Market Mechanisms for TB Control? Radical thinking.

Is this true? Do we always have to compromise on some aspect of performance? And what is the best compromise?

When it comes to improving public services, reaching for the market is often the default choice. It was therefore interesting to see the Royal Association of British Dairy Farmers (RADBF) calling for the introduction of market mechanisms for aspects of the TB control programme. Specifically, they wanted farmers to have the choice over who removed reactor cattle from their farm - full details are here. It is not just the RADBF who are calling for this type of agenda: in the coming weeks, Animal Health will unleash their Official Veterinarian Procurement programme which could radically change the way TB testing is organised in England (and maybe Wales).

The implication from both these calls for greater market involvement is that the state is inefficient and the market can resolve some of those problems in the cartoon above. This may be true. But the market and disease control may make uneasy bedfellows: I have written about how this neoliberal way of managing disease control has affected the veterinary profession and animal health elsewhere (see here).

Criticism of the government's performance may also be misleading and the idea of efficiencies illusory. This may be the case with the RADBFs proposals.The RADBFs complaint is that the state cannot remove reactor cattle from farms quickly enough, that maybe Animal Health are tied up in bureaucracy to do anything useful. They say that costs the farmer money by isolating cows - presuming that they do this is true and is factored into Defra's calculations of the cost of a breakdown. As a result, the RADBF suggest that by introducing farmer choice, then the market would be more efficient in removing reactors.

Bureaucracy in Animal Health: a bad thing?

But its important to remember a couple of things about reactor removal and look at the evidence of how Animal Health have handled reactor removal:

First, slaughterhouse capacity. The decline in the number of abattoirs means that limited capacity is a key blocking factor when it comes to speeding up the time it takes to remove reactors. As reactors are kept separate from cattle that are definitely headed for the food chain (many reactor cattle end up here too) this further restricts capacity: usually abattoirs will set aside a day to get through a load of reactors. But there is also competition between abattoirs for these contracts.

Secondly, the time it takes to process a reactor (ie. the time taken to remove it from farm once it is diagnosed) is governed by both decisions taken by vets and farmers. Last year I spent a lot of time looking at the data for the time it takes to process a reactor. There are a number of sticking points here: if the vet who conducts the TB test does not return the paper work on time, then that will delay the removal of reactors. Vets have a target for this - 24hrs - but there are no financial penalties if they miss it. In fact, Im not even sure if Animal Health still record this performance. Maybe this is a good performance indicator to have - when vets in Wales were told what it was last year it certainly made them take notice. Financial penalties may also be a good thing to have, but so would decent IT systems that allow electronic submission of TB test charts. That should be coming on line now, but this was one of the main reasons for the delay in returning charts. The data showed however, that where vets had returned their paperwork late, Animal Health were processing these reactors just as quickly as they were the reactors where they had had the paperwork on time. In Wales, that time had been cut significantly - thanks again to a target that focussed people's minds and resources on that problem - and was running at around 10 working days to get animals off the farm. Perhaps "bureaucratic" targets are not that bad after all?

Thirdly, another aspect of the removal time is whether the farmer accepted the valuation of the animal. Usually where the reactor removal time was not met it was because of a dispute over the valuation. Obviously, this varies between the different compensation regimes in England and Wales. Some farmers are quite happy to accept the valuation they are given, some would like standard rates so there is no need for a valuation, but others will contest them and want a proper valuation. Perhaps what this suggests is a compensation system that is also based on the time it takes to remove reactor cattle? For example, farmers could opt into a tabular valuation scheme if they wanted to, or a valuation involving a visit if they preferred, but the cost of running the scheme would be factored into the amount of compensation they received. It would be interesting to see that kind of farmer choice in action.

Finally, the last of the RADBF's points is that slower removal times may lead to further infection - in wildlife, or in cattle if there is ineffective isolation. This is true - to an extent. We need to remember that the TB test diagnoses a disease - it "medicalises" or "enacts" a condition. That is to say that it allows us to say that a cow has (or may have) TB. That in no way means that it didnt have it before that time. And where you have annual testing, it may have had for 364 days prior to the test, not even accounting for issues surrounding the accuracy of the test. So really, once a disease has been diagnosed how much difference does an extra day or so removing the animal make? It makes a hugely symbolic difference to the farmer, but in terms of disease control its too late. Perhaps that's the reason why in New Zealand there is less emphasis on the time it takes to remove reactors, or the lack of concern in the UK to shave off a day or two from reactor removal times.

I'm not saying that the market couldn't deliver the kind of perfmance Animal Health seemed to be achieving last year. It would be much better if reactor removal time was included in the monthly statistics that Defra produce - that could produce some sort of accountability.

Perhaps, though, the best reason for introducing markets and farmer choice is to enhance farmer ownership of TB policy. If farmers pay, then they should say too. And this means making choices over the contestable parts of TB policy: the parts where there is scientific uncertainty such as in diagnostics. For if we are responsible for things ourselves, then choosing which compromises we want to make and live with is much easier and more acceptable than having them made for us.