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New territory for surveillance

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THE portents have not been good from the start. Even so, ‘Surveillance 2014’ – the document which sets out the AHVLA's plans to change the arrangements for scanning surveillance in England and Wales1 – still makes worrying reading. Like the AHVLA's consultation document on the subject last December (VR, January 5, 2013, vol 172, p 2), the document does its best to put a positive slant on things, arguing that the changes precipitated by budgetary cuts provide a great opportunity to improve and strengthen disease surveillance. However, the fact remains that the number of AHVLA centres carrying out postmortem examinations (PMEs) for surveillance purposes in England and Wales is to be cut by more than half over the next 18 months – from 14 to six – and seven of these centres are scheduled to close next year.

The network of veterinary investigation centres carrying out PMEs has long formed the backbone of scanning surveillance in Britain. The importance of such activity has been illustrated by the AHVLA itself which, in an analysis in 2011, found that PMEs had been responsible for 64 per cent of the 117 first alerts for new and emerging diseases in recent years. In the circumstances, and despite the upbeat tone of the document, it is difficult not to be concerned about how effective the new arrangement will be.

As the changes are implemented, the AHVLA will stop carrying out PMEs at its centres in Aberystwyth, Truro, Preston, Newcastle, Luddington, Langford and Sutton Bonington in 2014, while its Winchester PME facility will close in the summer of 2015. The remaining AHVLA network will consist of centres at Bury St Edmunds, Carmarthen, Penrith, Shrewsbury, Starcross and Thirsk, supported by poultry facilities at AHVLA Lasswade. The AHVLA plans to support the transport of carcases from various collection points to these centres for three years, by which time it expects there to be more private sector provision of PMEs.

The number of AHVLA vets involved in scanning surveillance work will be reduced from the current 44 to about 35, and the number of administrative and support staff from 45 to 30. Viewed simply in numerical terms, this reduction might not seem that significant; however, change is inevitably disruptive in human terms and the effects could be much more significant in terms of reducing the core of available expertise. The relationship between veterinary practitioners and local AHVLA staff is a key element of the current arrangements for scanning surveillance and, as the BVA pointed out when responding to the AHVLA's consultation earlier this year, there is a real danger that, as the changes are implemented, this relationship could be put at risk (VR, March 2, 2013, vol 172, p 220).

In its response, the BVA also drew attention to the importance of PMEs on animals being performed within a set time after death, and ensuring that surveillance data are reliable and robust. Under the new arrangements envisaged by the AHVLA, routine PMEs will be carried out by private veterinary surgeons, with some of the more interesting cases being triaged and subject to more detailed examination at AHVLA and other dedicated centres. While this kind of arrangement might potentially result in more PMEs being carried out and help increase the geographical range of surveillance, as the AHVLA intends, it also raises quality control issues, which will need to be addressed. The AHVLA's plans are clearly of concern to the Royal College of Pathologists, as illustrated by a letter on p 585 of this issue.

One might feel a little more comfortable about the changes if all the new arrangements were in place before the existing system is dismembered. However, this is patently not the case. Eight centres look certain to close and, while every effort may have been made to maximise the reach of the remaining centres, it has been clear for some time that the rationalisation is being financially driven (see, for example, VR, July 27, 2013, vol 173, p 80). What is far less certain at this stage is whether the gaps left behind as existing AHVLA centres close will be filled by other providers, and whether the system will develop in the way the AHVLA envisages. The agency will no doubt do all it can to encourage wider involvement, and the plans may indeed present new opportunities for practitioners and others in the private and university sectors. Essentially, however, the changes are creating a vacuum which the AHVLA hopes others will fill and, at this stage, it is by no means certain that this will happen. The aims may be to extend geographical coverage, but surveillance is entering new territory in more ways than one.

It would be hard to disagree with the aims of the AHVLA's surveillance project, which are to create ‘a new more effective and financially sustainable surveillance system, including improving access through better geographical coverage, through better partnership working and developing deeper specialist skills and knowledge’. The question now, as it was when the whole process started, is whether less really can mean more and whether the aims will actually be achieved.

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