Nigel Jones draws on former BDA chair John Renshaw’s 60 years of experience in dentistry to examine the future prospects of NHS dentistry.
How realistic are the Labour government’s chances of solving the current problems of NHS dentistry? Practice Plan sales and marketing director Nigel Jones spoke to dentistry doyen and former BDA chair John Renshaw to benefit from his experience of nearly 60 years in dentistry.
Dentistry’s place in the future healthcare environment
Nigel: You qualified as a dentist in 1969, so you have been involved with dentistry and the NHS for more than half a century. From the late nineties/early 2000s, you were getting some insights into the way government was thinking. What was your role at that point?
John: I was a director of the North Yorkshire Health Authority. At that time, we had five major hospitals under our control. I was a board member, not because I was a dentist, but because I was a well-known figure in North Yorkshire at the time.
I began to listen to conversations where other people had clearly forgotten that I was a dentist and were saying things that they may not have said to me if they’d remembered that was the case. And I began to think we were being led up the garden path.
Even back then, the cost of the NHS was a huge problem. There wasn’t enough money in the kitty, and they were casting around looking for places to save money. And I knew they were looking at dentistry as a good way of hiving off a large portion of NHS responsibility in order to distribute that money in a more efficient way as they saw it.
That was when I began having great reservations about their willingness. So, as I had some status in the BDA, I persuaded them to address the issue of our profession’s place in the healthcare environment looking to the future. We arranged a big round table discussion with lots of senior figures there. It was very interesting to hear everybody’s views, but that was the beginning for me of a change of heart that was really radical. That was in 1996.
‘Sitting in two seats at the table’
John: By the way, I had been offering private dentistry since the mid-1970s. I did NHS work from the start like everybody else did. But it became very clear to me that my senior partner, who owned the business, was doing private work, which I hadn’t even thought of at that time. Then I realised, it wasn’t a bad idea.
At the time people said: ‘Oh no, you don’t want to be doing that. Stick to the NHS, that’s the right place to be.’ I wasn’t really convinced of that argument, so I went ahead and did my little bit of private work.
I had been sitting in two seats at the table at the same time for a long time before the 1990s. I went fully private when the 2006 contract came in. So the transition took me a long time, but nevertheless, it meant I was still an expert on the NHS but I also had a considerable grounding in the provision of dental care in the private sector.
Will this government be different?
Nigel: It’s interesting that in ‘96 there was a round table discussion, and in ‘97, we ended up with a Labour government. A lot of those discussions you were having in the late ’90s/early 00s were under a Labour government which is traditionally seen as a supporter of the NHS. And here we are now with another one in situ. What’s your sense of their thoughts about NHS dentistry? Is it different from the Blair government or is it pretty much the same?
John: I think the Blair government had the shock of a lifetime when they decided to put the extra money into the NHS in 2000 and they increased the funding available for the NHS as a whole. The whole system went from £100bn a year to £120bn. And I was told face to face by Alan Milburn (secretary of state for healthcare 1999-2003), dentistry was going to receive not one penny of that.
Interestingly, the £20 billion evaporated. It achieved nothing at all, and the actual result was next to zero. So, I think the Labour government then lost faith in the NHS altogether. They realised they were stuck with it politically, but they didn’t like the idea.
From then on, it’s been a matter of containment of cost. And this new Labour government is doing nothing more than the previous Tory government has done, which is to continue to try to keep a lid on the cost.
The cost of the NHS has every capability of bankrupting this country if it was let rip and they can’t afford to let that happen. So, no matter what their private thoughts might be, they’re stuck in a position where they probably can’t do what they might like to be able to do because the money won’t allow them.
‘Major hospital collapse’
Nigel: At this point I’m reminded of the Nuffield Trust report that came out at the end of last year which had in its title, ‘slow decay’. There were some fine words spoken at the conference earlier this year about the cavalry is coming, and some positive utterances about their desire to change the situation. Is Labour handcuffed to the current policies it’s inherited?
John: They have no choice. Because if you look at the priority list, virtually half the hospitals in the country are in danger of falling down. The maintenance costs of keeping those hospitals going have been neglected for at least 30 years. That’s a problem that is going to cause trouble. Sooner or later, we’ll have a major hospital collapse.
There are senior staffing problems where management are paid huge salaries without producing results. When it comes to clinical staffing, they don’t have enough people at the senior level, no matter how much they pay them, to be able to do the job properly.
Junior staff stay for a while, but once they realise what the NHS is really like to work for, they have to leave because they can’t cope with it. So, it’s a good place to get a foothold and learn the trade, but when it comes to making money, that place is outside of the NHS.
So, the NHS has a massive list of problems that need to be solved a long time before we reach any talk of dental services.
‘Expect the worst but hope for the best’
Nigel: There’s also the obvious point of the workforce issue. We seem to have fewer dentists wanting to work in the NHS, and even those working in the private sector seem to want to work fewer clinical hours.
In this day and age, compared to the 1990s when I started working with the profession, levels of productivity have nosedived, partly because of advancement of techniques, but also record keeping, defensive dentistry, and keeping the GDC at bay, all mean dentists just can’t see the same number of patients in a day now that they could then. This is before getting into a debate about the level of clinical skills of new graduates nowadays.
So, we have fewer dentists, working fewer hours and being less productive in those hours. I have no idea how a government can solve that issue quickly. And if it doesn’t, it’s hard to say how many NHS practices will be left, even if they want to be in the NHS, because they can’t recruit associates to deliver the activity.
Perhaps we should expect the worst but hope for the best. Thank you, John.
To listen to a longer version of this conversation in podcast form, please scan click here.
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