Location, location, location

When New Labour (through the lips of Tony Blair) adopted the catchphrase, ‘Education, Education, Education’ back in 2007, one presumes that the intention was not to demonstrate that the listening British audience was so thick that it was necessary to say things three times in order to generate a glimmer of understanding.  At a time when political ‘spin’ was being reinvented and turned into a science, the phrase was no doubt designed and intended to be memorable – and so it proved. The words came back to haunt New Labour, much to their chagrin, and they were re-quoted a good deal more than three times (and not in a kind way).

Similarly, since first coined about a century ago, the catchy strapline ‘Location, Location, Location’ has stuck as a way of emphasising that no other feature of a property matters more than the environment and position in which it is situated. Get that right and a lot of other things become possible. But get that wrong and you can spend all the money you like and never be able to compensate for it.

Unfortunately, it appears that all this endless repetition has another unwelcome side effect. ‘Regulation, Regulation, Regulation’ appears to be the new mantra of health and social care. We have our medical and social care colleagues to thank for this, and in particular the likes of Shipman, Neale, Ledward, Allitt et al. Bristol, Cleveland, Alder Hey and Haringey, West Kent, High Wycombe, Rochdale and Mid-Staffordshire are no longer just places on the map for those of us working in healthcare and social care – they are all important milestones on a journey we would have preferred not to take.

History books
Self-regulation of professions like ours is a concept that will soon be unimaginable to future generations, and consigned to stories exchanged from the laps of grandparents in the same way as descriptions of traditional ribbon typewriters might be today.
‘So how did they work, grandma? They must have had an amazing battery life, I can see there is no power lead.’
Those who are an integral part of a profession, have a vested interest in its welfare and its reputation. It matters to them (a lot) whether or not members of the public actually trust and have confidence in the profession.

A lot is said about the potential danger of the members of a profession ‘closing ranks’ and protecting each other, but in my experience most of the closing of ranks involves the profession having no time at all for those who are seen to have let the side down. When professions draw a line in the sand, they are generally on the same side of it as the public, for a number of very strong reasons.

The same is not always true of external regulation, and certainly not in these times where even the regulators are regulated. They have no vested interest at all in the profession that is being regulated, and there is often such a huge gulf in accountability that they become preoccupied with regulating (and being seen to be regulating) rather than any practical outcome for the intended beneficiaries.

Let us not forget that the FSA was regulating the financial services industry right up to (and since) the moment when the wheels came off the financial sector.  It is true that a few heads rolled (eventually) and a few tails got kicked.
The withdrawal symptoms continue at all levels in the industries concerned. But – and here is the parallel – it is the end-user who takes most of the pain now and as far into the future as we can see. The regulators let us all down every bit as much as the bankers, even though they probably earned less.

Ignorance is bliss
Does the existence of an external regulator reassure the public that everything is hunky-dory? Not any more, it doesn’t. In fact, for the most part, regulators have become a bit of a joke because time and time again it becomes clear that they didn’t understand enough about the thing that they were meant to be regulating. They thought that they did, and certainly gave the impression that they did, but their public display of confidence was later shown to be arrogant, deceptive and delusional.

The sub-prime mortgage fiasco in the US was a classic example of this. After the US$30 billion collapse of Fannie Mae and Freddie Mac the Federal Housing Finance Agency (FHFA) – whose job it had been to oversee their activities – concluded that there had been ‘improper actions by the firms and individuals. The loans had different and more risky characteristics than the descriptions contained in the marketing and sales materials provided to the Enterprises for those securities’.

Might it not have been helpful to spot this a bit sooner? The FHFA had been paid huge amounts of public money to regulate this important market effectively. But despite this, there was no suggestion of any ‘improper actions’ or failings by FHFA or people working for that regulator.

The same had been true in Australia a few years earlier when the major insurer HIH collapsed under the nose of the financial regulators (APRA) with far-reaching consequences – and you won’t need reminding that the FSA in this country is alive and well despite the chaos over which it presided.

Inside the tent
It is said to have been the former US President, Lyndon Baines Johnson (‘LBJ’) who – allegedly referring to J Edgar Hoover – commented that ‘it is better to have him inside the tent pissing out than outside, pissing in’. This is doubtless true of many people and many organisations, but it also reveals one of life’s great truths and because of this, has a wider application. Most of the time it is more constructive to have your say from within, than to bitch and gripe from without.

For some time now, the UK dental profession has been rained on (so to speak) from a variety of external sources. But have we even noticed, I wonder, that we have also been joined inside the tent itself and are now hopelessly outnumbered by people who have little or no experience of dentistry, precious little understanding of dentistry and in some cases a self-evident disdain for dentistry.

It was the dental visionary and writer Edward Sampson, one-time vice chairman of what later came to become the Dental Practice Board, who famously observed that the reason why dental practitioners never seem to be able to see the writing on the wall, was that they spend so much of their time with their backs to it.

But we do need to wake up pretty quickly to the pace at which the voice of dentistry – and of people who really understand dentistry – is being diluted and muffled in the regulation and future shape of dentistry.

Whether one looks at the future shape of the GDC itself, with the prospect of fewer dentists than you can count on the fingers of one hand, or the premises and facilities inspectorates (PFIs) like CQC, or agencies such the ISA, or the myriad other external players arriving into the tent and forcing their views upon us with not the slightest understanding of dentistry (the OFT being the latest of these), one is forced to ask how on earth this is meant to be in the best interests of members of the public.  

For the most part it places obstacles in the way of patient care and – as a matter of policy – intervenes in the patient: dentist relationship. Which is, as I am sure you would agree, counter-productive, counter-productive, counter-productive.

Kevin Lewis is renowned for his vibrant and influential writing, where he imparts his insight into UK dentistry. In his 20 years in full-time general practice, Kevin developed special interests in preventive dentistry and practice management. He has been involved with Dental Protection since 1989, and was appointed dental director in 1998. Kevin is also a popular speaker, lecturing on a variety of issues at many different events worldwide. He has contributed to two CD-Rom training programmes on infection control, and a BDA A12 Advice Sheet. In 2003, he became a member of the Council of the Medical Protection Society.

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