Health: Primary and Community Care

Lord Colwyn Excerpts

Thursday 24th June 2010 Lords Chamber

[Lord Colwyn]

My Lords, I congratulate the noble Lord, Lord Mawson, on securing this debate. I listened to his speech with great interest. He has a splendid vision for future healthcare and should be congratulated on all that he has done. I hope he will forgive me for not following directly his line of thought. I am not used to speaking so early in a debate; normally every subject has been covered by the time I get to my feet. I must concentrate on matters that have affected and will affect my dental colleagues. I have no need to declare an interest. I was in dental practice for more than 40 years but I have now been retired for two or three years.

As I said in the debate on the Queen’s Speech, the past 10 years have seen fundamental changes to the provision of dental services. We have been left with unfinished reform of NHS dentistry and must now work to deliver a better system both for patients and dentists, even at this time when the Government are making complex financial decisions which will affect us all. Alongside the challenges of oral health promotion and NHS dentistry, general dental practitioners face mounting challenges in the management of their practices. The creation of the Care Quality Commission, with which both NHS and private practices must be registered by the end of March next year, imposes a further layer of regulation on dental practices.

Why this current explosion in the evaluation, accreditation and remediation of health professionals? The CQC emphasis is on the registration and inspection of practices, rather than the assessment of individual performance. This will probably be followed by the General Dental Council’s proposed revalidation processes, focusing on individual registrants rather than the environment in which they happen to be working. There will be areas of overlap, which will need to be looked at to avoid duplication and possible misinterpretation.

The British Dental Association’s Good Practice Scheme recognises the practice, not the individuals within it, and Denplan Excel has, for nearly a decade, been independently auditing dentists against a full range of quality and oral health measures, regularly visiting the practices and de-accrediting those found wanting. The BDA has identified a significant surge in the demand for advice on regulatory issues. It says:

“It is clear from our analysis that the challenges facing dentists are increasing and changing”.

Paramount to its concerns is the growing burden that changes to professional regulation are placing on its practices and the impact it is having on the delivery of patient care. The BDA continues:

“Recent years have seen a significant and disproportionate elaboration of the regulation of dentistry, with the publication of new decontamination guidance and the advent of the Care Quality Commission. We hope that the (recent) announcement of the halting of the proposed vetting and barring regulations signal a fresh approach to regulation that puts patient care before bureaucracy”.

Dental Protection, the dental branch of the Medical Protection Society, which I used to have the honour of chairing, reports an unprecedented demand for its advisory services. It says:

“The controls are out of control”.

There is a widespread feeling in the profession, and a growing sense of anger and frustration, that there are too many hoops for practitioners to jump through, often resulting in a duplication of effort and with no real justification in most cases. The evidence base for many of these new requirements being imposed on dental practices is sketchy or non-existent. We desperately need a more balanced, logical and measured approach whereby any additional layers of governance are scientifically based and targeted where they are justified and most needed, rather than being applied across the board. The current environment is wasting the time, energy and money of many practitioners who are already doing an excellent job for their patients.

At a time when the new Government are proposing that high-performing schools should be inspected less often and freed from unjustified bureaucracy, the current excesses in the regulation of dental health professionals are impacting upon morale, deflecting effort and resources and ultimately not serving the best interests of patients. Now that many NHS practices are effectively operating on fixed incomes, any unnecessary expenditure in one area needs to be funded by cutting back on more constructive expenditure elsewhere.

I have received many letters from dental colleagues. I wish to quote from one that I received from Caroline Thornton, who practises in Gloucester. She comes from a family of dentists. Her grandfather was a dentist, as were her father, her brother and her husband, and she wants her 16 year-old daughter to become a dentist. She writes:

“We are trying very hard to conform to the avalanche of regulations piling up every day. However, in a recession, this is proving to be very expensive! We have spent thousands on a new sterilization room, paid for the nurses to be trained, registered, and their CPD up to date, CRB Checked, even though 2 are pregnant. We are having one of the surgeries revamped in August to make sure it is up to date with the HTN 1-5 regulations at a cost of £20,000, and even completed a clinical waste audit, amongst many other trivia, all at our own expense. At this rate we will have a lovely practice but be bankrupt!”

I could quote many other letters.

One detail that seems to be overlooked in this eagerness to be seen to be monitoring, documenting, auditing and acting is that when assessing the risk presented by an underperforming dentist, it pales into insignificance when compared to an underperforming medical practitioner or surgeon. Before all this monitoring, documenting, auditing and acting became an art form, how much actual damage was being done to how many dental patients? How often and how serious were the consequences? Medics can kill people. Even at the very worst, dentists are unlikely to do so. I am tempted to wonder whether we are creating an entirely new industry and spending an awful lot of money “fixing” an illusory problem, or heading off the hypothetical threat of a “virtual” problem that may not even exist in reality.