As the inhabitants of Westminster look forward to rushing off to their summer holidays, it appears that Healthcare England is dissolving into meltdown. In the aftermath of the Francis Report into Mid Staffs, and the creation of NHS England, we have the shoot-in–the-foot cover up (allegedly) at the CQC whilst NHS 111 is failing to answer just about any call that that happens to find its way to them. Doctors passing no confidence motions in the Health Secretary are added to surgeons who don’t want their data released and GPs who don’t want out-of-hours passed back to them at any cost. Seen from the middle distance, suddenly dentistry seems like a quiet backwater.
But the closer you look the less encouraging the view. Devastating news of bullying tactics, which may have led to the suicide of a dentist who was the subject of a clawback campaign, was rightly met at the LDC Conference by an unscheduled response from the Minister who deplored any such activity. Tragically, the news from elsewhere in health doesn’t give us much confidence, whether it’s about gagging clauses for whistle-blowing hospital managers or simply forgetting who said what in a meeting to “bury bad news” at the CQC.
Sadly one cannot see much future optimism, in the current environment of a government spending review which ring-fences the NHS budget but at the same time gives it only a 0.01 per cent costs rise in a year whilst demanding five per cent efficiency savings (according to some sources this is more productivity gain in a year than in the past 15 put together).
Dentists and MPs are growing anxious to know when, and in what form, a new dental contract is to be introduced by NHS England. The possibilities of a pre-election appearance were heightened when the Minister said earlier in the year that having given a commitment to introduce the new contract he would very much like to see it “in this Parliament”.
In the next sentence, or thereabouts, he then appeared to put its introduction back by implying that an element of fee per item would return. Those who remember the last ‘new contract’ might recall that it was in June 2003 that the Minister appointed Harry Cayton to lead a working group to look at dental charges. That group reported back in March 2004. A subsequent consultation was accepted by the Government in July 2005 in readiness for a new contract in April 2006 – a total of 34 months work in progress.
It’s been said before that one consequence of a new contract which included an IT-driven assessment and pathway approach will require significant investment in hardware and software by practices (some estimates put it at £20k). That’s another barrier.
One might be forgiven for thinking that squeezed between the rock of UDAs and clawback and the hard place of interminable piloting, dentists, like their other healthcare colleagues, are feeling more than a little frustrated by the pace of change (or lack thereof).
Perhaps, as I’ve said before, a phased introduction might be the best outcome, allowing those keenest on the new approach (or least keen on the existing one) to opt-in early, and mandating change only when (as with PDS in 2005) there are deemed a sufficient number of dentists to safely transition. That would, if the past two years of piloting are anything to go by, imply a dip in patient charges at a time of fiscal restraint on health.
Looking on the brighter side, Health Minister Norman Lamb has apparently been visiting healthcare facilities on the west coast of the USA (according to the Health Service Journal). Although he doesn’t seem to have popped into a dental ‘office’ he does extol the range of qualified staff working on the primary care frontline there, with high-tech communications and diagnostics. Given the departing NHS chief executive Sir David Nicholson’s slightly favourable comments about US health insurers in early June, perhaps change may be more significant than we thought?