was agreed that the issues needed to be considered in the context of how they specifically related to veterinary practice. It was also agreed that the use of legalistic language could cause confusion, and that the group s advice should be expressed in common language so as to be understandable by all. 8. The group discussed the circumstances under which the retention of animal body parts may occur. It was noted that body parts may be retained both from domestic animals and from animals kept for commercial purposes. 9. It was clarified that the group was dealing only with issues of consent pertaining to animals under our care, so this would include all species and sizes of animal. There was no distinction drawn between farm or domestic animals, or between living and dead animals. Although there was some debate about the point at which ownership of a dead animal passes to a veterinary surgeon tasked with its disposal, it was agreed that consent advice would apply to dead animals including those retained for post mortem investigation. It was also agreed that advice would apply equally to blood, tissue and body parts, regardless of the intended purpose for retaining or reusing these, to ensure consistency across the board. It was noted that separate advice for separate material may lead to confusion depending on the definitions used. It was acknowledged that there may be situations giving rise to shared ownership, for instance when a sample may belong to an owner, but the data derived from the sample may belong to the veterinary surgeon. 10. It was noted that the group were not trying to close off certain activities, but wished to allow those activities to occur in an honest and open way. It was also noted that further advice seeking to raise standards may have the effect of reducing the number of samples available, as was the case in the human medicine field when similar steps were taken. The group were also conscious that other religious positions needed to be considered when advice was formulated. 11. The group discussed the increasing interest in clinical audit, and veterinary surgeons desires to confirm diagnosis with the use of samples or further testing. It was commented that further and more specific Practice Standards Scheme guidance in this area may be of assistance, in addition to the existing more general clinical governance requirements. Consent 12. The group agreed that the starting point in any situation involving the use of samples was that consent was necessary. Should an owner consent to a sample being used for initial diagnostic purposes, and a further use becomes necessary, then consent should also be obtained for that additional use. 8

152 AC April 10 AI 07 Annex A 13. In order to determine the permissible limit of initial testing, the veterinary surgeon must be satisfied that the test is related to the well-being or benefit of that particular animal or of animals within the ownership of the person giving consent. It was acknowledged that there may be exceptions to this rule when dealing with matters of statutory surveillance. Method of consent 14. The group discussed the method of giving consent, and whether this should be by a procedure involving opt-in or opt-out. Ideally this should reflect the expectations of the majority of animal owners, although this preference may be difficult to establish. A third option was the inclusion of a comprehensive statement to clients advising that samples may be retained or used for other purposes without giving them the option of not agreeing to this. The group felt that this might be appropriate in some cases for general disease control, but not under other circumstances. 15. It was agreed that an appropriate statement should be added to relevant forms, accompanied by a tick box to confirm consent. This was thought to be a more positive acknowledgement by the client than a tick box to opt out, and would place the onus on the veterinary surgeon to explain what the client was consenting to. It was further agreed that a second negative statement should be included to allow clients the opportunity to decline consent, with a tick box to confirm. 16. The group agreed that such statements could include a general acknowledgement by the client that they have agreed to the intended use of the sample, and that they had this explained to them by the veterinary surgeon. It was felt that this would encourage veterinary surgeons to seek consent when necessary, document this consent where given, and ensure it was informed consent by discussing with the client. The Professional Conduct Department would be asked to develop draft wording for consideration by the group. 17. The group considered it appropriate for a copy of the form to routinely be provided for the client in order to assist with any problems that may arise later. 18. The group discussed the relationship between the veterinary surgeon and the Veterinary Laboratories Agency (VLA) when samples are submitted for disease surveillance. The group noted that when a client consents to the taking of samples, and those samples may subsequently be submitted to the VLA for disease surveillance purposes, explicit client consent was necessary. In particular, the client should be made aware of the involvement of a third party, and the nature of the work they would undertake. Advice Annex 19. The group considered the advice previously provided by the group, and which formed the current annex to the Guide to Professional Conduct in relation to consent and communications. 20. The group agreed that initially the revised consent and communications advice should remain as an annex, and perhaps be publicised in an edition of RCVS News to increase awareness of the changes. It was thought that the guidance could be referred for 9

153 AC April 10 AI 07 Annex A inclusion in future editions of the Guide to Professional Conduct as part of the review of that publication for The group suggested that the annex could contain generic examples covering common circumstances in which consent should be sought but perhaps where this was not always done. 22. In terms of the age of consent, the group agreed that consent forms should include confirmation that the signatory was over 18 years of age. It was further agreed that the forms should seek to confirm the relationship of the signatory to the owner of the animal. If the authority of the signatory is doubted, veterinary surgeons should consider not embarking on further treatment, other than the provision of first aid and pain relief as required of them by the Guide to Professional Conduct. 23. If a veterinary surgeon doubts a signatory s mental capacity, the group considered that full enquiries should be made and an objective opinion formed before proceeding. Such enquiries may include ascertaining whether a power of attorney or some other authority to act on behalf of an owner exists. 24. Following discussion, the group thought that potentially difficult situations should be highlighted in the guidance to provoke thought, such as when an animal is not accompanied by the client, for instance when a client s neighbour presents an animal on their behalf. 25. The group agreed that a brief paper could be taken to Advisory Committee containing their recommendations, after the group having first had the opportunity to discuss and finalise these via . In light of the next Advisory Committee meeting date, it was suggested that this matter was probably for discussion at the April Advisory Committee meeting. Anaesthesia, clinical and surgical procedures consent form 26. The group discussed the possibility of surgical procedures that do not go well, and whether the consent form should include an acknowledgement of the inherent risks of surgery in addition to risks associated with anaesthetic. It was agreed that generic information could be included on the form, and the veterinary surgeon could add further specific information if necessary, depending on the person and situation. 27. In the event that a further veterinary surgeon becomes involved, for instance when an animal is transferred to a referral practice, the group considered that the duty remained with the first veterinary surgeon to ensure that the client understood the process and provided the necessary consent. 28. It was noted that the VDS were pleased to see the reference to animal welfare on the second page of the guidance, but asked whether this could be expanded to include pain control drugs. It was agreed that the word emergency would be removed from the last bullet point of the guidance. The group considered this alteration was preferable to adding various specific incidences under which unauthorised medicines may be used. 10

154 AC April 10 AI 07 Annex A 29. The group suggested the following further specific amendments to the form: a. In the guidance on the second page of the form, the fifth bullet point should be amended to read: In the event that the veterinary surgeon is unable to contact me on the numbers provided, I understand the veterinary surgeon will act in the best interests of my animals b. The group agreed that the word not in following sentence on the first page of the guidance should be capitalised: NB: Please complete the section below if you are not the owner c. An extra guidance point should be added to the guidance on the second page in relation to the taking of samples, the wording of which will be decided by the group following discussion. d. The guidance should point out that the form does not apply to post mortems. An additional form and guidance should be provided in relation to consent for post mortem procedures. These additional documents would be agreed by the group following discussion. The general principle is that consent for a post mortem must be recorded on the relevant form, however this consent may be obtained over the telephone where necessary. Veterinary surgeons should be mindful that owners may be in a delicate state at this time. Euthanasia consent form 30. The group discussed the disposal of animals following euthanasia, and agreed that the second page of the consent form could include further options for disposal, such as home burial, and cremation with ashes returned or not returned. 31. The group discussed the disposal of controlled drugs by injection into cadavers. In light of VMD recently removing reference to this method of disposal from their Guidance Note 17, the group agreed that representatives of the BVA would also review their guidance on the issue. The general feeling of the group was that it was preferable for denaturing kits to be used for disposal of controlled drugs. Lay Observers Report 32. The group were grateful for the report, but considered that there were no issues arising for the group to progress on this occasion. Professional Conduct Department December

155 AC April 10 AI 07 Annex B 12

156 AC April 10 AI 07 Annex B E. COMMUNICATION AND CONSENT Specimen consent forms are available below Introduction 1. The purpose of this advice note is to provide guidance on communication difficulties that can arise when providing veterinary services. Communication issues have arisen in a number of complaints considered by the RCVS Preliminary Investigation Committee (PIC). While the intention is for the advice note to address the concerns expressed by the Lay Observers that sit with the PIC, the RCVS believes by and large most practices do a satisfactory job, based on the fact that the number of complaints is low in comparison with the number of consultations that take place in veterinary practice every day. Lay Observers Concerns 2. Three Lay Observers sit with the PIC, which considers whether to refer complaints against veterinary surgeons to the RCVS Disciplinary Committee. Each year the Lay Observers provide a report to the RCVS Council and in 2007, they raised the issues of communication and consent suggesting that additional advice to veterinary surgeons might reduce the number of such complaints received by the RCVS. They stated that: Poor Communication continues to be a major area of concern as is informed consent for procedures undertaken as well as the failure to provide estimates before treatment begins and when costs escalate. It would be beneficial to all parties if more focus were given to these critical areas by practices, as it would significantly decrease the dissatisfaction being expressed by members of the public. RCVS Guide to Professional Conduct 3. The advice on communication and consent in the RCVS Guide to Professional Conduct is as follows: 1. The provision of veterinary services creates a contractual relationship under which veterinary surgeons should f. Ensure that a range of reasonable treatment options is offered and explained, including prognoses and possible side effects; g. Give realistic fee estimates based on treatment options; h. Keep the client informed of progress, and of any escalation in costs once treatment has started; i. Obtain the client s informed consent to treatment unless delay would adversely affect the animal welfare (to give informed consent, clients must be aware of risks). RCVS Guide to Professional Conduct Part 1-D Your responsibilities to your clients 13

157 AC April 10 AI 07 Annex B 19. Good communication skills in professional and support staff are essential to good veterinary practice. 20. Veterinary surgeons must endeavour to ensure that what both they and their clients are saying is heard and understood on both sides, and encourage clients to take a full part in any discussion. Explanations should be given wherever possible in non technical language and if there is any doubt as to whether the client has understood, this should be recorded. 21. Informed consent, which is an essential part of any contract, can only be given by a client who has had the opportunity to consider the options for treatment, and had the significance and risks explained to them. Cost may also be relevant to the client's decision. If it is anticipated that any procedure will be performed by a veterinary student, a listed veterinary nurse or other member of the support staff the client should be made aware of the fact. 22. If the client's consent is in any way limited or qualified or specifically withheld, veterinary surgeons must accept that their own preference for a certain course of action cannot override the client's specific wishes other than on exceptional welfare grounds. 23. When arrangements have been made to bring an animal under the Animals (Scientific Procedures) Act 1986 for experimental investigation, the client should be made aware of the general provisions of the Act so that informed consent can be given, (see Annex 3B, A(SP)A and VSA interface) 4. Consent can be expressed orally or in writing or by implication. Obtaining consent is a process. The signature of the client on a consent form is the culmination of discussions that should have gone before. Clients should be encouraged to ask questions and given time to consider the information provided during the process of obtaining consent. Obtaining consent is the responsibility of the veterinary surgeon with the animal under his or her care. Obtaining consent may also be delegated to the veterinary nurses or other competent staff at the practice. 5. The importance of communicating effectively with clients throughout a case on continuing treatment options, as well as any escalation of fees, is an essential part of maintaining consent. If a client s consent is in any way limited or qualified (see Part 1 D of the Guide, paragraph 22 above), contemporaneous notes of this should be made on the clinical records. The provision of veterinary services contractual relationship 6. For a contract to be valid and legally enforceable there must be (i) capacity to contract; (ii) intention to contract; (iii) consensus ad idem (agreement as to the same thing); (iv) valuable consideration (eg payment); (v) legality of purpose; (vi) sufficient certainty of terms. 7. In the context of the provision of veterinary services, consent can be described as the agreement to carrying out specific actions, based on information of what the actions involve and the likely consequences. Effective communication between veterinary surgeon and 14

158 AC April 10 AI 07 Annex B client is essential. Clients should have an opportunity to consent to the services offered, and accept the costs of those services as estimated and agreed. 8. The existence or otherwise of a contract is relevant, for example, to recover non-payment of fees. Regardless of whether a fee is charged or not, the professional responsibilities remain the same towards the patient and client. For the purposes of determining to whom a veterinary surgeon s professional responsibilities are owed, the the client is the person who requests professional services for an animal. (Part 1 D of the Guide). Consent forms 9. Consent forms may be used to record agreement to carry out specific procedures. They form part of the clinical records. A copy of the form should be provided to the person signing the form unless the circumstances render this impractical.* If any amendments are made subsequently, these should be made in ink, initialled and dated and a note of subsequent conversations recorded on the clinical records. 10. Provision should be made for uncertain or unexpected outcomes. Clients should be asked to provide contact telephone numbers to ensure discussions can take place at short notice. Provision for the veterinary surgeon to act without the client s consent if necessary in the interests of the animal should be considered. 11. For routine procedures, information leaflets can be useful to explain to clients what is involved with a specific procedure, anaesthesia, expected outcome, after care etc. Clients should be given an opportunity to consider this information before being asked to provide consent. Use of information sheets should be encouraged but should not be used as a substitute for discussions with individual clients. 12. While responsibility for ensuring a client has provided consent rests with the veterinary surgeon, it should be recognised that veterinary practice staff may be the first to become aware of any misunderstanding concerning the procedure or treatment. Staff should be advised to communicate concerns to senior colleagues. The veterinary practice team should be encouraged to work together to ensure effective communication with clients and with each other. Who is the client? 13. The client may be the owner of the animal, someone acting with the authority of the owner, or someone with statutory or other appropriate authority. Care should be taken when consent is given by a client who is not the owner of the animal. Practice staff should ensure they are satisfied that the person providing consent has both the authority and capacity to provide consent. For example, if the person providing consent is not the owner and has not confirmed his/her authority of the owner to act,,only in exceptional circumstances, for example if the request is by the police, should the procedure be carried out. 14. Problems can arise identifying who the client is. Occasionally, more than one owner will come forward and while it is not for the veterinary surgeon to determine ownership, it 15

159 AC April 10 AI 07 Annex B will be important to identify who the client is so it is clear to whom the professional responsibilities are owed. This should be made clear on the clinical records. Has the client understood what has been said? 15. Veterinary surgeons should consider their clients language and communication needs. Clinical or technical terminology may need to be explained and clients may not wish to admit to a lack of understanding. 16. Misunderstandings can arise when using ambiguous terms and veterinary surgeons should be alert to the possibility of misunderstandings concerning terminology used by the practice. 17. A person s understanding of the issues may be affected by a number of factors, such as impaired hearing or sight; mental incapacity; learning difficulties; difficulties with reading or language. 18. A person may be competent to sign a consent form, but for reasons of physical disability is unable to provide a signature. An independent witness may be asked to confirm the client has given consent orally. If this is not practicable, then a suitable member of the practice staff could be asked to confirm consent. 19. Persons under the age of 18 are generally considered to lack the capacity to make binding contracts. They should not be made liable for any veterinary or associated fees. 20. Children under the age of 16 should not be asked to sign a consent form. Where they have provided a signature, the parents or guardians should be asked to countersign. 21. Where the person seeking veterinary services is 16 or 17, veterinary surgeons should, depending on the extent of the treatment, the likely costs involved and the welfare implications for the animal, consider whether consent should be sought from parents or guardians before the work is undertaken. 22. Particular care should be taken when the treatment involves issues of health and safety, as for supplying Controlled Drugs (within the meaning of the Misuse of Drugs Act 1971) to anyone under Where the client s ability to understand is called into question, veterinary surgeons will need to consider whether any practical steps can be taken to assist the client s understanding. For example, consider whether it would be useful for a family member or friend to be present during the consultation. Additional time may be needed to ensure the client has understood everything and had an opportunity to ask questions. Mental incapacity 24. The Mental Capacity Act 2005 (England and Wales) states: A person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, 16

160 AC April 10 AI 07 Annex B the mind or brain. It does not matter whether the impairment or disturbance is permanent or temporary.. See Adults with Incapacity (Scotland) Act 2000 [There is no primary legislation dealing with mental incapacity in Northern Ireland as yet] 25. Where it appears a client lacks the mental capacity to consent, veterinary surgeons should try to determine whether someone is legally entitled to act on that person s behalf, such as someone who may act under an enduring power of attorney. If not, veterinary surgeons should act in the best interests of the animal and seek to obtain consent from someone close to the client, such as a family member who is willing to provide consent on behalf of the person. *[The RCVS Practice Standards Scheme Manual provides that for General Practice (Tier 2 practices), signed consent forms are required for all procedures including diagnostics, medical treatments, surgery, euthanasia and when a patient is admitted to the care of a veterinary surgeon.] Specimen consent forms Specimen Form of Consent for Anaesthesia and Surgical Procedures (WORD 84Kb) Specimen Form of Request for Euthanasia (WORD 72Kb) 17

161 AC April 10 AI 07 Annex B SPECIMEN FORM OF CONSENT FOR ANAESTHESIA, CLINICAL AND SURGICAL PROCEDURES Owner s Name Address Telephone: Home Work Mobile NB: Please complete the section below if you have authority to act on behalf of the owner Name Address Telephone: Home Work Species and Breed Mobile Name Colour Age Sex M F Neutered M Neutered F Microchip/Tattoo/Brand Details of the Operation/Procedure 18

162 AC April 10 AI 07 Annex B I hereby give permission for the administration of an anaesthetic to the above animal and to the surgical or other procedures detailed on this form together with any other procedures which may prove necessary. The nature of these procedures and of other such procedures as might prove necessary has been explained to me. I understand that there are some risks involved in all anaesthetic techniques and surgical procedures. I accept that the likely cost will be as detailed on the [attached] estimate and that in the event of further treatment being required or of complications occurring which will give rise to additional costs, I shall be contacted as soon as practicable so that my consent to such additional treatment and costs may be obtained. In the event that the veterinary surgeon is unable to contact me on the numbers provided, I understand the veterinary surgeon will act in the best interests of my animal. In order to protect the welfare of my animal, in the unlikely event of an emergency, or where additional pain relief or sedation may be required, I understand the veterinary surgeon may decide to use medicines that are not authorised for use in [state species]. Notes and Instructions: The cost of the procedures described above (tick as appropriate) will be: OR will be within the range: to Inclusive of: VAT If you are NOT the owner, please tick the box to confirm you have the authority to act on behalf of the owner of the animal described above Please tick the box if you are UNDER the age of 18 *Signature Date of Signature *A copy of the form should be provided to the person signing and the original retained by the practice 19

163 AC April 10 AI 07 Annex B Explanatory notes: The purpose of the consent form is to record the client s agreement to treatment based on knowledge of what is involved and the likely consequences. The client may be the owner of the animal, someone acting with the authority of the owner, or someone with statutory or other appropriate authority. Care should be taken when consent is given by a client who is not the owner of the animal. Practice staff should ensure they are satisfied that the person providing consent has both the authority and capacity to provide consent. For example, if the person providing consent is not the owner and has not confirmed his/her authority of the owner to act, only in exceptional circumstances, for example if the request is by the police, should the procedure be carried out. Before being asked to sign a consent form, the person should be able to understand and retain the information provided and use it to come to a decision. The form should be seen as the culmination of discussions that have gone on before. If the practice uses standard information sheets, clients should be provided with an opportunity to read and ask questions before being asked to consent to the procedure/treatment. A person may be mentally competent to sign but for reasons of physical disability is unable to provide a signature. An independent witness may be asked to confirm the client has given consent orally. If this is not practicable, then a professional colleague may be asked to confirm this. A copy of the form should be provided to the person signing the form unless the circumstances render this impractical. Subsequent amendments to the form should be made in ink, initialled and dated. Where additional consent is required, a note of the conversation should be recorded on the clinical records. Consent: Veterinary surgeons must obtain the client s consent to treatment unless delay would adversely affect the animal s welfare (to give informed consent, clients must be aware of the risks) RCVS Guide to Professional Conduct Part 1-D paragraph 1 (i). (See also Part 2-D Communication and consent paragraphs ) A person s understanding of the issues may be affected by a number of factors, such as impaired hearing or sight; mental incapacity; learning difficulties; difficulties with reading or language. Age: Persons under the age of 18 are generally considered to lack the capacity to make binding contracts. They should not be made liable for any veterinary or associated fees. Children under the age of 16 should not be asked to sign a consent form. Where the person seeking veterinary services is 16 or 17, veterinary surgeons should, depending on the extent of the treatment, the likely costs involved and the welfare implications for the animal, consider whether consent should be sought from the parent or guardian. Has the client understood what has been said? Veterinary surgeons should consider their clients language and communication needs. Clinical or technical terminology may need to be explained and clients may not wish to admit to a lack of understanding. Where there are 20

164 AC April 10 AI 07 Annex B language barriers, it may be helpful to arrange for a family member or friend to accompany the client. Additional time may be needed to ensure the client has understood everything and had an opportunity to ask questions. Veterinary surgeons should be alert to the possibility of misunderstandings concerning terminology used by the practice (eg euthanasia and put to sleep ). Mental incapacity: The Mental Capacity Act 2005 (England and Wales) states: A person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain. It does not matter whether the impairment or disturbance is permanent or temporary.. See Adults with Incapacity (Scotland) Act 2000 [There is no primary legislation dealing with mental incapacity in Northern Ireland as yet] Where it appears a client lacks mental capacity to consent, the veterinary surgeon should seek consent from an appropriate person to act on behalf of the client and act in the best interests of the animal in the meantime. Fee estimates/escalation of fees: Veterinary surgeons should give realistic fee estimates based on treatment options and keep the client informed of progress, and of any escalation in costs once treatment has started.guide to Professional Conduct Part 1-D paragraphs (g) and (h). See RCVS Advice on Communication and Consent 21

165 AC April 10 AI 07 Annex B SPECIMEN FORM OF REQUEST FOR EUTHANASIA Owner s Name Address Telephone: Home Work Mobile NB: Please complete the section below if you have authority to act on behalf of the owner Name Address Telephone: Home Work Mobile Species and Breed Name Colour Age Sex M F Neutered M Neutered F 22

166 AC April 10 AI 07 Annex B Microchip/Tattoo/Brand I request the euthanasia /*and disposal (*delete as appropriate) of the animal described above. I have discussed the appropriate methods of disposal available. Please indicate which option for disposal you wish [Practice to include disposal options available Cost of euthanasia (and disposal*) (delete as appropriate) [eg cremation] (including VAT) If you are NOT the owner, please tick the box to confirm you have the authority to act on behalf of the owner of the animal described above Please tick the box if you are UNDER the age of 18 *Signature Date of Signature *A copy of the form should be provided to the person signing and the original retained by the practice 23

167 AC April 10 AI 07 Annex B Explanatory notes: The purpose of the consent form is to record the client s agreement to treatment based on knowledge of what is involved and the likely consequences. The client may be the owner of the animal, someone acting with the authority of the owner, or someone with statutory or other appropriate authority. Care should be taken when consent is given by a client who is not the owner of the animal. Practice staff should ensure they are satisfied that the person providing consent has both the authority and capacity to provide consent. For example, if the person providing consent is not the owner and has not confirmed his/her authority of the owner to act, only in exceptional circumstances, for example if the request is by the police, should the procedure be carried out. Before being asked to sign a consent form, the person should be able to understand and retain the information provided and use it to come to a decision. The form should be seen as the culmination of discussions that have gone on before. If the practice uses standard information sheets, clients should be provided with an opportunity to read and ask questions before being asked to consent to the procedure/treatment. A person may be mentally competent to sign but for reasons of physical disability is unable to provide a signature. An independent witness may be asked to confirm the client has given consent orally. If this is not practicable, then a professional colleague may be asked to confirm this. A copy of the form should be provided to the person signing the form unless the circumstances render this impractical. Subsequent amendments to the form should be made in ink, initialled and dated. Where additional consent is required, a note of the conversation should be recorded on the clinical records. Consent: Veterinary surgeons must obtain the client s consent to treatment unless delay would adversely affect the animal s welfare (to give informed consent, clients must be aware of the risks) RCVS Guide to Professional Conduct Part 1-D paragraph 1 (i). (See also Part 2-D Communication and consent paragraphs ) A person s understanding of the issues may be affected by a number of factors, such as impaired hearing or sight; mental incapacity; learning difficulties; difficulties with reading or language. Age: Persons under the age of 18 are generally considered to lack the capacity to make binding contracts. They should not be made liable for any veterinary or associated fees. Children under the age of 16 should not be asked to sign a consent form. Where the person seeking veterinary services is 16 or 17, veterinary surgeons should, depending on the extent of the treatment, the likely costs involved and the welfare implications for the animal, consider whether consent should be sought from the parent or guardian. 24

168 AC April 10 AI 07 Annex B Has the client understood what has been said? Veterinary surgeons should consider their clients language and communication needs. Clinical or technical terminology may need to be explained and clients may not wish to admit to a lack of understanding. Where there are language barriers, it may be helpful to arrange for a family member or friend to accompany the client. Additional time may be needed to ensure the client has understood everything and had an opportunity to ask questions. Veterinary surgeons should be alert to the possibility of misunderstandings concerning terminology used by the practice (eg euthanasia and put to sleep ). Mental incapacity: The Mental Capacity Act 2005 (England and Wales) states: A person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain. It does not matter whether the impairment or disturbance is permanent or temporary.. See Adults with Incapacity (Scotland) Act 2000 [There is no primary legislation dealing with mental incapacity in Northern Ireland as yet] Where it appears a client lacks mental capacity to consent, the veterinary surgeon should seek consent from an appropriate person to act on behalf of the client and act in the best interests of the animal in the meantime. Fee estimates/escalation of fees: Veterinary surgeons should give realistic fee estimates based on treatment options and keep the client informed of progress, and of any escalation in costs once treatment has started.guide to Professional Conduct Part 1-D paragraphs (g) and (h). See RCVS Advice on Communication and Consent 25

169 AC April 10 AI 07 Annex B 26

170 AC April 10 AI 07 Annex C ADVICE NOTE XX: THE USE AND RE-USE OF SAMPLES, POST MORTEMS AND DISPOSAL Informed Consent 1. There may be occasions when veterinary surgeons have to consider taking samples for treatment purposes, or post mortem. These samples may include blood, tissue, body parts or whole cadavers. After samples have been taken, it may be that the reuse of the sample for other proper purposes is considered. 2. The starting point for the use of samples is informed consent. A client should consent to a sample for initial diagnostic purposes, whatever the size or species of the animal, whether it is a farm animal or domestic pet and whether the animal is living or dead. Generally, a client should also consent to any reuse of the sample for other purposes. 3. The RCVS has produced detailed guidance on informed consent. This includes guidance on written/oral consent; contractual relationships; establishing who the client is; confirming the client has understood what has been said; mental incapacity; dealing with minors; and consent forms. This information can be found in the RCVS Guide to Professional Conduct 2010 (Part 1D, 2D and Annex E ). 4. In situations where another veterinary surgeon becomes involved in the treatment of an animal, for instance with a referral or transfer to a dedicated out of hours provider, the referring veterinary surgeons should ensure that consent is obtained from the client for the referral. Once the animal has been transferred to the second practice, consent for procedures subsequently carried out is a matter for the second practice. (Further information is available in Annex O to the Guide) Disease surveillance schemes and the re-use of samples 5. Veterinary surgeons may take samples from animals for testing for treatment purposes, academic research or statutory purposes. Generally, samples will be taken for a specific purpose. 6. Under current legislation in England and Wales, samples can be taken under the Animal Health Act 1981 as amended for the control of specified diseases, but this legislation arguably provides insufficient powers for general and pre-emptive surveillance testing. Scottish legislation does allow the use of samples for more than 27

171 AC April 10 AI 07 Annex C one purpose. There are additional provisions set out in European legislation with regard the taking of samples. 7. The legal obstacles to the re-use of samples for general disease surveillance can be overcome with specific consent of the client. This could be set out in a suitably worded consent form, making the client aware of the reuse of the samples from their animal. 8. The re-use of samples without the consent of the client may be reasonable for animal welfare or public interest reasons, for example, disease surveillance by the State, or where obtaining the consent of the relevant animal owners is impracticable and the samples are re- used anonymously. Post-mortem Examinations 9. The veterinary surgeon should ensure that the client has been fully advised of the scope of the post-mortem examination and/or any limitations to manage client expectations and understands not only the financial implications of that request, but also that the findings may prove inconclusive. The veterinary surgeon should give the client the option of an examination by an independent veterinary surgeon. 10. In cases in which the owner has retained the carcase of an animal following treatment by a veterinary surgeon prior to its death and subsequently requests another veterinary surgeon to carry out an independent post-mortem examination, the normal ethical rules regarding supersession and second opinions do not apply. Nevertheless, generally the original veterinary surgeon should be advised by his or her colleague that the post-mortem examination is to be carried out and should be invited to provide information regarding previous treatment as an aid to the preparation of an accurate report. The results of the examination must, however, be communicated only to the client and not to the original veterinary surgeon without the client's consent. 11. Veterinary surgeons wishing to carry out a post-mortem examination upon animals which they have previously treated, in order to satisfy themselves as to the cause of death, (rather than at the request of the client) must seek the permission of the client to carry out such an examination. Consent may be provided verbally, for example, by telephone, although it is best practice to obtain the consent in writing, for example, on a specific consent form which may provide for the use and re-use of samples. 12. Veterinary surgeons should be mindful that owners may be in an emotional or distressed state at this time. Disposal 13. Generally, a veterinary surgeon should seek consent from the owner to disposal of the cadaver and should ensure that any third party involved in the disposal is appropriately licensed, for example, if the animal is to be cremated. 28

172 AC April 10 AI 07 Annex C Clinical Waste 14. Detailed advice relating to hazardous waste and the disposal of infectious cadavers is available in the BVA practice guide to handling veterinary waste, available on their website at This includes the following definition; Hazardous wastes are those that are harmful to people, the environment or animals, either immediately or over an extended period of time, including those that are toxic, carcinogenic, infectious or ecotoxic. 15. The RCVS also produces guidance for veterinary surgeons dealing with the disposal of clinical waste. The RCVS Practice Standards Scheme Manual (2010 Edition) states that; 9.15 Hazardous (special*) waste must be appropriately segregated, safely stored and disposed of by a suitably permitted waste contractors The RCVS Inspector will ask to see evidence of; A contract with a permitted waste contractor(s); Policies and practice to segregate waste into appropriate streams and to store it hygienically; Consignment notes for hazardous waste disposal, which form the basis of a hazardous waste register for those practices in England and Wales; Hazardous waste registration for those premises in England and Wales that produce more than 200kg (**) of hazardous waste per annum *hazardous waste is referred to as special waste in Scotland ** under consultation, may be increased to 500kg Professional Conduct Department June

173 AC April 10 AI 07 Annex D 30

174 AC April 10 AI 07 Annex D POST-MORTEM EXAMINATIONS 1. When a client wishes to have a post-mortem examination carried out - and understands not only the financial implications of that request, but also that the findings may prove inconclusive - the veterinarian concerned should either consent to carry out such examination himself or herself or assist the client by making alternative arrangements with another veterinarian. 2. In cases in which the owner has retained or repossessed the carcase of an animal which was under treatment by a veterinarian prior to its death and requests another veterinarian to carry out an independent post-mortem examination on the owner's behalf, the normal ethical rules regarding supersession and second opinions do not apply. Nevertheless, the original veterinarian should be advised by his or her colleague that the post-mortem examination is to be carried out and should be invited to provide information regarding previous treatment as an aid to the preparation of an accurate report. The results of the examination must, however, be communicated only to the client and not to the original veterinarian without the client's consent. 3. Veterinarians wishing to carry out a post-mortem examination upon animals which they have previously treated, in order to satisfy themselves as to the cause of death, (rather than at the request of the client) must seek the permission of the client to carry out such an examination. 31

175 AC April 10 AI 08 MEETING Advisory Committee DATE 20 April 2010 TITLE CLASSIFICATION SUMMARY The Role of Veterinary Nurses and the epidural injections, thecal sac puncture (CSF sampling and myelography) and the collection of synovial fluid Unclassified Advisory Committee is asked to assist the Professional Conduct Department in providing advice in response to a query relating to the role of Veterinary nurses and epidural injections, thecal sac puncture and the collection of synovial fluid. The Committee is asked to consider the issues arising in the context of Schedule 3 to the Veterinary Surgeons Act. DECISIONS REQUIRED ATTACHMENTS AUTHOR To recommend advice Annex A Advice note 19 Maintenance and Monitoring of Anaesthesia Chris Murdoch Professional Conduct Department c.murdoch@rcvs.org.uk Sue Whall and Gordon Hockey Professional Conduct Department 1

176 AC April 10 AI 08 2

177 AC April 10 AI 08 BACKGROUND/CURRENT POSITION 1. The Professional Conduct Department has recently received requests for advice about veterinary nurses assisting and carrying out epidural injections, thecal sac puncture (CSF sampling and myelography) and the collection of synovial fluid. The advice sought asks whether veterinary nurses may be taught the preparation of equipment for epidurals, what to look out for in terms of adverse affects both during injection and during general anaesthesia. And whether they should be taught how to perform the procedure and whether they may carry out the procedure once qualified. 2. The Committee is asked to consider whether epidurals (and/or subarachnoid) injections and placement of catheters may be carried out within the Schedule 3 exemption for veterinary nurses. More specifically, a) Placement of a needle into the epidural space of dogs, cats, horses, ruminants and other animals with the animal conscious/sedated or anaesthetised. b) Injection of local anaesthesia, opioids and alpha-2 adrenoceptor agonists via the catheter. These may be administered alone or in different combinations depending on the species, procedure and whether anaesthesia of the limb or analgesia is required. c) Placement of an epidural catheter for longer term pain management. d) Administration of fixed doses of drugs via epidural catheters. 3. The Committee is also asked to consider whether puncture of the thecal sac at the cisternal and/or lumbar site for the collection of CSF and/or the administration of myelographic contrast agents are allowed to be carried out within the Schedule 3 exemption for Veterinary nurses. More specifically, a) Placement of a needle into the thecal sac (subarachnoid space) of dogs, cats, horses, ruminants and other animals with the animal conscious/sedated or anaesthetised. b) Collection of CSF samples via the placed needle c) Injection of myelographic contrast agents for the enhancement of radiographic images. d) Administration of fixed doses of myelographic contrast agents. 4. The Committee is also asked to clarify the position of veterinary nurses who wish to carry out synovial sampling (joint taps). 3

178 AC April 10 AI 08 THE VETERINARY SURGEONS ACT AND SCHEDULE 3 5. Broadly, the Veterinary Surgeons Act 1966 provides that veterinary surgery may be carried out by veterinary surgeons. Non-veterinary surgeons, including veterinary nurses (and student veterinary nurses) may only carry out veterinary surgery to the extent permitted by any of the exemptions within the Act, including the Schedule 3 exemption for veterinary nurses (those listed or registered with the RCVS) and student veterinary nurses (specific rules apply). 6. Therefore, when considering the activities and procedures in question, it is necessary to ask (i) whether what is proposed is veterinary surgery?; and (ii) if so, is it within the Schedule 3 exemption for veterinary nurses and student veterinary nurses? Having addressed these questions, a good check is to remember that under the Act, whatever a veterinary nurse may carry out under veterinary direction, a farmer or stockman may carry out of their own farm animals without veterinary direction. 7. Veterinary surgery is defined in the Act as meaning the art and science of veterinary surgery and medicine and, without prejudice to the generality of the foregoing, shall be taken to include- (a) the diagnosis of diseases in, and injuries to, animals including tests performed on animals for diagnostic purposes; (b) the giving of advice based upon such diagnosis; (c) the medical or surgical treatment of animals; and (d) the performance of surgical operations on animals 8. It is suggested that the activities under consideration are veterinary surgery, not least for the invasive nature of the procedures. In the event of any doubt, there is a standing working party charged with the task of considering whether certain procedures constitute veterinary surgery. It reports to Advisory and PAC and comprises the respective Chairmen of advisory, PAC and VNC. 9. What a veterinary nurse may carry out under the Schedule 3 exemption is explained in the RCVS advice for veterinary nurses available on the RCVS website. This provides that: Qualified veterinary nurses a) Listed veterinary nurses (these include Registered Veterinary Nurses) may administer "any medical treatment or any minor surgery (not involving entry into a body cavity)" under veterinary direction. The Schedule does not, however, authorise a veterinary nurse to carry out any of a number of procedures which are specified in Part II of the Schedule. These excluded procedures are the castration of a horse, pony, ass or mule, the castration or spaying of a cat or dog, and a number of other procedures relating to farm animals. 4

179 AC April 10 AI 08 b) The animal must be under the care of a veterinary surgeon and the treatment must be carried out at the veterinary surgeon's direction. The veterinary surgeon must be the employer of the veterinary nurse or be acting on behalf of the nurse's employer. The directing veterinary surgeon must be satisfied that the veterinary nurse is qualified to carry out the treatment or surgery. Student veterinary nurses c) A student veterinary nurse is someone enrolled for the purpose of training as a veterinary nurse at an approved training and assessment centre or a veterinary practice approved by such a centre. d) A student veterinary nurse may administer "any medical treatment or any minor surgery (not involving entry into a body cavity)" under veterinary direction. Schedule 3 does not, however, allow the nurse to castrate a horse, pony, ass or mule, castrate or spay a cat or dog, or carry out certain procedures relating to farm animals. e) The animal must be under the care of a veterinary surgeon and the treatment must be carried out at the veterinary surgeon's direction. The veterinary surgeon must be the employer of the veterinary nurse or be acting on behalf of the nurse's employer. f) The treatment or minor surgery must be carried out in the course of the student veterinary nurse's training. g) The treatment or surgery must be supervised by a veterinary surgeon or a listed veterinary nurse. In the case of surgery the supervision must be direct, continuous and personal. Any medical treatment and any minor surgery (not including entry into a body cavity) 10. The VSA does not define "any medical treatment or any minor surgery (not involving entry into a body cavity)". Ultimately, it would be for the courts to decide what these words mean. However, the RCVS provides the following guidance on the website; Veterinary nurses should only carry out medical treatment or minor surgery after considering in each individual case whether they are competent to do so, taking into account their training and experience, the nature of the treatment or procedure and the condition of the patient. The directing veterinary surgeon should take the same matters into account in deciding whether the nurse is qualified to carry out the treatment. 11. Veterinary nurses may carry out veterinary surgery to no greater extent than any medical treatment and any minor surgery (not including entry into a body cavity), however well qualified they may be as veterinary nurses and however competent they may be generally. 5

180 AC April 10 AI It is suggested that any part of the body that has a contained space is a body cavity - this could range from the abdominal cavity to a small blood vessel, but it is likely the intention of the Act was to define body cavities as the major spaces such as the thorax and abdomen. 13. On the basis that the collection of blood is considered to be an activity included within the meaning of minor surgery, it is suggested the definition anticipated "doing things" when in the cavity - not just collecting a sample. Also, on the basis that such sample collection is within the meaning to minor surgery, it is suggested that it must be minor. Therefore, where there are considerable risks associated with the procedure, it is suggested it cannot be minor. For example, cisternal myelography, in the neck close to the skull, runs the risk of permanent quadriplegia and even death; lumbar myelography runs the risk of paraplegia. Both have the attendant risks of infection and anaesthesia. It is suggested that neither could be described as minor and therefore, neither are within the meaning of the veterinary nurses Schedule 3 exemption. However, the complication risks of epidural are much lower and, therefore, it could be argued that this may be carried out by veterinary nurses. 14. There may be other clinical considerations to consider. For example, the immediate visual appearance of joint fluid contributes to the clinical assessment of the condition and could be missed if the sample is not obtained by the veterinary surgeon; who can assess its relative volume, colour and viscosity and whether it appeared to be bloody or blood contaminated from the procedure itself. It is suggested this should form part of the diagnosis. The same would apply to myelography where CSF is seen or even collected/withdrawn as part of the procedure - its volume, ease of withdrawal and visual nature are again important diagnostic features. Arguably these could mean such procedures are not minor. Other related issues 15. Even if it is thought a procedure may be delegated under Schedule 3, issues of consent and supervision arise. The exempted procedure may still warrant the veterinary surgeon responsible to be present during the procedure or at least available on the premises. The client should be made aware of any procedures to be performed by support staff who are not veterinary surgeons (Guide to Professional Conduct, Part 1D Responsibilities to clients?) 16. The Schedule 3 exemption in relation to the provision of any medical treatment or minor surgery (not involving entry into a body cavity) for farmers and stockmen with their animals used in agriculture is the same, but without veterinary direction. So, in theory anything the RCVS considers within the meaning of the veterinary nurses exemption may be carried out by farmers on their animals without veterinary direction. 6

181 AC April 10 AI Also, anaesthetic administered incrementally, or to effect, it may be carried out only by a veterinary surgeon; whereas inducing anaesthesia by the administration of specific quantity of medicine, as directed by a veterinary surgeon, may be carried out by a veterinary nurse (or student veterinary nurse under supervision); according to the RCVS advice on the Maintenance and Monitoring of Anaesthesia, advice note 19 (a copy is attached as annex A). 18. It is suggested that preparation of equipment for a veterinary surgeon is not veterinary surgery. PR IMPLICATIONS 19. It is suggested it is important to be supportive of veterinary nurses, but equally, any advice must be consistent with Schedule 3 and previous RCVS advice and applicable to the Act generally. CONCLUSIONS 20. The Committee has been asked to consider whether the following may be carried out within the Schedule 3 exemption for veterinary nurses: a) Placement of a needle into the epidural space or thecal sac of dogs, cats, horses, ruminants and other animals with the animal conscious/sedated or anaesthetised; b) Epidural injection of local anaesthesia, opioids and alpha-2 adrenoceptor agonists via the catheter. Whether administered alone or in different combinations depending on the species, procedure and whether anaesthesia of the limb or analgesia is required; c) Placement of an epidural catheter for longer term pain management; d) Administration of fixed doses of drugs via epidural catheters; and, e) Synovial sampling f) CSF sampling and myelography. The existing RCVS advice on the monitoring and maintenance of anaesthesia is relevant to the above. Professional Conduct Department 2010 Advisory Committee 7

182 AC April 10 AI 08 8

183 AC April 10 AI 08 Annex A ADVICE NOTE 19 MAINTENANCE AND MONITORING OF ANAESTHESIA 1) In 2005, Council decided that, in the long term, only veterinary nurses 1 and student veterinary nurses 2 should carry out the maintenance and monitoring of anaesthesia. 2) In January 2006, following concerns expressed by the Practice Standards Working Group and others, the Advisory Committee decided that further evidence was needed to justify advice that only veterinary nurses 1 should assist with the monitoring and maintenance of anaesthesia, and recognised that any advice must be practicable. 3) Therefore, the advice on the monitoring and maintenance of anaesthesia remained as follows; a) Inducing anaesthesia by administration of specific quantity of medicine directed by a veterinary surgeon may be carried out by a veterinary nurse 1 or, with supervision, a student veterinary nurse 2, but not any other person. b) Administering medicine incrementally or to effect, to induce and maintain anaesthesia may be carried out only by a veterinary surgeon. c) Maintaining anaesthesia is the responsibility of a veterinary surgeon, but a suitably trained person may assist by acting as the veterinary surgeon s hands (to provide assistance which does not involve practising veterinary surgery), for example, by moving dials. d) Monitoring a patient during anaesthesia and the recovery period is the responsibility of the veterinary surgeon, but may be carried out on his or her behalf by a suitably trained person. e) The most suitable person to assist a veterinary surgeon to monitor and maintain anaesthesia is a veterinary nurse 1 or, under supervision, a student veterinary nurse 2. 4) There is additional advice on RCVSonline for veterinary nurses 1 and student veterinary nurses 2 who, under schedule 3 of the Veterinary Surgeons Act 1966, may carry out medical treatment under direction of a veterinary surgeon. OCTOBER Those who are listed or registered with the RCVS 2 Those enrolled as student veterinary nurses with the RCVS Advice Note 19 Maintenance and Monitoring of Anaesthesia Page 1 of 1 9

184 AC April 2010 AI 09 MEETING Advisory Committee DATE 20 April 2010 TITLE CLASSIFICATION SUMMARY DECISIONS REQUIRED RSPCA Euthanasia Rules & Guidelines Unclassified The RSPCA have asked for comment on Euthanasia using a captive bolt and other matters as part of their review of the RSPCA 2004 Euthanasia Rules and Guidelines booklet. Dr Alistair MacMillan, RSPCA Chief Veterinary Officer (CVO) will join the Committee for discussion of this agenda item. Advisory Committee is asked to consider the use of a penetrating captive bolt as a means of euthanasia in dogs and provide general comments on the revision of the guidance. ATTACHMENTS Annex A: RSPCA Euthanasia Rules and Guidelines 2004 AUTHOR Chris Murdoch Professional Conduct Department Gordon Hockey Professional Conduct Department g.hockey@rcvs.org.uk 1

185 AC April 2010 AI 09 2

186 AC April 2010 AI 09 BACKGROUND/ CURRENT POSITION 1. The RSPCA CVO has indicated that the review of euthanasia procedures was a review of the methods used and the associated decision making process: when euthanasia is necessary and what methods are appropriate. The CVO has agreed to attend the Committee s discussion to clarify and explain the guidance and the RSPCA review process. 2. The RSPCA Euthanasia Rules and Guidelines 2004, attached as annex A, were drafted in light of the then-current technical knowledge and the requirements of RSPCA Council. 3. The guidance applies specifically to RSPCA Animal Centres undertaking the destruction of animals and, generally, where animals are destroyed on behalf of the Society. 4. Section A of the RSPCA guidance sets out the euthanasia rules and explanatory notes, and states that the persons certified to perform euthanasia by approved methods on behalf of the Society are Members of the RCVS, RSPCA Inspectors and suitably trained lay persons over the age of 18 (holding a certificate of competence issued by the CVO), and student RSPCA Inspectors as well as other lay trainees over the age of 18 (in the presence of an instructor authorised by the CVO). 5. Certified non-veterinary surgeons use pentobarbitone prescribed by the RSPCA s Chief Veterinary Officer (CVO) 6. According to the RSPCA guidance, where exceptional circumstances preclude the use of a recommended method, only suitably experienced persons may make a judgement to use other accepted methods. The RSPCA considers the following persons to be suitably qualified to make this judgment: MRCVSs, RSPCA Inspectors, suitably experienced managers of RSPCA establishments, veterinary nurses and other suitably qualified persons authorised by the CVO. 7. The RSPCA guidance states that only methods that are approved by the Society must be employed, and these are contained in Section C of the booklet. It is on these preferred procedures and other accepted procedures that the RCVS has been asked to comment generally. 3

187 AC April 2010 AI 09 DISCUSSION/ ISSUES 8. The RSPCA contacted the Assistant Registrar asking for comments on page 9 of the booklet, on the use of the penetrating captive bolt. The initial advice provided to the RSPCA after consultation with an appropriately experienced veterinary surgeon was: Re the Captive bolt issue vs free shot etc. A lot of the arguments will be basically around the issue of aesthetics and safety. A free bullet can go along way, ricochet and fragment, putting both operator and anyone around at risk (just look at the hunting scene for safety concerns - I could show you a very scary video from one of the main arms manufacturers in Germany as to bullet behaviour). The use of soft nosed bullets assumes expansion will be adequate to transmit enough damage to the animal and render the bullet safe. My experience in smaller species with such.32 bullets is that they barely expand and so damage may only have an effect similar to stunning with a captive bolt if bullet placement is not perfect. The benefit of a free bullet is the ability to work from a small distance rather than weapon directly applied to the head, and this can be relevant with antlered Deer as an example. Captive bolt is effective but requires pithing in many instances to ensure death which is messy and unpleasant. There is no mention of small bore shotguns in smaller species. It was common for hunts to use a.410 pistol applied to the head which shot penetrated the skull, the shot pithed the animal at the same time, and death was instantaneous and clean. Many horses have been slaughtered with these for years. I still have one on licence for humane despatch and use it for RTAs, sheep, Deer etc with good effect. A 12 bore as they state for some species is large, messy and unwieldy. Re Cats, Some cats are much larger than some aggressive dogs (compare the Jack Russel with the Maine Coon) Has the ballistics etc been looked at. It is similar to previous restrictions on firearms calibres to try and match calibre to species size which is a nonsense as far as the killing is concerned, but makes sense to a degree only where the issue of expansion, final outcome of the bullet etc are concerned (ie H&S). At last this is being seen as logical argument by issuing forces so larger calibres can now be used for smaller species. 9. The Committee is asked to consider and endorse this advice with any amendments. 10. The RSPCA also seeks general comments on the 2004 guidance to assist its review. Dr Alistair MacMillan will join the Committee for the discussion. 4

188 AC April 2010 AI 09 FINANCIAL IMPLICATIONS / PR IMPLICATIONS 11. There are no financial implications. The PR implications are those associated with endorsement of a potentially controversial method of euthanasia that is not accepted by the public as appropriate. CONCLUSIONS 12. The Committee is asked to consider the use of a penetrating captive bolt as a conditionally acceptable means of euthanasia in dogs. 13. The Committee is asked to provide any further comments on the booklet. 5

189 AC April 10 AI 09 Annex A

190 AC April 10 AI 09 Annex A Euthanasia rules and guidelines 2004 Veterinary department

191 AC April 10 AI 09 Annex A Euthanasia rules and guidelines Introduction 4 Section A: Euthanasia rules and explanatory notes 5 Section B: Training for non-inspectorate personnel 7 Section C: Preferred and accepted procedures 9 Section D: Firearms 15 Appendix A: Euthanasia consent forms 17 Appendix B: Intravenous injection of birds 19 Appendix C: Intraperitoneal injection of birds 21 Appendix D: Target sites for shooting and stunning 22 3

192 Introduction AC April 10 AI 09 Annex A 1. Euthanasia may be defined as the bringing-about of a more gentle and easier death; in the present context, this means destruction of an animal by methods which cause it to suffer the minimum of physical or mental stress. This principle must be adhered to in all cases. 2. Such destruction may be necessary for a variety of reasons which include prolonged or severe pain, distress or debility when related to incurable disease or injury. Unfortunately, animal welfare considerations may also dictate the destruction of healthy companion animals and wildlife which are unsuitable, on temperamental or physical grounds, for rehoming or for which satisfactory homes cannot be found. 3. It is clear that the Society must make provision for this unwelcome task to be carried out to a consistently high standard. Branches which are authorised are directly responsible to RSPCA Council for the standards of euthanasia maintained at animal centres within their area a detailed supervision by headquarters alone clearly being impossible. Local enforcement of the rules (and hence, protection of the reputation of the Society) is a matter for the branch committee. 4. The Euthanasia rules together with their explanatory notes, have been drafted in the light of current technical knowledge and the requirements of RSPCA Council. The rules apply specifically to RSPCA animal centres, whether large or small, undertaking the destruction of animals: they also embrace key principles which are applicable whenever animals are destroyed on behalf of the Society in other situations. 5. The Euthanasia rules and notes can only lay down reasonable minimum requirements they cannot possibly provide a practical recipe for satisfactory euthanasia. The skill of the operator, the quality of any necessary assistance and the working conditions are all important (and variable) ingredients to which must be added the nature of the animal to be destroyed. Similarly, aesthetic, safety and legal aspects of euthanasia cannot be covered completely. For these reasons, some further information on selected aspects of the whole subject is provided by means of a series of euthanasia guidelines. These guidelines are not, however, intended to be any substitute for the thorough and individual training of all RSPCA lay personnel, inspectorate and non-inspectorate, who are involved with euthanasia. 4

193 Section A: Euthanasia rules and explanatory notes AC April 10 AI 09 Annex A Rule 1 Euthanasia must only be performed by persons certified by the Society to utilise the particular method in question. Persons certified to perform euthanasia by approved methods on behalf of the Society are as follows: (a) (b) (c) Members of the Royal College of Veterinary Surgeons. RSPCA inspectors and other suitably trained lay persons who are over 18. In all cases, the individual shall be limited to the use of those approved methods for which he or she holds a certificate of competence issued by the chief veterinary officer (or appointed deputy) and which is endorsed by the chief officer of the inspectorate in the case of certificates issued to RSPCA inspectors. Student RSPCA inspectors as well as other lay trainees (over 18 years of age) who are receiving initial instruction in euthanasia and in the presence of an instructor who is authorised by the chief veterinary officer (or appointed deputy) to teach the method in question. In the case of barbiturate euthanasia, the instructor must always be a member of the Royal College of Veterinary Surgeons (or registered veterinary practitioner). For non-inspectorate training, such authorisation is required both for a particular training programme and for the inclusion of individual trainees. Following completion of authorised initial training and certification within the limits, trainees may gain additional field experience in euthanasia under the general supervision of suitable and experienced lay persons who are specifically authorised (by the chief veterinary officer or appointed deputy) to supervise such further training. In the case of other acceptable methods (see notes on Rule 2) additional restrictions are imposed. Such methods may only be used when, in the judgement of a suitably experienced person, exceptional circumstances preclude the use of a recommended method. Persons who are eligible to exercise such judgements must be suitably qualified in euthanasia and will be within the following categories:- (1) Members of the Royal College of Veterinary Surgeons (or registered veterinary practitioners). (2) RSPCA inspectors. (3) Managers of RSPCA establishments who have undergone a suitable period of experience in practical RSPCA work. (4) Veterinary nurses. (5) Any other suitably qualified person authorised by the chief veterinary officer (or appointed deputy). Rule 2 Rule 3 Rule 4 Rule 5 Rule 6 Only methods currently approved by the Society must be employed. Section C of these guidelines provides approved methods of euthanasia on a species-by-species basis for the most commonly encountered animals. Intrarenal euthanasia is not an RSPCA-recognised method of euthanasia and should not be carried out by RSPCA staff.. Following euthanasia, the carcase of any animal required to be disposed of shall not be placed in a clinical waste bag until rigor mortis is apparent, unless certified as dead by a veterinary surgeon. The possibility, however remote, of an apparently-dead animal recovering from deep anaesthesia must never be overlooked. Any legislation pertaining to the disposal of clinical waste must be taken into account. No animal shall witness or be made unnecessarily aware of the death of another animal. There will be occasions when non-adherence to this rule will be in the welfare interests of the animal(s). Carcases must be kept out of sight of other animals at all times. See note to Rule 4. Apparatus and drugs for euthanasia shall be entrusted only to persons certified to use the particular equipment in question. Apart from any questions of unqualified use, observance of Rule 6 is essential from a legal and safety viewpoint. 5

194 AC April 10 AI 09 Annex A Rule 7 Rule 8 Rule 9 Rule 10 Rule 11 Branch committees and the establishment management shall be responsible for ensuring regular and systematic inspection of their respective euthanasia facilities by a competent person. This inspection will include an appraisal of any staff involved. The chief veterinary officer shall be notified without delay of any deficiency in standards which may become apparent and which is not capable of immediate rectification. Inspection of euthanasia facilities shall be aimed at ensuring that premises and ancillary equipment are being correctly utilised and maintained, and are sufficient to ensure maintenance of the required standards. A supply of euthanasia consent forms (see Appendices A1 and A2) shall be kept. Such a form shall always be completed prior to destruction of any animal for which the Society is not already directly responsible. Society responsibility for a pet animal can only be established effectively by appropriate documentation. Euthanasia consent forms are a safeguard against tragic misunderstandings or spurious requests for euthanasia they must be signed by a responsible person over 18 year of age (eg an owner or close relative, or a police officer). The Society has a responsibility to perform euthanasia if so required. An owner must not be discouraged from seeking this service on the grounds of having to make a donation such a situation may lead to irresponsible rehoming or abandonment of the animal in question. All persons responsible for carrying out euthanasia at a Society or branch establishment at which euthanasia is carried out shall sign an undertaking (see Euthanasia standards procedures, Record of assessment book, E.2.) to the effect that: (a) He or she has read and understood the current Euthanasia rules. (b) The rules will at all times be enforced/observed at the establishment in question. (c) All euthanasia equipment and drugs must be stored and documented in accordance with such methods as may be required by headquarters. The importance of a thorough appreciation of the breadth of their responsibilities by those performing euthanasia on behalf of the Society cannot be over-emphasised. Each relevant branch committee should nominate one person who is responsible for ensuring that any changes to these guidelines is put into effect and that the branch s copy of the guidelines is amended as relevant. The avoidance of the effects of changes in committee personnel or animal home personnel on a clear understanding of these guidelines is desirable. Owned animals n Agent of necessity should be the only reason for euthanasing an owned animal therefore any animals should be taken to a veterinary surgeon prior to euthanasia if they do not fall into this category. n RSPCA employees must not accept animals for euthanasia and then rehome. n RSPCA staff should ensure that the member of the public understands that Put to Sleep (PTS) or put down means euthanasia. 6

195 Section B: Training for non-inspectorate personnel AC April 10 AI 09 Annex A Inspectors must complete euthanansia training while on their initial training course. When using a method for the first time, inspectors must be under the direct supervision of a veterinary surgeon. Animal collection officers (ACOs) may start euthanansia training after completion of three months employment with the Society and then all euthanansia training must be under the direct supervision of a veterinary surgeon. Apart from having practical experience and understanding of the species of animal involved, non-inspectorate personnel selected for training in euthanasia must be both physically and mentally suitable for work of this nature. Such personnel must be endowed with genuine compassion, calmness, determination and patience. They must also be mentally alert and receptive to training. An ability to deal with members of the public who may frequently be distressed and behaving irrationally is a further essential quality. It is because of the factors mentioned above that age limits are imposed upon candidates for training in euthanasia. A young person under the age of 18 years is unlikely to have developed sufficient stability of character for the task in hand. It should be noted that holding a licence to euthanase is a privilege granted to the RSPCA by the Home Office and any application for a licence should be well thought through before it is made. The chief veterinary officer is ultimately responsible for any euthanasia that is undertaken by a Society employee and a breach of these guidelines could mean our licence is revoked and the veterinary surgeon struck off. The RSPCA do not wish to licence any more people than is necessary and training can no longer be given by any other method than described below. A person with a licence already eg an inspector or ACO cannot sign off a trainee s book. 1 Application for training An employee must have a supervising veterinary surgeon locally before the process is embarked upon. Training will be confined to permanent employees. Criminal Records Bureau (CRB) disclosure With effect from July 2003 all staff applying for euthanasia training must first have a CRB check completed. This can be arranged through the following procedure. n Employee obtains and completes the appropriate form from human resources department at headquarters. n Line manager completes relevant sections of the form. n Form returned to the human resources department for countersignature and onward despatch to the CRB. n Form returned to the human resources department line manager informed of the content and any issues raised. n A disclosure number will be issued and line manager can apply for euthanasia training for their employee. Euthanasia application forms n All RSPCA employees need to have completed an application form apart from inspectors. This includes hospitals, animal centres, wildlife centres, branches and ACOs. n These can be obtained from the veterinary nurse training officer in the training department at headquarters or in the Managing staff training and development manual. n After completion by line manager, forms should be returned to the training department 2. Training n The chief veterinary officer will approve the training and the details will be added to the course in the region. n Five dates will be set, one in each region and applicants will be added to this list. The chief veterinary officer will then complete the one day ethics course. n Any employees who apply outside of these dates will have training completed by their regional superintendent. n Once the course has been authorised, the employee will be issued with a euthanasia training standard procedures Record of assessment booklet. This should be completed by his/her line manager and veterinary surgeon. n Line managers will be issued with euthanasia trainers notes. n Once this booklet has been completed it should be returned to the training department, then a certificate of competence will be issued by the veterinary department. n Training should be completed within six to 12 months of attending the ethics course. 7

196 AC April 10 AI 09 Annex A A certificate of competence will be quite specific in relation to the euthanasia methods which may be used by the holder and can be amended accordingly. An employee should not undertake a euthanasia method if it is not included on their certificate. Its period of validity will depend upon individual circumstances but will not exceed five years. 3. Renewal, variation and revocation of certificate of competence When a certificate of competence is approaching expiry, it is important that application for renewal (if required) be made by the line manager at least three months before the expiry date. Renewal is entirely at the discretion of headquarters. In certain cases headquarters may consider re-training to be desirable prior to renewal of certificate. It must be emphasised that line managers are responsible for ensuring that relevant certification for their staff is valid at all times. Variation of the certificate by headquarters may be requested (following additional, authorised training) in order to increase the scope of the methods included therein. Conversely, restrictive variation may be necessary due to demonstrable incompetence in a particular technique or obsolescence of that technique. It must be appreciated that headquarters reserves the right to temporarily suspend or permanently revoke a certificate of competence at any time. Generally, the grounds for such action would be incompetence, but other circumstances (such as mental illness or failure to observe the safe-keeping requirements and recording of usage for drugs or firearms) could be involved. If a member of staff leaves the certificate should be returned to the veterinary department. If any details on the certificate should change, eg surname, it should be sent to the veterinary department to be amended. 4. Cost of training Any fees payable to local veterinary surgeons involved during training will be the responsibility of headquarters. Other expenses of trainees in relation to travel, meals and accommodation (where necessary) will be a matter for the line manager of the employee. 8

197 Section C: Preferred and accepted procedures AC April 10 AI 09 Annex A Species: dog, cat, fox 1. Preferred procedures 1.1 Method Irreversible anaesthesia using pentobarbitone sodium 200 mg/ml. 1.2 Route of administration Intravenous injection. 1.3 Dose rate 1 ml/1.5 kg body weight. Note: For intravenous injections use 21 gauge, 23 gauge or 25 gauge needles. For intraperitoneal injections use the above or 18 gauge or 16 gauge if more appropriate. Guidance will be given during training. 2. Other accepted procedures 2.1 Intraperitoneal injection of pentobarbitone sodium 200 mg/ml Dose rate as above. Notes: (i) An 18 gauge or 16 gauge needle may be used. The animals must be suitably restrained. (ii) Only to be used where euthanasia must be carried out immediately but in circumstances when intravenous injection is not possible (ie lack of assistance, species in which a vein cannot be identified etc). 2.2 Intracardiac injection of pentobarbitone sodium 200 mg/ml Dose rate as above. Notes: (i) The same gauge needles as indicated above are suitable. The animals must be suitably restrained. (ii) This route should only be contemplated if the animal is unconscious. 2.3 Shooting (dog and fox only). Notes: (i) Captive bolt euthanasia should be considered before contemplating using a free bullet and then only if the approved methods of injection of pentobarbitone sodium 200 mg/ml (see 2.1) are impractical. (ii) Shooting domestic cats is not an acceptable procedure. Species: badger 1. Preferred procedures 1.1 Method Irreversible anaesthesia using pentobarbitone sodium 200 mg/ml. 1.2 Route of administration Intraperitoneal injection. 1.3 Dose rate 1 ml/1.5 kg body weight Notes: (i) An 18 gauge needle will be suitable in adult badgers. A 20 gauge needle will be suitable for use in cubs. (ii) Appropriate restraint will always be necessary. 9

198 AC April 10 AI 09 Annex A 2. Other accepted procedures As for dogs and foxes. Note: (i) Having established that dogs, foxes and badgers should only be shot where euthanasia by injection would be inappropriate, the smaller size of these animals must be taken into account ensuring the angle of trajectory is calculated so as to ensure that the bullet does not leave the animal creating a dangerous ricochet. The same rule applies when shooting any small animal. Species: rabbit, guinea pig, hamster, small rodents and bats 1. Preferred procedures 1.1 Method Irreversible anaesthesia using pentobarbitone sodium 200 mg/ml. 1.2 Route of administration Intraperitoneal injection or intravenous injection into the ear vein for a rabbit is acceptable if restrained correctly. 1.3 Dose rate 1 ml/1.5 kg body weight. Notes: (i) A 25 gauge needle is required for the euthanasia of bats. (ii) Bats are capable of prolonged inactivity at a low metabolic rate. Greater care must therefore be taken that rigor mortis has set in before disposal. Species: reptiles (lizards, snakes, tortoises, terrapins) euthanasia in these species requires specialist training and should not be undertaken if not included on employee s certificate 1. Preferred procedures 1.1 Method Irreversible anaesthesia using pentobarbitone sodium 200 mg/ml. 1.2 Route of administration Intravenous injection into ventral tail vein. 1.3 Dose rate Based on approximately 0.5 ml/1.5 kg body weight. Note: Euthanasia should be carried out at vivarium temperature. Effect seen three to five minutes after injection. 2. Other accepted procedures 2.1 Intraperitoneal injection of pentobarbitone sodium 200 mg/ml Dose rate as above. Notes: Death may take many hours if this method is used. Species: Fish euthanasia in these species requires specialist training and should not be undertaken if not included on employee s certificate 1. Preferred procedures 1.1 Method Small fish (< 10 kg): a single blow to the head with a heavy, blunt instrument. Large fish (> 10 kg): instantaneous severance of spinal cord just behind the skull using a sharp knife. 10

199 AC April 10 AI 09 Annex A Species: amphibians (frogs, toads, newts, salamanders, axolotls) 1. Preferred procedures 1.1 Method Irreversible anaesthesia using pentobarbitone sodium 200 mg/ml. 1.2 Route of administration Intraperitoneal injection. 1.3 Dose rate Based on approximately 0.5 ml/1.5 kg body weight. Notes: (i) Euthanasia should be carried out at vivarium temperature. (ii) Chilling/freezing is not an acceptable method of restraint or euthanasia. Species: birds (wild and domestic) 1. Preferred procedures for birds larger than 1kg 1.1 Method Irreversible anaesthesia using pentobarbitone sodium 200 mg/ml. 1.2 Route of administration Intravenous injection into the medial tarsal vein (especially in waterfowl) or the brachial vein. See Appendix B. 1.3 Dose rate Example dosages are: n swan (10 kg) 8 ml n goose (5 kg) 5 ml n duck (1 kg) 2 ml. 2. Other acceptable procedures 2.1 Intraperitoneal injection of pentobarbitone sodium 200 mg/ml. See Appendix C Dose rates as above. Note: Death will take longer following injection by this route. The bird must be suitably restrained in a quiet place until death intervenes. 3. Preferred procedures for birds smaller than 1kg 1.1 Method Irreversible anaesthesia using pentobarbitone sodium 200 mg/ml. 1.2 Route of administration Intraperitoneal injection. See Appendix C. 11

200 AC April 10 AI 09 Annex A 1.3 Dose rate Example dosages are: n raptor(750 g) 1 ml n pigeon(500 g) 1 ml n dove(250 g) 0.5 ml n blackbird(100 g) 0.5 ml n sparrow(50 g) 0.25 ml n wren(10 g) 0.1 ml. Notes: (i) The bird must be suitably restrained in a quiet place until death intervenes. (ii) Care must be taken to avoid injecting fluid into air sacs, which causes distress. 4. Other acceptable procedures for domestic poultry, pigeons, game birds and corvids up to 2.5 kg 4.1 Dislocation of the neck. This is only appropriate where specialist training has been completed and has been included on employee s certificate. Species: seals Note: This method is not suitable for use in very small birds or in those with a long, mobile neck. 1. Preferred procedures 1.1 Method For seals weighing in excess of 80 kg: shooting with suitable firearm. (RSPCA inspectors only). Notes: The provisions of the Conservation of Seals Act 1970 must be borne in mind with regard to the exemption under Section 9 (2) allowing for humane destruction when necessary. An RSPCA free bullet slaughter pistol may be used at point blank range Target area - see Appendix D For seals weighing less than 80 kg: irreversible anaesthesia using pentobarbitone sodium 200 mg/ml. 1.2 Route of administration (pentobarbitone sodium 200 mg/ml) Intravenous injection ONLY TO BE CARRIED OUT WHERE SPECIALIST TRAINING HAS BEEN COMPLETED AND INCLUDED ON EMPLOYEE S CERTIFICATE.. For all other registered users: intraperitoneal injection. 1.3 Dose rate 1 ml/1.5 kg body weight. Species: cattle, sheep, goat and pig only to be undertaken once specialist training has been given and included on euthanasia certificate 1. Preferred procedures 1.1 Method Stun by captive bolt followed by pithing to ensure death, ensuring that health and safety precautions are taken to prevent zoonosis. (RSPCA inspectors only) 12

201 AC April 10 AI 09 Annex A 1.2 Target area See Appendix D. 1.3 Charge 2.5 grain blank for animals weighing up to 110 kg and 3 grain blank for heavier, if in any doubt use 3 grain blank. Note: Horned sheep and horned goats, boar, Vietnamese pot bellied pigs and bulls must always be stunned with a 3 grain blank. 2. Other accepted procedures 2.1 Shooting, using a free-bullet having due regard to the size of the animal and its location, keeping safety in mind. 2.2 Shotgun only appropriate where specialist training has been completed. 2.3 Irreversible anaesthesia using pentobarbitone sodium intravenous injection at 1 ml/1.5 kg body weight. Note: Also consider the amount of pentobarbitone sodium required to destroy a large animal and the difficulties in disposing of a contaminated carcase, although the latter must not affect judgement when choosing the most humane method. Species: horse, donkey, mule 1. Preferred procedures 1.1 Method Shooting, using a free-bullet 1.2 Target See Appendix D. 1.3 Charge.32/85 round of ammunition with soft bullet head. Note: (i) If any doubt occurs regarding the sufficiency of penetration in horses, deer and donkeys then the animal must be pithed in accordance with procedures for captive bolt stunning of cattle. 2. Other accepted procedures 2.1 Stunning horses or donkeys using a Cash Special captive bolt (no other captive bolts permitted), followed by pithing Target See Appendix D Shotgun only appropriate where specialist training has been given Captive bolt charge 2.5 grain blank for animals weighing up to 110 kg and 3 grain blank for larger animals. 3. Irreversible anaesthesia using intravenous pentobarbitone sodium 200 mg/ml injection at a dose rate of 1 ml/1.5 kg body weight. Note: The amount of pentobarbitone sodium 200 mg/ml required to destroy a large animal must be 13

202 AC April 10 AI 09 Annex A Species: Deer taken into account in addition to which the problems associated with disposing of contaminated carcasses must also be considered. The latter should not be a factor in consideration of the most humane method of destruction on standing horses. 1. Preferred procedures 1.1 Method Shooting, using a free-bullet. 1.2 Target See Appendix D. 1.3 Charge.32/85 round of ammunition with soft bullet head. Notes: (i) If any doubt occurs regarding the sufficiency of penetration the animal must be pithed in accordance with procedures for captive bolt stunning of cattle. In the case of smaller species of deer and immature animals extra care must be exercised regarding the angle of trajectory ensuring the bullet does not leave the animal creating a danger to the operator or bystanders. (ii) When shooting deer on humane grounds the provision of the exemption under Section 6(2) of the Deer Act 1991 must be taken into account. Where a deer cannot be shot at point blank range, the use of a humane slaughter pistol or captive bolt is not permitted. A soft-nosed bullet exceeding 0.24 inches with a kinetic energy of at least 1700 ft lbs is needed. The assistance of a competent marksman is obligatory under these circumstances. (iii) The use of a 12-bore shotgun is permitted under some circumstances. This must have a barrel of at least 24 inches and must fire a single projectile weighing not less than 350 grains or a cartridge containing shot, each of which is inches in diameter (AAA or larger.) This should only be attempted by a trained marksman. 2. Other accepted procedures 2.1 Stunning deer using a Cash Special captive bolt, or any captive bolt of the same efficiency, followed by pithing Target See Appendix D Charge 3 grain blank for all deer. 3 Irreversible anaesthesia using intravenous pentobarbitone sodium 200mg/ml injection at a rate of 1ml/1.5 kg body weight. Notes: The amount of pentobarbitone sodium 200 mg/ml required to destroy a large animal must be taken into account in addition to which the problems associated with disposing of contaminated carcasses must also be considered. The latter should not be a factor in consideration of the most humane method of destruction. n For information on any species that have not been covered, please contact the RSPCA veterinary department, your veterinary surgeon or a zoo. 14

203 Section D: Firearms AC April 10 AI 09 Annex A 1. Applicability When correctly performed, the humaneness of shooting cannot be called into question but aesthetic considerations can pose real problems, particularly in relation to pet animal euthanasia. The method is sometimes perceived as crude or even violent and is apt to upset people who are unprepared for noise, haemorrhage and the necessity, very often, to pith. As far as animal establishments are concerned, the use of firearms is, in general, inappropriate. It requires the provision of a suitably sited destruction room, out of earshot of the general public or an open area with a safe back stop, and this area must offer complete safety together with facilities for thorough and rapid cleaning. Apart from its applicability to large animals, this method may, occasionally, be applied to single-handed euthanasia of dogs, badgers, foxes and seals. This may be particularly relevant to rapid destruction of a severely injured, trapped, or dangerous animal in a field situation. 2. Legal considerations Free-bullet pistols are Section 1 firearms within the terms of the Firearms Act 1968 (as amended). Following the Firearms (Amendment) Act 1997, they attract Section 5 (prohibited weapon status) necessitating very strict security and safety procedures to be applied. They may not be held without a valid firearm certificate and without provision being made for the safe storage of firearms and ammunition at all times. Strict compliance with the inspectorate standing orders (ISO) protocols must be maintained. Firearms certificates are issued by the chief officer of police for each constabulary, subject to stringent conditions. The applicant must be a responsible person of good character, must have genuine reasons for requiring such firearms and must state the circumstances under which they will be used. The conditions of the firearm certificate are quite specific regarding the type of firearm and quantity of ammunition which may be held or purchased at any time. Only firearms and ammunition issued by the appointed firearms officer at the Society s national headquarters, may be used. Under exceptional circumstances authority may be sought through the headquarters training school firearms officer for the use of a firearm which is not issued by the Society. In the absence of any other firearm, and if the use is justified, permission will not be unreasonably withheld. No Society personnel will destroy an animal using a firearm unless they have been trained to a satisfactory level of competence by Society approved trainers. While captive bolts and blanks do not require the operator to have a firearm certificate, the same rigorous security and safety protocols are applied. 3. Approved equipment 3.1 Pistols There are two modified.32 calibre pistols issued to Society personnel. The vast majority of these comprise the Taurus/Cash single shot humane killer plus a few Mark IV Webley and Scott single shot humane killers. The latter are being phased out. Both are designed to be fired at point blank range into the animal s brain. Ammunition is of appropriate strength (.32/85) and of the soft nosed bullet variety manufactured specifically for this purpose. The correct use of this equipment results in sufficient brain damage to kill the animal instantaneously. For reasons of safety, pistols should not be employed where the use of a captive bolt would be more appropriate. 3.2 Captive bolts The captive bolt in greatest use by Society personnel is the.22 (calibre blank) Cash Special but a number of the Temple Cox Universal captive bolts are still in circulation. Captive bolts are designed purely to stun the animal by causing instantaneous trauma to the higher brain centre. While sufficient brain damage may be achieved to cause death, all animals stunned with a captive bolt must be pithed to ensure death has taken place. (Please refer to the ISO concerning pithing). 15

204 AC April 10 AI 09 Annex A Each firearm must only be activated with its own specific type of ammunition or blanks. Regard to the size and species of the animal must always be taken into account when choosing the appropriate weapon and ammunition. Any colour coding denoting strength of blanks varies from stunner to stunner. 4. Firearms safety Although safety is dependent upon correct training it also requires consistent discipline. Familiarity must never be allowed to breed contempt. The safety procedures laid down at the time of training must always apply. 5. Maintenance of firearms Satisfactory euthanasia is entirely dependent upon reliability of the equipment. Firearms and ammunition must be maintained to the highest standard of cleanliness and efficiency at all times. Since firearms are, generally, used infrequently it is vital to see that maintenance and regular inspection is not neglected. Firearms must be activated at least once a year to ensure correct performance is being achieved. The maintenance procedures laid down at the time of training apply at all times. 6. Adherence to technique The following points must be strictly observed at all times: 1. On no account will a humane killer be applied to any region of the animal other than the head in accordance with the recommended target points. 2. Where a captive bolt is used, destruction of the hind brain must be ensured by using a pithing rod. Any solid rod may be employed provided sufficient brain damage is achieved. For the purpose of humane destruction it is not necessary for the rod to enter the spinal cord but it is essential that the rod penetrates as far as the brain stem. A screwdriver or cane of sufficient length is suitable. 3. The correct type of ammunition/blanks must always be used. 4. If more than one animal is to be shot every effort must be made to ensure an animal is not shot within the sight of another animal and there must be no sight or odour of blood detected by another animal. Only in instances where this is impossible to achieve without causing unnecessary pain and distress to other animals will an alternative procedure be accepted. Where such deviation from procedure is unavoidable all humanity will be shown to any animals present. 16

205 Appendix A1: Euthanasia consent form AC April 10 AI 09 Annex A Hospitals/animal centres/branches This part to be completed by individual consenting to the humane euthanasia of an animal Important note: Stray dogs cannot be accepted for euthanasia. In accordance with the law, during normal office hours, these should be reported to the local dog warden. Outside office hours, they should be taken by the finder to the police station nearest to where the dog was found. 1. Date animal handed over for euthanasia 2. Description (state whether cat, dog etc. and give colour and sex) and name, if known 3. Name and address of person consenting to the euthanasia of the above animal 4. Name and address of actual owner of above animal (if other than the person referred to under 3.) 5. Reason why person other than owner gives consent 5a. Confirmation from owner received in writing Y / N 6. Reason for euthanasia Signature: This part to be completed by RSPCA official I hereby certify that a, declared to be the property of, will be/has been* euthanased in a humane manner at I acknowledge receipt of as a voluntary donation. Date: Signed: for and on behalf of the RSPCA. * Delete as appropriate 17

206 Appendix A2: Euthanasia consent form AC April 10 AI 09 Annex A Inspectorate/animal collection officers This part to be completed by individual consenting to the humane euthanasia of an animal Important note: Stray dogs cannot be accepted for euthanasia. In accordance with the law, during normal office hours, these should be reported to the local dog warden. Outside office hours, they should be taken by the finder to the police station nearest to where the dog was found. 1 Date animal handed over for euthanasia 2 Description (state whether cat, dog etc. and give colour and sex) and name, if known 3 Name and address of person consenting to the euthanasia of the above animal 4 Name and address of actual owner of above animal (if other than the person referred to under 3.) 5 Reason why person other than owner gives consent 5a Confirmation from owner received in writing Y / N 6 Reason for euthanasia Signature 18

207 Appendix B: Intravenous injection of birds AC April 10 AI 09 Annex A Medial tarsal vein injection Medial tarsal vein located within the shaded area. 19

208 AC April 10 AI 09 Annex A Appendix B: Intravenous injection of birds Ventral surface of left wing Lift these feathers forward (cranially) to reveal site of vein. Brachial (wing) vein injection (ventral) 20

209 Appendix C: Intraperitoneal injection of birds AC April 10 AI 09 Annex A Internal view (ventral) Air sacs (area to avoid) Correct needle placement External view (ventral) Air sacs (area to avoid) Correct needle placement Internal view (ventral) Area to avoid Correct needle placement External view (ventral) Area to avoid Correct needle placement 21

210 AC April 10 AI 09 Annex A Appendix D: Target sites for shooting and stunning Horse Deer 22

211 AC April 10 AI 09 Annex A Appendix D: Target sites for shooting and stunning Cow Goat 23

212 AC April 10 AI 09 Annex A Appendix D: Target sites for shooting and stunning Dog Fox Badger Seal 24

213 AC April 10 AI 09 Annex A Appendix D: Target sites for shooting and stunning Sheep Pig 25

214 AC April 10 AI 09 Annex A Notes 26

215 AC April 10 AI 09 Annex A 27

216 AC April 10 AI 09 Annex A Registered charity no The RSPCA receives no government funding. Royal Society for the Prevention of Cruelty to Animals, Veterinary Department, Wilberforce Way, Southwater, Horsham, West Sussex RH13 9RS Telephone: Facsimile: Website: Updated Illustrations: D Bainton

217 AC April 2010 AI 10 MEETING Advisory Committee DATE 20 April 2010 TITLE CLASSIFICATION SUMMARY British Horseracing Authority s Rule of Racing provisions in the RCVS Guide to Professional Conduct Unclassified To consider proposed changes to the RCVS Guide to Professional Conduct following changes to the British Horseracing Authority s (BHA) Rule of Racing. To consider an annual meeting between RCVS and BHA. DECISIONS REQUIRED To recommend to Council any Guide change To endorse an annual meeting between RCVS and BHA ATTACHMENTS AUTHOR None Chris Murdoch Professional Conduct Department Gordon Hockey Professional Conduct Department g.hockey@rcvs.org.uk 1

218 AC April 2010 AI 10 2

219 AC April 2010 AI 10 BACKGROUND/CURRENT POSITION 1. In September 2008, the Advisory Committee considered proposals to revise part 2D of the RCVS Guide to Professional Conduct on euthanasia without an owner s consent. 2. As part of the proposals, The British Horseracing Authority (BHA) was asked to confirm its rules with regard to the destruction of horses, and the legal affairs manager provided revised rules. 3. The Advisory Committee was asked to consider the revisions from the BHA and the following paragraph was approved and included in the Guide changes 2009 update, (Part 2D Paragraph 32): Destruction of injured horses 32. The British Horseracing Authority s (BHA) Rules of Racing, which apply to BHA-regulated events state: Where, in the opinion of the attending veterinary surgeon, a horse is so severely injured that it ought to be humanely destroyed, the Owner or the Trainer should, wherever possible, first be informed. However, the veterinary surgeon may proceed with humane destruction, without reference to Owner or Trainer, in order to prevent undue suffering to the horse. Before taking this action the veterinary surgeon should, wherever practicable, seek a second opinion. (Ref: the British Horseracing Authority Instruction J17 and FEI Article ) PROPOSED CHANGE 4. The BHA has informed the RCVS that the Rule has been revised without any significant change in meaning. 5. The revised wording is as follows: Where a horse is, in the opinion of a racecourse Veterinary Surgeon, so severely injured that it ought to be humanely destroyed in order to prevent undue suffering the racecourse Veterinary Surgeon will seek to inform the owner or Trainer of the horse and obtain a second opinion before proceeding with the humane destruction, but if it is not practicable to do so, he may proceed with humane destruction without reference to the owner or Trainer. (Rule (D) 81 of the Rules of Racing) 3

220 AC April 2010 AI The Committee is asked to approve the inclusion of the revised rule to replace the existing quote. 7. The BHA has also suggested an annual meeting with the RCVS, to discuss matters of mutual interest including, for example, regulatory investigation practices. 8. To the extent that this affects advisory issues, the Committee is asked to endorse the proposed annual meeting; and offer suggestions for agenda items for a first meeting. PR IMPLICATIONS 9. There are none. CONCLUSIONS 10. The Committee is asked to consider and approve the revision to part 2D (32) of the Guide to Professional Conduct The Committee is asked to endorse the proposed annual meeting between RCVS and BHA at a suitable time in the future. 4

221 AC April 2010 AI 11 MEETING Advisory Committee DATE 20 April 2010 TITLE CLASSIFICATION SUMMARY DECISIONS REQUIRED Advice Note on Student Placements - Criminal Records Bureau (CRB) checks and the Independent Safeguarding Authority (ISA) Unclassified This paper proposes the introduction of a new advice note for veterinary surgeons asked to consider offering work experience placements for children/students particularly in relation to whether Criminal Records Bureau (CRB) checks and/or registration with the Independent Safeguarding Authority (ISA) will be required To consider the issues as highlighted by the paper and to consider whether to approve the advice note as currently drafted ATTACHMENTS Annex A Advice Note on Student Placements - Criminal Records Bureau (CRB) Checks and the Independent Safeguarding Authority (ISA) AUTHOR Laura McClintock Professional Conduct Department l.mcclintock@rcvs.org.uk 1

222 AC April 2010 AI 11 2

223 AC April 2010 AI 11 BACKGROUND 1. In February 2010, the Public Affairs Committee agreed that the College should consider producing advice for veterinary surgeons who are asked to offer work experience placements for children/students particularly in relation to whether Criminal Records Bureau (CRB) checks and/or registration with the Independent Safeguarding Authority (ISA) is required. 2. This issue has been considered in the past and brief advice was given in the November 2003 edition of RCVS News. Veterinary surgeons thinking of offering work experience placements were advised to consider the publications available from the Department for Education and Skills (DfES) at that time. The DfES publications offered practical advice on work experience placements and explained the legal background, for example, in relation to organisational and health and safety considerations, as well as specific concerns relating to the protection of children. The RCVS News article also advised veterinary surgeons to be aware of the guidance produced by the Health and Safety Executive (HSE) on these matters. 3. Since the publication of this article, there have been a number of changes to the legislation governing this area, particularly the increased awareness of child protection and the introduction of the new Vetting and Barring Scheme (VBS) by the Independent Safeguarding Authority (ISA) in October In addition, the Health and Safety Executive and the new Department for Children, Schools and Families have produced updated guidance following the introduction of new legislation on child protection. 4. The British Veterinary Association (BVA) has also produced a guidance document entitled The Criminal Records Bureau A Guide to Routine Checks which is available to download from their website. CURRENT POSITION 5. Work experience introduces young people to the workplace and is a worthwhile and essential part of their education. When a veterinary surgeon is approached by a school or educational institution to consider offering work placements, one of the most common concerns will be the potential requirement for a Criminal Records Bureau (CRB) check. 6. Ultimately it will be up to the schools or organisations involved to advise on individual placements and determine whether the work experience provider satisfies the criteria for a CRB check. Eligibility is governed by legislation and a veterinary surgeon will be eligible for a check if the normal duties include regularly caring for, training, supervising or being in sole charge of a child. 3

224 AC April 2010 AI Since the introduction of the Vetting and Barring Scheme (VBS) in 2009, another consideration is whether registration is required with the Independent Safeguarding Authority (ISA). The ISA aims to prevent those individuals who are a known risk from working with vulnerable children or adults. 8. Even though registration is mandatory for most employees and volunteers working regularly with children and vulnerable adults, there are some circumstances where the scheme does not apply. These exceptions are set out in detail in the ISA guidance available on line and may include work experience placements. When considering offering work experience placements, veterinary surgeons should consult the ISA guidance to determine whether registration is required. 9. The requirements in terms of CRB checks and registration with the ISA have been set out in more detail on the draft advice note along with links to the relevant governing bodies. DISCUSSION/ ISSUES 10. Veterinary surgeons may also be asked to offer work experience placements on a more informal basis, not through an educational institution. Under current legislation individuals cannot apply for CRB checks, except for Scotland where anyone can apply for a basic low level check. In these circumstances, veterinary surgeons should consider whether the placement could be arranged via the student s educational institution or if impracticable consider whether it is appropriate to accept the placement student. 11. Prior to accepting a work placement student, either on a formal or informal basis, veterinary surgeons are encouraged to consider a number of issues which have been set out in more detail on the draft advice note. The advice note also encourages veterinary surgeons to seek further advice from the Health and Safety Executive (HSE) in relation to the practical health and safety concerns including the legal obligations regarding young people in the work place. 12. It is important that the issues are considered important by the profession, and appropriate checks, planning and preparation is undertaken for such placements. It is equally important that this is proportionate so that veterinary surgeons continue to offer appropriate placements, formally or informally, so that students have access to the profession. FINANCIAL IMPLICATIONS / PR IMPLICATIONS 13. There are no foreseeable issues in this respect. CONCLUSIONS/RECOMMENDATIONS 4

225 AC April 2010 AI The Committee is asked to consider the proposed advice note to ensure it explains the issues appropriately. 5

226 AC April 2010 AI 11 6

227 AC April 10 AI 11 Annex A DRAFT ADVICE NOTE STUDENT PLACEMENTS - CRIMINAL RECORDS BUREAU (CRB) CHECKS AND REGISTRATION WITH THE INDEPENDENT SAFEGUARDING AUTHORITY (ISA) 1. Veterinary surgeons in practice may be asked by local schools or organisations to consider offering work experience placements for students. Work experience introduces young people to the world of work and can be a valuable and crucial part of their education. There may, however, be a number of questions raised when taking on responsibility for a minor most notably whether a Criminal Records Bureau (CRB) check or registration with the Independent Safeguarding Authority (ISA) is required. What is the role of the Criminal Records Bureau and will a check be required? 2. The Criminal Records Bureau (CRB) provides access to criminal record information through its disclosure service enabling organisations in the public, private and voluntary sectors to identify individuals who may be unsuitable for certain work particularly work involving children and vulnerable adults. 3. It will be up to the schools or organisations involved to advise on individual placements and determine whether the work experience provider satisfies the criteria for a CRB check. Eligibility is governed by legislation and everyone will be eligible for a check if the normal duties of their position include regularly caring for, training supervising or being in sole charge of a child 1. Factors to consider will include whether the student is vulnerable for educational, medical, behavioural or home circumstance reasons; length of placement; lone working periods; isolated environments; travelling; and placements with a residential element. 4. There is no requirement to CRB check all staff who may come into contact with a student on placement. Although it is the responsibility of the school or organisation to determine whether a check is required, generally the checks will be limited to the person with day-to-day responsibility for the student. 5. Veterinary surgeons may also be asked to offer work experience placements on a more informal basis and not through an educational institution. Under current 1 Guidance on eligibility can be downloaded from the Criminal Records Bureau website at Applicants Guide to the CRB s Disclosure Service 7

228 AC April 10 AI 11 Annex A legislation individuals cannot apply for checks themselves except for Scotland where anyone can apply for a basic low level check. In these circumstances, veterinary surgeons should consider whether the placement could be arranged via the student s educational institution or if impracticable consider whether it is appropriate to accept the placement student. What is the Independent Safeguarding Authority (ISA) and do I need to register? 6. The role of the Independent Safeguarding Authority (ISA) is to help prevent unsuitable individuals from working with children and vulnerable adults. The ISA s Vetting and Barring Scheme, which was introduced in 2009, aims to prevent those individuals who are a known risk from working with vulnerable groups. It covers anybody who wants to volunteer or work with children or vulnerable adults (vulnerable groups) in a regulated activity on a frequent, intensive or overnight basis The ISA works in close conjunction with the CRB to deliver the scheme and will assess all relevant information held on the Police National Computer, disciplinary action by employers and social services records, but will only use information which suggests somebody may pose a risk to vulnerable groups. Anybody deemed a risk or unsuitable to work with vulnerable groups will be placed on one of two (ISA) barred lists. 8. Registration is mandatory for most employees and volunteers working regularly with children and vulnerable adults, but there are some circumstances where the scheme does not apply. These exceptions (including advice on the frequency and intensiveness tests) are set out in detail in the ISA guidance available on line and may include work experience placements. When considering offering work experience placements, veterinary surgeons should consult the ISA guidance to determine whether registration is required. 9. It is a criminal offence for individuals barred by the ISA to work, or apply to work, with vulnerable groups. It is also an offence for employers to knowingly use an ISA barred individual for working with vulnerable groups. 10. Both the ISA and the CRB have jurisdiction in England, Wales, and Northern Ireland and in the latter they are linked to Access NI. Disclosure Scotland, which is an executive agency of the Scottish Government, maintains a separate scheme with links to its UK counterparts. 2 Regulated Activity is the statutory term used to describe specific activities which involve working or volunteering with children or vulnerable adults and certain situations where individuals have contact with those groups. It covers any work, paid or unpaid, carried out on a frequent, intensive or overnight basis, but does not include family or personal arrangements- Vetting and Barring Scheme Guidance March

229 AC April 10 AI 11 Annex A Additional Considerations 11. Prior to accepting a work placement student, either on a formal or informal basis, veterinary surgeons are encouraged to consider the following non-exhaustive list of questions; - Is the student old enough? - Have the objectives and limitations of the placement been identified and is a pre-placement interview desirable to achieve this? - Have any relevant health and safety issues been considered? - Have contact details been sought from the parents/guardians/school? - Will the practice s insurers cover the placement and have they been notified? - Will the work experience be at the practice premises where others will always be present, or not? - Will the placement be located in an isolated environment? - Will the placement involve travelling (for example, attending domiciliary visits with the veterinary surgeon) and will a member staff be alone with the student? - Have the relevant issues been discussed with the student s parents/guardians/school? - Has the student disclosed his or her relevant medical or personal information, for example, is the student diabetic? 12. Veterinary surgeons must consider relevant child protection issues. 13. If you offer work experience placements to students, you have the same responsibilities for their health, safety and welfare as for all practice staff. The Health and Safety Executive (HSE) advises that a risk assessment should be carried out before the young person starts work and provides guidance (available on the HSE website) on what you need to do when assessing the health and safety risks to all young people in your workforce below the age of 18, including work placement students. Links Guidance on these issues can be found from the following sources; British Veterinary Association The Criminal Records Bureau- A Guide to Routine Checks Criminal Records Bureau Independent Safeguarding Authority The Vetting and Barring Scheme Guidance March

230 AC April 10 AI 11 Annex A Health and Safety Executive (HSE) The Right Start- Work Experience for Young People: Health and Safety Basics for Employers and Young People at Work A Guide for Employers Department for Children, Schools and Families Disclosure Scotland Access Northern Ireland Professional Conduct Department June

231 AC April 10 AI 12 MEETING Advisory Committee DATE 26 January 2010 TITLE Guide Review 2010 CLASSIFICATION Unclassified apart from annex E, which is confidential SUMMARY Proposals for the 2010 review of the RCVS Guide to Professional Conduct. DECISIONS REQUIRED To provide answers or indications in relation to each of the questions, to give a steer to the Guide Working Party that was agreed in September ATTACHMENTS AUTHOR Annex A - The European Council of the Liberal Professions statement of Common Values Annex B - The FVE Good Veterinary Practice Guide Annex C - The European Veterinary Code of Conduct Annex D - Paper o principle-based regulation Annex E - Counsel s opinion on an RCVS health protocol Gordon Hockey Head of Professional Conduct / Assistant Registrar 1

232 AC April 10 AI

233 AC April 10 AI 12 BACKGROUND AND INTRODUCTION RCVS 1. RCVS Council approves the RCVS Guide to Professional Conduct for veterinary surgeons ( the Guide ) and any changes to the Guide are notified to the profession, formally, on an annual basis. It includes key principles, veterinary surgeons (major) responsibilities and guidance, as well as annexes on specific aspects of practice, for example, the work of the Named Veterinary Surgeon and is the veterinary profession s primary source of advice on professional practice or conduct. 2. In 2000, the Guide underwent its last major revision and was considerably smaller and more principles-based than its predecessors in 1993 and Since then, the Guide has been updated annually and reissued biennially. Advice on professional practice (professional conduct matters) is also provided by Advice Notes, more recently approved by the Advisory Committee, and advice from staff of the Professional Conduct Department in response to queries from the profession and the public. 3. In 2005, the RCVS Practice Standards Scheme was introduced with a Manual of Practice Standards, which is an annex to the Guide. The Scheme now includes approximately half of all veterinary practices and the Scheme Rules and Manual of Standards have been revised recently and were approved by Council in November The Manual now sets out responsibilities and guidance on the same page. Core standards are legal requirements and requirements of the Guide. 4. In 2007, a Guide to Professional Conduct for veterinary nurses was introduced following the same format of the veterinary surgeons Guide to Professional Conduct. The veterinary nurses Guide is very similar to the (veterinary surgeons ) Guide and only the principles and responsibilities vary, with the guidance and annexes identical. 5. Since the introduction of the veterinary nurses Guide the RCVS has sought to issue professional conduct advice to the veterinary team, veterinary surgeons and nurses. 6. A full review of the Guide in 2010 has been within RCVS plans and in September 2009 the Advisory Committee agreed a Guide Working Party would consider the detail of a revised Guide to Professional Conduct or similar named document. 7. The Advisory Committee and Council are asked to decide a number of key issues, to assist the work of the Guide Working Party. Europe 8. The European Council of the Liberal Professions (CEPLIS) statement of common values for the liberal professions, which was published in June 2007, is attached as annex A. The veterinary profession is one of the liberal professions to which the statement applies. It states what are considered to be the key responsibilities of a liberal profession. While these are provided for within the Guide currently, it is suggested that any revised Guide might seek to emphasise these principles. 3 3

234 AC April 10 AI The FVE Code of Conduct and Good Veterinary Practice Guides are attached as annexes B and C. It is suggested that the Guide Working Party should have regard to their provisions, in particular, the principles-based layout of the Code of Conduct and the emphasis on management and service delivery (or outcomes) in the to Good Veterinary Practice Guide. 10. EU Directive 2006/123/EC on the provision of services in the internal market will also need to be taken into consideration by the Guide Working Party. It provides for example, that service providers, including veterinary surgeons, should give customers and clients relevant information such as their contact details; much of this information is provided in the normal course of business. However, the Directive also requires service providers to set out, for example, the details of any regulator and insurer (if required for practice) and certain information must be provided on request, such as the price of a service or if an exact price cannot be given the method for calculating the price. KEY ISSUES Principles Based Regulation 11. Questions: a) Should the revised Guide be a short, principles-based Guide without detailed guidance? b) If not, should a short principles-based Guide complement a more detailed Guide? 12. Attached as annex D is a detailed paper relating to principles-based regulation and the format and language of Codes and Guides. 13. A number of professional regulators have moved to so called principles-based regulation, and have sought to reduce the content of their professional Guides to the basic requirements of the profession; in effect, a statement of the minimum necessary to maintain professional conduct. For example, the Royal Institute of Chartered Surveyors (RICS) has reduced its Guide to a statement of the five principles of better regulation, proportionality, accountability, consistency, targeting and transparency and nine personal and professional standards of integrity and competence (RICS Rules of Conduct for Members 4 June 2007, version 2 with effect from 01 January). The RICS does have an additional principles-based code of conduct for firms. 14. However, principles-based regulation is not new. The Financial Services Authority (FSA) recognised this indicating that its rulebook has always been founded on high-level principles and while there will continue to be some detailed rules, but the balance between the two is changing. The FSA suggests that this less prescriptive approach will give greater responsibility to the those regulated and allow them to focus on outcomes (presumably the service delivered to the client); and that although there will be no lowering in standards, there will be a bit less certainty about those standards 4 4

235 AC April 10 AI 12 (Principles-based regulation, focusing on the outcomes that matter, April 2007). However, the FSA appears to have a considerable quantity of additional guidance to promote good practice. 15. Arguably, the RCVS Guide to Professional Conduct issued in 2000 was more principlesbased than its predecessors as it sought to dispense with the detailed guidance provided in the 1996 Guide. The experience of the last ten years (the increase in annexes to the Guide and Advice Notes providing detailed guidance) suggests that it has been only partially successful in promoting principles-based regulation within the veterinary profession. For example, guidance from the 1996 Guide has been reintroduced (e.g. Blood banks, Advice Note 5; Artificial breeding techniques including embryo collection and transfer, Advice Note 10) and additional advice has been issued on a number of issues already covered in the Guide in principle (Veterinary Medicines Regulations frequently asked questions, Advice Note 24; Equine pre-purchase examination, Advice Note 26). More recently, there has been a decision to provide additional practical information about providing 24-hour emergency cover. 16. Principles-based regulation is sometimes equated with statements the breach of which will result in suspension or removal from the register. It is sometimes suggested these are preferable to good practice guides which do not make clear that some guidance is more significant in the profession s complaints and disciplinary procedures: that certain misbehaviour, for example, dishonesty, is likely to lead to suspension or removal from the register, while other misbehaviour may result in no formal disciplinary action. To an extent this may be correct, but during the Shipman Fifth Inquiry, Dame Janet Smith suggested there was a need for separate thresholds guidance for this purpose. She indicated there is a need for professionals and the public, as well as those who adjudicate on complaints, to understand the seriousness of certain guidance breaches. She indicated that the General Medical Council s revised guide Good Medical Practice and its indicative sanctions guidance were not enough for this purpose and proposed that thresholds should be developed in one of two forms: an indication of how certain behaviour would be dealt with by the complaints and disciplinary process, or an analysis of how complaints had been dealt with in the past (Shipman Fifth Inquiry, Chapter 27, Proposals for change affecting the General Medical Council). 17. In conclusion, it is suggested that while a short, concise principle-based document may be appropriate, the detailed guidance accumulated over the last ten years or more should be retained in the Guide, or other related guidance documents, otherwise this may need to be re-issued in subsequent years. It is also suggested that the Guide should not seek to replace any information that is or ought to be provided on thresholds in the complaints and disciplinary procedures 5 5

236 AC April 10 AI 12 Format and language 18. Questions: a) If the revised Guide includes detailed guidance, should this be set out in similar format to the current Guide, or in the format of the new Practice Standards Manual, or in some other format? b) Should there be some form of independent validation of the Guide? 19. The format of the Guide is as follows: top level principles, specific responsibilities and more discursive guidance, with additional annexes and finally advice notes on specific or topical issues. These are set out sequentially. This has resulted in advice on one issue appearing in a number of different parts of the Guide or in an annex and occasionally in an Advice Note as well. As a result, all relevant advice can be difficult to find, although arguably this could be addressed by an index or electronic links. The aim should be that relevant advice can be found easily by the profession and the public. 20. It might be appropriate to draft the revised Guide in the format of the revised Practice Standards Scheme (PSS) Manual, which links requirements with advice on the same page. The revised PSS Manual was considered and approved by Council in November However, even with such a system, there will still be a need for topical advice on an ongoing basis, but it is suggested this could be linked to the Guide, to ensure advice is accessed through one system. 21. Professional Guides have been drafted with a variety of language to express the importance or desirability of compliance, from must at all times, to must, should ought and could, with many alternatives. It is suggested that generally statements of time periods are unhelpful because they add nothing to the guidance and that otherwise the drafting should be consistent in the terms used and, so far as practicable, there should be a logical structure which allows readers to identify easily what is mandatory and what is guidance; as the Guide does now. It is suggested that a review of the current and proposed Guide is carried out, as proposed in annex D, to ensure that the revised drafting of the Guide is consistent. It is also suggested that the RCVS might seek Crystal Mark approval from the Plain English Campaign. 22. Unless the Guide is reduced to a statement of principles, no change is suggested to the current structure of stating responsibilities as they may be owed to different groups, for example, patients, clients, colleagues and the public. 23. In conclusion, it is suggested that the Guide should be similar in format to the PSS Manual, with all advice on one issue grouped together or easily linked and, in addition, that the language should be consistent and in plain English. 6 6

237 AC April 10 AI 12 Practice Standards Scheme 24. Question: a) Should the PSS Manual have a status similar to the Guide, as a Guide for Veterinary Practices? 25. The Core standards under the PSS are a mixture of legal requirements and Guide requirements and, therefore, should be met by all practices. However, this is not necessarily clear even though the Manual is an annex to the Guide, because the PSS is a voluntary scheme. Arguably Core Standards should be recognised more prominently as applicable to all practices, not just those in the PSS, and given a status similar to the Guide. 26. Recognising the PSS Core Standards as a guide for veterinary practices might also indicate a greater willingness on the part of the RCVS to regulate corporate practice and could give a framework for further relevant discussion with corporate organisations. It could also help to indicate to veterinary surgeons in positions of responsibility in management what is expected of them. Also, the guide requirements are restated in the main body of the Guide, which is arguably unnecessary. 27. However, giving the PSS Manual or Core Standards an independent status similar to the Guide may lead to confusion about the general practice and hospital standards in the PSS and whether these apply to all practices; although a booklet of core standards only might reduce such confusion. Practice Standards might also be considered as a specialist document, applicable only to those who own practices and therefore not consulted by all veterinary surgeons. In addition, it might suggest the RCVS can regulate veterinary practices, whereas the RCVS jurisdiction relates solely to veterinary surgeons and from late 2010, registered veterinary nurses and not bodies corporate. 28. In addition, some requirements will have to be repeated in both the PSS Manual and the Guide, because certain professional requirements relate to the individual but are checked within PSS, for example, the need for continuing professional development to be completed. Therefore, the impact of any standalone Guide for Veterinary Practices may be reduced. 29. The RCVS voluntary code of practice for corporate practice (an annex to the Guide) already provides a framework for a senior veterinary surgeon to be responsible for the delivery of clinical services by a corporate by seeking the agreement of the corporate body to: 1. recognise the professional responsibilities of veterinary surgeons, in particular the responsibilities set out in the RCVS Guide to Professional Conduct and additional guidance issued by the RCVS; 2. appoint a Chief Veterinary Surgeon to director or equivalent status within the business or an appropriate status within a charity [to be in effect a practice principal]; 7 7

238 AC April 10 AI agree with the Chief Veterinary Surgeon that he or she has overall responsibility for professional matters within the business or charity, including: clinical policy guidelines; procedures by which medicines are obtained, stored, used and disposed*; and, procedures for addressing clients' complaints on veterinary issues. 30. It may be that this clinical oversight or responsibility by a veterinary surgeon who is senior in the corporate body is the key to public assurance that bodies corporate provide a professional service and this may be better provided through the Guide. 31. It is suggested that the PSS Manual or at least the Core Standards are given a status alongside the Guide, to avoid unnecessary repetition and to emphasise the RCVS regulation of veterinary services provided by bodies corporate, but that additional guidance should also be provided on the responsibilities of veterinary surgeons involved in the management of bodies corporate providing veterinary services. Veterinary Nurses 32. Question: a) Should the Guide (for veterinary surgeons) and the Guide for veterinary nurses be combined, for example, in a Guide for the Veterinary Team? 33. In favour of a joint Guide is the similarity of the advice for the two professions and that the veterinary surgery carried out by veterinary nurses is under the direction of a veterinary surgeon. Also, in many circumstances the veterinary service is provided by a practice or veterinary team rather than an individual veterinary surgeon. Also veterinary surgeons and nurses would be able to see clearly their respective responsibilities. This may be particularly helpful when the RCVS complaints and disciplinary procedures includes provision for complaints against registered veterinary nurses and one incident may prompt complaints against a veterinary surgeon and a registered veterinary nurse. 34. Against a joint Guide might be the arguments that the two professions are distinct and should be subject to their own professional codes or guides. While the professions may work as part of a team this does not automatically mean the principles of the professions should or will be the same. In addition, if the Guides are separate they can develop according to the needs of the individual professions. The Guides cannot diverge significantly because the responsibilities of the two professions must be compatible and significant differences could cause problems within a practice. 35. In 2007, when the Guide for veterinary nurses was considered, there was an understanding that subsequently professional conduct advice would be directed at the veterinary team: veterinary surgeons and nurses. Generally, this has been done and it is suggested a revision of the Guide would prompt similar consideration of the Guide for veterinary nurses. In addition, in 2007, the nurses wanted various professional responsibilities, which were not included in their Guide because they required 8 8

239 AC April 10 AI 12 consideration in relation to veterinary surgeons as well. This included, for example, the nurses desire to introduce a duty to report yourself to the RCVS if convicted of a criminal conviction, or to report a colleague if the colleague is considered to be unfit to practise, for example, by reason of alcohol or drugs. The understanding was that these issues would be addressed when the Guide for veterinary surgeons was reviewed. Therefore, it is suggested that consideration of both Guides should be carried out together, whether the Guides are combined into one Guide for the veterinary team, or not. 36. It is suggested that the Guide (for veterinary surgeons) and the Guide for veterinary nurses are combined although the views of the Veterinary Nurses Council will need to be taken into account and whether veterinary nurses themselves want a separate Guide or a combined Guide. Clinical Governance 37. Question: a) Should the Guide include clinical governance? 38. The Department of Health s definition of clinical governance is the system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which clinical excellence will flourish. (G Scally and L J Donaldson, 'Clinical governance and the drive for quality improvement in the new NHS in England' BMJ (4 July 1998): 61-65). The so called seven pillars of clinical governances are said to be clinical effectiveness and research, audit, risk management, education and learning, patient and public involvement, using information and IT and staffing and management. 39. Notably, this definition relates to the NHS and to some extent the medical profession as a whole. As it relates to the veterinary surgeons it might be better expressed as the activities which veterinary surgeons should undertake to maintain and improve the veterinary service provided to animals under their care and to ensure they are accountable to their clients. However expressed, it is suggested that clinical governance is and has been for many years a feature of the profession. It is simply that generally the profession does not refer to clinical governance directly and does not seek to group professional requirements in this way. By way of example, the profession carries out clinical governance in the following ways, in terms of: a) clinical effectiveness - the profession advocates evidence based medicine; b) risk management - the profession reports adverse drug interactions and responds to complaints; c) education and training - CPD is a responsibility under the Guide; d) using information - client confidentiality is respected. 9 9

240 AC April 10 AI 12 What, perhaps, is missing is information to bring all the aspects together and greater consideration of audit and the patient and public involvement. Arguably this consideration needs to be led by the RCVS. 40. Section 2 of the revised RCVS PSS manual which is to be introduced in April provides: Clinical Governance and Communication 2.1 The practice must have a system in place for monitoring and discussing the clinical outcome of cases and for acting on the results. The implementation of this provision is subject to its inclusion in the RCVS Guide to Professional Conduct, but it may be that clinical governance should be given greater recognition and prominence than currently proposed in the PSS. 41. It is suggested that the revised Guide should place greater emphasis on clinical governance and in the process the RCVS should consider the extent to which clients of veterinary practice and animal owners, as stakeholders in the work of the RCVS, may wish to comment about the standards that veterinary practices should reach, in the public interest; and talking account of the financial implications of raised standards. Health and Performance (Competence) 42. Question: a) Should the Guide include additional responsibilities to support a health protocol associated with the RCVS complaints and disciplinary procedures? 43. The Professional Conduct Department has been considering the feasibility of a health protocol to manage health related cases in a similar manner to the General Medical Council s statutory health jurisdiction. The basis of such health jurisdictions is to protect the public interest while at the same time assisting professionals with health problems. Advice has been sought from independent Counsel and is attached as annex E. The health protocol envisages that veterinary surgeons (and in due course veterinary nurses) accused of misconduct will not need to be referred to the Disciplinary Committee if the public interest can be protected by undertakings offered by the veterinary surgeon or nurse (similar to those undertaking currently offered to the Disciplinary Committee in such cases) and in some cases to the Preliminary Investigation Committee already. 44. The Guide changes will need to indicate, for example, that veterinary surgeons and nurses must take (or demonstrate) reasonable steps to address adverse physical or mental health where there is harm to (or a risk of harm to) animal health or welfare and/or public health and/or the public interest; accede to a regulator s reasonable request (for example to undergo medical examination and/or to accept undertakings); and, comply with any undertakings given to the Preliminary Investigation or Disciplinary Committee. 0 10

241 AC April 10 AI It is suggested that the RCVS must regulate the profession to the full extent of its jurisdiction and that such changes to the Guide are likely to be necessary to do so. 46. In view of the robust advice received by the RCVS in relation to the health protocol, there is now consideration of how else the scope of misconduct might be widened, or ought to widened, and this has been considered by Penningtons solicitors as part of its review of the RCVS complaints and disciplinary procedures, which is due to be considered by the Corporate Governance group. This could lead to additional changes to the Guide, for example, on performance (competence), or continuing professional development. 47. The Guide already requires veterinary surgeons to work within their areas of competence, but an increased competence jurisdiction might allow the RCVS to become more involved in clinical failures which although serious and require a response, for example, the veterinary surgeon to undertake additional CPD, are not so serious that they currently justify referral to the Disciplinary Committee. While the Preliminary Investigation Committee currently gives advice in appropriate cases, a wider jurisdiction could allow the Committee to require veterinary surgeons to comply with the advice or recommendations. RCVS Officers are considering this issue initially. Continuing Professional Development 48. Question: a) Should veterinary surgeons responsibilities with regard to CPD be strengthened and increased? 49. While the current Guide to Professional Conduct states that CPD is mandatory, it does not state the number of hours that must be completed, or require veterinary surgeons to complete a CPD record, or provide the CPD record to the RCVS. Generally, veterinary surgeons under investigation will provide CPD records to the RCVS, but the provision of information to the RCVS following a complaint is subject to separate consideration in the Guide. 50. Some other regulators seek to make ongoing registration subject to completion of sufficient and satisfactory CPD. The RCVS cannot do this without a change to the Veterinary Surgeons Act. However, there are current discussions to revise the Registration Regulations and it could be that in tandem with changes to the Guide, veterinary surgeons could be asked to provide a copy of their CPD records on a regular basis, with the RCVS moving to a more proactive and risk-based regulatory role. 51. It is suggested that the Guide requirements for CPD should be strengthened with the RCVS requiring veterinary surgeons and nurses to keep a record of CPD undertaken and to produce this to the RCVS for inspection unrelated to the complaints and disciplinary procedures. 52. The Guide requirements for PDP could be similarly strengthened. 1 11

242 AC April 10 AI 12 Initial Comments from the Preliminary Investigation and Disciplinary Committee 53. Question: a) Should the following issues be addressed? 54. The Preliminary Investigation Committee and the Disciplinary Committee have provided initial comments for consideration in the review of the Guide and which will be made available to the Guide Working Party. The committees considered that: a) the guidance on certification should be reviewed to ensure that the distinction between certification in accordance with the 12 Principles and certification in accordance with the four C s of certification should be made fully apparent to the profession; b) the advice on 24-hour emergency cover be brought together in one, easily accessible place and certain aspects to be clarified; c) the management of corporate practices and their incentive schemes be considered (the Society of Practising Veterinary Surgeons has provided an initial analysis of current incentive schemes which is not attached); d) the responsibilities of locum agencies be considered; e) there be more detailed guidance on how to respond to requests for the euthanasia of healthy animals (following disciplinary cases on this issue); f) the Guide have an index; g) high or inappropriate fees should be a conduct issue; h) veterinary referrals and clarification of who is and who is not a specialist, following the recent Lowe Report (Work on this is ongoing in the Education Department); and, i) administrative requirements such as members legal requirement to notify the RCVS of any change of address within 28 days. 55. There was support from the statutory committees on a number of the other issues mentioned in this paper. The Preliminary Investigation Committee (and its Lay Observers) indicated concerns about corporate practice and suggested additional guidance would be helpful, as well as indicating that clinical governance was an integral part of veterinary practice and should be embraced. The Disciplinary Committee was keen that issues involved in a significant number of recent disciplinary cases should be given prominence and all advice or guidance on one subject should be available in one place. 56. It is suggested that the above requests for clarification of the Guide should be addressed as part of the review. 2 12

243 AC April 10 AI 12 Student Guide 57. Question: a) Should the Guide include guidance for veterinary students? 58. Increasingly the veterinary schools have become involved in fitness to practise issues relating to their students and it is suggested there is a need to coordinate this and the schools introduction of student codes of conduct. It is suggested that this might be achieved in conjunction with this review of the Guide, for example, with a statement of professional principles that are consistent with students obligations. 59. It might be considered that this is a separate issue to be considered alongside the Guide review. Consultation 60. Question: a) Should the RCVS consult with the public and animal owners? 61. Consultation with the profession is standard RCVS practice. In addition to this, it is suggested the RCVS should give greater consideration to consultation with the public and animal owners as it seeks to introduce a revised Guide to Professional Conduct. Increasingly other regulators involve the public in the consultation process and it is suggested this helps to maintain the confidence in those professions. It also allows issues of most concern to the public to be discussed fully. Such issues for a review of the Guide might include fees and negligence and a discussion of these issues may be of assistance for a general understanding of the role of the RCVS and its statutory responsibilities. A consultation with the public on these issues might also lead to a Guide with greater emphasis on these issues: increased professional responsibilities in relation to these issues. Delivery of the Guide 62. Question: a) Should the Guide continue to be issued to the profession in hard copy form? 63. During the last 10 years, the Guide has been issued in hard copy, biennially, with an annual hard copy update in the intervening years. The Guide has also been available on the RCVS website. While there is increasing uptake of information in electronic form and it is cheaper for the RCVS to provide information in this form, there is not universal use of the internet and computers. Therefore, to ensure the Guide is available to all members it is suggested it should be provided or offered to all members in hard copy form. This would mean no change to the current position. It might be that those who do not wish to receive a hard copy Guide could opt out of receiving it, although this is likely to be administratively impracticable for the RCVS, unless a revised RCVS website allows members to make this chose themselves. 3 13

244 AC April 10 AI 12 Composition of the Guide Working Party 64. Questions: a) Who should be part of the Working Party? 65. It is suggested that because the Working party will need to draft guidance, it should be small, so that the difficulties associated with drafting by committee are avoided, so far as possible. However, the Guide must be acceptable to the whole profession and should be as accurate as possible prior to any consultation and therefore any proposed text should be scrutinised by veterinary surgeons from a variety of areas of practice. It is suggested this might be achieved by asking such groups as the Practice Standards Group, which has representation from the profession and the PSS Inspectors, who come from a wide variety of areas of practice to consider drafts of the Guide. The Advisory Committee and Council will consider the draft Guide in the usual way. 66. With regard to who should be part of the Working Party, it is suggested that a veterinary nurse member of VN Council should ensure the professional responsibilities of veterinary nursing are appropriate and proportionate; a lay person should seek to ensure the Guide meets the needs of the public and what the public may expect of the profession and a practising veterinary surgeon should ensure that the responsibilities are reasonable and the guidance practical. 67. The Chairman as been identified by Officers already. Jan

245 AC April 10 AI 12 Annex A Conseil Européen des Professions Libérales European Council of the Liberal Professions Europaïscher Rat der Freien Berufe Common Values of the Liberal Professions in the European Union Preamble In March 2000 the European Council of Lisbon adopted a programme for reform. The aim was to m ake the EU the m ost co mpetitive and dynam ic knowledge-based economy in the world by The Commi ssion s Communication Professional Services S cope for m ore reform of 5 Septe mber 2006 recognises the contribution that liberal professions make to the economy in all Member States and thus to the EU economy as a whole.. One m ajor identifying factor of a profe ssion is the w illingness of individual practitioners to com ply with ethic al a nd professional standards that exceed the minimum legal requirem ents. Directive 2005/36/EC of 7 Se ptember 2005, m akes it clear that where a servi ce is provided cross border, the host Mem ber State s professional rules linked to professional qua lifications, particular ly tho se linked to consumer protection and safety shall appl y. This recognises the current position i n which codes of conduct for an individual professional may differ from one Mem ber State to ano ther and tha t those who use a cross -border se rvice will exp ect it to be provided subject to the same ethical and practice standards as apply where they live. The curren t text of th e Draf t Dire ctive on Se rvices in th e In ternal Market asks Member States, in cooperation with the Co mmission, to encourage the drawing up at Community level of professional codes of c onduct and to ensure that such codes are accessible by electronic means. The Resolution of the European Parliam ent of 13 th October 2006 responding to the Communication of the Comm ission mentioned above, supports the adoption of codes of conduct by professional serv ice providers and adds that these should be drawn up with the involvement of all relevant stakeholders. The European Council of the Liberal Profe ssions (CEPLIS) circulated a questionnaire to Interprofessional Groups in Member Stat es and to Monoprofe ssional organisations at EU level seeking comments on specific va lues that all liberal professions should exhibit. The response was uniformly positive. 15

246 AC April 10 AI 12 Annex A CEPLIS therefore proposes as a firs t step to seek dialogue with ot her stakeholders at EU level with a view to securing agreement on these common values. This is intended to set the scene for individual professions at EU level to incorporate these values in codes of conduct to be applied throughout the EU. CEPLIS recognises that there will be differe nces in detail in codes for individual professions at EU level, fo r exam ple in the area of c onfidentiality of inform ation. There will also necessarily be differences in detail in the way that the values in the EU code are reflected in the codes at Mem ber State level to recognise differences in legislation for example on data protec tion and in culture and tradition. The initiative should however result in consid erable narrowing of differences in codes applicable in individual Member States. The activities of libe ral prof essionals com prise inte llectual ta sks f or the prop er discharge of which a high level of legal and technical and som etimes scientific knowledge is required. The necessary knowledge is acq uired by th e successful completion of studies leading to a degree or diploma of higher education and/or the award of a recogn ised profession al title. In som e cases there m ay be additio nal requirements leading to registration w ith a regulatory body before practice is permitted. The liberal profession al then becomes subject to th e code of conduct applicable to that profession drawn up by the appropriate professional body with a focus on th e in terests o f those who seek se rvices from the prof essional concerned. That professional is aware that contravention of the provisions of the code may lead to disciplinary sanctions. Clients must have confidence that alleged contravention of the provisions of Codes of Conduc t will be treated seriousl y by the professional body concerned and, if proved, will result in action proportionate to the seriousness of the breach being taken. CEPLIS considers that Codes of Conduct for liberal professions at E U level should contain provisions covering the following topics. 1. Confidentiality Confidentiality is the co rnerstone for the building of trust between professionals and their clients or patients. Codes of Conduct should m ake it clear that prof essionals must respect and safeguard the conf identiality of inf ormation acquir ed in the cours e of providing prof essional services and ensure that inform ation about an individual is not disclosed to others except in specified circum stances and, where possible, with the inform ed consent of the individual. 2. Participation in Continuous Professional Development Codes of Conduct should m ake it clear that professionals have an unequivocal responsibility to develop and maintain competency in their field of practice and to this end m ust participate in continuous professional developm ent throughout their working lives. 16

247 AC April 10 AI 12 Annex A Those who use professional services have a right to expect that practitioners will keep their knowledge in th eir field o f pr actice up-to-date and will extend their competencies as the demand for new services develops. 3. Independence and Impartiality Codes of Conduct should m ake it clear that liberal professionals have the right to exercise personal judgem ent in the fra me of t heir responsibilitie s after taking into account all relevant circumstances, without any application of external influence. Those who use liberal 1 professional services have a ri ght to expect as sessment of circumstances to be carried out and decisions to be m ade impartially and objectively, without pressure from external sources and without conflicts of interest. 4. Honesty and Integrity Codes of Conduct should m ake it clear that professionals are required to act with respect, loyalty and in tegrity in the ir relationships with clients and others, including professional colleagues and m ust not engage in any activ ity or be haviour that would be likely to bring the profession into disr epute or undermine public confidence in the profession. The first priority in the provision of professional services must be the best interests of the client or pa tient. Nevertheless, professiona ls have also duties to th e courts and third parties and m ust balance these with those of the client to uphold the proper administration of justice. Those who use liberal professional services have the right to expect to be treated with courtesy and respect. They are also entitled to receive sound pr ofessional advice in terms they will understand, as well as information before and during the provisions of services, both on the procedure it is in tended to pursue to achieve the desired objective and on the fees involved. 5. Supervision of Support Staff Codes of Conduct should m ake it clear that professionals are required to ensure that any member of support staff to whom a task is delegated has the knowledge and skills necessary to undertake that task effectively and efficiently. There should also be appropriate supervision. Those who use professional serv ices place their trust in the practitioner with whom they have direct contact and have the right to be confident that tasks will be delegated only to mem bers of support staff who have the necessary knowledge and competencies. In that context, it should be clear that the responsibility for a delegated task rem ains with the delega tor.[ It would apear to be important to ensure that the 1 Liberal professions, [ ] are, according to this Directive, those practised on the basis of relevant professional qualifications in a personal, responsible and professionally independent capacity by those providing intellectual and conceptual services in the interest of the client and the public. in Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the Recognition of Professional Qualifications 17

248 AC April 10 AI 12 Annex A CEPLIS docum ent clarif ies the question of the ac countability of the liber al professional who delegates a task to a member of support staff. - JF] 6. Compliance with Codes of Conduct and Practice All codes of Conduct should m ake it clear th at members of the profession concerned are naturally required to com ply not only with the provisi ons of the Code of Conduct itself but also with legislation and the pr ovisions of codes of practice and standards relating to specific professional services they may provide. Those who use professional services have the right to expect a se rvice of high quality through strict compliance with all relevant legislation and codes of practice. 7. Professional Liability Insurance Codes of Conduct should require that those providing professional services have in place a form of insurance in respect of potential liabilities to recipients and, where applicable, to third parties arising out of the provision of the service and at a level suficient to ensure that a justified claimant would be adequately compensated. This insurance may be provided through a national arrangement in the case of services provided by the state, by an employer, or by the individual practitioner. Exceptionally, and by formal prior arrangement, the risk may be borne by the recipient of the service. Those who use a professional service have the right to expect adequate information on the insurance or similar arrangements made by the provide r to cover liabilities in the event of ad verse effects resu lting from errors or om issions made in the provision of the service 8. Conflict with Moral or Religious Beliefs Those who lawfully seek a professional service should not have access to that service barred due to the m oral or religious beliefs of the individual professional from whom that service is initially sought. Codes of conduct should make it clear that, although members of a profession have no obligation to offer to provide a professional service in ways which conflict with their own m oral or religious belief s, th e do have an oblig ation to r espect the m oral, religious and cultural beliefs of those re questing a professional service. Moreover, they do have an obligation to provide in formation on wher e that serv ice can m ost conveniently be obtained from an appropriate professional colleague. After agreeing to provide a service, liberal professiona ls are bound to set aside any personal religious, political, cultural, philosophical or other convictions and always to do their best for the benefit of the service user. 18

249 AC April 10 AI 12 Annex B Federation of Veterinarians of Europe Code of Good Veterinary Practice 19

250 4 Definitions Identification of processes makes it possible for all the personnel of the veterinary organisation to analyse their own activity and their interactions and thus to improve the cohesion of the system. Quality manual: document stating the quality policy and describing the quality system of a organisation listing all protocols, work instructions and registration forms that are in place at the time, in an orderly and classified manner. Quality: degree to which a set of inherent characteristics fulfils requirements. Quality management system: Management system to direct and control an organisation with regard to quality. Quality policy: overall intentions and direction of a organisation related to quality, as formally expressed by management. Requirement: Need or expectation that is stated, generally implied or obligatory. Review: activity undertaken to determine the suitability, adequacy and effectiveness of the subject matter to achieve established objectives. 5 Bibliography (1) ANAES (1999) Manual of accreditation of the establishments of health. Anaes Paris.101p (2) AAHA (2002) American Animal Hospital Association. AAHA USA 116 p (3) BSAVA (1998) System of practical standards BSAVA. [on line: (4) ISO (2000) Quality management of systems. Fundamentals and vocabulary. NF IN ISO 9000/ 2000 standards. Iso Geneva. 30p (5) ISO (2000) Quality management systems. Requirements. NF IN ISO 9001/2000 standards. Iso Geneva. 26p (6) ISO (2000) Quality management systems. Guidelines for performance improvements NF IN ISO 9004/ 2000 standards. Iso Geneva. 59p Table of Contents AC April 10 AI 12 Annex B System: set of interrelated or interacting elements. 22 Traceability: ability to trace the history, application or location of that which is under consideration. Veterinary check: any physical check and/ or administrative formality, which is intended for the protection, direct or otherwise, of public or animal health. Veterinary organisation: Any organisation where any field of veterinary medicine and/or science is practised. Veterinarian: Any holder of a diploma, certificate or other evidence of formal qualification in veterinary medicine required to take up and pursue the activities of a veterinarian. This term is equivalent to veterinary surgeon. Veterinary Practice: The total of buildings, infrastructure, veterinarians, support personnel and necessary documentation. However, the term veterinary practice in Good Veterinary Practice is defined as any veterinary service provided by a veterinary organisation. 1. Introduction European Veterinary Ethics & Principles of Conduct A Veterinarians and animals B Veterinarians and their customers C Veterinarians and the veterinary profession D Veterinarians and medicinal products E Veterinarians and their personnel F Veterinarians and safety & health at work G Veterinarians and public health H Veterinarians and the environment I Veterinarians and the competent authorities Quality Management Systems within a Veterinary Organisation A General requirements B Documentation requirements C Management responsibility D Resource management E Service realization F Measurement, analyses and improvement Definitions Bibliography

251 20 4 Definitions Competent Authority: the central authority of a Member State, competent to carry out veterinary checks or any authority to which it has delegated that competence. Conformity/ compliance: fulfilment of a requirement. Continual improvement: recurring activity to increase the ability to fulfil requirements. Corrective action: action to eliminate the cause of a detected nonconformity or other undesirable situation in order to prevent recurrence. Customer: recipient of a product or service. Customer satisfaction: customer s perception of the degree to which the customer s requirements have been fulfilled. Documentation: all records, in any form (including, but not limited to, written, electronic, magnetic, and optical records, scans, x-rays, and electrocardiograms) that describe or record the methods, conduct, and/or results of an activity, the factors affecting an activity, and the actions taken. Documented system: a system, which allows the user to add data, via documents (in hard form or electronically), in a legible and detailed manner and to order data in an effective way and which makes data easy to retrieve and to control. The system should have a built in mechanism to protect the data from being lost or inadvertently changed. Good Veterinary Practice: a standard which ensures that services provided by the veterinary profession are consistently produced and controlled to the quality standards defined by FVE. Interested party: person or group having an interest in the performance or success of an organisation (i.e. stakeholders such as customers, owners, personnel, suppliers, unions, partners or society). Internal audit: the regular or periodic assessment of the implementation and the efficiency of the quality system, inclusive of the implementation of and controls on effectiveness of corrective action by an independent member of the veterinary organisation concerned. Management: coordinated activities to direct and control an organisation or person in charge of an organisation. Management system: system to establish policy and objectives and to achieve those objectives. Nonconformity: non-fulfilment of a requirement. Organisation: group of people and facilities with an arrangement of responsibilities, authorities and relationships. Organisational chart: Schematic description of the tasks, responsibilities and hierarchic organisation within the organisation. Personnel: anyone employed by or working for an organisation. Pharmacovigilance: the post-authorisation surveillance of medicinal products. The scope of veterinary pharmacovigilance covers: Suspected adverse reactions in animals, including those that occur when products are used off-label Lack of expected efficacy Human reactions to veterinary medicines Potential environmental problems Reported violations of approved residue limits Preventive action: action to eliminate the cause of a potential nonconformity or other undesirable potential situation in order to prevent occurrence. Procedure: specified way to carry out an activity or a process. Process: set of interrelated or interacting activities, which transform inputs into outputs. Processes can be classified according to three types: Realization processes, which are the easiest to identify as they contribute directly to service delivery (e.g. consultation, hospitalisation, surgery ), Support processes, which bring the resources necessary for the realization processes (e.g. customer records, scientific data and information, equipment ), Management processes, which direct and ensure coherence of realization and support processes by determining the policy and the objectives of the organisation. AC April 10 AI 12 Annex B 21 21

252 3 Quality management systems within a veterinary organisation equivalent with the person responsible for the animals) and for routine preventative anti-parasite treatments in companion animal practice. Prescriptions shall be filed in such a way that it should be possible to establish the traceability of products and services. Customers shall be informed as to the risk and possible side effects of the handling and administration of medicinal products. An assessment of the benefits and the costs of the prescription shall be carried out in relation to the customer. 3.E.d.5 Certificates Certificates shall be given for pre-defined purposes and shall be regarded as a statement of fact made with authority. All the necessary steps shall be taken to ensure the integrity of certification. Certificates shall be written in a precise, understandable way and safeguarded in accordance with applicable regulatory requirements. Legal standard documents shall be used where required. Certificates shall be recorded and filed in order to ensure their traceability 3.E.e THE ORGANISATION SHALL CONTROL THE MEASUREMENT AND INVESTIGATION EQUIPMENT RELATING TO ITS PROCESSES A list of all measurement and investigation equipment shall be drawn up. Equipment shall be regularly inspected, maintained and calibrated. 3.E.f THE ORGANISATION SHALL PERIODICALLY EVALUATE AND RE-EXAMINE ITS PROCESSES AND THE RELATED DATA The processes shall be regularly evaluated and re-examined. Communications with the customer shall be regularly evaluated and re-examined. The documentation of the processes shall be regularly evaluated and re-examined. The data and information generated by the various processes and their management shall be regularly evaluated and re-examined. Controls of the measurement and investigation equipment shall be regularly evaluated and re-examined. 3.F Measurement, analyses and improvement 3.F.a THE ORGANISATION SHALL DETERMINE, COLLECT AND ANALYSE THE DATA EVALUATING THE RELEVANCE AND THE EFFECTIVENESS OF ITS SERVICES Investigations of satisfaction shall be planned, carried out and analysed. Customer complaints shall be collected and analysed. Internal audits shall be planned, conducted and analysed. Data relating to the processes and their indicators shall be collected and analysed. Data relating to controls of the measurement and investigation equipment shall be collected and analysed. Data relating to the nonconformity of services and products shall be collected and analysed. 3.F.b THE ORGANISATION SHALL CONTINUALLY IMPROVE ITS QUALITY MANAGEMENT SYSTEM All the data and analyses relating to paragraph 3.F.a shall be documented, recorded and communicated within the organisation. All the data and analyses relating to the reviews of the management processes and support processes shall be documented, recorded and communicated within the organisation. Quality meetings should be planned and carried out to reexamine and improve operation of the organisation by supporting the involvement of all the personnel. Corrective actions relating to nonconformities shall be defined, implemented, recorded and re-examined at planned intervals. Preventive actions relating to potential nonconformities shall be defined, implemented, recorded and re-examined at planned intervals. AC April 10 AI 12 Annex B

253 3 Quality management systems within a veterinary organisation Specialized information (e.g. laboratory analyses) shall be associated with or referred to in the customer records. Administrative information (unpaid bills, deferred payments, complaints...) shall be associated with or referred to in the customer records. 3.E.d.2 The case handling procedure The veterinary organisation shall organise and ensure a system for the continual reception of cases. If this is not possible, there must be an established procedure for referring customers to another veterinary organisation. Precise and understandable information on access to an alternative organisation shall be available by any normal means of communication. All communications shall be answered promptly and courteously. There shall be a priority case handling procedure for any emergency. If a request for assistance does not come within its competence, the organisation shall be willing and able to refer cases to another organisation. AC April 10 AI 12 Annex B The initial and regular evaluation of the case shall be communicated in an understandable way to the customer. The customer shall be informed of the benefits, risks and costs of the services proposed and the customer s informed consent should be obtained before providing any service. The organisation shall inform the customer about its tariffs and apply the tariffs in a consistent way. Detailed bills, showing all services and products supplied, shall be issued. The specific needs of the animal (anxiety, pain, well-being...) shall be identified and dealt with. The specific needs of the customer shall be identified and dealt with. The continuity of services shall be assured. 3.E.d.3 Medicinal products and consumables Organisations with a stock of medicinal products/consumables shall have documented systems in place to ensure medicinal products/consumables are ordered, received, stored, administered, dispensed, prescribed and destroyed in a manner that takes account of the relevant legislation and of the manufacturers recommendations. A list (standard and quantity) of the medicinal products and the consumables that should be in permanent stock shall be established. Stock control (ordering, reception of orders, delivery and rotation) shall be established, and documented. Documents shall be filed so as to make it possible to establish traceability. The expiry dates, the times of use and the condition of the medicinal products shall be regularly controlled. The products and the suppliers shall be selected on the basis of predefined quality criteria. 3.E.d.4 Prescriptions Prescriptions shall be written in a precise, understandable way and in accordance with applicable regulatory requirements. Medicinal products shall only be administered, dispensed or prescribed, based on a probable diagnosis obtained after an adequate clinical examination of the animal(s) or of a representative sample of the group of animals involved. The above may not be required for some types of medication in the case of farms under contract for routine veterinary supervision (subject to agreed written protocols or

254 3 Quality management systems within a veterinary organisation 3.E Service realization Veterinary services include many linked activities (processes). Their identification as well as an appreciation of their interactions allow improved coherence and effectiveness of these services. 3.E.a THE ORGANISATION SHALL DEFINE ITS PROCESSES The various processes of the organisation shall be identified. Their interactions shall be defined. AC April 10 AI 12 Annex B 3.E.b THE ORGANISATION SHALL COMMUNICATE WITH THE CUSTOMER The organisation shall identify customer requirements. The organisation shall take account of the relevant applicable regulatory requirements. 3.D.b.3 Support processes An efficient system for keeping customer records and related documents shall be implemented. A library of information on current professional practices shall be available. Cleaning, disinfecting and sterilization shall be organised in accordance with the services offered by the organisation and the applicable regulatory and hygiene requirements. Waste disposal shall be organised in accordance with the applicable regulatory and hygiene requirements. Appropriate safety measures shall be organised and assured. Support processes and their management shall be documented, evaluated and re-examined at planned intervals. 3.D.c THE ORGANISATION SHALL IMPLEMENT EFFECTIVE MANAGEMENT OF ITS WORK ENVIRONMENT The rules concerning health and safety within the organisation (fire and electrical hazards, X-ray radiation, hazardous products, restraint, work-related illnesses ) must be established and observed. Working conditions shall be evaluated at planned intervals. Assessments of personnel satisfaction shall be planned and documented. The work environment and its management shall be documented, evaluated and re-examined at planned intervals. The organisation shall inform the customer (explanatory booklets, system of recalls...). The organisation shall record customer complaints. 3.E.c THE ORGANISATION SHALL DOCUMENT ITS PROCESSES The necessary resources (material, equipment, consumables, medicinal products...) shall be allocated for each process. Responsibilities shall be allocated for each process. Standard operating procedures or work instructions shall be available. Quality indicators shall be defined for each process. 3.E.d THE ORGANISATION SHALL MANAGE ITS HORIZONTAL PROCESSES (CUSTOMER RECORDS, CASE HANDLING PROCEDURE, MEDICINAL PRODUCTS AND CONSUMABLES, PRESCRIPTIONS, CERTIFICATES) IN A CONSISTENT WAY 3.E.d.1 The customer record Records shall be written in a detailed, legible and understandable way and in accordance with applicable regulatory requirements for every customer. Customer confidentiality shall be ensured. Records shall be organised, filed and constantly available. The reasons for consultation and the conclusions of the initial evaluation shall be recorded in the customer record. Records shall comprise all procedures performed in chronological order

255 3 Quality management systems within a veterinary organisation 3.C.d THE RESPONSIBILITIES AND AUTHORITY OF INDIVIDUALS SHALL BE CLEARLY DEFINED An organisational chart shall be established. Any personnel shall have an understanding of what his/her responsibilities are. A person with responsibility for quality and with authority to take the necessary actions should be appointed by management. 3.C.e THE ACHIEVEMENT AND THE RELEVANCE OF THE OBJECTIVES OF THE ORGANISATION SHALL BE EVALUATED AND RE-EXAMINED AT PLANNED INTERVALS The achievement of objectives shall be evaluated and the results of internal audits, of customer feedbacks, of process performance analysis and nonconformity declarations be taken into account for that purpose. The strategy of the organisation shall be improved (process reviews, management reviews). 3.D Management responsibility The achievement of objectives shall be evaluated and the results of internal audits, of customer feedbacks, of process performance analysis and nonconformity declarations be taken into account for that purpose. The strategy of the organisation shall be improved (process reviews, management reviews). 3.D.a THE ORGANISATION SHALL IMPLEMENT AN EFFECTIVE HUMAN RESOURCES MANAGEMENT STRATEGY The organisation shall implement an effective human resources management strategy, taking into account the applicable regulatory requirements, the estimated workload, the need for replacement and the competence of the personnel. Job descriptions shall be available for each position within the organisation. Personnel shall be recruited with consideration of their job role and with appropriate selection criteria. When recruiting new personnel, the organisation shall ensure that personnel have obtained the formal qualification required to take up and pursue the activities for which they are recruited and that they comply with the professional rules applicable to them. AC April 10 AI 12 Annex B In house training shall be provided to personnel joining the organisation. Improvement of the knowledge and skills of the personnel shall be encouraged and ensured by a programme of continually and periodically evaluated development activity. Documents relating to personnel, such as contracts of employment or equivalent, job descriptions, proofs of completion of formal qualifications, of continual development activities, and of appraisals should be established and recorded. 3.D.b THE ORGANISATION SHALL IMPLEMENT EFFECTIVE MANAGEMENT OF ITS MATERIAL RESOURCES 3.D.b.1 Premises and their surroundings The premises and their surroundings shall be suited to the needs and activities of the organisation as well as in compliance with applicable regulatory requirements. A plan of the premises and of their surroundings as well as of their use shall be recorded. The safety and the maintenance of the premises and of their surroundings shall be ensured and recorded. The cleaning and/or disinfecting of the premises and of their surroundings shall be planned, documented and in conformity with hygiene rules. The premises and their surroundings and their management shall be documented, evaluated and re-examined at planned intervals. 3.D.b.2 Equipment (movable and immovable) Equipment shall be suited to the needs and activities of the organisation as well as in compliance with applicable regulatory requirements. A list of equipment and its specifications shall be available. The maintenance and the calibration of the equipment shall be planned and documented. The cleaning of the equipment shall be planned, documented and in conformity with the rules of hygiene. The equipment and its management shall be documented, evaluated and re-examined at planned intervals

256 3 Quality management systems within a veterinary organisation Procedures (written, documented and updated) relating to all the processes affecting service quality, All documents necessary to ensure the planning, the operation and the effective control of the processes. The level of documentation depends on the size and the types of activities of the veterinary organisation. Documentation can be in any form and on any type of support. All documents affecting the quality of the service shall be: Dated, approved before their publication (signed by the persons in charge) and recorded, Distributed to relevant personnel in accordance with pre-established distribution lists, Re-examined, analysed, updated according to a written procedure and again approved, Available, legible and readily identifiable at points of use. The documentation will be defined, implemented, reexamined, controlled and continually improved. All documents of external origin (applicable regulatory requirements, codes of ethics, etc.) shall be identified, available and their control shall be assured. Any non-intentional use of obsolete documents shall be avoided. If these documents are preserved, they shall be identified in a formal way. Records shall be retained securely for a period of five years or more if required by legislation, according to a documented procedure. They shall remain legible, readily identifiable and retrievable. 3.C Management responsibility Management shall develop a quality policy and involve the personnel of the organisation in so doing. The quality policy shall include strategic directions for the organisation and shall be devised to meet customer requirements as well as applicable regulatory requirements. Management shall be committed to ensuring the success of this step. 3.C.a MANAGEMENT SHALL LAY DOWN, PLAN AND DOCUMENT A QUALITY POLICY IN A CONSISTENT WAY The quality policy defines the objectives and the quality aims to be achieved for the benefit of customers (improvement of satisfaction, latent needs, competitiveness) but also for the benefit of the organisation itself (effectiveness, profitability). Hierarchical and achievable quality objectives shall be defined in a consistent way. Activities relating to the quality objectives shall be defined and planned. The necessary resources (financial, material, human) shall be taken into account. 3.C.b A "CUSTOMER FOCUS" SHALL BE IMPLEMENTED Action shall be taken to identify external customers and interested parties, to ascertain their needs and to evaluate their satisfaction. This information shall be communicated and understood within the organisation. 3.C.c A POLICY OF INTERNAL COMMUNICATION SHALL BE IMPLEMENTED Management shall communicate within the organisation the quality policy and information relating to the quality of services. Management shall set an example. Management shall recognize the efforts and the achievements of the personnel. AC April 10 AI 12 Annex B

257 2 European Veterinary Ethics & Principles of Conduct 2.I Veterinarians and the Competent Authorities Veterinarians shall foster and endeavour to maintain good relationships with the Competent Authorities. Veterinarians shall fulfil, whenever required, promptly and in accordance with the instructions given, the obligations of public service which they undertake on behalf of the Competent Authorities. Veterinarians, when performing tasks on behalf of the Competent Authorities, shall ensure that there is no conflict of interest and shall not use their position to try to extend their clientele or to gain a personal advantage. When veterinarians are required by the Competent Authorities to perform tasks for the customer of another veterinarian, and when asked by the customer to perform any task other than these, veterinarians shall not accept without agreement from the other veterinarian. 3 Quality management systems within a veterinary organisation This part of the Code offers a quality management system, which can help a veterinary organisation that wishes to have such a system, to improve customer satisfaction, encouraging the organisation to analyse the requirements of its customers and to define and control the activities, which contribute to delivering services that are acceptable to its customers. 3.A General requirements The veterinary organisation shall: Identify its processes and their application throughout the organization. Determine the sequences and interactions of these processes. Determine the criteria and methods needed to ensure that both operation and control of these processes are effective. Ensure the availability of resources and information necessary to support the operation and monitoring of these processes. Monitor, measure, and analyse these processes. Implement the continual improvement of these processes. AC April 10 AI 12 Annex B The quality management system will be defined, documented, implemented, re-examined, controlled and continually improved B Documentation requirements Quality system documentation shall include: A signed declaration by the management expressing its quality policy and its commitment, A quality manual or handbook (written, documented and updated) including the documented procedures of the quality management system as well as the description of the processes and their interactions, 3. What is documented is written, dated and recorded. 4. What is re-examined is analyzed, evaluated and can be the subject of a modification. 4. Any modification is the object of an update and thus a new recording by taking account of the additional modifications, which can result from it. The system is then controlled

258 2 European Veterinary Ethics & Principles of Conduct 2.E Veterinarians and their Personnel Veterinarians shall implement the relevant legislation applicable to employers, employees and business owners. Veterinarians and their personnel shall be insured for legal and professional liability. Veterinarians shall encourage and ensure the continual improvement of the professional and/ or technical knowledge and skills of their personnel. Any personnel of the organisation shall maintain a high level of personal hygiene and cleanliness. 2.F Veterinarians and Safety and Health at Work Veterinarians shall ensure the safety, health and welfare of their personnel, patients and customers, in particular concerning: Manual Handling (Lifting of weights and restraint) Slips, trips and falls (Protection against wet floors, uneven surfaces, steps etc) Fire Safety (Dealing with combustible substances, fire and electric hazard) Work equipment (Proper use of equipment, awareness of electrical and fire hazards) Hazardous substances (X-ray radiation, anaesthetic gases, pharmaceutical and hazardous product) Work-related illnesses AC April 10 AI 12 Annex B It is therefore the responsibility of the veterinarian to take all reasonable precautions to protect their personnel, patients and customers from these issues by ensuring that: Premises are secure Personnel is trained in Safety and Health at work Basic first aid is available and all personnel know where to find the First Aid Box Personnel knows how to evacuate the premises in the event of fire and practice these skills Protective clothing is provided to personnel where there is a requirement for personal safety The personnel and the public are made aware of any potential risk to them 2.G Veterinarians and Public Health Veterinarians shall seek to ensure the best protection of public health. Veterinarians shall, whenever appropriate, advise their customers about measures to minimise the risk of exposure to zoonotic agents, food borne pathogens, residues, contaminants (biological and chemical agents) and antimicrobial resistance. Veterinarians shall make animal owners aware of their responsibilities to the public. 2.H Veterinarians and the Environment Veterinarians shall attempt to reduce pollution of the environment by waste avoidance, recycling, using re-usable articles when appropriate, and correct disposal of waste. Veterinarians shall endeavour to reduce environmental pollution by careful and appropriate use of disinfectants, medicinal products and other chemicals. Veterinarians shall aim to be environmentally responsible by the economical use of energy and water. Veterinarians shall organise facilities for separate collection of different types of waste so that they can be sent to the appropriate recycling points. Veterinarians shall encourage customers to dispose of veterinary waste in a safe manner

259 1. These requirements are without prejudice of the national ethical and principles of conduct that any veterinarian must observe as a member of the veterinary profession. 2. Freedom from hunger and thirst. Freedom from pain, injury and disease. Freedom from fear and distress. Freedom to express normal behaviour. Freedom from discomfort. 2 European Veterinary Ethics & Principles of Conduct Veterinary organisations seeking to implement this Code of Good Veterinary Practice shall ensure that those veterinarian members of their personnel comply with the principles of this chapter. 1 2.A Veterinarians and Animals Veterinarians shall endeavour to ensure the welfare and health of the animals under their care in whichever section of the veterinary profession they work. Veterinarians shall always take into account the five freedoms 2 for assessing animal welfare. When aware of violations to animal welfare legislation, veterinarians shall immediately bring this to the attention of the owner of the animal(s) and do everything within their reach to solve the problem. Veterinarians shall treat all animals in their care with respect. 2.B Veterinarians and their Customers Veterinarians shall foster and maintain a good relationship with their customers. Veterinarians shall earn the trust of their customers through full communication and by providing appropriate information. Veterinarians shall respect their customers views and protect their customers confidentiality. Veterinarians shall respond promptly, fully and courteously to complaints and criticism. Veterinarians shall be aware of the different needs of their customers. 2.C Veterinarians and the Veterinary Profession Veterinarians shall familiarise themselves with and observe the relevant legislation and Codes of Conduct in relation to veterinarians as individual members of the veterinary profession. AC April 10 AI 12 Annex B Veterinarians shall not bring the veterinary profession into disrepute. Veterinarians shall foster and endeavour to maintain good relationships with their professional colleagues. Veterinarians shall ensure the integrity of veterinary certification. Veterinarians shall maintain and continue to develop their professional knowledge and skills. Veterinarians, when performing tasks on behalf of a third party or another veterinarian, shall ensure that there is no conflict of interest and shall not use their position to try to extend their clientele or to gain a personal advantage. When asked by the customer to perform any task other than these, veterinarians shall not accept without agreement from the regular veterinarian. 2.D Veterinarians and Medicinal Products Veterinarians must understand and comply with their legal obligations in relation to the prescription, safekeeping, use, supply and disposal of medicinal products. Any problem relating to the handling or administration of medicinal products shall be recorded and dealt with according to general pharmacovigilance principles and requirements. These include: It shall be reported to the Marketing Authorisation holder and/ or the Competent Authority not later than 15 days following the event. The telephone numbers/ addresses of Marketing Authorisation holders and the relevant Competent Authority shall be available in the organisation. The relevant forms for the recording of adverse reactions, as supplied by the relevant Competent Authority, shall be available in the organisation. If the Competent Authority does not supply those forms, the veterinary organisation shall report the event on self-created forms detailing all relevant information

260 1 Introduction Veterinarians play an important role in protecting animal welfare, animal health, public health as well as the environment and provide a wide range of services. This Code of Good Veterinary Practice is a standard specifying the European veterinary ethics and principles of conduct as well as the requirements relating to the quality management system within a veterinary organisation, when the latter: 1. Wishes to improve its ability to give services in conformity with: The legislation in force, The Professional Code of Conduct in force, The requirements of the clients, The ethics principles relating to the services provided and/ or the animals under its care. 2. Must demonstrate its ability to deliver services, which are constantly in line with customer requirements and the legislation in force. AC April 10 AI 12 Annex B Implementation of this Code is therefore voluntary. The requirements of this standard are designed in such a way that they can be applied to any veterinary organisation, whatever its size or its area of activity. Where any requirement of this standard cannot be applied due to the nature of an organisation and its service, this can be considered for exclusion. Such exclusion shall not affect the organisation s ability or responsibility to provide services that meet applicable regulatory requirements as well as the ethics and the principles of conduct applicable to the veterinary profession. This Code, however, only sets general principles. Additional guidelines should be developed to cover the more specific requirements that apply to the different areas of activity of the veterinary profession. This Code was prepared under the auspices of the Federation of Veterinarians of Europe (FVE) by veterinarians for veterinarians and will be given the status of a European standard for veterinary organisations. The objective of this Code is to serve as a basis for FVE member organisations wanting to implement their own GVP/Quality management system scheme. FVE member organisations could have their GVP/ Quality management system scheme assessed by FVE for compliance with this Code. This Code was drawn up in such a way that it can be used as an aid to achieve an ISO 9001:2000 certification. All the quality vocabulary of this standard is therefore taken from the 2000 version of the ISO 9000 standard. The provisions of this standard are complementary to and do not replace national or European legal obligations. This Code shall be reviewed at least every five years. A commitment to continual improvement is an integral part of this Code

261 AC April 10 AI 12 Annex B Federation of Veterinarians of Europe Rue Defacqz, 1 B-1000 Brussels Tel Fax info@fve.org Website: FVE MEMBER ORGANISATIONS Austria Bundeskammer der Tierärzte Österreichs Belgium Union Professionnelle Vétérinaire Vlaamse Dierenartsen Vereniging Bulgaria Chamber of the Veterinary Practitioners in Bulgaria Croatia Hravtska Veterinarska Komora Societas Veterinaria Croatica Cyprus Pancyprian Veterinary Association Czech Republic Komora veterinarnich lekaru Ceské Republiky Denmark Den Danske Dyrlaegeforening Estonia Eesti Loomaarstide Ühing Finland Suomen Eläinlääkäriliitto France Ordre National des Vétérinaires Syndicat National des Vétérinaires d'exercice Libéral FYROM Makedonska Veterinarna Komora Germany Bundestierärztekammer Greece Hellenic Veterinary Association Hungary Magyar Állatorvosi Kamara Iceland Dyralæknafélag Islands Ireland Veterinary Ireland Irish Veterinary Council Italy Federazione Nazionale degli Ordini Dei Veterinari Italiani Latvia Latvijas Veterinararstu biedriba Lithuania Lietuvos Veterinarijos Gydytoju Asociacija Luxembourg Association des Médecins Vétérinaires du Grand-Duché de Luxembourg Malta Malta Veterinary Association Netherlands Koninklijke Nederlandse Maatschappij voor Diergeneeskunde Norway Den Norske Veterinärförening Poland Polska Izba Lekarzy Weterynarii Portugal Ordem dos Medicos Veterinarios Sindicato Nacional dos Medicos Veterinarios Romania Asociatia Generala a Medicilor Veterinarin din Romånia Slovak Republic Komora veterinárnych lekárov Slovenskej Republiky Slovenia Veterinarska Zbornica Slovenije Spain Consejo General de Colegios Veterinarios de España Sweden Sveriges Veterinärförbund Switzerland Gesellschaft Schweizerischer Tierärzte/ Société des Vétérinaires Suisses Turkey Türk Veteriner Hekimleri Birligi UK British Veterinary Association Royal College of Veterinary Surgeons Yugoslavia Veterinary Chamber of Serbia & Montenegro Sections European Association of State Veterinary Officers (EASVO) Federation of European Veterinarians in Industry and Research (FEVIR) Union of European Veterinary Hygienists (UEVH) Union Européenne des Vétérinaires Praticiens (UEVP) 31

262 AC April 10 AI 12 Annex C 01 European Veterinary Code of Conduct 02 Veterinary Act one profession one vision one voice Federation of Veterinarians of Europe 32

263 AC April 10 AI 12 Annex C Table of contents Introduction p3 01 European Veterinary Code of Conduct p4 - p15 Preamble p5 The role of the veterinarian in society p5 The purpose of a professional Code of Conduct p5 The purpose of a European Code of Conduct p6 The FVE European Code of Conduct p7 chapter 1 Core Values of the FVE European Veterinary Code of Conduct p8 1.1 General Principles p8 1.2 Veterinarians & Animals p9 1.3 Veterinarians & Customers p9 1.4 Veterinarians & Veterinary Profession p9 1.5 Veterinarians & Veterinary Team p Veterinarians & Competent Authorities p Veterinarians & Society p Veterinarians & Environment p11 chapter 2 Further recommendations on implementation of core values p Veterinarians & Animals p Veterinarians & Customers p Veterinarians & Veterinary Professions p Veterinarians & Veterinary Team p Veterinarians & Competent Authorities p Veterinarians & Society p Veterinarians & Environment p14 Bibliography p15 Annex 1 & p15 02 Veterinary Act p16 - p21 Dear Reader, Adopted by all FVE member organizations -representing the veterinary profession in 38 European countries as well as in all its disciplines - these documents aim to serve as guidance for the veterinary profession throughout Europe. They clearly demonstrate the profession s commitment to assuring the health and welfare of animals and people and its adherence to ethical standards. Both papers are a next step in our profession's policy towards the continuous improvement of the quality of its services. I sincerely hope that this brochure will serve all those with an interest in the health and welfare of animals and people. Dr Walter Winding President of the Federation of Veterinarians of Europe Dear Reader, It is my pleasure to recommend the Veterinary Code of Conduct to you. Drawn up by the Federation of Veterinarians of Europe, it clearly outlines the way the veterinary profession in Europe looks upon its role and responsibilities and how these should be delivered to societies. Together with the definition of the Veterinary Act, it shows the profession s clear view on its tasks, the way these should be carried out, as well as the profession s wish to be accountable for these tasks. I am particularly pleased by the fact that this Code was designed to apply to all veterinarians, including practitioners, hygienists, research workers and policy officers, both in the public and in the private sector. By working closely together towards the same goals, all veterinarians will reinforce their contributions to assuring the health and welfare of animals and people in Europe. Dr Bernard Vallat Director General of the World Organisation for Animal Health (OIE)

264 AC April 10 AI 12 Annex C 01 European Veterinary Code of Conduct Preamble The role of the veterinarian in society In answer to societal needs, veterinarians play an essential role in protecting animal health, animal welfare and public health as well as the environment by providing a wide range of services. A veterinarian s function lays on him a variety of legal or moral obligations, namely towards: animals, customer, veterinary profession in general and each colleague in particular, professional veterinary team, society, competent authorities. On occasions, these obligations may conflict with each other and therefore the veterinarian may be presented with a dilemma. In such situations it is the veterinarians responsibility to balance these obligations. The purpose of a professional Code of Conduct A Code of Conduct is a standard specifying the veterinary ethics and principles of professional conduct. It should ensure that: Veterinarians provide high quality services for the benefit of animal health, animal welfare and public health, Customers can have confidence in the services provided. The activities of veterinarians comprise intellectual tasks for the proper discharge of their duties which require a high level of legal, technical and scientific knowledge. Recognition of the veterinary degree is based upon minimum training requirements, as specified in article 38 and Annex V of the Directive on the Recognition of Professional Qualifications (2005/36/EC) 1. For obtaining the authorisation to practice, additional requirements (e.g. registration with a competent authority) might have to be met. Veterinarians are subject to the Code of Conduct drawn up by the appropriate competent authority. They should be aware that contravention of the provisions of the Code might lead to disciplinary sanctions. Customers must have confidence that alleged contravention of the provisions of Codes of Conduct will be treated seriously by the appropriate competent authority concerned and, if proved, will result in action proportionate to the seriousness of that breach being taken. (1) See Annex I 4 34 EUROPEAN VETERINARY CODE OF CONDUCT 5

265 AC April 10 AI 12 Annex C The FVE European Code of Conduct The purpose of a European Code of Conduct The increase in cross-border activities and the development of a genuine Internal Market for services call for a greater convergence of professional rules at European level. It is therefore important that professional organizations reach agreement between themselves at European level on a common set of rules which will ensure an equal level of protection for recipients and a high quality of services throughout the EU. A European Code can: facilitate the free movement of service providers lead to recipients enhanced trust and confidence in services offered by providers from other member states. A European Code of Conduct should apply both to the provision of services cross-border as well as to the provision of services within the territory where the service provider is established: the aim is to establish a common set of rules at European level and not to draw a distinction between national and cross-border provision of services. A European Code of Conduct should contain the principles which are at the core of the exercise of regulated professions in Europe such as professional independence, confidentiality, honesty, integrity and dignity. This does not exclude member states or national professional associations from stipulating more detailed rules aimed at greater protection in their national law or national Code of Conduct. (ref Handbook services) In accordance with the Directive 2006/123/CE on Services (art. 15 freedom of establishment and art. 16 free movement of services) those more detailed rules should respect the following conditions: non-discrimination: the requirement may be neither directly (nationality or location of registered office) nor indirectly (residence or place of principal establishment) discriminatory; necessity: the requirement must be justified for reasons of public policy, public security, public health or the protection of the environment; proportionality: the requirement must be suitable for attaining the objective pursued, and must not go beyond what is necessary to attain that objective. One of the challenges of an European Code of Conduct would also be its concrete implementation, in order to ensure that applications of these minimum set of rules can be enforced in practice. According to this preamble, the members of FVE agree on a FVE European code of conduct. This Code of Conduct contains principles which shall: be recognized at the present time as the expression of consensus of core values between all members of FVE and be implemented within national codes of conduct: CHAPTER 1 be taken into account by all members of FVE in all revisions of national Codes of Conduct with a view to their progressive Definitions: Competent Authority means any body or authority which has a supervisory or regulatory role in a Member State in relation to service activities, including, in particular administrative authorities, professional bodies, and those professional associations or other professional organisations which, in the exercise of their legal autonomy, regulate in a collective manner access to service activities or the exercise thereof. (Directive 2006/123/EC). Regulated profession means a professional activity or group of professional activities, access to which, the pursuit of which, or one of the modes of pursuit of which is subject, directly or indirectly, by virtue of legislative, regulatory or administrative provisions to the possession of specific professional qualifications; in particular, the use of a professional title limited by legislative, regulatory or administrative provisions to holders of a given professional qualification shall constitute a mode of pursuit. (Directive 2005/36/EC). Service means any self-employed economic activity, normally provided for remuneration, as referred to in Article 50 of the Treaty. (Directive 2006/123/EC). Veterinarian providing a service can be either self- employed either member of a company. implementation aimed at greater protection of recipients and a higher quality of services: CHAPTER 2. This FVE European Code of Conduct will not be legally binding unless it is made binding either by the European Union or National legislation. As the circumstances in which it may be implemented will vary widely, FVE does not accept responsibility and is not liable for any use that is made of this Code as a matter of private law. Customer means a person, company or another entity (such as the government) which purchases goods and services provided by a veterinarian, his staff or his veterinary team. Member State means a Member State of the European Union. Home Member State means the Member State where the veterinarian acquired the right to bear his professional title. Host Member State means any other Member State where the veterinarian carries on cross-border activities to bear his professional title. 6 EUROPEAN VETERINARY CODE OF CONDUCT 35 EUROPEAN VETERINARY CODE OF CONDUCT 7

266 AC April 10 AI 12 Annex C CHAPTER 1 Core Values of the FVE European Veterinary Code of Conduct. These values shall be recognized at the present time as the expression of consensus of core values between all members of FVE and be implemented within national codes of conduct. 1.2 Veterinarians & Animals Veterinarians shall have knowledge of animal health and welfare legislation. Veterinarians shall restore and/or ensure the welfare and health of the animals under their care in whichever section of the veterinary profession they work. Veterinarians shall give emergency first aid and pain relief to any animal according to their skills and the specific situation. Veterinarians shall as far as reasonably possible ensure informed consent is obtained from a customer before treatment or procedures are carried out. Veterinarians may inform the public about their services in an accurate and not misleading manner. Such communication must be truthful, transparent and correct. Commercial communications by veterinarians shall comply with Community law, aim in particular to guarantee the independence, dignity and integrity as well as professional secrecy. (ref Handbook services). 1.1 General Principles Independence and impartiality Veterinarians shall exercise personal and independent judgement after taking into account all relevant circumstances, without any application of personal interest or external influence. Customers have the right to receive impartial, independent and objective advice. Honesty and Integrity Veterinarians shall act with courtesy, honesty and integrity in their relationships with customers and others, including professional colleagues and must not engage in any activity or behaviour that would be likely to bring the profession into disrepute or undermine public confidence in the profession. Customers have the right to expect to be treated with courtesy and respect. Confidentiality and professional secrecy Veterinarians shall protect the customers confidentiality 2 except in specified circumstances and, where possible, with the informed consent of the individual. Customers have the right to expect that veterinarians will respect confidentiality except in specified circumstances, especially when disclosure concerns public or consumers health 3, animal heath and/or welfare or when disclosure is required by law. Competence and professionalism In carrying out their profession, veterinarians shall act in all conscience and to the best of their professional knowledge. Veterinarians shall maintain and enhance their knowledge and skills relating to the state of veterinary science. Customers have the right to expect that veterinarians will keep their knowledge in their field of practice up-to-date and work within their competency level. (2) Confidentiality / professional secrecy: safeguard information acquired in the course of providing professional services and ensure that information about an individual is not disclosed to others. (3) See 1.6. Accountability and Insurance Veterinarians shall ensure that the customer can be adequately compensated in the event of adverse effects resulting from errors or omissions made in the provision of a service. For that purpose, veterinarians should carry insurance or another form of guarantee. The customers have the right to expect an adequate compensation in the event of a justified claim. 1.3 Veterinarians & Customers Veterinarians shall respect the needs and requirements expressed by their customer as long as such needs and requirements do not conflict with compliance with the Principles and Applications of this Code and/or with the laws of the Member State in which they wish to provide a service. No veterinarian shall discriminate on grounds of race, gender, religion, politics, disability, marital status or sexual orientation. All veterinarians owe a duty to their customers to carry out work and services faithfully, conscientiously, competently in a professional manner, and with independence, impartiality and integrity using due care, skill and diligence. 1.4 Veterinarians & Veterinary Profession Veterinarians shall familiarise themselves with and observe the relevant legislation and Code of Conduct in relation to veterinarians as individual members of an European veterinary profession. Where a veterinarian of a Member State co-operates with a veterinarian from another Member State, both shall take into account the differences which may exist between their respective laws and the professional organisations, competences and obligations of veterinarians in the Member States concerned. All veterinarians shall conduct themselves in a manner that respects the legitimate 8 EUROPEAN VETERINARY CODE OF CONDUCT 36 EUROPEAN VETERINARY CODE OF CONDUCT 9

267 AC April 10 AI 12 Annex C rights and interests of others. They shall acknowledge the professional aspirations and contributions of their colleagues and respect their rights. Veterinarians shall recognise all others veterinarians of Member States as professional colleagues and act fairly and courteously towards them. Veterinarians shall ensure the integrity of veterinary certification. They shall not sign a certificate or any other relevant statutory application unless the signatory is the designer or: either where the design has been prepared under the signatory s direct supervision and/or authority, either on the basis of an official recognized certificate, designed as above, that has been signed by another authorized veterinarian. 1.5 Veterinarians & Veterinary Team 4 Veterinarians shall maintain and enhance their knowledge of, and observe the relevant legislation applicable on Health and Safety to employers, employees, business owners. All veterinarians shall ensure that conduct of their teams conforms to the Code of Conduct, so that anybody dealing with any provider of veterinary services may have confidence in being protected against incompetence or false or misleading statements. All veterinarians shall take all reasonable precautions to ensure the health, safety and welfare of their team. Veterinarians shall communicate with colleagues and staff to ensure co-ordination of care of patients Veterinarians shall ensure that any member of support staff to whom a task is delegated has the knowledge and skills necessary to undertake that task effectively and efficiently whilst maintaining overall responsibility. There shall also be appropriate supervision. 1.6 Veterinarians & Competent Authorities All veterinarians shall observe the laws governing their professional activities and so, shall foster and endeavour to maintain good relationships with Competent Authorities. Veterinarians shall contact the relevant Competent Authorities and inform themselves as to the rules which will affect them in the performance of any particular activity in a particular Member State: they shall ensure that they abide by the reulations of the Competent Authority of the member State in which they wish to provide a service. Veterinarians, when performing tasks on behalf of the Competent Authorities, shall ensure that there is no conflict of interest and shall not use their position to try to extend their clientele or to gain a personal advantage. Veterinarians, when performing inspections on behalf of the Competent Authorities, shall understand the importance of impartiality and uniformity in enforcement of these inspections. 1.7 Veterinarians & Society Veterinarians shall maintain and enhance their knowledge of, and observe the relevant legislation applicable on public health. Veterinarians shall understand their role and comply with legal obligations in the food chain. Veterinarians shall, whenever appropriate, bare in mind the possible impact his/her actions might have on the end product and the consumer. Veterinarians shall seek to ensure the best protection of public and consumers health. Veterinarians shall understand and comply with their legal obligations in relation to the prescription, safekeeping, use, supply and disposal of medicinal products, especially when relating to the handling or administration of medicinal products which shall be recorded and dealt with, according to general pharmacovigilance principles and requirements. Veterinarians shall report any suspicion of a notifiable disease to the appropriate Authority. 1.8 Veterinarians & Environment Veterinarians shall maintain and enhance their knowledge of, and observe the relevant legislation applicable on environment protection. All veterinarians shall take account of the social and environmental impact of their professional activities in the implementation of such work and services. (4) employers, employees, business owners 10 EUROPEAN VETERINARY CODE OF CONDUCT EUROPEAN VETERINARY CODE OF CONDUCT 11 37

268 AC April 10 AI 12 Annex C CHAPTER 2 Further recommendations on implementation of core values. These values should be taken into account in all revisions of national Codes of Conduct with a view to their progressive implementation aimed at greater protection of recipients and a higher quality of services. Veterinarians should respect the confidentiality of information acquired in the course of providing veterinary services and ensure that information about a client is not disclosed to others unless disclosure is required by law and, where possible, with the informed consent of the individual or any relevant party. Veterinarians should respond promptly, fully and courteously to complaints and criticism. If any dispute of a professional nature or a breach of a rule of professional conduct arises between customers and veterinarians, they should resolve the dispute locally or through the Competent Authority. Veterinarians should respect the rules for pricing where they exist. knows or can ascertain by reasonable inquiry that another provider of veterinary services has an existing contract with the same customer, should notify the other provider. Veterinarians should deliver only those services for which they are competent. Veterinarians should help the client to find another veterinarian who is capable of providing the service asked for. Veterinarians should acknowledge the contribution made to their services by organisations representing the veterinary profession. According to their possibility and ability, they should support the professional representation (suggestions, criticism, exercising voting rights...). 2.1 Veterinarians & Animals Veterinarians should be aware of the particular ethical status of animals as sentient beings and the veterinary responsibility for animal health and animal welfare. Veterinarians should always take into account the five freedoms for assessing animal welfare: Freedom from hunger and thirst, Freedom from pain, injury and disease, Freedom from fear and distress, Freedom to express normal behaviour, Freedom from discomfort. Veterinarians should use the least stressful techniques necessary for a sound diagnosis and treatment. Veterinarians should attempt to relieve animals of pain and suffering as soon as possible; if the condition is untreatable, they should perform euthanasia (killing with as little pain, distress and fear as possible). Veterinarians should consider to euthanize an animal even without the owner s permission in urgent cases, in which there are no medical means to prevent excessive suffering of the animal (in case of accident, first aid etc., when the owner of the animal may not be present or cannot be contacted). Prior to taking such a decision, however, all possible treatments should have been carefully considered and ruled out in all conscience and to the best of one's knowledge, assuming full responsibility for the act. When aware of violations to animal welfare legislation, veterinarians should immediately bring this to the attention of the owner of the animal(s) and do everything within their power to solve the problem. Where applicable, in these specified circumstances, veterinarians should report it to the appropriate legal authority. Beyond first aid, veterinarians should only undertake veterinary services where they possess adequate knowledge and abilities: if they do not, veterinarians should refer the case to a veterinarian with the appropriate knowledge and skills. 2.2 Veterinarians & Customers Veterinarians should give sound professional advice in terms customers will understand, as well as information before and during the provisions of services, both on the procedure it is intended to pursue to achieve the desired objective (treatment options, prognoses, possible side effects) and on the fees involved. Veterinarians should give information about emergency services systems where necessary. 2.3 Veterinarians & Veterinary Profession Veterinarians should not maliciously or unfairly criticise or attempt to discredit another veterinarian. If any personal dispute of a professional nature or a breach of a rule of professional conduct arises amongst veterinarians, they should resolve the dispute locally or through the Competent Authority. Veterinarians should maintain and develop their professional knowledge and skills. Veterinarians, if approached to undertake a veterinary service upon which the provider 2.4 Veterinarians & Veterinary Team Veterinarians should treat their colleagues and their staff in a fair and reasonable way and assure them a fair salary. Veterinarians should encourage and ensure the continual improvement of the professional and/or technical knowledge and skills of their personnel. Veterinarians and their staff should be insured for legal and professional liability. Veterinarians should support the professional development of the next generation of veterinarians EUROPEAN VETERINARY CODE OF CONDUCT EUROPEAN VETERINARY CODE OF CONDUCT 13

269 AC April 10 AI 12 Annex C Bibliography Annex 1 Annex 2 OIE standards: Terrestrial Animal Health Code (2007) 2.5 Veterinarians & Competent Authorities Veterinarians should fulfil, whenever required, promptly and in accordance with the instructions given, the obligations of public service which they undertake on behalf of the Competent Authorities. When veterinarians are required by Competent Authorities to perform tasks for the customer of another veterinarian, and when asked by the customer to perform any task other than these, veterinarians should inform the other veterinarian. Veterinarians should not commence any form of proceedings against a colleague without first informing the Competent Authorities to which they both belong, specially if they are from different Member States: they such give Competent Authorities concerned an opportunity to assist in reaching a settlement. 2.6 Veterinarians & Society Veterinarians should make animal owners aware of their responsibilities to the public. Veterinarians should, whenever appropriate, advise their customers about measures to minimise the risk of zoonotic agents, food borne pathogens, residues, contaminants (biological and chemical agents) and antimicrobial resistance. 2.7 Veterinarians & Environment Veterinarians should attempt to reduce pollution of the environment by appropriate use of disinfectants, medicinal products and other chemicals. Veterinarians should encourage customers to do the same. Veterinarians should aim to be environmentally responsible by the economical use of energy and water. Veterinarians should organise facilities for separate collection of different types of waste so that they can be sent to the appropriate recycling points FVE Working Group Code of Conduct Catherine Roy France - Chair Walter Winding Austria Jörg Peter Luy Germany Henrik Ericsson Sweden Jan Bernardy Czech Republic Lynne Hill UK Frank Gasthuys observer EBVS Stephen Ware UK - alternate for Walter Winding Nancy De Briyne Secretariat The Working Group was formed in September The draft Code of Conduct was adopted in the FVE General Assembly of Vienna in May FVE (2002) European Code of Good veterinary practice 2. ACE (2005) European Deontological Code for providers of Architectural Services 3. CCBE (2006) Code of Conduct for European Lawyers 4. CEPLIS (2006) Common Values of the Liberal Professions in the European Union 5. EC - Treaty establishing the European Community 6. EC (2005) Directive 2005/36/CE on recognition of professional qualifications 7. EC (2006) Directive 2006/123/CE on Services in the Internal Market 8. EC (2007) Handbook on implementation of the Services directive 9. EC (2007) DG internal market - Développer la qualité des services dans le marché intérieur: le rôle des codes de conduite européens 10. OIE Standards (2007) Terrestrial Animal Health Code Ref: Directive 2005/36/CE on recognition of professional qualifications LexUriServ/LexUriServ.do?uri=OJ: L:2005:255:0022:0142:EN:PDF 1. The training of veterinary surgeons shall comprise a total of at least 5 years full-time theoretical and practical study at a university or at a higher institute [ ] covering at least the study programme referred to in Annex V, point [ ]. 2. Admission to veterinary training shall be contingent upon possession of a diploma or certificate entitling the holder to enter, for the studies in question, university establishments or institutes of higher education recognised by a Member State to be of an equivalent level for the purpose of the relevant study. 3. Training as a veterinary surgeon shall provide an assurance that the person in question has acquired the following knowledge and skills: (a) adequate knowledge of the sciences on which the activities of the veterinary surgeon are based; (b) adequate knowledge of the structure and functions of healthy animals, of their husbandry, reproduction and hygiene in general, as well as their feeding, including the technology involved in the manufacture and preservation of foods corresponding to their needs; (c) adequate knowledge of the behaviour and protection of animals; (d) adequate knowledge of the causes, nature, course, effects, diagnosis and treatment of the diseases of animals, whether considered individually or in groups, including a special knowledge of the diseases which may be transmitted to humans; (e) adequate knowledge of preventive medicine; (f) adequate knowledge of the hygiene and technology involved in the production, manufacture and putting into circulation of animal foodstuffs or foodstuffs of animal origin intended for human consumption; (g) adequate knowledge of the laws, regulations and administrative provisions relating to the subjects listed above; (h) adequate clinical and other practical experience under appropriate supervision. Chapter 3.1: Evaluation of veterinary services Mcode/en_chapitre_1.3.1.htm Article : The quality of the Veterinary Services depends on a set of factors, which include fundamental principles of an ethical, organisational and technical nature. The Veterinary Services shall conform to these fundamental principles, regardless of the political, economic or social situation of their country. [ ] Article : Fundamental principles of quality The Veterinary Services shall comply with the following principles to ensure the quality of their activities: Professional judgement [ ], Independence [ ], Impartiality [ ], Integrity [ ], Objectivity [ ], General organisation [ ], Quality policy [ ], Procedures and standards [ ], Information, complaints and appeals [ ], Documentation [ ], Self-evaluation [ ], Communication [ ] and Human and financial resources [ ]. 14 EUROPEAN VETERINARY CODE OF CONDUCT EUROPEAN VETERINARY CODE OF CONDUCT 15 39

270 AC April 10 AI 12 Annex C 02 Veterinary Act 01 The Federation of Veterinarians of Europe (FVE) is the representative body for approximately 200,000 veterinarians in 38 European countries. The General Assembly comprises representatives from 46 national organisations, including regulatory authorities, and 4 international groups representing specific spheres of activity. 02 The veterinary profession is a well-educated and trained liberal profession, practising a wide range of activities on the basis of specific qualifications which are not just limited to private clinical practice. These qualifications provide intellectual and practical services to clients and patients and to the general public in a personal, responsible and independent manner. The veterinary profession is also a regulated profession. In order to avoid inferior services which could harm animal health and welfare, as well as public health, access to and the practise of veterinary medicine and surgery is subject to adequate training for the particular purpose and to registration and/or control by national competent authorities. 03 The European public has come to demand a high level of protection of animal welfare for all species, and a high degree of quality assurance in the ethical production of food of animal origin as the profession assists in safeguarding both animal and public health. Companion animals have become even more important as members of the family. 04 The FVE is concerned that there are too many people carrying out veterinary tasks without a clear mission, or without appropriate education or training. In many countries groups of non-veterinarians who perform certain veterinary tasks are already established. Increasingly, these groups wish to undertake more of the traditional veterinary work and, in some countries at least, there are moves by government bodies to undermine the role of the veterinarian and to encourage the transfer of the veterinary role to others VETERINARY ACT 17

271 AC April 10 AI 12 Annex C 05 Where veterinary acts are undefined and unregulated, there is a danger that the welfare of animals and the reputation of the veterinary profession may suffer, and animal and public health are compromised. 06 The FVE believes that the veterinary profession should be acknowledged as possessing a unique competence and expertise which can guarantee a high level of animal health and welfare, as well as bringing an important contribution to human health and public safety. However, the purpose of this paper is not to protect the veterinary profession but to protect the welfare and improve the health of animals. FVE accepts that some veterinary Acts may be delegated to non-veterinarians but takes the view that such persons should be appropriately trained for what they do. 07 Such restrictions are in the interests of ensuring that animals are treated only by people qualified to do so. 08 FVE has therefore adopted the following definition of veterinary acts: Definition of veterinary acts A. all material or intellectual interventions that have as their objective to diagnose, treat, or prevent mental or physical disease, injury, pain, or defect in an animal, or to determine the health and welfare status of an animal or group of animals, particularly its physiological status; including the prescription of veterinary medicines; B. all interventions that cause or have the potential to cause pain; C. all invasive interventions; D. all veterinary interventions, including food or feed chain activities, affecting public health; E. veterinary certification relating to any of the above. 18 VETERINARY ACT VETERINARY ACT Criterion (a) emphasises the traditional role of the veterinarian in the art as well as the science of veterinary medicine and surgery, whereas the remaining criteria refer to the more practical aspects of veterinary activities. It should be noted that some interventions may be either material or intellectual, or both, and may also satisfy either one or more of the criteria. 10 The FVE strongly believes that the acts of examination, diagnosis, recommendations for subsequent action, and the prescription of medicines or surgery are all strongly linked and must be the exclusive preserve of the veterinarian. A diagnosis cannot be made without examination, either physical examination of the animal or investigative examination of samples. A treatment cannot be recommended or a surgical intervention performed without an examination and a diagnosis. The same applies to a veterinary prescription. 11 The FVE makes the same argument in respect of the role of the veterinarian undertaking official tasks, who has an equally important role in Animal Health, Public Health and Animal Welfare. 12 Only a veterinarian can take the holistic approach in any given situation and, in addition to the application of scientific principles, to exercise the art of veterinary medicine and surgery by virtue of evidence based scientific knowledge and established experience. 13 The OIE Terrestrial Animal Health Code defines veterinary paraprofessional as follows; a person who, for the purposes of the Terrestrial Code, is authorised by the veterinary statutory body to carry out certain designated tasks (dependent upon the category of veterinary para-professional) in a country, and delegated to them under the responsibility and direction of a veterinarian. The tasks authorized for each category of veterinary para-professional should be defined by the veterinary statutory body depending on qualifications and training, and according to need. 41

272 AC April 10 AI 12 Annex C 14 FVE accepts the delegation of certain tasks/interventions to those who are technically and legally competent and subject to varying levels of veterinary supervision appropriate to the specific task. Such delegation can be encouraged in the interests of the client, the consumer, and the general public, which has a right to expect economic activities as well as ethical procedures in terms of welfare and the environment. 15 In the course of encouraging the delegation of certain tasks it is expected that anomalies surrounding the current legality/illegality can be removed. It must also be expected that para-professionals are properly trained in full cooperation with the veterinary profession in certain, limited, procedures which provides effective treatment for all animals and ensures enhanced public confidence in the production of safe food and in the veterinary profession. 16 However, certain principles should be established first. A. Law and practise must conform. It is not acceptable that the different groups should be given the legal right to care for animals or to undertake certain interventions without an equal legal obligation for competence and regulation. B. The competence of the individual must be assured C. It is necessary to determine the level of responsibility and the relationship with the veterinarian who may have overall responsibility and control, for example: I. interventions may be carried out under the authority of and/or in the presence of the veterinarian II. interventions may be carried out under the authority of the veterinarian who is able to intervene in an emergency III. interventions carried out in the absence of the veterinarian IV. independent or autonomous interventions D. the level of legal responsibility must be proportional to the level of practical responsibility. 17 Overall, based on models already established in the medical health professions we can foresee a general, and sometimes specialised, competence for veterinarians (who are basically qualified to carry out all interventions) and specific or restricted competences for clearly identified professions or activities. 18 In conclusion, differences in historical and cultural backgrounds between countries and people have led to diversity in national legislation. Ever growing international contacts and the increasing number of veterinarians providing cross-border services or establishing in other countries have created a need for a clear, practical and international definition of veterinary acts. There is an unbreakable link between animal health (whatever the species), animal welfare, food safety and public health and welfare. It is the veterinarian who occupies a pivotal position within that chain. 20 VETERINARY ACT VETERINARY ACT 21 42