Does Animal Health Need to Pay Attention to its Marginal Gains?
When the Great British cycling team dominated the 2008 Olympic Games, their manager attributed the success to the ‘aggregation of marginal gains’. In other words, its the little things that matter – and if you don’t pay attention to them or take them for granted, then you wont’t get anywhere.
Much the same is true in agriculture. Farmers should therefore be concerned about Animal Health’s intention to change the way they employ local veterinarians by contracting them on a competitive basis. In future, local vets delivering services such as TB testing could be replaced by vets working from a couple of large companies. Previous experience shows that this is the most likely effect of putting public services out to competitive tender. The Meat Hygiene Service offers an example - just a few companies supplied vets to carry out this work.
The result could be the loss of those marginal gains that the current way of using local vets already provides, and worse. It is true that veterinary practices in some areas of the country make a lot of money from TB testing which covers the salaries of vets within the practice. Depending on the practice, TB testing can account for 20-40% of turnover.
Vets will say they are best placed to do this: they are trusted by farmers, can keep an eye on other diseases, provide advice to farmers, and respond to other emergencies. Besides, no-one else is going to be prepared to turn up at short notice or at morning milking to start a TB test. If these opportunities are taken away, the resulting loss of staff would force rural practices to amalgamate, leading to fewer vets further away from their clients.
Some might say this is speculation, that real evidence is needed to support these beliefs. This might be true - some quick polling by the BCVA in response to this threat showed that around 90% of vets said they were conducting passive surveillance and other work whilst TB testing. When I surveyed vets in Wales after the Health Check Wales, the figure was much lower with many vets saying they simply did not have time to do this. The real figure is likely to vary between farms and be dependent on the context and the relationship between the vet and the farmer. In my ethnography of vets, Ive seen it happen.
Estimating the financial value of these benefits would be very difficult. That does not mean they do not exist or have no value. We should also be familiar with the effects of other examples of competitive tendering: when it was applied to school meals, for example, cheap rather than local food ended up in school dinners, contributing to public concern over the food we eat. Failure to appreciate the value of intangible benefits can have serious consequences.
Perhaps these benefits are worth loosing if it saves money – the current financial crisis is something that we, apparently, are all in together. This is one of the reasons Animal Health give for putting TB testing out to tender. However, the evidence on whether competitive tendering results in cost savings is decidedly mixed. Instead, ‘Parkinson’s Law’ suggests that competitive tendering often increases costs by creating more bureaucracy. The popularity of tendering in managing public services appears more to do with managers copying what other managers have done without actually thinking about what is actually best.
It would therefore seem perverse for Animal Health to focus solely on costs when managing animal disease. Doing so could significantly damage the provision of veterinary services in rural areas, and actually prove more costly. Appreciating the marginal gains of the existing system might be a better option.
