In my last blog, I noted a developing Critical Mass for change in how we address infant caries and its consequences. And barely a month later, the steam pressure has been increased once again.

The Chief Dental Officer Dr Sarah Hurley, is starting to make public inroads into her role, and recently delivered the 2016 Pendlebury Lecture. It was in stark contrast to the one delivered in 2014, demonstrating a wide understanding of the playing field that is dental health.

Critical Mass 2

It comes at the end of a week in which the state of children’s teeth once again was publicly pilloried, on the back of the General Anaesthetic numbers.

While it remains a problem in England, just look at Scotland. After many decades when Scotland has been spiritual home of the UKs dental problems, it suddenly produces numbers through its Child Smile initiative that suggests significant inroads are being made to improve the health of children’s teeth and prevent dental caries [and thereby reduce the costs and morbidity of unrestricted dental breakdown]. It is not really rocket science, they have just been investing in infant dental health.

So we in England [and Wales and Northern Ireland to a similar extent, but out with the CDO[NHSE]’s remit] have a problem.

We know the target population for any changes must now be parents and infants in equal measure.  There seems to be ample evidence that parking the dental professionals in discrete buildings, called Dental Surgeries, is simply not working, and it is evidence that Dr Hurley seeks.

We know that the medical stakeholders are now on board, as obesity and diabetes rear their heads with all the long term cost implications. Indeed it is the medical drive for a sugar tax to discourage the dietary shortcomings that is also driving the publicity that emerged in the Daily Telegraph over the weekend of the 26^th February, and was subsequently widely discussed on broadcast and printed media.

Follow the money

So increasingly the priority is being defined. But the thorny issue will arise of funding.

Which Departments will pay?   How will we [the public] pay for the inevitable targeted measures that are due to follow, as day follows night?  A sugar tax undoubtedly could easily raise the funds but the political will in the chaos pre-Referendum is clearly not there.

There is a serious danger in the current fiscal period of restraint that the HM Treasury will insist on a cost neutral option.  Maybe not, but we must for now assume that.

Could it be that the GDP Budget is being eyeballed [at £3.4Bn] as the low hanging fruit of funding that could or perhaps should be used to address the issue of infant dental health?

The Chief Dental Officer is clearly leading dental health to a better place – but who will pay for this Piper’s plans?

The role must soon change it seems to that of Chief Decision Officer.  

Interesting times, but the sooner we address the issue of Dental Health for the young child, the sooner we can restore some pride to our profession.
 

As a GDP you would do well to plan for big changes. Not sure what but for sure very significant.
 

Have great Easter, assuming the snow has eased back!

2016 letter to Telegraph http://www.telegraph.co.uk/comment/letters/12077501/Letter-The-NHS-dental-health-system-is-unfit-for-purpose.html

Dentistry response http://www.dentistry.co.uk/2016/01/11/nhs-dentistry-letter-published-in-the-telegraph-unhelpful/

Feb 26 article DTel  http://www.telegraph.co.uk/news/health/news/12174796/Thousands-of-children-have-decayed-teeth-out-in-hospital.html

BDAs Press release  https://www.bda.org/news-centre/press-releases/tooth-decay-stats-should-offer-wake-up-call-on-prevention

GDPUK News https://www.gdpuk.com/news/latest-news/2151-gas-for-dental-extractions-in-children-on-increase

GDPUK CDOs response https://www.gdpuk.com/news/latest-news/2152-strong-response-to-child-ga-figures

GDPUK Scan of other media [Dr Tony Kilcoyne]  https://www.gdpuk.com/forum/gdpuk-forum/telegraph-third-world-dentistry-crisis-in-engand-21379?start=130#p239340

Scottish example  http://www.child-smile.org.uk/professionals/childsmile-core/toothbrushing-programme-national-standards.aspx

·         Since 2011, all elements have been delivered in all Health Board areas throughout Scotland.

·         "As a result of our efforts, dental health in Scotland is improving, particularly in deprived communities. In the Primary 7 age group dental health has never been better and on a Scotland level the target of 60 per cent of this age group having no obvious decay has been met. This is a fantastic success story."

Summary of 2016 Pendlebury lecture http://www.fgdp.org.uk/content/news/synopsis-of-the-2016-malcolm-pendlebury-memorial-l.ashx

Dear Colonel Hurley,

The profession would like to congratulate you on your appointment to the post of Chief Dental Officer. As someone with a reputation for professional change management, then your appointment is seen as a welcome one by many.

The profession has not recently been blessed with a CDO who it can feel it truly relates to, and many may feel that the last few years have been detrimental to the quality of dental care available in the United Kingdom. Whilst the position of CDO will always be to do the will of its paymaster, Her Majesty’s Government, I am sure you will continually keep your professional responsibility to the profession at the forefront of your mind.

At a time of unprecedented change and pressure within the profession, you will have the opportunity to rebuild the bridges that have been lost over the years. One of the ways of doing this would be to listen very closely to the concerns of the profession, and most importantly do not be afraid to tell the truth of the problems we are experiencing. After all, you are a member of our profession first and foremost, and what is bad for the profession is bad for patient care.

A New NHS contract will no doubt be a priority; but in whatever incarnation this takes, it needs complete and total clarity as to what treatment is available for patients under the rules. There should be no room for abuse by those who use a lack of definition to perpetuate the problems of the current system. Contract negotiations based on honesty are a must; and if the government cannot afford what it wants, then it should be told in no uncertain terms that this is impossible to achieve. Not only do our representatives the BDA have this responsibility, but so do you. Only by listening to and working with the profession in a fully engaged and mutually respectful manner can this be secured. If this means a core service for the NHS, or a new way of thinking that benefits both patients and teams alike then it should be piloted properly and not forced on the profession in the manner it has before; please don’t forget that the success of dental care depends on those delivering it. You have a track record in delivering high quality change within a budget; but do not underestimate the suspicion of the profession as to how government will treat them.

The inequities of dental care must be addressed; and the continued lack of a joined up policy on dental health in the nation is still something that makes dentistry a poor cousin to other health issues. When dental problems are the number one cause of admission to hospital for children, can nobody actually see it would be cheaper to fight the problem at source rather than wait until the problem occurs? There would be no better long term legacy for a CDO than to have truly changed the face of dental health in the UK for the better. A public face of the profession that is prepared to stand up for the patient and not hide behind government spin and empty promises is what the profession requires if faith in the position of CDO is to be renewed. A clear message is what the public need.

The situation with our young practitioners having to play some kind of bizarre lottery to gain a job on graduation is another aspect of the profession that you must turn your attention to. At the very beginning of their careers, we have an increasing number of them considering whether or not they have made the right choice for their futures; and by association this is the future of the profession too. Whilst part of this lack of morale lies at the door of our failing regulator, to then heap on the uncertainty of a tiering system will eventually result in the profession being devoid of is youngest talent, without which it will wither.

So, as you approach the start of your tenure as CDO, the profession can only really ask one thing of you.

After years of obfuscation, spin, and confusion;

We need clarity.

Yours Sincerely,

The Profession.

Image credit - Jason Dean  under CC licence - not modified.