Neil Carmichael asks what the long-awaited dentistry recovery plan needs to prioritise to achieve real change in dental policy.
Sir Charles Cunningham, a distinguished and effective permanent secretary at the Home Office during the years 1957 to 1966, observed that any policy was rather like an elephant, being difficult to describe but easy to recognise. Ongoing attempts to solve the access crisis in dentistry appear to capture the essence of Sir Charles’s point.
This, in turn, highlights the difference between incremental policy making when a series of small changes prevail and a more rational approach involving setting objectives and deploying resources for delivering preferred outcomes.
Sir Charles’s elephant analogy invites us to wonder about the scale and scope of the long-awaited dentistry recovery plan. And more specifically, if it is a policy change or just another ratchet shift in trying to improve implementation.
Furthermore, given the plan is apparently still lodged with the Treasury, it might be subjected only to ‘value for money’ scrutiny rather than tested as a contribution to public policy development. The looming danger is any announcement will seem underwhelming and ineffective in dealing with the now blatantly obvious access problem.
Ministerial turnover
The role of the Treasury should never be underestimated. Periodically, the authority of the Treasury has been challenged by Prime Ministers – usually by introducing some structural change such as the creation of the Department of Economic Affairs in 1964. But the Treasury has always managed to protect its own supremacy.
Recently, a study of the Treasury explored the question of its institutional memory and how this influences public expenditure decisions. But with constant structural changes in other departments, it is difficult to see, in the case of dentistry, how the Department of Health and Social Care can resist the Treasury.
Another consideration in policy making and implementation is around the machinery of government. One obvious problem is the frequency of ministerial turnover – ministers of dentistry do not last long.
It is encouraging to see a former Secretary of State of two different departments taking on the role of Minister for Dentistry at junior minister level. However, a few months in post might prove to be insufficient even for an experienced minster to ‘make the weather’ in policy making.
Access and policy
The case for a rational approach to policy making in dentistry is overwhelming. The queues of patients waiting for access to a dentist are just one measure proving the need for imaginative thinking. Two problems must be tackled.
Firstly, recruitment. The Association of Dental Groups has identified ‘dental deserts’, a frequently used term to describe areas where additional access to dentistry is difficult if not impossible because practices cannot recruit enough dentists.
The sensible response to this this situation would be to increase the supply of dentists and easiest way to do this is by accelerating the pace of approvals for dentists to practice in the United Kingdom. It almost goes without saying this should be in parallel with measures to increase the output of domestic dental schools.
Sir Charles would recognise this as a policy – a rational policy – and one likely to garner Treasury approval. Not least because the General Dental Council as the body responsible is awash with money.
Contract reform
The second problem to tackle is the NHS contract. Without doubt, it is unpopular with the profession. Dentists are imbued with professionalism, a strong sense of responsibility for patients and a wider commitment to the public good. However, many feel constrained and undervalued by the contract.
Measuring how public money is managed is good practice. But reform of the contract must also salute the now widely recognised requirements for a greater focus on prevention. We need to be reaching out to children and tackling social deprivation.
Essentially, this all amounts to a clarion call for a reform package based on a clear understanding of priorities and a willingness to propel the agencies involved – especially the General Dental Council (GDC) – to provide for the challenges of modernising and ambitious dental community.
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