Q&A from Healthy Feet Lite Webinar

Vets Owen Atkinson (OA) and Nick Bell (NB) answer all the questions from the Healthy Feet Lite webinar on 9 June 2020.

Becoming a Mobility Mentor

How much training is involved in becoming a Mobility Mentor, and will it be online given Covid?

OA: Normally a 2-day small group course for eligible people (vets, suitably qualified trimmers and advisers); Online options are being looked into for part of the delivery, however, not all aspects can be delivered online.

Are old mentors going to retain grandfather rights for delivery of the HFLite?

OA: Yes; there is no expiry date for MM training but we expect ongoing lameness CPD.

Are you publishing a RRP to deliver HFLite?

OA: No. It might be argued that a RRP of full HFP was a hindrance because the farmer focused on the headline cost, and maybe not appreciating this would be spread over a period of time.

What auditing system is there to ensure the HFP is being delivered in a semi-consistent fashion?

OA: None. We aim to support MMs and help them develop their skills, not check up on them. All HFPs must be delivered by a Mobility Mentor who has completed the specific 2-day training.

NB: There are some eligibility criteria to ensure only suitably qualified vets, trimmers and advisors can become a Mobility Mentor.

If someone has done other training covering all these aspects such as formal First Step training can this be crossed over to being a Mobility Mentor for the Healthy Feet Programme?

OA: No, but this might be a first step for a suitably qualified person (non-vet) to become eligible for HFP training. Mobility Mentor training is unique and specific to the HFP. It will be quite different to training received for First Step.

Mobility Mentor Resources

Is the questionnaire readily available for Mobility Mentors on AHDB website? Is a login needed?

OA: All the resources are available in the Mobility Mentor Resource Centre.

Do you provide standardised material for the Mentor - similar to the milk sure programme?

OA: No…but there are lots of AHDB resources linked to HFP (eg Pocket Guide for Foot Checks; new Footbath guide; Lesion recognition guide), and we have been building these recently to include Lying Time Guide; Cubicle Assessment Guide.

What scope there is to update the programme as new information comes out?

OA: It does get updated regularly, often within addition of new resources through AHDB. The MM training is evidence-based and includes our best current knowledge.

Instigating Change

Owen describes an approach to Lameness management that sounds very like the business management mantra See IT, Own IT, Solve IT, Do IT. Seeing it and owning it seem to be the biggest barrier - what is the best way to get farmers to see and own lameness?

OA: Answering this question receives a lot of attention during MM training. It is a challenge, certainly, but we are confident that MMs are equipped with skills to work with clients to develop their own awareness. It is recognised that individuals who undertake MM training are unlikely to then be “the finished article” and providing further CPD opportunities for MMs to hone these skills is something Nick and Owen are both keen to do.

NB: One of the best ways to raise awareness is through an independent mobility score recorded by a RoMS accredited mobility scorer. Owning it is probably best achieved through facilitation and tailored delivery. I support systematic assessment through the checklists but the team owning the action plan is what the facilitated discussion at the end of the HFP/HFPlite is all about.

One of the key drivers of improved lameness recently have been supermarket contracts. Is there going to be some industry-wide drive through retailer and Red Tractor Farm Assurance to encourage/force farms to undertake HFP as a standardised approach where mobility score is poor? I get there is a risk of a negative attitude towards it if they are 'forced' to do it but it would get people used to it.

OA: Currently, AHDB are supporting a project with Sara, Nick and Owen, in conjunction with the RAU (Cirencester), to use a Participatory Policy Development process to drive this forwards with key stakeholders. It will be a challenge (again!), but definitely work in progress. Certainly, we need greater awareness of the HFP, and encouragement for farmers to do it. Coercion may be part of that.

NB: Many vets have welcomed some coercion from 3 rd parties, nudging or pushing farmers into the right direction Perhaps the best scenario is for farmers to see the need before they are pushed. One farmer who had received HFP through a retailer said they were glad of the push! HFP/HFLite is intended to support farmers in improvement. Some Mobility Mentors have been offering HFP to all clients, and in one case making sure all clients went through it at some point. Our intention is that HFLite offers a mechanism for any farmers to get involved, regardless of scale of problem or finances. They need to be aware of it of course!

Communication/Coaching

If poor cubicle design flags up as being a major contributor to lameness issues on a farm, as this is already an expensive piece of infrastructure, how do you work with the farmer to improve this whilst being mindful of expenses?

OA: This is an excellent example where a MM will ideally help a farmer to build their own selfefficacy for change. It is never a question of build new shed, or accept status quo. Whilst a new shed might be an achievable long term aim, short term actions with lower capital costs might include reducing stocking density; temporary structural improvements/ fixes; or increasing bedding. New Cubicle Assessment resources can help farmers and MMs assess the current beds and then agree the correct actions to take. Understanding economic impact of lameness is part of HFP and MM training.

NB: Sometimes talking through the cheaper short-term improvement is sufficient “change talk” to make someone realise there could be further benefits to making long-term plans. Having the discussion with lots of positivity and enthusiasm is sometimes all that is needed to build confidence (self-efficacy) that a solution can be found by the farm team.

I understand and agree with the principle of mentoring/coaching. However, how do we achieve this whilst providing up to date EBVM advice? For example, how are farmers meant to know that low BCS cows are at risk of lameness if we have only just learnt this from the evidence? How do we intervene if they make a suggestion that is inconsistent with what we advise - such as antibiotic footbathing for digital dermatitis?

OA: These are skills we cover and practice in the MM training. Coaching/ mentoring and providing factual EBVM advice are not mutually exclusive. On the matter of digital cushion and BCS, and speaking anecdotally, farmers are often more aware of this new science than many vets. This is possibly because they have been exposed to it more through the farming press than vets might have had access to (which is excellent), and possibly because they do not have to “unlearn” things they were taught at vet school!

NB: Rarely is it lack of scientific knowledge that is creating the barrier to improvement. By asking the right questions, focused on the right problem (using data, and your scientific understanding) you can actually direct attention to the area that needs addressing. I like to use the “lameness map” and risk checklists to work with the team to find the solutions and often the answer comes from within the team. Letting go of our ownership of the solution is probably the hardest change to accept (it was for me). The greatest skill as Mobility Mentor is listening and building the team confidence. Bizarrely you get more credit for helping people gain recognition of their ideas and raise confidence in delivery than offering the most technically brilliant ideas that no-one can implement. I was recently with a podiatrist (ironically I injured my foot 18 months ago) and I was blown away by his technical brilliance, and enjoyed the consult, but he didn’t once listen and so I had to find my own solution. He was brilliant but useless.

How good are farmers at early detection in reality and how can we help them improve their ability to assess this?

OA: Certainly, this is one of the bigger challenges. Improving awareness of current lameness prevalence, and how this can be achieved, is given a lot of attention during MM training.

NB: I’ll be slightly provocative and highlight within my PhD studies, I found farmers were better at identifying lameness than vets, with some quite startling differences. Most of the time it is lack of farmer opportunity, discipline and skills to deal with the early lame cow which is the barrier. Of course there are people who are blind to the problem and they stand out as they have huge numbers of lame cows. However, trim a few cows together and the true barriers to dealing with early lame cows start to leap out. Confidence in trimming and treatment is a huge issue underlying the lack of lameness perception.

Lameness Management

Nick: During your research did you create common “environmental parameters” to standardize the farm? or was farm specific? Was it part of the questionnaire?

NB: We used systematic checklists for both the PhD and Healthy Feet Project, which used a scoring scheme which we standardized as much as possible and summarised in an overall score for the critical control points. This was important for a. research into risk factors b. facilitator understanding of the farm. The difference was, in the first study we reported all the risks back to the producer which with hindsight was hugely demoralizing! In the Healthy Feet Project we had a facilitated discussion picking up on the risks relevant to the predominant lesion causing lameness on the farm. So the assessments were generic, but the risks focused on tailored to farm specific priorities, heavily influenced by lesions causing lameness (although we gave facilitators permission to allow farmers to explore other areas related to lameness risk if they wanted).Thank you for the question – you’ve given me fond memories reminiscing about this work.

What advice would you give a farmer who is a flying dairy herd as to quarantine time or treatment for bought in cows?

OA: DD risk will always be significant in such a situation, and that include buying in further strains which may not already be present. DD prevalence is very common, and dormant subclinical infections can be difficult to see. However, foot inspection and treating clinical lesions on arrival would be sensible, and allowing them to resolve before mixing with the herd. Treated cows are likely to remain carriers. Consideration should be given to concurrent infectious disease control, which may be implicated in DD through immunosuppression. Stress through transport and mixing groups is an additional risk for flying herds when considering DD control. For all these reasons, the other aspects of DD control become even more important for flying herds.

NB: Check cows coming in (hose feet in the parlour), treat active (or any DD) lesions and then focus on the normal areas of digital dermatitis control Owen mentioned. Unfortunately, flying herds will always have the greatest challenge but in spite of this they seem to do OK with awareness of risk and proactive control measures. I did explore a protocol involving systemic antibiotics to eradicate, but I no longer think this is responsible AMU.

Is over trimming an issue? On some farms the trimmer is perhaps treating too many lame cows vs corrective trimming.

OA: Yes. Sara is currently working on this through her PhD and this (assessment of trimming technique) is an example of an area where we hope to build knowledge and then resources to further strengthen the HFP.

NB: It’s a fine balance between improving foot angle and not over-intervening. It is an area of current research and so I hope we will have some further insights soon.