Professor Jimmy Steele took the stage to address an expectant Local Dental Committee (LDC) Conference last month.
But despite the applause that greeted many parts of his talk – delivered in the run-up to the official release of his review into NHS dentistry – the mood was one of decidedly cautious optimism.
Privately, many dentists expressed their doubts over whether Professor Steele’s review went far enough – and how far his recommendations will be adopted by the Department of Health.
It was a conference defined by both the profession’s continued dissatisfaction with the 2006 reforms and the chief dental officer Barry Cockcroft’s continued insistence on its success.
This frustration was summed up when the Conference agreed by a landslide that UDAs are ‘utterly useless as measures of output, quality or access’. The motion was highlighted by LDC chair Jerry Asquith as ‘probably the most important’ one that morning.
Accordingly, Professor Steele’s talk – despite being interrupted by a fire alarm that set the conspiracy theorists in the audience talking darkly of DoH sabotage – was easily the anticipated highlight for most people there.
But while the audience warmly received his enthusiasm, his clear determination to produce a balanced report robbed some of the impact from his presentation for some.
Acknowledging the difficulty posed by appearing a scant two days before the official release of his long-awaited review, he said: ‘The review is published next week – which puts me in a bit of an odd position.’ Opting to give a ‘flavour of the principles’ underlying his report rather than go into detail on the content, he explained his findings with broad brush strokes.
Pinpointing one of his greatest challenges – the need to shift the government’s focus from treatment to prevention – he said: ‘This change is actually quite a difficult concept to grasp for the government.
As dentists, we understand that value for money doesn’t mean more fillings, because we know it’s about health. But for civil servants – most of whom are economists – it’s a difficult shift to make.
‘It’s a complex message, and trying to reduce it to something that’s understandable is a huge challenge.’
He was quick to address the views of many dentists at the conference, saying: ‘If I have learned nothing else during the last six months, I have realised that if the people at the top want something to happen, then it will. And while the politicians may listen to dentists, they hear the public.’
Anyone hoping for fire and brimstone was left disappointed as Professor Steele stressed the
importance of support from all political parties in recognising dentistry as a valued part of the NHS.
And, at the same time, he called for the profession to play their part in facilitating change, admitting there would be tough decisions ahead in terms of opening up to more scrutiny over measuring quality and prioritising care in the light of limited funding.
He added: ‘This time it’s so important that if we want this change, we must push it through.’
The greatest reaction was reserved for his comments on the controversial topic of UDAs. He said: ‘Oral health, not more dentistry, needs to be the aim. But we must think about what that actually means. We need to align the incentives for dentists so that they recognise this and address a blend of quality and activity.
‘I am making specific recommendations about quality, which needs accurate data and careful
measuring. But we need a set of measures that can be applied across the country.’
Advocating the need for careful implementation of any changes, he said: ‘The real risk is in not running a pilot for long enough. While I will recommend some substantial changes to the contract, they must be subject to meaningful pilots.’
Despite wariness on behalf of many of the LDC members, the official line on Professor Steele’s review was positive.
John Milne, giving his update as chair of the General Dental Practice Committee (GDPC), was in a generous, if somewhat combative spirit.
Promising to keep fighting on behalf of the profession, he explained: ‘A discontented workforce is bad for the NHS and bad for patients. I am personally well acquainted with the difficulties of UDAs and providing a good level of care, and it is clear to me that a quality NHS service cannot be provided on the cheap.’
He praised Professor Steele’s energy, but admitted that the weight of expectation would lie heavy on him, and urged the assembled LDCs to ‘keep their eye on the ball’ in continuing to negotiate with PCTs.
He too called for a fresh approach, saying: ‘The best way for the profession to move forward is through discussion and understanding. Only through constructive dialogue can we reach this understanding.
‘I think we are entering a new stage for NHS dentistry. But it is up to us to seize that opportunity for change.’
