Salt with your fish and chips? Not apparently if you live in Stockport. Salt shakers are being removed from counters and table-tops at curry houses, fish and chip shops and cafes. According to some newspapers, customers will have to ask for salt. It may not be true of course, but one chip shop manager said: 'We just wanted people to stop and think. Don't just shake it for the sake of it.' In 2009 the same council gave cafes salt cellars with five holes instead of 17.
The move was welcomed by health campaigners who said it would 'nudge' people in the right direction. Although this is a favourite phrase of the health secretary, Stockport's conservative group leader is quoted as saying that the initiative created a 'nanny town'. He claimed that the council's latest move could actually be counterproductive.
'British people don't like being ordered around. If you actually want people to use more salt, then tell them not to,' he said.
My first reaction was, as a health care professional, I should be thoroughly behind this move. After all wouldn't we as dentists prefer it if sweets were not strategically placed at supermarket checkouts where the 'little darlings' can be pacified with something cariogenic. These retailers are made of sterner stuff and argue that if their customers want to buy sweets at the checkout they have a right to do so, no matter what damage this may do to their teeth.
Furthermore they would argue their job is to maximise profits for their shareholders not act as dental health campaigners. So were I behind the counter at a fish and chip shop I should logically say 'if the customers want salt with their chips, then it is up to me to give it to them, not hide it under the counter like a bit of porn.' My job is to sell fish and chips and earn a living; if the customers are worried about their blood pressure, heart disease or risk of stroke they should consult their doctor.
Now I know that neither I nor my readers serve in a fish and chip shop (or I assume they don't – I am sure CQC would not approve). But reading the latest offering from the Chief Dental Officer I am beginning to wonder if we are not being put under similar moral pressure. At the end of March he wrote about work that had been done on the recall interval since Nice published its guidance in 2004.
He points out that 70 per cent of dentate adults had no active caries and a similar percentage visited their dentist within nine months. The implication is that some, or perhaps many, people are being recalled unnecessarily. Now we cynics will say that it suits the Government, any Government, to argue that if dentists see patients less frequently, then they will have room to see more patients and there will be no access problems.
But just as the fish and chip owners can argue that it is not their job to implement Government health policy, we can argue that it is not a dentist's job to help their dental health policy. Dentists are in business and, as such, we need to make a profit and satisfy patients' demands, providing that what we advise is what we believe is in their best interests.
The CDO's letter also stresses the importance of explaining that a longer recall interval is based on 'clinical and risk factors', just as the chip shop owner is supposed to tell customers that less salt is best for their health. Most patients, however, are smart enough to think that it is all part of the 'cuts'.