The big lie

the big lieTony Kilcoyne discusses his campaign ‘The big lie’ and explains what he is fighting for after his letter was published in The Telegraph.

On the second of January 2015, over 100 colleagues and myself signed a letter published in The Telegraph (, 2015), to raise concerns that the NHS dentistry system is simply not fit for purpose.

This was not done lightly, but after raising such concerns publicly exactly one year previously, what has really changed or improved centrally?


Sadly the answer seems to be far from positive action, we’ve had more inaction, several major aspects getting a lot worse and the usual hot air and spin from NHS England and what is now being mocked as its department of excuse making.

We have learnt in the last 12 months that the different pilots, taken place over several years, weren’t actually pilots. Centrally their data has been deemed ‘unreliable’ and frankly it’s mostly been a waste of time, because no matter how one tries to do it, you cannot have more quality plus more time plus a higher volume of people through the doors, in a centralised limited system.

We could have told the Government that, without what appears to be a charade designed to keep 90%+ of practices still using the deeply flawed and much criticised units of dental activity (UDA) target system in England past its safe ‘use-by’ date, thus it continues to make the nation sick.

Indeed, it’s not just opinion, the previous set of pilots, 2002-05, showed exactly the same thing (remember primary dental service (PDS)?), when we were similarly strung along and promised ‘options for change’. But we were double-crossed last minute, all pilots were not used and totally experimental UDAs were imposed on 1 April 2006, with a ‘take it or get out of the NHS completely’ ultimatum.

So the scene was set for aggressive conflict with the dental profession, which explains the wider adversarial problems we now experience too.


Now bearing in mind this was during the ‘boom’ period economically too, before the recession started in 2008 – so fast forward to now, our recent options turn out to not be options at all. Indeed, NHS England has said any new contract won’t be any of the pilots, so now they are talking about two or three new pilots starting again, trialling what is in effect units of capitation activity, or UCAs if you like, but volume based targets nevertheless.

So now we seem to have claims all is changing, but the fundamental flaws remain, just repackaged as UCAs within the same ‘limited’ resources, but feeding the public the same big lie by saying: ‘To be clear, nothing in the changes planned is intended to reduce or change the scope of NHS care available to patients.’ (, 2015)

This comes to the heart of the problem that plagues NHS dentistry in England; the disgraceful lack of full openness and transparency from the Government and the Department of Health towards the public, about the real intrinsic limitations of their current fixed-budget system offering unlimited treatment for the clinical needs of the whole nation.

They then go on to claim publicly that all NHS treatments are at least as high a quality as private (unlimited funding) treatments – I suppose if you are going to tell a big lie publicly it may as well be a whopper, but to many in the know it goes beyond spin and is starting to appear delusional.

The dental profession has simply been handed mission impossible, while the Government fosters unrealistic public expectations – is this really mistaken, incompetent or genuinely disingenuous?


Either way, no progress or improvement can be made until the big lie is admitted clearly to the public. Repackaging silly volume targets and confusing quality measures with quantity measures, is just compounding errors and is frankly unacceptable.

To Lord Howe’s credit, when I asked him at question time at the last annual BDA conference if he would do the honourable thing and admit the NHS dental system was limited to the audience present, he said an unequivocal yes. For that I thank him, but NHS England and the wider Department of Health are still stuck in denial it seems, and of course one cannot find such an honourable admission anywhere in writing.

So clearly the scope or the volume has to be reduced if one is to stay in existing limited resources and actually increase quality of care to an acceptable level – this should be discussed now so MPs can be held to account democratically and to test their honesty, frankly.

So this is the bottom line, ladies and gentleman – we cannot trust the Government and the DH to be fully open and honest publicly about the limitations now in NHS dentistry. Therefore to the public what other more complex or crucial areas can we trust the Government and civil servants to be fully honest?

In the next three months, Governments and politicians of all parties, must not be allowed to sweep dentistry’s increasingly chronic problems under the carpet – they should be held publicly and democratically accountable, starting with the most important concern first, that of full honesty and transparency publicly.

References (2015) retrieved 28/01/15 (2015) retrieved 28/01/15

All content is purely personal opinion of the author and totally independent of any other posts or positions held.

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