The decline and fall of UK dentistry: a political tragedy

I know I’m an old reactionary, but most would agree the standard of our dental services is on the slide. There’s every indication that a series of poor political decisions at state level are to blame.

A lack of real vision

Ministerial agendas are always constrained by time. A new health minister will want to make their mark within the first 18 months of their appointment. Due to the divisions within a coalition government, and with only nine months until the next election, it’s unlikely any awkward issues will be addressed. A coalition government may be a good thing during a time of war, pooling resources and uniting the nation in the face of a major crisis. But the health service is in a major crisis and most ministers are too scared to make any unpleasant decisions. The NHS continues to be one of the largest corporate employers in the world, but has never been able to adopt a long-term strategic vision.

European legislative interference

The situation with hospital dentists is similar to our medical counterparts. Consultants in the fields of maxillo-facial surgery, orthodontics and restorative dentistry are found in teaching and district general hospitals. These consultants are supported by juniors with dental qualifications, who may aspire to become consultants, or may wish to gain further specialist knowledge before returning to practice.

Recent initiatives from Europe have reduced the hours worked by these juniors to 48, where their predecessors worked around the clock. This, coupled with the central Government’s initiative to fast-track consultant training, has now resulted in consultants being appointed with considerably less flying hours than their senior colleagues. 

These changes are also part of the managerial agenda to encourage retirement of senior consultants with old contracts that are difficult to control. As a result, young consultants, tied to restrictive new contracts, are being wagged by the tails of management and become yes men and women.

This brings us to that initiative to ensure there are as many female as male consultants to comply with equal opportunity regulations. Many consultants elect to juggle domestic and professional activities when raising a family. Part-time consultants are not always going to be in the shop when emergencies arise, and alternative cover is not likely to be as well informed about individual cases as a full-timer.

Irrelevant inspections

Previously responsible for policing hospitals, clinics, nursing homes and general medical practices, the CQC (Care Quality Commission) has been awarded the task of vetting dental practices. Whereas the former institutions are prone to patient neglect and abuse leading to malnutrition, starvation, dehydration and premature death, I struggle to see how this body adds any value to dental services. The dentist has to pay for the privilege of these visits, adding an average £25,000 a year in administration costs to a practice, a practice already accountable to at least 25 other public bodies.

My clinic was visited by a CQC inspector who was a former solicitor. Her understanding of dentistry was limited to her own experience as a patient. When it was explained that she had to wear protective overshoes to minimise contamination, she spent 10 minutes outside the entrance refusing to put them on. Apparently it wasn’t on her checklist.

All the views and opinions expressed by the author are personal but I’d welcome debate on the issues included. 

Toby Talbot BDS MSD (Washington) FDS RCS is a specialist in restorative dentistry, prosthodontics, endodontics and periodontics with 20 years as an expert witness with a specific interest in dental negligence litigation claims.

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