Lovely, thanks very much, Wendy. So as, as Wendy said, this is about recognising NAI and veterinary practise. Part of what Dave and I will be doing this afternoon is certainly covering reporting and and reporting of any sort of abuse.

So in that context, what we will do is go through the, the, the different types of abuse and then obviously come back specifically to NAI. For those of you who were at the session this morning, you'll remember we spoke about the, the, the common denominator, of the human perpetrator, and in terms of the circumstances of the violence, the actions involved, and the excuses offered, and I really wanted you to start off with this case, which I think really just demonstrates that. This is an RSPCA case.

Tyson, was a 6 month old rottitaffy cross, belonged to a young couple. We'll call them Kevin and Kylie. And the RSPCA were .

Cold out one day, sorry, my oh, hang on. We just finished the polling. Snuck in there, sorry about that.

It's OK. All right, hopefully There we go. OK, so the RSPCA were called out to the house one day, there had been lots of, screaming and shouting and yelping, and they found Tyson was lame and had a bruised eye.

And at the time, Kylie said that Tyson had fallen down the stairs, and, and we'll come across that word fallen quite a bit as we go through this afternoon, because Kevin had beaten him for chewing a suitcase. And Kevin wasn't sure what was going on, but just said his head was all over the place. The suitcase was quite important at the time.

Kylie was heavily pregnant and the case was packed ready for her to go into hospital to give birth. And certainly the indications were not that, Tyson had fallen down the stairs, but that Kevin had actually kicked him down the stairs. Tyson was signed over to the RSPCA.

Kevin thought this was best because of the upcoming birth of the baby. And certainly the RSPCA were starting to gather information as to whether they would take a prosecution forward or not for Kevin's, abuse of Tyson. The following month, Kylie gave birth to a little boy called Alfie.

In May of the same year, Kevin was charged with young Alfie's murder. Initially, Kyle, Kylie said that young Alfie had fallen down the stairs, so we've got that word fallen again, but later Kevin admitted to throwing his young son down the stairs. .

Could we have made a difference to this case? I think given the timelines, it's very, very unlikely, but it really does just illustrate that common denominator of the human perpetrator and how he's the actions of the perpetrator, Kevin in this case had absolutely repeated themselves first with Tyson and then with his young son. So, if we, if we're starting to look at abuse, and we're starting to look at reporting, it does mean involving, conversations with, with other, individuals within our profession, with other professions, perhaps with the legal profession.

We really need to be very, well versed in the terminology. And this really highlights one of the first challenges that we have, in, in terms of dealing with abuse. If I were to ask all of you to write down, your interpretation of the word abuse, I'm very quickly going.

Come up with a very long list, and this is exactly what I found, when I went to the dictionary to, to, to look for, well, what does abuse mean. So you can automatically see that there you, that there is a a level of confusion here, because what I, I interpret the word abuse to be maybe very different to you. Other challenges that we face as a profession, is that we don't deal with one species, but we deal with multiple species.

And it's not the fact that they are that they are multiple species, but we have very different attitudes towards them. So for example, take these two dogs here, if I were to neuter these dogs, it would be full general anaesthesia, appropriate analgesia. It's perfectly legal in the UK to castrate a calf under 6 months of age with no anaesthesia or analgesia at all.

So you can see it just adds another layer of complexity for us as a profession, in terms of how we approach and how we deal with cases. We mentioned this morning as well, we, we, we looked at, the incidence of domestic abuse, and we looked at the incidence, of an AI experienced by, by veterinary surgeons in practise. And again, this just adds another layer of challenge for us.

I put this slide up this morning, just to strates that I do think as a profession, we do see the tip of the iceberg, in terms of cases. And the ones I've highlighted here in yellow, these animals are already dead, and therefore we would never see them, come across, come across into veterinary practise. So what we are seeing is a very small proportion of.

The, the, the whole of, in terms of animals that are impacted by non accidental injury, and interesting to hear colleagues earlier on today saying that er they felt the same with with domestic abuse, the, the, the level of domestic abuse that we're aware of is probably is not doesn't represent the, the, the whole of the domestic abuse that is going on. So what we need to do is just look at those different types of abuse, and then, as I mentioned, we'll come back specifically to NAI. So, 4 types of abuse, physical, sexual, emotional, and neglect.

So this is an example of physical abuse. These two dogs were presented to the RSPCA Harmsworth, and it's thought what's happened is that the dogs were standing side by side, and some sort of scaling liquid was thrown over them, hence why we've got the, the lesions purely on the trunks of the two dogs. Synonyms for physical abuse, non accidental injury, or we shorten it to NAI, and then a couple of terms that aren't used so much now.

One is battered child syndrome, and the other, which is really thanks to the work that Helen Monroe undertook just over 20 years ago, we have the term battered pet syndrome. In terms of inflicting physical abuse, there's a whole range of means of inflicting abuse on an animal, or, or a human for that matter. I just wanted to highlight a couple of these here.

With drugs and poisons, I do include alcohol, and I do include, so-called recreational substances there. Microwaving is a favourite of, sadly of some individuals, you know, quite a dreadful way to inflict abuse on an animal. And then this term fabricated or induced illness, I'm sure you're familiar with the term Munchausen syndrome by proxy.

This is really the, the, I suppose the, the, the preferred term now, where somebody invents or actually induces an illness, in an animal. It is rare in veterinary medicine, but it does happen. And this case here, I, I, I put this up to you, most certainly not to, beat the, the veterinary nursing profession.

But for two reasons. One is, this is one of those rare cases of fabricated or induced illness, where the perpetrator was actually injecting her own dog with insulin and then presenting the dog out of hours for the, the effects of, of that insulin. So, so this is one of those rare cases, but the other thing really for to, to, to illustrate with this is that anybody can potentially perpetrate abuse.

So it's not one particular group of society. Anyone can be a perpetrator. Sadly, in this particular incident, the perpetrator was a veterinary nurse.

I think the important thing here is, obviously it's. Absolutely not condoning the actions, but we, we know, we don't know the backstory to this, we don't know why this was happening, but really quite a, a, a sad and tragic case. In terms of animal sexual abuse, again in with with regards to the terminology, animal sexual abuse is very much the, the preferred term, and, and, and for a number of reasons, in, in terms of the, the first term their bestiality, intercourse does not have to occur for sexual abuse to take place, so any act or injury involving the rectum, the anus, the genitalia would be a form of sexual abuse.

And sadly some individuals will call themselves zooophiles as a an excuse to have sexual relations with animals. And I think the other challenge with both of these terms is that neither of them takes into account the effects on the animal. If we go back to to basic WHO definition of abuse, abuse is physical, it's mental, and it's social.

So depending on the, the, the, the species involved, depending on the actions involved, we may or may not see physical injury, but we have to be mindful that we may or may not also see a behavioural response because of the abuse that has been inflicted on an animal. And, and I think that's that that that really is quite important because we know so much more, about animal behaviour than we did say 2030 years ago. And then emotional abuse, I, I went back to the dictionary for a definition of emotional abuse, and, and the definition is very much threatening behaviour, verbal harassment.

And again, thinking back 20 or 30 years, you'll be very aware that the that the training techniques back then, . Certainly quite often involved punishment, so whether it's check change, whether it was a rolled up newspaper, whereas now very much the, the, the preferred method of, of training, is by reward, by, by positive reinforcement of an individual. And in that context, I, I put this picture up to you.

This picture hit the, the press a few years ago. The reason is because the man in the picture is Prince Edward. And, and the big question at the time was, did the stick hit the dog?

Well, none of us know we weren't there. But the reason I put it up to you is, is just to, to highlight the stance of the dog on the left hand side. You know, this dog is taking aversive action.

Now, whether you feel that that is threatening behaviour or not, I will leave you to make your own minds up. But one thing that has really, come to the fore in the past few years, and again it was mentioned in the previous session was that since 2015, there has been this specific offence of, a serious offence of coercive and controlling behaviour. And it really does recognise the impacts that one individual can have on another without laying a finger on them at all.

And to illustrate that, I wanted just to share this case with you. It's not an animal case clearly, but, it, it really does just highlight the importance of that piece of legislation. This is Justine Rees and her ex-part Nicholas Allen.

They'd got together. They'd moved in together, and that's when the abuse started. Justine eventually left.

She went to a number of refuges. He stalked her, he harassed her, he harassed her family. He sent her over 5000 texts, excuse me, over 3500 texts in a little over 3.5 months.

In the end, she took her own life and the note that Justine left just said, I've just run out of fight. At the time that Justine passed away, Nicholas was, he's, he was arrested, his computer was seized, and he was found to have been searching, online for, you know, can I be charged with somebody's manslaughter? Can I be charged with somebody's murder if I don't physically hurt them?

And because of that piece of legislation, he is now serving a custodial sentence for her manslaughter. It's a totally tragic case, but it just absolutely reflects the importance of that piece of legislation. More recently, Scotland has, has introduced a new, domestic abuse bill, and within the guidance of that domestic abuse bill, absolutely again recognises the impact of perpetrators and specifically mentions family pets as a means that a perpetrator may have an impact on their, on their victim.

So the example given is, for example, not, not being able to feed the dog, . We spoke about the pet fostering services earlier on today, and we know that with our, with our own Freedom Project, some of the dogs coming into our project do need quite a lot of veterinary intervention, because one of the things the perpetrator has done is not allowed the victim to take the, the, the dog to the vet. And, and therefore, there is a, a, an element of neglect, but it's not a, it, it's not a deliberate act because the victim physically hasn't been able to take the dog to the vet.

And more recently, this was just from, this time last year, there was a storyline in Coronation Street about coercive control. And it, it certainly certainly set up a bit, quite a lot of discussion. So this is Jeff, one of the characters who was, had, was exerting coercive control over his partner Yasmine, and if you read at the bottom, it says, viewers already hated him and now he's killed Charlotte.

Charlotte was Yasmin's pet chicken, and what Jeff had actually done was to murder Charlotte. And then he cooked her and served her up to Yasmine as dinner. And then as she was partway through her dinner, then he told her that that she was actually eating.

Her own chicken. Now, going back to the, the importance of the human animal bond, you know, one can only begin to imagine the, the, the what she may have felt, when he told her that. So another example of coercive control there.

And then neglect, again, I went back to the dictionary for a definition here, to give not enough care or attention to people or things that are your responsibility. And the, the your responsibility is really quite important to, this was when the, 2006 Act came into effect in 2007. For the first time it put a positive duty of care on animal keepers.

For their animals. So what that means is that, you know, as a, as a parent or guardian of a child, you are ultimately responsible, for them and, and for their pets. So, for example, the, the person that says, well, my, my child had a hamster, they kept it in the bedroom, they forgot to feed it and the hamster died.

As a, as a responsible parent or guardian in that situation, you are ultimate responsible for the, the care of that hamster under the Animal Welfare Act. So this was a big step forward to have that positive duty of care. Bring it back into our world, and it's deprivation of the basic necessities of life, food and water, shelter, veterinary and medical treatment, and, and certainly failure to seek appropriate treatment at the appropriate time is a form of neglect.

And within that natural disease is not a mitigating factor. The last one, affection, you can see that we, we've borrowed this from our, our human health professionals. I, I perhaps wouldn't use the term affection, but I would use the term companionship.

We know that dogs in particular are, are social creatures, and, and, and certainly if you've, ever visited any of our, our rehoming centres, you'll find that by and large, where we can, we We keep our dogs in pairs, and the primary reason for that is generally dogs cope a lot better if they're with a pal, than to be kept in isolation. Clearly, it doesn't always play out, but where we can, we will. And, and one question I would put to you is, if we have a, a, for example, a dog with a known, separation related behaviours, and we choose not to treat that, is that a form of neglect?

Again, perhaps something to, to have a, have a think about over coffee. Whenever we're dealing with cases of neglect, it, it's not a, it's not a straightforward, black and white question, but the question we do have to ask ourselves is what would a reasonable person do? Is it reasonable for this person to have or have not acted in a particular way?

This cat was presented, again to the RSPCA Harmsworth. We can see it's got a, a, a nasty oral facial tumour. You can see the distortion of, of the cat's nostrils, and I, I believe this is just the it, it's tongue just hanging out to the side here.

But the question is, is it reasonable to have expected the owner of this cat to have presented it before it had got to this point, and I, I hope you'd agree with me that it's not unreasonable to have expected this cat to be presented before it got to this stage. But another area of, of clinical practise, that we perhaps don't automatically think of as neglect, but is certainly becoming a growing problem is obesity. This is Cassie, she was signed over to us a few years ago.

Now, she is a collie. We'd expect a collie to maybe weigh 2022 kg. Cassie was 57 kgs when she came into our care.

But I can tell you that that Cassie was one of the lucky ones in that we were able to, reduce her weight, and we were able to successfully rehome her. But about the time time that Cassie came into our care, we had another collie of similar proportions, came into one of the other rehoming centres. That colleague was 13 years of age and sadly passed away before we could help it.

So you, this is, like I say, perhaps don't automatically think of it as neglect, but the impact of this level of obesity in terms of, you know, strain on the heart, strain on the joints, or the inflammatory mediators that are there, and, and this is why it's just so important that if we, we, we, we know that our, our patients generally are, are getting bigger as a nation. That, you know, we do keep good clinical notes. If we're taking body weights, let's measure them.

If we do, checking body condition scores, please record them, record them with the, whichever scale that you are using. Hopefully, you will never see, a patient in, of the proportions of CASE. But if you do, and you have that history, then it's, you know, we have the ability to, to then report on and take action as necessary.

But with so just coming straight back to to non accidental injury or deliberate physical injury, with any case, it's so important that we are objective and it's really important that we don't make assumptions. We mentioned earlier on this morning and I, I, you know, I, I, I. Make no apology for mentioning it again today.

If you are dealing with an animal that has died, please, please, please resist the temptation to do a postmortem in practise, because the sorts of postmortems that we do in practise will destroy the forensic evidence and, we do need that forensic evidence and, and you sometimes we do need that objectivity of somebody who's that one step removed from a case. But also important to bear in mind that not every case is going to be clear cut. You will just need to use the eye of faith a little bit, that the cat that's standing by the daffodil has a stump for a tail.

Not uncommon, we know cats, you know, will have arguments with, with cars, sometimes they'll have pelvic injuries, sometimes we'll have, paralysis of the tail as a result of that. The reason we know that this cat was a victim of non accidental injury is because it was presented as a kitten with the end of its tail severed. Compare it to this dog that was presented to the RSPCO Harnsworth, I think there's no doubt that this is a clear non accidental injury.

I don't think that the dog popped the elastic band on its neck to see what had happened, so, just the other end of the scale here. So in terms of diagnostic pointers we have. They are established to help separate accidental from non accidental injury in children, and we absolutely need them in animals, in terms of animal welfare, as and as possible indicators of other abuse happening in the family.

Whilst we cannot say that the person that beats their partner is going to beat the family pet or vice versa, if we have one, it should be giving us a strong index of suspicion that there may be other abuse happening in that particular situation. And this is where the the research of Helen Monroe comes into play. So this was, like I say, it's over 20 years ago now.

Helen devised this with, in conjunction with the RSPCA Scottish SPCA. This was a postal questionnaire that went out to 1000 small animal practitioners across the UK. Now normally to get a 15% response is doing incredibly well.

Helen had over 400 responses to this, which means they could apply good robust statistics from it, to it. And as a result, we now have good diagnostic indicators for NAI in pets. It was presented in a series of papers in the Journal of Small Animal practise, which I would strongly recommend anybody reads.

It's not easy reading, but it gives a lot more information than we can do this afternoon. If we look at those diagnostic pointers of NAI in a child, you can see a number of signs there. The behaviour of the parent and or the child is in conjunction with one or more of the top three.

And we do see some behaviours that that are attributed to children that grow up in an abusive household. So the child that is conditioned that if they, if they react in any way, that there is going to be a punishment, that they they learn the behaviour not to react. So the, the classical scenario is where a child is taken to their GP for their childhood vaccinations.

One would expect that, you know, as a child is vaccinated, that you will get some sort of response, and they are totally unresponsive. It's so-called frozen watchfulness, and it's because that child is, is conditioned that if they react, they will be punished as a result of it. There's certain patterns of injury, two I would mention.

One is, cigarette burns, which we do see in both children and in animals. Another sort of injury we do sometimes, or that's sometimes seen in children, is so-called fingertip bruising. This is where a child is held by perhaps the torso or.

By the neck, and where the fingertips contact the child, where they've been held tightly, you will see bruising as a result of that. Now, clearly in those cases, it's incredibly important to rule out any underlying blood dysplasia before coming to a a a a a, you know, a a suspected diagnosis of non accidental injury. If we look at the diagnostic pointers of NAI in a pet, you can see exactly the same.

No real surprise there because of that common denominator, but it's great that we have Helen Monro's research to to validate that this is the case. So with a history inconsistent with the injury, what we mean there is generally the injury is far too severe for the history that's been given. A discrepant history can either be the same person giving a different story to different members of the practise, or different members of the family giving different stories to the practise.

And this is why it's so important that if we do suspect a case of NAI in a patient, that, that we do speak to other members of the practise that have encountered that client. And repetitive injuries should be giving us a strong index of suspicion, and Dave will be taking us through a case in just a moment. The other thing I would add in with that, is the families that have had multiple pets, particularly if we don't know what's happened to those pets.

And again, just as in NAI in children, the behaviour of the owner and or the pet in conjunction with one or more of the top three indicators there. That's history. Do beware of the word fell, fell, fell downstairs, fell off the bed, fell off the sofa.

Animals don't tend to fall, but if they do, then they're, they're generally pretty good at landing the right way up. Now, clearly we can't take the word fell in isolation, but if, if you are, told the word fell, then it should just, just raise an index of concern, and, and do examine the history very, very carefully. OK, so I'm gonna hand over to Dave now who's gonna take us through a few cases.

The first couple are, I would say, in inverted commas, relatively straightforward, and then we've got really quite a, a complicated and involved case but I'll hand over to Dave to take you through those. Thank you Paula. This first case, was a slightly unusual case in that this was reported by the person who subsequently turned out to be the assailant, but at the time we believed him to be the, or the police believed him to be a victim.

And he reported that someone had come to his doorstep, threatened him with a machete, and then sliced off his dog's ears. The police were obviously very concerned about this, this person's and for their wellbeing and safety, so they placed them overnight into a hotel, and took the dog to a local vets for treatment because the dog had severe haemorrhage from the ears. The dog was subsequently reported to the RSPCA, to, for the RSPCA to take on the care of the dog, and, and the police were gonna look after the victim.

The RSPCA inspector was slightly suspicious about this and just felt it didn't all add up quite right and brought the dog down to me. The first thing that occurred to me was if this story was correct, was where was the assailant, or rather, where were the chunks of the assailant that the dog had bitten off. Because although you might just about manage to slice off one ear of a staffy cross pit bull, I very much doubt you're gonna be able to do it a second time without leaving your arm behind.

And also noted that the incisions on these ears were very neat, they were very tight to the head, and there was no other injury to the dog at all, which again didn't fit with this whatsoever. The police went back to the victim in inverted commas and arranged some alternative accommodation for him for which he didn't have a door key. It later turned out that he, wanted to make his dog more aggressive looking, so he decided he'd remove its ears to make it look like a fighting dog.

And to achieve this, he had given the dog some cocaine, and then he and a friend had sat on it and er cut its ears off with a Stanley knife. So what appeared initially, at least to the police officers, to be a a relatively horrendous situation with the dog as as and the owner as a victim, subsequently turned out not to be the case. Paula, can you advance the slides, please?

Next slide please, Paula. Sorry, I'm trying to. Oh sorry.

OK, here we go. Thank you. .

This is a another situation where the, the history just kept changing and kept being discrepant. This was a Jack Russell, it belonged to the eventual assailant, eventually identified assailant's girlfriend, and the dog had been left with her partner. Of the day, he was very house proud and very, very, very tidy, almost to the extent of OCD, it later turned out.

And he'd reported that his, he'd come home having left his dog and the, the Jack Russell in the house. Come home from work, he'd opened the front door, the dogs had hurtled down the stairs, knocked over his bike, and then fled out the front door and disappeared into the night. And that he'd gone and tracked down the dogs, and he'd found the Jack Russell, er, in a car park where it had been run over.

Later on, in the, in the history of this, he suggested to somebody else that the dog had been assaulted by an unknown person while straying away from the house. To cut a long story short, . It was, there was considerable reason to suspect that none of these stories were true.

And, and the police were and and RSPCA were subsequently called to the house. The, the dog was postmortem and was found to have some very significant injuries to the top of the back, as well as a ruptured liver and severe haemorrhage perirenally. The dog obviously died, the guy hadn't sought any veterinary attention for this dog at all, the dog was still within the lounge, collapsed, and, and clearly dying, and he was absolutely.

Well, I wouldn't say oblivious to this, but absolutely unconcerned about the fact the dog was dying. And despite, you know, having previously claimed the dog had been run over or the dog had been assaulted by someone, he'd not tried to seek any form of veterinary attention. And his girlfriend was very upset by this.

She was present in the house as well. And questions were duly asked of her as to why she hadn't sought veterinary attention for the dog, and it became very clear that that was because she hadn't been allowed to. Subsequently turned out, following interview that what had happened was that the dog had peed on his bed.

He had lost his temper with the dog and kicked the dog down the stairs. The dog had sustained significant injuries on its trip down the stairs, and he'd opened the door and thrown the dog out. And the dog had managed to crawl off up the pavement to where it was subsequently found by a member of the public and returned to him.

That same member of the public was really concerned by the lack of concern he showed for his dog, and he, the member of the public, reported it because he was concerned the dog wouldn't be taken to the vets. He obviously didn't realise at the time quite why the dog had become injured. This gentleman eventually pleaded guilty in court, and was sentenced to a custodial sentence.

Can we advance the slide please, Paula? Right, so this is a, a complicated non- accidental injury case. As you can see there are multiple episodes of injury in these four cats which I have have named gin, whiskey, vodka and rum, for simplicity, .

The, it all starts off with this couple who had two cats, gin and whiskey, who they presented for their first vaccination at their local veterinary practise. Can we advance the slide please, Paula? So if we look at Gin, who, as we say, first beginning of the year was presented with his friend Whiskey, for his first vaccination, there were no concerns raised by the veterinary practise at all.

Two happy little kittens, the family seemed to be, potentially good owners, interested in everything that was said, etc. Etc. On the 9th of June, it was reported to the vets that they, the owners were concerned because the the kitten was groggy after its first vaccination, which did cause the practise some degree of concern because obviously, it would be unusual to have a reaction to a first vaccination, particularly one that's lasted a week.

But they gave some advice and and said, offered to see the, see the kitten, and the owner said no, they'd they'd see how they got on, and, and the practise thought that's fair enough. They'll come back to us if there's a problem, or we'll, we'll see it at second vaccination. By the 14th of January, however, they received a phone call from the owner reporting that gin was now dead, and saying that, they'd come into the kitchen and found gin in the, in the kitchen, having knocked over the recycling, that he'd then collapsed and died, which caused.

Them some slight surprise cos he was only a, a sort of 899, 10 week old kitten by this point. But you know, they, they didn't really think a great deal more of it at that time. It raised an eyebrow but nothing more.

If we can go on to the next slide please. So whiskey again, had his first vaccination absolutely fine. He was brought in on the 15th of January, so the day after gin had died, because they wanted him checked over to make sure he was all fine.

I'm not quite sure what they thought was going to affect whiskey, as to considering the history that had been given for gin, but he was checked and he was fine. But then. Literally a week later, he was presented with sudden onset, 100 lameness.

Now it's important to say at this stage that none of these cats ever went outside. They were entirely house cats. That was confirmed repeatedly, by questioning of the owners.

So these injuries were all happening internally. So he was 100 lame, he had a tibial fracture on his right hind leg, which was surgically repaired. He had.

Regular post-op checks, which all went OK. And the owners didn't give any explanation as to how this tibia had become fractured. They just said they found the kitten with 10 tents lame one morning, and they couldn't explain as to how it had broken its leg, which, again, just rang a few alarm bells, but nothing particularly significant at the surgery, but they were just a little bit, starting to get a little bit concerned by this point.

Suddenly on the 15th of, February 1 of its post-doc checks, it came back. It was just suddenly a little bit lame. This, this cat had been pretty much sound, up until this point, and the owner said there was a small amount of blood on the bed, but there was no obvious sign of where this blood might have originated from.

In whiskey. So again, the vets, they just sort of advised accordingly, keep an eye on it, the usual sort of things, they were just, just observing and seeing where, where this cat went. Nothing was causing them too many concerns at this stage, although they were starting to get a little bit suspicious that things weren't quite right.

Can we advance the slides, please? 23rd of February, whiskey suddenly reported to have this, by the owner what they described as a kink in the tail. On examination, in actual fact, there were two quite distinct kinks within the tail, two areas where there was, where there was concerns there was likely to be fractures.

Again, there was little reason given as to why this might be. It was perhaps suggested at one point that, the kitten had, . Had been in the kitchen and that they'd found it with the kinks, husband was saying no, the kitchen kitten when it was found was in the hallway and there was absolutely nothing in the hallway that the kitten could have got its tail entrapped on or caused any injury to it.

Two days later. The kitten was presented back to the practise, and its tail was literally hanging off. It was only hanging on by a tiny bit of tendon.

And the practise was really quite concerned now as to what was going on. But they didn't report it. They, they will continue to work with the client.

They were, they were, but they were certainly getting, getting quite concerned. They did make some early inquiries about, you know, how can we report, who do we report to, what can we do, but those didn't seem to go anywhere, those inquiries perhaps found it difficult to decide what to do, . And then about a week later after they'd done the surgery, they noticed that there was some hair loss over the back.

And over that that started at, I'd say 7 days after the tail amputation. By about 9, 10 days afterwards, these were turning into areas of complete skin necrotic skin and sloughing. It was clear that the cat had sustained some significant burns.

They checked to make sure whether they'd used hot hands or anything else, and there'd been no, no opportunity for the cat to sustain the burns in the surgery. And also the burns had taken rather a long time to present if they had been a consequence of, of something like hot hands or a hot water bottle being inadvertently used during the surgery. At this point, the questions were being asked, started to be asked quite strongly of the owners, and they decided they were going to move to a new veterinary practise.

And the cat was, they initially presented to new kittens for vaccination. On the 15th of March, and we'll, we'll see them in a minute. But then on the 16th of March, they suddenly presented whiskey out of the blue.

The wound skin was now highly necrotic, there was a lot of sloughing, there was severe infection present and whiskey was very pyrexic. He was started immediately on broad spectrum antibiotics. The wounds were cleaned up, and the, the vets were, were worried and concerned about that he was going into sepsis.

The very next day, he was presented back again to the vets for a follow up to the, the, the skin and the concern of the sepsis, but he was now 9/10 laying on his right hind leg, . So they were getting so that should be actually his left hind leg, it was the leg that he hadn't had originally had surgery on. They did some x-rays, they couldn't find a fracture, and they couldn't find a cause for why his sudden sudden onset lameness.

And they were quite concerned about this, especially considering the cat was really quite ill the previous day and wasn't the sort of cat that was gonna be climbing and jumping and doing. This was the cat that was sitting in a heap, feeling really pretty unwell. .

They continued to manage the wounds, but they, they were failing to heal. They were not doing very well. Cats weren't being presented on a regular basis for for post-doc checks and for checks.

So on the 2nd of May, they admitted him and they surgically closed his wounds. They did a massive debridement and they completely surgically closed them up. Next slide please.

We then get moved on to vodka. Whiskey wasn't seen again. Whiskey had had those wings closed and whis and the, we don't, we don't see whiskey again.

We then move on to vodka, who was presented with his mate rum for initially on the twenty-eighth of February and then subsequently middle of March, for his vaccinations. He was absolutely fine, he did really well, no concerns, no problems, everything seemed to be all OK. .

And then, you know, there wasn't vast amount of vets' visits going on. Whiskey was still coming in occasionally for his back, and then he had his major surgery on the 2nd, and then suddenly on the 7th of May, vodka was presented with an avulsion injury to his chin, . Bizarrely at this point, it was very obvious that this injury was not fresh.

The injury had started to heal, the chin had not, was not healing well. There was quite a lot of scar tissue developing in here. And when the the owners were asked about this, they said, that the injury had occurred a week ago, the cat had fallen, no real.

To have fallen off what or how it had managed to avulse its chin, and they'd left it in the hope it would healer, and it clearly wasn't healing, it was all lopsided, so therefore they'd brought it into the practise to get it fixed. The practise did some surgery, re-sutured the chin back into its proper place. Unfortunately, .

Well, unfortunately they'd had, they'd had to use the canine teeth as anchor points for their sutures. One of the canine teeth then fell out because it was deciduous, so they had to redo the surgery, within about a week. So Vodka, Vodka's chin was, was slowly healing.

And then suddenly on the 15th of May, he was presented with a very, very obvious fracture dislocation of the tail. And I mean there is a huge distraction in that tail on that radiograph. .

They were very perhaps very concerned about this. Once again, the owners were, inconclusive with their history. It was suggested that perhaps he might have been behind the sofa, and perhaps he might have got his tail trapped between some boxes that they stored behind the sofa.

Or that perhaps he'd got it trapped in some way. But the story was changing, there was never a definitive story, and it would alter subtly between Mr. And Missus, depending on who presented the cattle or who was asked the questions.

Surgery was obviously done on this tail around about the 15th, but on the 25th he was represented again, and it was found that the skin around the wound was now devitalized, and a further amputation higher up had to be performed. The practise was then suddenly notified on the 5th of June that vodka had just been found dead in the kitchen. They questioned as to what may have happened to Vodka.

Mr. Said, just came down one morning and found him dead on the floor. And Missus said that she'd come, she'd found him dead on the floor, and lying next to him was a NutriBullet, and that she believed that therefore he'd knocked the NutriBullet off the worktop and somehow managed to fall off the worktop as well, and the NutriBullet had hit him over the head with sufficient force to render him dead.

Which takes quite some doing if you think about it, cos it would mean the cat must have been falling faster than the NutriBullet, and the NutriBullet must have been falling pretty fast to generate enough force to fracture a cat's skull, . So, again, there were significant concerns about this cat. There were questions raised by the vets.

The suggestion of non accidental injury was advanced to the owners, they denied everything. The practise were just starting to think that this is now time to make a report. Can we go on to the next slide, please?

4th cat, again, as we've said previously, 1st and 2 vaxs as per per the as for vodka. So just after this, incident where vodka has been found dead, they switched to a new veterinary practise. They run out on the new veterinary prac run out of practise 2 and go into practise 3.

And they present rum, 9/10 lame on his left hind. Initially on examination, the practise can't find anything that is definitive for a fracture. They do what we all do.

They gave him a couple of days non-steroidals, come back a couple of days, if he's no better, came back, an X-ray showed a fractured femoral neck. They, by that point had gathered together all the history from the previous vets. And they had a very clear picture of what was going on, and they reported the matter to the RSPCA.

Who duly managed to arrange for both rum and. Whiskey to be taken into our SPCA care. So as we can see, we've got a very complicated case here.

We've got a number of key things that indicate non accidental injury. We've got repetitive injury, we've got discrepant history, we've got injuries that don't fit with the history. But we've also got some evidence, some other things going on here.

We've got evidence of vet shopping, which we know is something that the medical profession. Very aware of in terms of child injuries, that, that parents may, deliberately seek to get their injured child treated by a num different medical practitioners in different locations, travelling to different A&E units or, or switching GPs. So we've got that going on as well.

We've got some unexplained deaths, and, and, and. Again, death of more death of more than one animal, within a short period of time within a household, particularly when there are other things going on and other evidence that causes concern, is often a warning flag, . The behaviour of the owners also caused some concern in that Mr.

Was never ever showed any sign of emotion whatsoever. Never showed any sign of concern for the cats, never showed any signs of concern for really anything. Missus was more.

More emotional and was more involved in the care of the animals emotionally. But again didn't strike the practise as to be as concerned and as, as upset as you would have expected someone to be, in relation to the repetitive injuries to four of their cats. They were prosecuted for non- accidental injury, and eventually, he pleaded guilty to the offences and was sentenced to custody.

The the fact that also was running through here is that there was involvement of a child, and concerns for that child at the time, and certainly the. The fact that the RSPCA investigation and the subsequent guilty plea in relation to the injury to the animals was highly relevant to social services and the actions they took in the care of that child. And it's really key why.

This is not just about the animals, this is about children and and adults as well. And it's the part of the bigger picture. And in this case, we provided the piece of final piece of the jigsaw to the social services that allowed them to take the necessary actions that they wanted and needed to take.

But they weren't able to until they had that final piece of jigsaw. Next slide please. Lovely, thanks, Dave, and I, I think the one thing I would say, and obviously we're going to cover reporting in a moment, but, Dave has really hit the nail on the head that, you know, we don't know when we make a report, whether it is the final piece in a jigsaw or not.

It's important that it's not our, it's not our job to be judge and jury. It's certainly not our role to step out of our area of expertise, but to make those, make those reports accordingly. And I think that the, the case of the four cats really does just, demonstrate how challenging these cases can be.

This is a this in the next slide is a quote from a book called The ABC of Child Abuse, but it absolutely applies to us as well. The diagnosis of NAI is a difficult intellectual and emotional exercise. It's one of the most difficult subjects in clinical work, needing time, experience, and emotional energy.

The most important step in diagnosing NAI is to force yourself to think of it in the first place. And all those working with children or animals should be warned that their overwhelming impulse on confronting their first case will be to want to cover it up. Now that's not a awful.

Of our duties, it really is, I think, getting your head around that oxymoron of why would somebody deliberately hurt an animal and then bring it to me to get it fixed. You know, I think what we are doing is trying to search for a rational, plausible explanation of why an animal has sustained injuries that does not involve a deliberate act, by another human being. Just in terms of some of the signalments, I mean, this is some of the work again that that came out of Helen Monrose's research, .

It is mostly young animals that are at risk, direct correlation here with humans. The most at risk group of humans are young boys under a year of age, so total correlation there. In terms of social background, certainly the feeling from Helen's work was that that abuse was more prevalent in areas of poverty and social deprivation.

But I think that the, the important thing that the take home message here is anybody can potentially be a perpetrator of abuse, as, as we've seen already. But bear in mind that, that educated people can be much more plausible. You know, how could you possibly think I would do something like that?

So it, it really is that it's not one particular group of society. Perpetrators are mostly male, particularly for violent offences, but again, it does not mean to say that females cannot be perpetrators of abuse. We saw that, with the, the, the springer spaniel a little bit earlier on.

In terms of identifying NAI, the challenge is that no single point is diagnostic. It's a combination that raises concern, and that combination is variable, and that's what makes them so challenging, it's not an A + B equals C situation. And those three little words inconsistent, discrepant, and repetitive.

So I just want to touch on the ARDR programme that we mentioned earlier on today. This is a programme that the links Group has, adapted, from that was initially developed by some dentists in the US and we've adapted it for the sort of the UK veterinary profession. And the whole concept behind it is you, whether you are faced with, a, a suspected human or animal victim in front of you is a, is a means or a, a, a, a process to go through to try and, understand what, what has actually happened.

So the asking is certainly asking er nonconfrontational questions, but it may be something along the lines of er sometimes when we see injuries such as this, they may be the result of a deliberate act. Do you think that has happened here? And again, as as our domestic abuse colleagues mentioned earlier on, it just that, that asking may be the first time and it may well open the door to a disclosure.

The reassurance that it's never OK to hurt an animal or a human. The documentation that keeping the good clinical notes and, and, and certainly if somebody does, disclose to you, you try and use those those words verbatim, if possible. So, for example, if a client says, well, my, my partner hit the dog over the head with a stick, clinically it's fine to say the dog sustained blunt trauma to the top of its head, but you, you can obviously appreciate how much more powerful it is if we, if we quote what the client has said.

And the refer side of things for suspected NAI in a, in a patient, that's obviously referring on to the appropriate authority, which, generally in the first instance would be the SPCA for suspected human victims of abuse, as I mentioned, it's really important we don't step outside of our area of expertise, but to have the ability to refer them to where they can get help from. The caveat with that is if you think that somebody is in immediate danger, then obviously it may be a, a, a situation of taking action at the time. Putting it into practise.

Having a protocol, having a practise protocol before you come across a case, using the links guidance, and in combination with the code of professional conduct. Appointing a practise links advisor, that now that may be within a practise, it may be across a group of practises. But what we mean by that is a go to person within the practise that can collate all of this information so that you can take an objective view.

You've got everything you need, you've spoken to everybody that you need to, to help you decide, how you deal with the case. Please get to know your local SPCA inspector, and particularly for obviously the RSPCA covers England and Wales, Scottish SPCA covers Scotland. Please put aside, you know, your, your own personal views on some of the more contentious issues like, fox hunting or, or badger culling.

Please do get to know your local inspector, because they really are worth their weight in gold. They can be, the most invaluable resource of informal information without you breaching any client confidentiality at all. If you get to know them, it can.

Easily be a case of picking the phone up and saying, I've got this, what do you think? Certainly, I work alongside, one of the prosecution's case managers for the RSPCA when we, speak at the, the vet schools. And he's my informal resource.

I, I don't speak to him every week, or, or even every month, but I know if I need some impartial objective advice, I can pick the phone up to him, and I, I can't tell you how valuable that is. And obviously goes without saying about keeping good clinical notes. This is the links guidance document, you, you can, access it through the, the links website.

It will be updated in the next few weeks or so, but it, it will still again be on the website and also via the BVA AWFF website as well. So just to expand on establishing that support network, and it really is I think making those links before you need them. In terms of immediate advice, it could be the prof conduct department and, and, and Dave will mention a bit more about that in a moment.

The VDS and, and certainly myself and my colleagues at the Lins Group are, are, are happy to, to help where we can. And then just getting those good relationships, so for example, your local domestic abuse unit, knowing the contacts for your local domestic abuse services, if you do have pet fostering agencies in the area where you're working, get to know them and, and the contact for them. And do bear in mind, although we have absolutely focused on companion animals today, that you, you may also come across, situations on farm that you're concerned about, er and certainly APHA and the Farm Crisis Network can help with that.

In terms of reporting, it's important to point out that veterinary nurses are just as important as veterinary surgeons in this situation, and particularly if we're dealing with hospitalised patients, it may well be our VNs that are highlighting that they have seen the, the same patient. Or animals belonging to the same client, because they're, they're, they're seeing them from a, a hospitalisation perspective. But the supporting guidance is the same for both vets and VMs.

Both professions can report, suspected concerns. And this is that guidance, basically where animal welfare or the public interest are compromised, we can breach client confidentiality. This particular piece of guidance was actually enhanced just a couple of years ago, to give examples and specifically it now says where an animal shows signs of abuse or child or domestic abuse is suspected.

So this is a real recognition, that, you know, as a profession we are going to see cases of abuse in our professional lives. And then the, the, the other bit of the, the supporting guidance specifically mentions NAI. So if you've got an an injury where you cannot attribute the clinical sign to the history that you've been given, so that history and consistent with the injury, you should include NAI on your list of differentials.

I'll hand back to Dave now to cover report writing and giving evidence. Thank you, sorry, I've managed to find the unmute button. I think it's a really key, just before we go on to that, to say that one of the things that I think is, crucial when looking at non-acidental injury cases, potentially in practise, is to be very aware that it's a team diagnosis.

It's not a veterinary surgeon diagnosis. It's a diagnosis that will require input or potentially require input. From every single member of your team, because every single member of your team will pick up parts of this jigsaw.

So we always work on training the receptionists because we all know that clients are not always discreet about what they say and do when they're sat in the waiting room, and that receptionists may pick up on things that cause them concern, that might feed into what your concerns are with non accidental injury. That nurses are really good about picking up on behaviour. And the way animals are behaving when they're within the kennels.

And also that if the owners have come to see their animal whilst in the kennels and their nurses are in the kennel room, they're generally see sorting out other patients, that they will be able to observe subtly and the behaviour of the owners with the animal and the animals. With the owners, and may pick up on, on, on things that, would be really useful for the vet to know. And obviously the vet is going to be the one doing the clinical examinations and obtaining history, but it really is a team diagnosis, and we do need to work as a team in these situations.

But just progressing on to, writing reports, one of the things that, vets. Are, are one of the reasons vets are often give us as being reluctant to making reports is concerns about having to go to court, and to have to write a statement and then give evidence. So we thought it would be useful just to give you a few tips and pointers for doing those things.

And whenever you're writing a statement or a report or a document that might end up in front of the court, it's really important that you stay very, very neutral. But you cover all of the points that are relevant to the case. Whether those are positive or negative to the case.

It's not your case point to be judge and jury, you just need to tell the whole story, absolutely, and, and, and completely. And it's really, really crucial that you tell that story in plain English. Treat these reports as if you were writing something for a client.

And if you treat them as if you're writing something that someone . A moderately intelligent client would understand. And if you have to use a veterinary term in it because it, it's really important that that properly defines what you're, what you're describing, then you must define that veterinary term and not assume that that a court is going to understand that veterinary term.

And be very careful when using things that may have one meaning to a veterinary surgeon and something slightly different to a lady. Person, found that acute and chronic often mean very different things to lay people than they do to vets. They could consider, if you acute and chronic pain, rather than being considered to be short or long term pain, some people considered them to be, to be a guide as to the severity of that pain.

So just, just be very careful using those sort of terms. If in your statement you want to refer to something, be that photographs, be that laboratory results, be that some other piece of documentary evidence, please find out what the exhibit number or the reference for that exhibit is and refer to it by that within your statement. This is.

Really crucial when you come to photographs. All the photographs will have numbers and make sure you refer to the photographic number so that it's clear that someone reading your report can make sure that they understand and they're looking at the same photograph as you were looking at. Otherwise it can get incredibly confusing and it can frustrate the court beyond belief.

Don't use emotive terms. Try to avoid being emotional, try and be very, very cold and scientific, and I know that can be really difficult, but we don't want to be using sentences like it's the worst case you've ever seen, even if it is, we need to try and stay very calm and very level on this. And if you have an understanding of the parts of the offence that you're trying to write a report about, and you should have an understanding of the relevant parts of the offence because the RSPCA inspector or the, the person who's asked you to write that report should explain what the end purpose of that report is trying to demonstrate or not demonstrate.

Then make sure you've covered off the parts of it. So for instance, if we're dealing with a non- accidental injury and we're dealing with issues as to whether the animal was caused to suffer unnecessarily, we need to definitively give an opinion as to whether the animal was suffering, and we need to use the word suffering. It may be obvious to us that if we say the animal was in pain, that that means the animal was suffering, but please just spell it out.

We also need to consider as to whether that suffering was unnecessary. So could the suffering have been alleviated or could it have been avoided? And if the only way that could have been avoided was euthanasia, that's still a way of alleviating that suffering.

But obviously, it may be common sense. The suffering could have entirely been avoided on the dog that we used in the example earlier on, who had his ears chopped off, could have been avoided by the owner not taking a machete and chopping the dog's ears off. That would be quite a simple way of avoiding that suffering altogether.

And yes, that may sound like completely and utterly common sense, but unfortunately, you have to state it. . And then you need to try and give an opinion as to the reasonableness of what a, what a normal client would have done.

Would a normal client present a dog that was clearly 10/10 lame, or a cat that was 10/10 lame, or a cat that would have lost its chin within a 24 hour. Or would they also have left it for a week, without seeking veterinary treatment? Is that a thing you would expect a client to reasonably do?

And again, so you need to make that statement as well. But as long as you do those, then there is no reason why you need to be fearful of it. I say, write everything positively and stay neutral as neutral as you possibly can.

Can we have the next slide, please? If you don't feel that you are in a position where you can give definitive opinions. It is appropriate and it's acceptable for you to give a purely factual statement that just sets out absolutely what you have seen and what you have done, but doesn't provide that interpretation or that, that considerations of the, of the, the interpretation and opinion from those facts.

So you can set out that you examined the cat, that the cat was 10/10 lame, that you took an x-ray of the cat and it shows a fractured tibia. End of, if that is what you're comfortable with, that is perfectly reasonable and acceptable and that the RSPCA or the SSPCA or the USPCA or whoever can then go and take that statement and pass it on to someone to further expand on it and give an opinion in respect of it. But so if you have to do that, you can just give the clinical straight facts.

If you end up giving evidence and having to attend court, then a few very, very simple tips for doing it. First of all, always make sure you arrive really early. There is nothing more stressful than trying to get to court, getting stuck in a traffic jam, not being able to find a car park, knowing that the clock is ticking, you're running around like a headless chicken, you arrive in court with 30 seconds before it's due to start, or if it's just started 30 seconds ago, you will be in a stressed mess before you even get going.

So always, always leave yourself plenty of time. Please turning up looking like you are a professional. I've seen vets turn up to give evidence wearing boiler suits, covered in various, material that's emanated from various orifices in various species, invariably because they've forgotten that they're supposed to be somewhere and they've had to abandon what they're doing and run.

It can cause a laugh from the court, but it sometimes can convey a lack of professionality. The court will either take ask you to take an oath or an affirmation. An oath is a swearing on the holy book and an affirmation is just a promise to tell the truth.

It does not matter one iota which one you do. But what I would ask is that you know which one you're gonna do when you get into the witness box, cos there's nothing that looks less professional or casts doubt about the knowledge and the information you're about to impart as if you stand there for 5 minutes trying to decide which one you're going to do. Have decided, tell the usher, do it.

I say, it doesn't matter to the court which one you do. Speak clearly, speak slowly, and speak in plain language. Don't try and baffle the court with long words.

Don't try and confuse them. And don't, when you think that you're getting yourself into a corner, just resort to speaking veterinary because the court will not be impressed by it. They're much more impressed if you speak slowly and clearly and you explain yourself in plain language.

Watch the judge's pen because they're trying to make a note of everything you say. So effectively you're dictating your evidence to them. And if you keep half an eye on their pen, you will manage to find that the evidence flows better rather than getting halfway through a sentence and being told to slow down, stop, or can you just repeat what you just said.

Always listen to the question that you are asked. When you're giving evidence, you will first of all be asked questions by the lawyer from the side that has instructed you that effectively has asked you to come to court. So theoretically those questions are friendly.

So listen to the questions because the answer is likely to be in the question. And if they say something like to you, please would you like to refer to your statement? That's a clue that you haven't actually remembered something that you've put in your statement.

So don't just ignore that and plough on regardless. They're trying to get a piece of information from you that you've written in your statement that you've not just told the court. And be aware that the court probably won't have your statement.

All the court will have will be what you tell them. So that stuff you've written down, if you don't then tell it to the court orally, the court will be completely unaware of it, which is why you may get asked the same question by your, the solicitor from the side who've instructed you 2 or 3 times if there's something they really want you to say that you haven't said, and they may get increasingly exasperated with you and tell you to refer to your statement, and can you look at your statement? There's a clue in the question.

So listen really carefully. Can I have the next slide, please? Second part of your your evidence will be questions asked by the opposing lawyer.

And it's really important that you don't get into an argument with them. So what I would always suggest is that you talk to the bench, you talk to the judge, and you don't talk to the defence barrister. And it seems really rude to not look at them when they're asking you questions, but if you angle your feet towards the judge and talk to the judge, it is the judge who needs to hear your answers, or the jury that needs to hear your answers, not the defence barrister.

It means you won't engage them in eye contact with the defence barrister and you may manage to find it easier to keep your cool. Watch out for them making statements and not asking questions. Their job is to ask you questions, but occasionally they will make statements.

Point out that it's a statement or say something along the lines of, is that a question? Because they shouldn't be asking you, just making statements. Watch out for situations where the defence barrister turns to you and says, you would agree with me, wouldn't you?

And then goes on with a great long question that has multiple parts to it. Invariably, you probably will agree to the first part of that state question, but the second half of the question, you probably won't. But the problem is they've added it into such a long convoluted question, you've probably lost concentration halfway through it, and the temptation is you should just agree, because they've told you that you would agree with them, wouldn't you?

Be very aware of them. I am always dubious of any lawyer that tells me I will agree with them, invariably I don't. Always let them finishing asking a question, don't interrupt them, but then don't let them talk across you when you're answering a question.

If they try to cut you off when you go, yes, but. Then make it very clear that you've got more to say. Invariably the judge will step in and say, let the witness finish their finish their answer.

If the judge doesn't. The lawyer from your side will have a chance to go back to your evidence finally before you're told you're finished. And if you've clearly indicated that answering a question you were cut off and you didn't give the full answer, you can bet your bottom dollar that you're the solicitor on the side that has instructed you or the barrister on the side that has instructed you will go back to you and ask you to finish that answer, so you will get a chance to, to have your say.

If a solicitor or barrister asks you a question. And the answer to that is different from what you've put in the report because they've asked you something that you haven't thought of before. Be completely prepared to make a concession.

You are there to help the court. And if there is something that you hadn't thought of before, something that completely comes out of left field, be honest and admit it and say, I hadn't thought of that. That's a valid point.

I hadn't considered that before. Can I have a minute to think about it? Most of all, stay cool, stay calm, stay professional.

Remember that you are the veterinary surgeon in there. You're the one with the 5 years training, you're the one with the experience, you're the one with the scientific knowledge, not the idiot in the wig. They may sound like they know everything, they don't.

They are very, very skating on thin ice because their knowledge is very, very shallow. So just remember that you are the one who knows what you're talking about and stay cool and don't get into an argument with them. It's not worth it.

Can we have the next slide, please? We thought it would be useful just to have a look at the impact that COVID has had on non-acidental injury, and abuse, both in humans and in animals. The human side of things, we've taken these, or I've taken these statistics from a Women's Aid report, in the, on the impact of COVID on domestic abuse.

And it's concerning and alarming because there is very high, . Levels of evidence suggesting that abuse has worsened, it's more frequent, and the abuse that is occurring is worse, . And the other thing that's perhaps really important here is that the amount of abuse is increasing and worsening in respect of children.

Now we therefore can probably reasonably its effect that the same thing is happening in relation to animals. Because they're the vulnerable with particularly vulnerable within that relationship within that family unit. So we are concerned that things are gonna have got worse for human for animals in the same way that they have for humans.

Next slide please, Paula. So the impact on animals, no one has yet been able to manage to measure what's happened with non-acidental injury in animals. And there are a number of reasons to think that we're gonna have, that COVID's gonna have had unique effects on our ability to detect non-acidental injury.

And there are some negative effects of this and some positive effects of this. I'm certain that car park consulting and restricted client contact will have made it much, much harder for practises to identify suspicious NAIs. The reason, or one of the key ways of of becoming suspicious about a non accidental injury an animal.

Is the length of time that you spend talking to the client, cos the more you talk to the client and the more client contact you have, the more chance you give them to themselves to say something that they didn't mean to say or to trip themselves up or to change their story. Because we're having very little client contact in some cases and in some parts, it's much easier for them to manage to maintain a story. And we're tending to work and do our clinical examinations more in a vacuum with less clinical history.

And hence it is possible that one of the effects of car park consultations is that we are less able to detect non accidental injury. The other point is there's a lot less access to support networks. Practises are not, we're not going to CPD meetings, we're doing things virtually.

We're not having the opportunity to interact with colleagues as much as we normally would. And lots of people are working from home, they're doing reduced working hours. We're not having those informal conversations over the, over coffee.

We're not going to the conference and having lunch with. Colleagues where we can just say, can I just run something past you? Can I just get your opinion on this, those sort of things have been lost at the moment.

And again, I think that is, those are really crucial to people being getting the confidence to report the cases that they're suspicious about. On the positive side of things. Car park consultations and having one member of the family bringing the animal into the practise does give you an opportunity to separate family members and allow clever practises, if they are concerned that it might be non accidental injury, to obtain multiple histories from different members of the members of the family at the same time.

So for instance, if one member of the family has brought the animal into the practise. And is being, spoken to by a veterinary surgeon in the consulting room. There's nothing stopping a nurse going out of the car park and having a chat with the other member of the family who's waiting in the car park, and seeing whether they get the same history and the same story, and giving an opportunity for disclosures to be made if they want to, because often when there's multiple members of the family within the consulting room, you've got victim and perpetrator in the same space, and the victim is not gonna make a disclosure in those circumstances.

Also gives you an opportunity to assess the animal's behaviour, and I've put dog here very deliberately because obviously the cat's in the cat box, so it's much harder to do it. But you can assess whether the dog's behaviour on parting from the owners when it goes into the surgery and then being returned to the owners in the car park, is what you would expect. Is the animal happier to come away from the owner than it is to go back to them?

Because that would be unusual and abnormal. And it's one of the warning signs that we may want to be thinking that is there a possibility that these injuries are non accidental injury? Is there something going on?

Now, the behaviour of animals in relation to their owners associated with non accidental injury is complex. And I believe that it's where that is present, that often tends to suggest that there's been multiple incidents. Of abuse, so that that behaviour has become learned and ingrained, because we certainly don't see it in every case by any means, but when I do, I'm always quite concerned about it.

Next slide please. Lovely. Paula.

Thanks, Dave. And the other thing I would just add, just in terms of the, the COVID side of things to again just trying to put it into context, we mentioned earlier on that 2 women a week are killed, as a result of domestic abuse in England and Wales. In the early weeks of the first lockdown, that number tripled, so it, it does certainly give us a level of concern that NAI in our patients may well have been similarly impacted.

So just a, a, a few slides just to, to wrap, the, the sort of the presentation side of this session up. The, the first is I would strongly recommend any practise has this book, on the shelves. Please don't be put off by the title of forensic veterinary pathology.

It's a, yeah, it's not a great tone, but it's very easy to dip in and out of and, certainly give you grated. Advice on, on, on some of the, the, NAIs that we will come across. Just some resources that Linked Group have.

First and foremost, we've produced these, the, the, the sort of credit card size cards, with the domestic violence helpline number on them, and also contact for the linked group as well. But just a word of warning for this, . If we have a, a human victim of abuse who, whenever they go home, their partner searches their bag, searches their wallet, it may not be safe to carry something like this.

This in itself might be a trigger for further abuse. So it, it really, we, we do have to be guided by the human victims in terms of, how we can help them, what, what can be done. So the other thing that we have done as a group, and, and please treat this as confidential because it, that, that's the only way that it, it works.

Just an innocuous voucher for, money off dog food or pet food. If you visit the website, it goes to a holding page to say, sorry, this, this, offer is no longer valid. But the important thing is, again, the, the barcode here, that.

That's the free, the, the helpline number. So it means that somebody can put this in their bag or wallet, and then when they are ready to, to make, make that call, then they are able to do that. As was mentioned in the, the previous session, you know, the most dangerous time for a victim, of domestic abuse is when they're leaving that violent situation.

So they've got to be in the right place to be able to do that. I hope you can see that this very much sits under the one welfare banner which I'm sure you're all very, very well versed in so we've got domestic violence here, so on homelessness, animal abuse, so it very much sits under that banner, . This is a statement from Phil Archer, who's based in the States who really does drive the, the link, the link coalition in the States.

When animals are abused, people are at risk, and when people are abused animals are at risk. So whilst we cannot say the person that beats their partner is going to beat the family pet or vice versa, if we have one, it should be giving us an index of suspicion there may be other abuse happening. And I just wanted to finish off, with one last slide.

Just as a profession, we are not mandated to report. Certainly in some parts of the world there is mandatory reporting. There are pros and cons of, of mandated and non-mandated reporting.

But I do think that that we do have a, an ethical and a moral responsibility to report our concerns on. And, and this is a sort of a, a, a version of an Aristotle quote by Ronnie McCall. Basically, to say nothing, to do nothing, stops nothing.

And, and really that's sort of the, 11 of the pillars of the, the, the links group. The whole point of the links group is to encourage, the relevant agencies to communicate and cross report so we can try and break this link down. So I'm going to finish there and stop sharing and we'll hand back to Wendy to see if we have any, any questions.

Yeah, so, somebody had a question about COVID, and I think that's been covered, so if, if, if we haven't covered, could you please ask, another question? In the chat box we've got, someone's found it very worrying to see that there could be as many as 3 or 4 different practises involved on a case with multiple animals. Are there any tips or indicators that vet practises could use to try and identify abuse cases earlier?

Is it mainly an education issue, a confidence issue, or simply the average time it, it could take for a case evidence to be collated? I think it's all 3 of those. I think there's definitely issues with confidence, issues with training and knowledge.

It's important to be aware that obviously the links group is 20 years old now, has been talking to vet students for most of that time in most of the universities, but not all of the universities. So there is a large quantity of the profession who now has had some training at some point. In non accidental injury, but equally there's a very large chunk of the veterinary professionals who have never had any training in non-acidal injury identification and recognition.

So there is a massive training need, undoubtedly. There's real concern and confidence issues, about round reporting and confidentiality. There's real naturally understandable concerns that what if I get it wrong, I report this as something I'm suspicious about and it turns out to be completely innocuous and I was wrong.

. Very occasionally, and it's really, really uncommon, have I seen. Concerns being reported turn out to be wrong. I've seen many more and many, many more cases where people have ignored their suspicions and not reported it, than have made, become suspicious, reported it and have actually found out that they were wrong.

And even in those very occasional cases where it has turned out that they were wrong, and there is an innocuous explanation to it that's eventually been reached, their suspicions were entirely correct in that they should have been suspicious of what was going on, and the information they had, they really, really should have made, done the actions they've done, and no one would ever criticise them for taking those actions. And I think the concerns about confidentiality with the recent guidance from the college are much, much. Less than, than they have been, but people perhaps are not as aware that the of the changes that the college has made to the guidance that we can safely report, we can safely make these disclosures where we are concerned and we have suspicion.

But it's, it's a big thing. And you know, we've all had it drummed into us that confidentiality is king. But in these sort of situations, as Paula just said with that last quote, we'd have to do something.

We can't just stand by and stick our heads in the sand. I think I would just add that if I just refer you back to the, the case of the four cats that Dave took you through, you know, particularly with the, the first cat where, you know, it, it had been vaccinated and then it was found dead, you're probably not going to be. It's probably not going to raise too many concerns at that point, so it, it is for some cases, not until you're a bit further down the line where, where you're starting to get these flags going up as well, and I, I think it is just a reflection that that these cases are complicated, that it's it, as I mentioned earlier on, it's not an A plus B equals C, and, and that's where the experience comes into it, and, and again, as David has mentioned, speaking to everybody in the practise as well, so that you can collate as much information as possible about the cases.

I think also with, with practises being generally perhaps getting bigger and more vets in each practise, clients are quite good at managing to see multiple vets within the same practise. And we always try and expect clients to want to see the same vet, and we try, often try to ensure that clients do have continuity in their care. But some of these clients are very good at making sure that they don't get continuity in their care and that they do see a different vet from the last one they saw.

And. If you're running on, on tight consultation times, trying to keep your consults to time, you don't always have the time to properly sit down and read vast pages of clinical history. And hence, you know, sometimes these things don't so much get missed as don't get fully appreciated.

The full background isn't appreciated when the person sees that, that animal, which is, as what Paul has just said, it's really imperative we work as a team and we, we share information. If we look at that first cat Jin, . The per phone call into the practise to say the cat has been dead, it's probably been taken by a receptionist, and she's probably put it on the computer.

But if no one then sees Gin again, who's gonna go in and see Gin's records and see that Jin died in suspicious circumstances, unless someone's going really suspicious and starts ploughing through all the different cats that are on the computer system. Cos most practise management systems, when you call up the animal, you only get that animal's history. You don't get the history of all the other animals at the time.

So if, if you're getting history from or in that, as in that case, injuries in multiple animals, but you're only seeing one animal at a time, you may not realise that there are multiple animals involved in this. Absolutely. So the question about, lockdown is, is there any evidence that the scale and type of injuries due to non accidental injury have got worse during the lockdown?

I think the difficulties we've got at the moment is the, the evidence from the human side of things is that the, the severity of the incidents and severity of the injuries on the human side is definitely getting worse. The problem we've got in the animal side of things is if the injuries get worse, then the we get an increase in mortality, and if the animals are dead, we never get to see them. .

And I think that as we know, we only ever see the tip of the iceberg of the animals that are presented. Now if the mortality rate has risen then that we're seeing even less of that iceberg. And I suspect that is going on as well.

And that does make life really difficult. Obviously it's much harder to dispose of a of of a dead human than it is a dead animal. Absolutely.

OK, so we've got a comment, on occasions where I've been concerned and saw RCVS Profcon advice. The tone of the profcon response has been quite unhelpful. For example, well, if you are concerned, it felt as if I was very much out on my own and unsupported, and this was within the last two years.

I'm not surprised by that comment in the slightest when I ever speak to people and say to them, they say they look, they're considering reporting on breaching client confidentiality. I always say to people, you must ring the Royal College. You must log it with Prof Profcon.

What I always say to them is, do not expect Profcon to say, yes, you're doing absolutely the right thing, you must do this. The best, in my experience you'll get out of Profcon is pretty much nothing and a non-committal answer. I always take the view and always advise people that if Profcon had concerns about what you were doing and thought what you were doing was completely wrong, that they would tell you not to do it.

But they're never gonna tell you to do it because reporting is not mandatory. It is, it is a personal choice. Therefore, as long as they don't say no, for goodness' sake, don't do that, you'll make a complete fool of yourself, I would take that as a profcon or a happy for you to go ahead and do it.

We are looking to offer and to work with the Royal College to, update their training on the links group and, and what we do, to try and persuade Profcon to be perhaps a little bit more supportive in their conversations. But again, I think. And I, I may be wrong on this, and I'm sure Paula or, or Wendy will correct me if I'm wrong.

I think the people who answer the phones at Profcon are not vets. So they've never been in this situation themselves. So therefore, they've probably not got the empathy that you would if you were speaking to one of the veterinary team at Royal College, who would, it's understand the, the, the conflict that you're going through and the difficulty that you're, you're faced with this and perhaps might be a little bit more sympathetic.

Yeah, absolutely, they're, they're not vets. I believe they have more of a sort of a legal background, and I think that one of the challenges we've had is that we have had dialogue with the, the Royal College, for a number of years, but obviously they've had a change at a turnover of staff and, and that's why, as Dave quite rightly says, we're, you know, we're, we're working towards. Providing some sort of updated training for them, so that they understand, but I think the important thing is, as David said, you, you, that they're never going to say, yes, you must report, but it is important to make that call and let them know that that that's what you're going to do.

It, it does just give you a bit of protection if someone then comes back and complains about your breaching client confidentiality, the college have got at least logged that you rung them and that they didn't tell you not to. Yeah. And, and the response is that that's absolutely, what she got, but it felt like they were saying, well, on your head be it.

And her advice is to others, yes, speak to RCVS, but see it as informing them, not seeking advice. Yeah, that's always what I tell people is you're, you're, you're telling them, not asking them. And and hoping that if they think you're gonna do something really daft, that they will tell you not to.

Yeah. OK, that's great. Thank you.

Thank you very much for that. We're just gonna, Helen, could we have the poll question, please? We just got a little question we would like you to answer.

Thank you very much. And while, while you're filling that out, David and Paula, thank you very much. And we've had a comment saying very comprehensive answer fully agree, there are multiple issues.

The work you're doing is really key to help support and address them. Thank you. That was in the response to the, to the, the question you answered a few moments ago.

Oh, so we've got 67% know a little, and 33% now have a good understanding. Can I have the second question please, Helen? Oh, sorry, Helen, this question's for later.

That question's for that, that question's for the next session. Thank you. So if, do we have any more questions?

Has anybody got anything else to add? Couple of points I might like to raise, if, if I may, Wendy, and I'm gonna ask Dave to comment on these. One is obviously a lot of this Dave is, is tied around the Animal Welfare Act, and I wonder if you could mention sort of section 4, section 9, and also particularly Section 18, because I think that that's come into play if you've got a, perhaps an animal you feel ought to be euthanized or action needs to be taken.

Yes, I think, I think there are 3. Key sections of the Animal Welfare Act that practises ought to be aware of. The the section that is perhaps most useful to veterinary practises, but is probably least known about and least used by veterinary practises, is what's often referred to by RSPCA inspectors as Section 18 certificates.

These are the mechanism by which you can er or it is possible for an animal to be taken away from an owner or for an animal to be euthanized without owner consent. Now these have multiple uses. They're clearly useful in in neglect or non accidental injury cases where the police or the RSPCA want to remove animals from a person to stop them further harming it.

But they also have a use where you've got an animal, for instance, a severely injured animal that's presented to you without an owner, where you need to put that animal to sleep. And you need some form of consent for that. Now it may be that if that animal is presented an absolute extremist, you're just going to do that.

And perhaps if you're lucky enough, you've got a colleague who can agree with you that this animal is an absolute extremist and needs to be put down, you're just gonna do that and take, take what comes and, and no one is gonna criticise you for doing that. But what you do with an animal that is in significant distress needs to be put to sleep. But you don't have an owner, and an owner is not forthcoming.

But for instance, an animal with multiple fractures that could be the pain could be maintained and relieved for a few hours using opiates, but you don't want to be keeping that animal on opiates for the forever more, and you're not gonna be putting the animal through surgery. The only option for that animal realistically is the euthanasia. Section 18 offers an opportunity for you to do that with consent of a police officer.

And fundamentally it's a completion of a certificate that says in your veterinary opinion, this animal is suffering. And that this animal needs to be destroyed in its own interests. You write that certificate and you sign that certificate, and you show it to a police officer and you explain that under Section 18 of the Animal Welfare Act, they therefore have powers to authorise you to put that animal down, to effectively act as as the owner for that animal or act in the absence of that owner, and you can therefore then euthanize that animal.

With some form of legal, with a legal consent so that no one can come back at you and accuse you of either criminal damage for destroy damaging their their property or, a a a euthanasia without consent, and, and try and sue you for, for putting an animal down without consent. So that is a really useful piece of legislation that I would strongly advise people to look at. You can get.

Copies of what a section 18 certificate should look like, the RSPCA can give you blank copies of it. The SSSPCA will be able to give you a blank copy of it that you can just hold at the practise for those very rare occasions where you require. Or you can literally just write onto a blank piece of paper.

I, your name, certify that this animal is suffering and its own interests should be destroyed. Sign it, date it, time on it, and always get the police officer to countersign it. In fact, you don't even need to have a police officer present in the surgery.

You can tell the police officer you've done the certificate in writing, it has to be in writing, and send them a copy of the certificate by email or by text message or however else you want to get it to them, and they can authorise that euthanasia over the phone. But the certificate does have to be in writing. So that's, that's a really useful thing to have in practise, and we've certainly done in our practise, on occasion when we've had, had, had issues and problems with that.

You know, animals run over on the road, where we, where we're concerned that, that we, we need to get this animal euthanased, but we don't have a clue who the owner is. The two other sections that that we made, Paula made reference to are section 4 and section 9, and these are the these are two of the sections that cause create criminal offences effectively under the law. Section 4 is the offence of causing unnecessary suffering.

So effectively it is, it is a person who has caused or permitted an animal to suffer. Now they can cause that by doing something, i.e., hitting the dog over the head with a spade, or by not doing something, i.e., not feeding the cat.

Both of those cause suffering, so it can be by either act or remission. And that suffering was unnecessary in that it could have been avoided or alleviated. And that suffering, the way the actions they've done or the inactions they've taken are not consistent with the behaviour of a reasonable person in those circumstances.

And what I would always use as an example of a reasonable person is I would ask myself, what would one of my normal clients do in these circumstances? Would they seek veterinary attention? Would they feed the dog?

Would they realise the cat's losing weight and I need to do something about it? Would they realise the rabbit's hopping around on three legs, and I need to get it to the vet? Those are, those are the three questions that you need to ask yourself.

Section 9 is the duty of care offence. The animal does not need to be suffering, but it is the duty of the owner to take reasonable care of the animal and effectively to meet its five freedoms. So they need to make sure that the animal has somewhere suitable to live in.

It's got a safe environment, it's clean, it's comfortable, it's not full of hazards. They need to ensure it's fed properly. They need to ensure, ensure the animal's protected from pain, injuries, suffering and disease.

Now that doesn't mean that they've got to go to extremes, it just means they need to do what's reasonable and appropriate. They need to make sure that the animal effectively has all of its five freedoms met, that it's free, from mental suffering, that it's got company of other animals or people, or that it's kept apart from other animals or people if necessary. So those are, that's, that's the duty of care offence, and it doesn't need to be suffering, it's designed to to be brought in to allow enforcement agencies to take action before suffering occurs.

Either by prosecution or by serving enforcement notices that says to an owner, you need to do more than you are doing. You are not providing suitable care. Do this or else we may prosecute you for this.

There are lots and lots of other sections in the Animal welfare A, but those are the sort of three sections that I would, I would think that every vet who's in clinical practise really could do with having a basic understanding of, and section 18 could well save you a lot of heartache. The other thing I would just add on to that, we we mentioned earlier on about if you've got a dead animal, and certainly. We, we, we've mentioned about not undertaking a postmortem in practise, but certainly if you have concerns about an animal, the, the big question is, well, who's gonna do the postmortem, who's going to pay for it?

If you have sufficient concerns and it's a case of reporting it on to the SPCA, they will then become your client who will help organise the postmortem, they would fund it. Similarly, just to, to be very clear, one of the things you may sometimes do if you've got a suspected NAI. Look for other old unexplained injuries, for example, old old healing rib fractures and the such like.

You know, we, we don't have the authority to undertake investigations without consent. We don't have the authority to confiscate, or refuse to give patients back. But this is again where we, you know, it's important to bring in the the the the relevant SPCA at the right stage so that we can then take things forward.

The other thing that we do, always mention when we, when we do the undergraduate training. Is, you know, if you do have concerns in the consulting room, there, there's absolutely no reason why you can't, implement the, the art of veterinary medicine rather than the science. And what we mean by that is, basically, there's, there's nothing to stop you admitting the patient, for observation.

It, it, it gives you time to have a think about it, speak to your colleagues, you know, perhaps have that informal conversation with your, local SPCA inspector so that then you can, work out how you're going to actually take that case forward. The other thing, so I'm just typing in answer in the chat box, the other thing I would, . Would say again is, is, is the art of veterinary science, and if, if you're thinking, what I said to say, it's amazing how bad my collimation come come become when I'm, when I'm seeing a X-raying a fracture that perhaps might be associated with a non accidental injury and how I accidentally end up with chest X-rays on limb fractures.

And how common I may end up doing catagrams in, in, in cases of suspected non- accidental injury, where normally we're quite good at collating our X-rays. And it, it's things like that, if you're concerned, you want, as Paul says, you want to buy yourself time, admitting it for observations and pain relief, and, and to explain to the client that that's pain relief that can only be given by intravenous injections, so they can't possibly take it home and give it something orally. All of these sort of things that just allow you to get that thinking time.

Just, just to get that second opinion, get that thinking, get that, get those, get those ideas and, and, and, and buy yourself some breathing space. And as experienced practitioners, you know, there's, you can usually find a reason to hang on to an animal for a few hours. OK.

Brilliant. Thank you. Thank you very much for that.