AS many of you will have heard
there is an online petition to feed
into the RCVS’ call for evidence on
out-of-hours provision. The
petition is calling for the removal of
mandatory home visits.
I have written on this subject
before after vets have been struck off
for not doing a home visit (usually
out-of-hours, but home visits can
happen at any time). I have limited
column space and enough to say here
for a year’s worth of Cross-words
columns.
The petition has been set up by a
practitioner called Jo Dyer. At the time
of writing
(the
beginning of
February) the
petition has
had over
2,000
signatories.
This is a huge
response for a UK veterinary issue,
that would be similar to a national
online petition gaining 12 million
signatories (i.e. approaching a fifth of
the population). Surely the RCVS
cannot ignore that?
I interviewed Jo…
Gareth: This has been a grumbling
issue for years, what prompted you to
start the petition?
Jo: I’ve been a small animal vet for
over 27 years, first as an employee,
then a practice owner, and now I’m a
practice management consultant who
also does some locumming.
Ten years ago I told my employed
vets not to perform house visits out-
of-hours. I had a duty of care to look
after their health and safety; and whilst
I have my doubts about, for instance,
having to have a box of plasters
available in a building full of bandages,
and other such H&S trivia, it seemed
to me to be a clear and present danger
to send people out on their own at all
hours to strangers’ homes.
I also told them I would defend
them to the hilt if they should have
any RCVS complaints about this.
They, however, told me they could not
obey because of their personal
responsibility under the Code.
Ironically, the very next OOH visit
someone felt obliged to go to was at
2am to a filthy bedsit occupied by
heroin addicts to see a sick parrot.
So when I heard about Mr Chikosi,
I really felt the time had come to stop
moaning and do something. As far as I
can remember, his is about the fourth
such case in the last 10 years where a
vet has been struck off for refusing or
delaying attendance at a home visit.
However, his case seemed even
worse than the others, and I was ashamed that he was treated as he was
by a profession that I am part of. I
could entirely imagine myself in his
position in my younger and less
confident days – trying to keep his
employer, his staff, his client, his
patient and the RCVS all happy at the
same time – a clearly impossible task.
I thought he acted very sensibly,
and in line with his employer’s
protocol. The dog was seen and put to
sleep – although she would have been
seen more quickly if Mr C had been
able to say, “No, I am not coming out,
get her here as soon as possible.”
There was also the fact that I finally had time in my life to be able to
do something about it. As vets we all
work extremely hard over long hours
so I thought if I could make it easy
for people to contact the RCVS in
response to the “call for evidence”
then that might give everyone who felt
the same as me a voice.
Gareth: A few technical points re the
petition: how long is it up for, does it
feed directly to the RCVS? How do
readers access it?
Jo: Originally I had in mind to close
the petition on 17th February, the
deadline for the “call for evidence”.
However, it has been suggested to me
that it could be treated as a stand-
alone issue anyway so it will be
available for the foreseeable future.
It can be accessed at
www.change.org/en-
GB/petitions/royal-college-of-
veterinarysurgeons-remove-mandatory-house-visits-from-the-
code-of-professional-conduct or just
go to change.org and search “code of
professional conduct”.
Each time someone “signs”, an e-
mail is sent to RCVS.
Although the headline is about
removing mandatory house visits, the
actual message is a request to modify
the Code to make it much clearer that
owners are the ones responsible for
their animals. This would, incidentally,
bring the Code into line with the
Animal Welfare Act of 2006. At the
moment, for some bizarre reason, as
soon as the owner contacts the vet,
they “place the onus of decision-
making onto the veterinary surgeon”.
We are asking that this
responsibility is not until they have
undertaken a physical examination of
an animal. This examination may take place at the surgery
or other address
entirely at the
discretion of the
veterinary surgeon
on duty. We also
want to delete
Clause 3.13
altogether, i.e. the
one with the woolly
wording about “on
rare occasions it
may be necessary to visit”, etc.
[For full details please see the
online petition; for reasons of space I
cannot rewrite it all here – Gareth]
Gareth: The RCVS has responded to
the petition and said that OOH visits
are not mandatory if clear reasons are
given to refuse; what would you say to
this?
Jo: I would say, “actions speak louder
than words”. Clear reasons for refusal
have been given in the past but people
were still struck off. In the Code it
makes clear that “risk to life and limb”
is the only acceptable reason for
refusal. My risk assessment for my
employed vets was that visiting OOH
was a H&S issue. They did not trust
the RCVS to agree with that view.
Neil Smith (the Royal College
president) in his statement has relied
heavily on the fact that the word
“mandatory” does not appear in the
Code. However, through their actions,
the DC have made people believe that
it is not possible to refuse visits. Also,
the word “mandatory” does not
appear in the e-mails the
RCVS have been
receiving from the
petition, so it seems
convenient for him to
latch on to the one word
which is not actually
going directly to them.
The College started
the “call for evidence”
because they were
reportedly unaware of much unrest
and wanted direct feedback. So now
they need to listen carefully to that
direct feedback and not put up
smokescreens based on semantics.
[There are also explicit instructions
in the practice standards scheme
manual that it is not acceptable for a
practice to have a “No home visit
policy”. So with the double negative
there, logically this makes them
mandatory – Gareth]
Gareth: I have been made aware of a
case where a dog eviscerated after an
op and the vet from an out-of-hours
co-operative refused to attend, the
owners felt unable to cope and the
dog died. This is one of the few cases
when an out-of-hours visit being
mandatory (possibly status epilepticus would be another)
and basic animal
welfare are
indivisible; how
would you defend
giving the vet the
right to refuse any
visit in any
circumstance?
Jo: Clearly, cases of
evisceration,
impalement and entrapment are likely to need visits. At
no point have I suggested the
abolition of visits. However, the Code
should not be a list of all the possible
things we must and must not do, it
would be extremely long if it was! Vets
are conscientious and highly intelligent
individuals; it is insulting to treat them
like naughty children. The necessity
“not to bring the profession into
disrepute” would of course still be
present.
I would like to say that none of
this would have come about if the
RCVS DC had followed their own
lawyer’s advice at Mr C’s hearing.
Quoting from the transcript: “It has to
be shown that no reasonably
competent veterinary surgeon in
general practice, providing an out-of-
hours service would have done what
the respondent is alleged to have
done.”
No “reasonably competent
veterinary surgeon working OOH”
was asked for their opinion on this,
and a DC comprising three academics, a referral
ophthalmologist and
a retired large animal
practitioner made
their own decision.
Gareth: Following on
from that, I also
think that in previous
cases the RCVS DC
have applied
hindsight to visit cases with comments like “it was a
quiet night on call otherwise”. No vet
on call, at the time you have to make a
decision, knows what will happen in
the next 10 seconds on call, never
mind the rest of the night. When the
dust has settled it’s easy to say “It was
quiet after all.”
There are plenty of on-call nights
when, in hindsight, I could have gone
out to the pub, but if I was found
blind drunk on call I would expect to
be struck off. I would not expect
“Well it’s OK because the phone never
rang” to work as a defence, but the
RCVS have used this hindsight as part
of their condemnation of refusal to
do a visit. This all adds to the fear we
feel when that drunkard calls at 2am
for his coughing dog and we all think
“I’ve got to go.”
Can you sum up in one or two sentences why home visits should not
be mandatory?
Jo: (a) the maintenance of the mental
and physical health and safety of
veterinary professionals; (b) the
welfare of the vast majority of our
patients whose owners bring them to
our premises and who may be
neglected while we are out on a
house call, and the welfare of any in-
patients we may also be responsible
for during that time; and (c) as vets
we are all passionate about animal
welfare, but vet welfare is important
too, and we cannot continue to
provide a service if we do not look
after ourselves and our colleagues.
Also, the ambiguity we have at the
moment means that the welfare of
the patient can be compromised
while waiting for the vet to arrive,
when it would have been more
quickly seen and more effectively
treated if it had been taken straight
to the surgery.
Often the vet just acts as a taxi
service anyway. And one of the
commonest reasons I have had for
requesting a house visit is that the
owner cannot afford a taxi.
Gareth: Are there precedents from
other developed countries?
Jo: I have asked groups of vets from
all over the world, and the UK
appears to be the only country where
the vet’s responsibility for the animal
starts at the moment of contact with
the owner, rather than at the surgery
doors.
Gareth: Do you think that if we
remove this from the Code then
people will no longer do house visits?
Jo: Changing the wording of the
Code would not mean that no one
did house visits (as I say in the
petition). Also, clients would be able
to choose their practice on the basis
of availability of visits if that was
important to them. House visits are a
customer care issue, not an animal
welfare issue, and therefore many
practices will always offer them
where possible.
Gareth: Your petition currently has
2,000 signatories. For the RCVS
Council election, this will be enough
votes to get elected, are you going to
stand?
Jo: No. When I read that “The role
of RCVS Council is not to represent
the veterinary professions, I ruled
that one out! I would, however, very
much like to be invited to the
standards committee meeting which
is being held to discuss the findings
of the “call for evidence”. I have
asked a couple of times but not had a
positive answer yet! If anyone else
would like to request RCVS that I
attend then please feel free.
Gareth: Thanks Jo.
Comments on petition
I want to end by quoting some of the
comments on the petition. You often read
that the risks to vets doing out-of-hours
visits are theoretical, or that it “could
happen”.
What is unique about this petition is that
it has drawn out real experiences of vets.
After this has run its course, the
next time a vet is assaulted I would not
want to be the RCVS when the victim’s
employer/father/mother/brother
brings the RCVS to court and in front
of the HSE for causing the incident.
When the HSE looks at accidents
and fatalities, one of the main things it looks at is how the organisation in
question deals with near misses and
warnings.
RCVS,if you are reading this: this
is your warning, these real experiences
listed in the panel are your near misses.
Take action, listen to the petition.
- garethcross@hotmail.com
