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Animal welfare needs sticker

BVA encourages profession to inspire next generation of vets

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As children return to school this month, the British Veterinary Association is encouraging veterinary teams to help children learn about animal welfare after figures show 85% of school children have never heard of the five animal welfare needs – but primary school is the age when most vets decide they want to enter the profession.

BVA’s recent Voice of the Veterinary Profession survey revealed that more than 50% of young vets surveyed had settled on pursuing veterinary medicine by the age of 10, and 76% said that their choice was driven by an interest in caring for animals.

Unfortunately, despite over half of UK households owning a pet, PDSA’s Animal Wellbeing (PAW) Report shows that only a quarter of children have been taught how to care for pets at school, even as 97% of veterinary professionals cite the value in encouraging pet owners to better understand and provide for the five welfare needs of their pets.

To support the next generation to be more aware of how to care for their pets, the Veterinary Animal Welfare Coalition – which includes BVA, the British Veterinary Nursing Association (BVNA), British Small Animal Veterinary Association (BSAVA), British Veterinary Zoological Society (BVZS), Blue Cross, PDSA and RSPCA – launched a set of stickers to coincide with the 10-year anniversary of the Animal Welfare Acts as an educational tool for vets, teachers and parents.

The stickers are designed to be a used as a fun way of introducing and discussing the five vital needs of animals as described in the UK’s Animal Welfare Acts:

  • the provision of a suitable living environment
  • a suitable diet
  • the need to exhibit normal behaviour
  • to be housed with, or apart from, other animals
  • to be protected from pain, suffering, injury and disease

BVA hopes that by teaching children about the five welfare needs, they will in turn discuss this with their family and friends at home too. Apart from the principles of responsible ownership, it is hoped that sensitisation to the welfare needs of animals will instil in young people a lasting respect and compassion for all animals, from fish and rabbits to dogs and horses.

British Veterinary Association President John Fishwick said:

“Year on year, irresponsible ownership and lack of owner understanding for pets’ needs comes out in vets’ top three concerns.

“Educating children and young adults about the five welfare needs of animals is an invaluable step towards ensuring that the next generation not only values the human-animal bond but is aware of its responsibilities towards pets.

“We hope that using these stickers and holding sessions on animal welfare at school, local groups or in practice will translate to happy pet owners and, indeed, happy healthy pets too.”

To order a set of five welfare need stickers for free, email the BVA on media@bva.co.uk with the requested amount (max 10 sheets/150 stickers) and a postal address.

What role might patient safety play in the veterinary profession?

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What role might patient safety play in the veterinary profession? is the question posed by our Vet Futures blogger, Mark Turner, this month in considering what the profession could learn from the NHS.

Mark graduated from Liverpool Veterinary School in 1996. His career has included spells as a veterinary surgeon and as a business owner. During this period he has developed an interest in patient safety and a profound belief that risk management, properly implemented, can improve many aspects of care. Mark is currently undertaking an MRes on veterinary patient safety at the Royal Veterinary College.

In his blog, Mark outlines the major impact that a move to a more patient-safety-centred approach has had within human medicine, and also the aviation industry, noting that adopting a culture that does not blame individuals was key: “Human medicine has discovered that real improvements start when people understand that mistakes are inevitable in complex industries, and everyone will make them. This shift in perspective allows hospitals to start framing accidents, and near misses, as opportunities to improve the system. Accident auditing, then, rather elegantly, becomes another arm of evidence-based practice,” he says.

He exhorts the veterinary profession to take note, and consider integrating patient safety into its systems, concluding: “Perhaps all we need to do is learn this single, yet potentially transformative, lesson, in order to start our own safety revolution.”

This month’s our poll will therefore be asking website visitors if they feel that patient safety features high enough on the profession’s agenda.

In last month’s poll we asked “Do you feel that you were given adequate business training at vet school?” Of the 70 respondents, 96% said ‘no’, with 3% saying ‘to some extent’ and only one voter saying ‘yes’.

This theme is picked up in the Vet Futures report, launched at the BVA Congress at the London Vet Show on 20 November, with one of its recommendations being: “Enhance business and finance skills amongst veterinary professionals through education, extra-mural studies and continuing professional development” (recommendation 25).

To read the blog, comment on the issues it raises and to take part in this month’s poll please visit vetfutures.org.uk/discuss.

In addition, a recent research paper in Veterinary Record by Oxtoby et al from the University of Nottingham discussed error in veterinary practice: “We need to talk about error: causes and types of error in veterinary practice” (Veterinary Record 2015; 177:438).

It was accompanied by a research editorial by Dr Mickey Tivers of the University of Bristol: “Reducing error and improving patient safety”.

What role might patient safety play in the veterinary profession?

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Mark Turner graduated from Liverpool Veterinary School in 1996. His career has included spells as a veterinary surgeon and as a business owner. During this period he has developed an interest in patient safety and a profound belief that risk management properly implemented can improve many aspects of care. Mark is currently undertaking an MRes on veterinary patient safety at the Royal Veterinary College.

He has written for the Veterinary Times and Veterinary Practice, presented at the RCVS Knowledge first international EBVM Conference and at BSAVA Congress 2015 on the subject of Risk Management.

At the beginning of the new millennia, the report into the Bristol heart scandal was published (Department of Health, 2001). It established why the mortality rate after paediatric cardiac surgery (PCS) at Bristol hospital was twice the national average. In many respects it can now be seen as an important turning point in the history of the NHS. The report identified a host of risk factors at work at the time. But as the document went on to say, “professionals working in Bristol… were victims of a combination of circumstances which owed as much to general failings in the NHS at the time,” as to any individual short-comings (Department of Health 2001, p 11).

The report made almost 200 recommendations. Some of these were specific to PCS provision, but many more were generic proposals for a superior health service: one in which care quality was a central aim.

Since then the NHS has embarked on a quiet revolution of clinical services management, which has placed the discipline of ‘patient safety’ centre stage.

Mark Turner

Mark Turner

Patient safety, or risk management, recognises that high quality health provision relies upon an institution-wide commitment to safety. Integral to this is a culture of openness: this allows workers to report accidents, allowing valuable lessons to be learnt for the ‘system.’

A good example of how this ‘systems’ approach can benefit a complex industry is aviation. The airline industry embarked on a well-documented drive to improve its safety record in response to accidents like the Tenerife airport disaster in which 583 people died. (Interestingly, in common with many other accidents of the time, mechanical failure was not the dominant cause.)

It was understood that safety would only improve if the industry learnt lessons from every single incident in which the ‘system’ broke down. The understanding of these accidents and near misses, in all their complexity, could then be incorporated into modifications to work practices. To this end, a culture that exulted pilots made of ‘the right stuff’ was deconstructed, and behaviours, including error reporting, high functioning team work and cross-checking, were encouraged (Gordon, Mendenhall and O’Connor, 2012). Each played an important role in the startling reduction of air accidents.

A similar culture of error reporting and collective learning is taking root in healthcare, not just in the UK but throughout the world. A report published by the Institute of Medicine (IOM) in the US in 2000 had this to say about healthcare: “The focus must shift from blaming individuals for past errors to preventing future errors by designing safety into the system. This does not mean that individuals can be careless. People must still be vigilant and held responsible for their actions. But when an error occurs, blaming an individual does little to make the system safer and prevent someone else from committing the same error.” (Kohn et al, 2000, p 5.)

This year it was revealed that in a decade the complication rate from paediatric cardiac surgery in the UK has almost halved, from 4.3% in 2000 to 2.6% in 2009. Could patient safety be partly responsible? It seems reasonable to assume as much.

So what role might patient safety play in the veterinary profession? Rates of veterinary error remain opaque, and the safety of our systems is a legitimate subject of debate. Are we anywhere near as unsafe as the US medical system, which may kill 98,000 of its patients a year according to the IOM report quoted earlier? There are many unanswered questions but what is beyond doubt is that we in the veterinary profession have not yet widely adopted the philosophy of care quality that exists in the human health sector. What effect could this social science have on veterinary patient safety? Human medicine has discovered that real improvements start when people understand that mistakes are inevitable in complex industries, and everyone will make them. This shift in perspective allows hospitals to start framing accidents, and near misses, as opportunities to improve the system. Accident auditing, then, rather elegantly, becomes another arm of evidence-based practice. Perhaps all we need to do is learn this single, yet potentially transformative, lesson, in order to start our own safety revolution.

 

References:

Kohn LT, Corrigan JM, and Donaldson MS, (eds) (2000) To Err is Human. Building a Safer Health System. Washington: National Academy Press.

Gordon S, Mendenhall P, O’Connor B (2012) Beyond the Checklist. What Else Health Care Can Learn from Aviation Teamwork and Safety. London: IRL Press.

Department of Health (2001) The Report of the Public Inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984–1995. Learning from Bristol. Available at: http://webarchive.nationalarchives.gov.uk/20090811143745/http:/www.bristol-inquiry.org.uk/final_report/the_report.pdf. (Accessed: 20 October 2015)

The views expressed here are those of the author and do not necessarily reflect those of either the RCVS or the BVA.

David Main

Veterinary professor argues that the profession should prove its animal welfare advocacy credentials

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In this month’s guest blog, an academic specialising in animal welfare argues that the profession needs to do more to deliver on society’s expectation of vets as animal welfare advocates.

David Main is Professor of Animal Welfare at the School of Veterinary Sciences at the University of Bristol, with research interests in welfare assessment, animal welfare education and intervention strategies to improve welfare.

In his blog Professor Main makes two key arguments. His first is that the profession urgently needs to deliver on society’s expectation of vets as animal welfare experts and, second, the introduction of safeguards to prevent inappropriate profit-seeking behaviour.

“Veterinarians could perhaps… do more at an individual level to act as animal welfare advocates. It is easy to inform clients on the technical rationale for a specific husbandry change but then walk away knowing full well the client will not action the advice. In the medical profession, advanced communication techniques are becoming more widely accepted to promote positive change within their patients. Perhaps we should be more explicit in teaching our veterinary students influencing skills,” he says on the first point.

On the second aspect of his argument, he believes the vast majority of individual veterinary surgeons and practices are not motivated by money and do have animals’ best interests at heart. However, he argues that “perceptions as well as reality matter amongst our clients and society,” adding: “The obvious difference between the business structure of veterinary and medical practitioners in the UK means the profession will always be at risk of challenge for excessive profiteering.

“Since we still live in the age of the media scare story, it would seem prudent for the profession to embed some anti-profit seeking safeguards in our regulatory controls before, rather than after, a problem is highlighted.”

He believes that such safeguards, which he says could be incorporated into the RCVS Practice Standards Scheme, would be a “healthy demonstration” that the profession has animal welfare rather than profit as its main priority.

In response to David’s blog, this month’s Vet Futures poll asks visitors ‘Do vets always act as animal welfare advocates?’ If you have a view on this topic, do make sure to take part in the poll and leave a comment on the blog.

The previous month’s poll, which was based on the blog co-written by Erwin Hohn and Adi Nell from MediVet, asked to what extent vets would be willing to work collaboratively with others if it would benefit all. Of the 50 who answered, 60% said they would be completely willing to work with others, 32% a lot and 8% to some degree – no one said they would be unwilling to work with others.

Are we animal welfare advocates or profit-seekers?

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David Main is Professor of Animal Welfare at Bristol Veterinary School. His research interests are welfare assessment, intervention strategies to improve welfare and animal welfare education. He is a former member of the Farm Animal Welfare Council, and current member of Soil Association Council. He is project co-ordinator of the AssureWel project; a collaboration with RSPCA and Soil Association, that aims to embed welfare outcomes into the assurance process of certification schemes.

He was principle investigator for the Healthy Feet project that has been widely adopted by the dairy industry and he is also part of the EU WelNet project that is a network of welfare scientists providing welfare advice to the European Commission. 

The recent survey from the Vet Futures project shows that the public place a high degree of trust in the veterinary profession. Despite this encouraging assessment I will argue in this article that the profession should work harder to deliver on a societal expectation for us to be animal welfare advocates and that it ought to introduce safeguards against profit-seeking influences on our clinical decisions.

David Main

Professor David Main

Profession urgently needs to deliver on society’s expectation as animal welfare advocates
Individual clinicians would be well justified to say that their daily ambition in veterinary practice is to promote the interests of animals in their care. However, a minimal scratch below the surface reveals obvious tensions in this well-intentioned mantra within the profession.

At an organisational level, the BVA can be applauded for campaigning for stunning at slaughter. However, this campaign is relatively uncontroversial as it does not conflict with the interests of clients of many BVA members. Could you imagine the BVA launching a public campaign encouraging the pig industry to change its husbandry system in order to reduce the need for tail docking in pigs or improving the prevention and treatment of lameness of dairy cows? It requires strong leadership for the profession to discuss issues that raise difficulties for clients that pay the practice bills. Hopefully discussion around the BVA Animal Welfare Strategy will focus our attention on such issues.

Veterinarians could perhaps also do more at an individual level to act as animal welfare advocates. It is easy to inform clients on the technical rationale for a specific husbandry change but then walk away knowing full well the client will not action the advice. In the medical profession, advanced communication techniques are becoming more widely adopted to promote positive change within their patients. Perhaps we should be more explicit in teaching our veterinary students influencing skills.

Advocacy requires us to promote our patient’s rather than our client’s interests at both an organisation and individual clinician level.

Profession ought to introduce safeguards preventing inappropriate profit-seeking behaviour
Whilst the profession is clearly focused on our client’s interests, widespread profit seeking behaviour amongst clinicians is unlikely. Clients are likely to avoid veterinary surgeons that they perceive to be focused on performing unnecessary expensive treatments. Furthermore, you do not talk need to talk to many veterinary clinicians to realise that money is rarely a primary driver.

I have also argued previously that offering the best veterinary treatments from the animal’s point of view is very often the most profitable for the practice. In practice I suggest that many veterinarians fail to offer the best treatment as they are overly worried about the financial impact on the owner. Since it is not our role to make judgments on how our clients should spend their money, our default position should be to offer the best treatment option. However, we should be careful to avoid causing guilt amongst owners that are not able to afford the treatment. Concentrating on the animal’s interest need not conflict with a legitimate need to operate a profitable veterinary business.

However, perceptions as well as reality matters amongst our clients and society. The obvious difference between the business structure of veterinary and medical practitioners in the UK means the profession will always be at risk of challenge for excessive profiteering. Since we still live in the age of the media scare story it would seem prudent for the profession to embed some anti-profit seeking safeguards in our regulatory controls before, rather than after, a problem is highlighted.

A potential safeguard could be a prohibition within the RCVS Practice Standards Scheme of crude turnover-based incentives. Salary based on performance, of course, is a legitimate management tool, but incentives could be based on health outcomes rather than simply selling more stuff. A debate at a practice or national level on the nature of these safeguards could be a healthy demonstration of the profession’s desire to act as animal advocates.

Read more about Prof David Main→

The views expressed here are those of the author and do not necessarily reflect those of either the RCVS or the BVA.