Are excessive regulations endangering the public?

Neel Kothari

This month, Neel Kothari discusses the ‘ridiculousness’ of daily audits and needless regulations, and why they do more harm than good.  

Recently one of my nurses went to A&E in severe pain, but despite waiting for most of the night she still wasn’t seen. Hers is not an isolated story, and extended wait times are slowly becoming the norm in a health service that is stretched beyond the point of safety.

‘Beaten into submission’

What’s this got to do with dentistry? Well, at face value very little. But over the last two decades dental professionals have been subjugated by the whims of bureaucrats who have pushed untried rules and regulations under the name of progress and standards. The nature of these rules tends to follow a similar pattern: more audits, more courses and more companies willing to provide a compliance service for a nominal fee. Just like A&E departments, this also means more time ticking boxes and less time providing patient care.

By now, the dental profession – apologies, the dental trade – has given up fighting the geniuses who have come up with these rules. It has been beaten into submission, having to accept the ridiculousness of having daily audits to check fridge temperatures or weekly checks to see if emergency medications are ‘still’ in date, all because someone somewhere thinks that these are good ideas. They are remaining blind to the obvious detriment of diverting resources and energy away from patient care.

So, why is this an issue? After all, it only takes a minute, right?

Sure, but the minutes add up. And it’s almost impossible to measure the slow erosion of one’s soul in having to comply with ever-increasing policies designed to mitigate risk to the nth degree. Further, it’s precisely for these reasons that dentists are opting in droves to stay away from domiciliary care or emergency out of hours appointments. Not because there isn’t a demand, but rather because it’s now too difficult and, sadly, not worth the hassle.

This is a shocking unintended consequence that I’m sure the faceless architects of HTM01-05 didn’t envisage.

Is this progress?

Let’s take dental nurses’ registration. I’m reasonably sure that when the dental nurses’ groups pushed for General Dental Council (GDC) registration, they didn’t envisage the GDC wasting everyone’s annual retention fee going after nurses who are one hour short of a CPD cycle, or passing judgement over what nurses have posted on Facebook. But nevertheless, this is the reality.

We have now arrived at a point where those entering dental nursing are likely to face a lengthy apprenticeship of up to two years at an hourly rate of £5.28. This isn’t even close to competing with stacking shelves at Tesco. Is this progress?

This may sound controversial, but perhaps we can’t afford the sacrifices needed to achieve someone’s idea of what ‘excellence’ looks like, or the ever-progressive drive towards improving standards, when the status quo is more than sufficient and, in many cases, far easier to achieve.

I’m not against rules per se, but rather those made without an objective standard to be measured against. It seems bizarre that between now and the rest of my career, I can carry out over 100 hours of verifiable CPD per five year cycle without a single CPD hour having anything to do with teeth.

As a profession, we have become obsessed with areas such as decontamination, safeguarding, consent, confidentiality and GDPR etc. These are, of course, important, yet it isn’t entirely clear at what point we go too far.

In my opinion, parts of our health service are in or close to absolute crisis and this crisis cannot be solved by another audit.

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