To understand the current status of the UK veterinary nursing profession with respect to regulation, it needs to be viewed in the context of veterinary nursing professional development as a whole. This article examines the developments leading to the current status of veterinary nurses and explains why a non-statutory register of veterinary nurses has been implemented rather than full statutory regulation.
The move towards statutory regulation
Progress towards statutory regulation (Box 1) has been developed within the restrictions of the current 1966 Veterinary Surgeons Act, which is 44 years old, almost as old as the veterinary nursing scheme itself. A note sent on 13 August 1980 from the Royal College of Veterinary Surgeons (RCVS) to the Ministry of Agriculture, Fisheries and Food (MAFF) said:
Box 1
- The list — the only record of qualified veterinary nurses up until September 2007 and although the Veterinary Surgeons act of 1966 established the list, it is not regulated. It has become a place where the names of veterinary nurses who are not registered are recorded. Nurses on the list are entitled to use the post nominals VN
- The register (since September 2007) — this is where the names of veterinary nurses who are registered are recorded. Nurses on the register are entitled to use the post nominals RVN and adhere to the Guide to Professional Conduct for Veterinary Nurses
- Self-regulation — when a profession imposes regulation on itself, in the absence of legislation, in order to ‘quality-assure’ practitioners. This is usually done by a membership society or trade association as a condition of membership
- Statutory regulation — this means that the state has seen fit to impose legislation that regulates an occupation/profession. The legislation identifies a regulator and imposes regulations
‘It is recommended that provision should be included in any new legislation for … the establishment of a register for Registered Animal Nursing Auxiliaries’.
(Royal College of Veterinary Surgeons, 1980)
The note was a shopping-list of desired changes in the Veterinary Surgeons Act 1966. The following April the Ministry consulted a range of organizations on proposals for a number of amendments to the Act. The consultation did not make a firm proposal for a statutory register for Registered Animal Nursing Auxillaries (RANA), but said this was under consideration, and the Ministry later reported that there was considerable support for it.
MAFF did not go ahead with updating the Act, and an explanation for this was not provided. However, in 1991 Schedule 3 of the Veterinary Surgeons Act 1966 (which sets out things that can be done by people other than veterinary surgeons) was changed to enable veterinary nurses to provide medical treatment and carry out minor surgery under veterinary direction, subject to a number of conditions.
Seven years later, in 1998, the RCVS, British Veterinary Nursing Association (BVNA) and British Small Animal Veterinary Association (BSAVA) endorsed a statement proposing that, ultimately, there should be new legislation for the following purposes:
‘To define veterinary nursing as a profession in its own right and protect the title.
To define the qualification necessary to be described as a veterinary nurse.
To allow for student veterinary nurses to undertake procedures under the supervision of a veterinary surgeon or a qualified veterinary nurse in order to acquire pre-qualification experience.
To define what procedures veterinary nurses can undertake under the direction or supervision of a veterinary surgeon (this should allow for the development of new techniques and new qualifications).
To provide the means of regulating the professional conduct of veterinary nurses, perhaps by means of maintaining a Register and a disciplinary body.’
(Royal College of Veterinary Surgeons, 1998)
Assessing the need for regulation
In 2003 an RCVS consultation document asked veterinary nurses whether they agreed ‘that regulation is necessary for veterinary nursing to develop as a profession’ (Royal College of Veterinary Surgeons, 2003) and invited views on the form that regulation might take. Later that year the Department for Environment, Food and Rural Affairs (DEFRA previously MAFF) again launched a consultation on changes in the Veterinary Surgeons Act and during the consultation one of the questions asked was whether veterinary nurses should ‘be regulated by the RCVS with new powers provided to regulate their conduct, or alternatively should veterinary nursing become an independently regulated profession’ (Department for Environment, Food and Rural Affairs, 2003).
In 2005 a further RCVS consultation document proposed a new structure within which veterinary nurses would be regulated in just the same way as veterinary surgeons. This included a statutory Veterinary Nurses' Council alongside the RCVS Council and new arrangements for supervising the professional conduct of veterinary surgeons and veterinary nurses. In November 2005 the RCVS Council formally adopted the proposal, and the government was invited to put it into effect.
The reason for a non-statutory register
It is apparent that for the last 30 years there has been serious discussion surrounding changing the law to make veterinary nursing a fully regulated profession. Despite this statutory regulation has not taken place and instead the Veterinary Nurses' Council has introduced a non-statutory Register of Veterinary Nurses. The question is ‘why’?
The answer lies in the way laws are made in the UK (Box 2). When a bill has completed its passage through parliament and become an act it may turn out to have shortcomings, or it may become out of date as circumstances change. The standard way to change an act of parliament is by promoting another bill, which may be designed either to amend the original act or cancel it and put something new in its place. The new bill has to go through the same process of scrutiny in both houses of parliament, and amendments may be tabled for purposes other than those that the government had in mind.
Box 2An act of parliament starts out as a draft, called a bill, which is placed before parliament and goes through several stages of scrutiny in the House of Commons and the House of Lords.Most bills are promoted by the government of the day, but the act that emerges may not be quite what they originally planned. This is because any member of parliament (MP) and any member of the House of Lords may table amendments to a bill during its passage through the two Houses, and amendments are debated and voted on.The process is lengthy, complicated and very demanding for the government department sponsoring the bill.
There are constraints on the number of bills any government can realistically hope to put through parliament at one time, and sponsoring legislation can make major demands on resources, financial and human. The government, therefore, adopts a legislative programme for each session of parliament, and an individual department that wants to introduce a bill has to make a case for including it in the programme. There is fierce competition for the available space. It would appear that the Veterinary Surgeons Act has not been updated yet because in spite of all the discussions over the past 30 years, successive governments have given priority to other candidates for inclusion in the legislative programme. In 2008, Lord Rooker, now Chairman of the Food Standards Agency but at that time the minister responsible for veterinary matters, told a parliamentary committee that his department had no plans to devote resources to updating the veterinary legislation for the time being.
There is, however, sometimes scope for changing an act of parliament without promoting another bill: the Veterinary Surgeons Act includes a power for ministers to modify Schedule 3 by making an order. The order has to be approved by parliament, but the process is much less daunting than the passage of a new bill. Ministerial orders might be called legislation lite. The modification of Schedule 3 in 1991 was done through an order, and a further order was made in 2002 to allow listed veterinary nurses to treat animals other than companion animals and to cover the treatment of animals by student veterinary nurses. Ministers also have power under the Legislative and Regulatory Reform Act 2006 to make orders ‘legislative reform orders’ for certain purposes, including that of amending the constitution of a statutory regulatory body such as the RCVS. The College has asked for a legislative reform order to be made in order to change the composition of the RCVS Preliminary Investigation and Disciplinary Committees.
Parliament, however, does not give ministers open-ended powers to rewrite the statute book. Such powers are usually subject to tight conditions. As a result, if the government agreed to legislate to recognize and regulate veterinary nursing as a profession this would have to be done by putting a bill through parliament. There is plenty of support for the view that this should be done. The Parliamentary Committee before which Lord Rooker appeared 2 years ago said in its report: ‘There appears to be general agreement that the veterinary nurse profession has evolved to a stage where it warrants its own statutory framework of regulation.’ Sadly, such agreement does not of itself guarantee that the government will devote resources to making it happen at any particular point in the future.
The register
In view of this, and the financial savings that all government departments are currently having to make, it is just as well that the Veterinary Nurses' Committee (now the Veterinary Nurses' Council) recommended to the RCVS Council back in November 1999 that it should set up a working group to develop a voluntary system for the regulation of veterinary nursing. The aims were to ‘establish a quality assurance system for VN practice’ and ‘provide the basis for legislative change and eventual statutory regulation of veterinary nursing’ (Royal College of Veterinary Surgeons, 1999). The RCVS Council agreed, and after much discussion veterinary nurses were consulted in 2006 on proposals for setting up the Register of Veterinary Nurses. The Register came into operation on 1 September 2007.
The Register has been established under powers in the RCVS Royal Charter, and there are limits to what can be done under Charter powers. Nevertheless it is a major step towards professional status. More than that: it is a necessary step. It is most unlikely that the RCVS would be able to persuade any government to promote a bill to regulate veterinary nursing unless there is a well-established and generally accepted non-statutory scheme in place.
Why is that the case? Because that is the way things tend to happen in this country. Politicians do not generally court controversy, and it is much easier to get support for new legislation if informal arrangements are already in place and seen to be working well. For the human health professions the government has made clear that it will not consider extending statutory regulation to a new group of practitioners unless they already have voluntary arrangements in place. In 2007 the government published a White Paper: Trust, Assurance and Safety — The Regulation of Health Professions in the 21st Century (The Stationery Office, 2007). This spelled out what were seen as necessary conditions for extending regulation to a new role, namely:
- The role should be a discrete and homogeneous area of activity
- The role should encompass a defined body of knowledge
- The role should carry out evidence-based practice
- There should be an established professional body
- There should be a voluntary register or list of eligible practitioners
- There should be defined entry routes into the role
- There should be independently assessed entry qualifications
- The role should be governed by standards of conduct, performance and ethics
- There should be disciplinary procedures to enforce those standards
- There should be a commitment to continuing professional development.
No mean challenge for any group which aspires to recognition as a profession and statutory regulation! Although this white paper referred to the role of regulation in the human health professions it could also apply to veterinary nursing.
If we consider that the two main concerns that should be in the forefront of our minds as we work in our professional capacity as veterinary nurses are public confidence and animal welfare, it becomes clear why non-statutory regulation is an important step for the veterinary nursing profession in the UK to take. The general public will be confident in the knowledge that registered veterinary nurses will have:
- Assured standards of training and qualification
- A code of professional conduct
- Commitment to maintain competence
- Sanctions for those who transgress
- Practitioners held in high public regard
The RCVS Veterinary Nurses' Council believe non-statutory regulation to be first formal step to full professional accountability. This is important because it helps to provide an assurance to the public, such as clients and employers, of the standards of behaviour and professional skill that can be expected of a registered veterinary nurse.
Listed or registered
There is a difference between being listed and being registered as a veterinary nurse. Listed nurses are required to have stipulated qualifications to enter the list, there is payment of listing and retention fees and listed veterinary nurses do have a licence to treat animals under veterinary direction under the Schedule 3 amendment of the Veterinary Surgeons Act 1966. However, when on the list, there is no requirement of an assurance of professional conduct or to remain competent and there are no sanctions for misconduct.
On the register, however, nurses adhere to the Guide to Professional Conduct for Veterinary Nurses (Royal College of Veterinary Surgeons, 2008) and undertake mandatory annual continued professional development (CPD). They are committed to refresh on return to practise and it is likely that they will be de-registered for misconduct after 2011. The RCVS is currently seeking legal advice regarding the extent of the powers of the Royal Charter.
This is of benefit to employers who in the knowledge that they have professionally accountable employees are likely to have the confidence to delegate more. It is also of benefit to clients because a registered veterinary nurse will be expected and required to adhere to an assured standard of skills, will have standards set for professional behaviour, will be accountable for professional conduct and from 2010 there will be a structure via which complaints can be made. However, with self regulation rather that statutory regulation there is no such assurance and the introduction of the disciplinary and regulatory process is required.
It is proposed the RCVS disciplinary process, which is intended to be in place in early 2011, will mirror the existing system in place for veterinary surgeons; there will be an examination and assessment of any complaint made by the RCVS Professional Conduct department, and if deemed necessary there will be an investigation into the complaint and the information passed to the Veterinary Nurses Preliminary Investigation Committee. If this committee believe that the complaint made against the veterinary nurse is of a serious nature then the case will be referred to the Veterinary Nurses Disciplinary Committee.
Conclusion
This article aimed to demonstrate the process that has been undertaken in order for the veterinary nursing profession to arrive at the point it is at in 2010, including the level of consultation with both the veterinary nursing and veterinary profession. It has also documented the dialogue that has taken place between the government and the RCVS in relation to the requirement for a new Veterinary Surgeons Act, which is needed in order for full statutory regulation of veterinary nurses to take place. Until this happens the veterinary nursing profession has gone as far as it can regarding regulation.