In the wars

Will a Health Select Committee report put an end to dentist bashing, asks John Tiernan?

Dentistry has once again hit the headlines. At the end of February Eddie Crouch, a founding member of pressure group Challenge and chairman of the Conference of Local Dental Committees, had a part win against his primary care trust in relation to clause 12 of his contract, which gave the PCT the right to terminate it at any stage. The Judge, Justice Collins, ruled in Eddie’s favour, although one day later elation turned to shock as another ruling on the issue of public consultation came down on the PCT’s side. Even so, during the hearing Justice Collins was absolutely damning about the regulations that dentists have to cope with in the NHS contract.
I hope that the profession will help to support Eddie’s legal fees. He was fearless and tireless enough to take on the PCT and has won a victory for all dentists. At the time of writing I do not know whether either side will appeal the Court’s decision.
The verdict from Eddie’s case follows a month of publicity that included the Health Select Committee hearing evidence about the impact of the new contract and articles published about the lack of patient access to NHS dentistry. The Health Select Committee took evidence twice in February. In the first session John Renshaw and Eddie Crouch spoke on behalf of Challenge, as well as John Taylor, the ex-chairman of the Dental Practice Board. At the same session the Chief Dental Officer gave his view.
One of the strong points reiterated by Challenge was the lack of consultation and forethought that went into the introduction of the new contract in April 2006. The MPs had been well briefed and came across as anti-dentist, particularly in relation to the issue of dentists seeing parents on a private basis while treating children on the NHS. One MP was of the view that patients felt forced into private alternatives to secure NHS dentistry for their little ones. The MP in question seemed more intent on getting John Renshaw and Eddie Crouch to admit that this was unacceptable than on asking questions about the real reasons for a huge number of dentists having left the NHS and many patients being unable to secure NHS treatment. It is interesting, of course, that many PCTs still allow children-only contracts as a way of preserving some form of NHS work. The incentive is also now for PCTs to provide less treatment for children on the basis that there are no patient charges.
It is fair to say that the views on the success of the contract were diametrically opposed between Challenge and the health department before the Health Select Committee. On one side there seems to be a majority in the profession who feel that the contract is tragically flawed and then there are those who consider it successful. The latter camp is spearheaded by the current Chief Dental Officer. Individual circumstances in the contract vary greatly and, for those dentists who are not achieving targets, I have no doubt that the view is likely to be negative. On the other hand, for those deriving more income, things are rosy and the contract may be deemed a success.
Published statistics might fuel the debate, given that approximately half a million fewer patients have been treated on the NHS in the two years to October 2007 than in the two years to October 2006. The actual figure is probably worse, as there is a six-month overlap and my guess is that larger numbers of patients were seen in the base year on which contract values were determined. The Liberal Democrat spokesperson for health, Norman Lamb, has called on the Government to admit that the dental contract has failed, as indeed have many others. A British Dental Association survey at the start of the year showed that 1,000 or so dentists have left the NHS since the introduction of the contract.
One of the problems the profession has is that there are a lot of data and firmly held views, some of these allied to political stances. It is difficult to see a way forward in assessing the benefits and pitfalls of the new contract because, inevitably, both exist. No one from the health department is going to risk his/her career by admitting that the contract is an unmitigated disaster.
Perhaps one way of unlocking the problem is for a professional in the department to agree some key criteria that should be evident if a contract for NHS state-funded dentistry is successful. If these criteria can be agreed then there must be a way of developing some objective measures, which both sides could determine. It might be argued that the conflict of interest on the two sides would prohibit any objectivity, as the department would want a set of criteria tailored to its needs while the profession might look at different guidelines. Similar conflicts have arisen in the past in relation to funding of pay and an independent review body was established. I am not a great believer in quangos, but the time has now come for an independent audit body to be established without political orientation that seeks to develop neutral criteria by which the benefits and pitfalls of a particular contract can be examined.