BDA Chair Eddie Crouch on what new reforms could mean for the future of dental care.
White Paper launched by Health Secretary Matt Hancock spells fundamental change in the way healthcare works in England. The Lansley Reforms of 2012 could be history (well for the most part) and new laws are set to reach the statute books in 2022.
“Brace yourself for another re(dis)organisation of dentistry.”
Brace yourself for another re(dis)organisation of dentistry, say veteran NHS watchers. But change will not be limited to the NHS. Readers will struggle to find the word ‘dental’ in the document, but the results will likely be felt by colleagues across NHS and private services, in high street, community and hospital settings. And while technically England-only, the policies set out are likely to influence the direction of travel in other UK nations.
It’s our job to secure the best possible deal for all our members and the patients they treat. And these wide-ranging reforms will impact on the delivery, commissioning and regulation of dental care. It’s early days, but here’s what you need to know:
Inaction on prevention?
When papers were first leaked to the press ahead of the formal announcement there was much trumpeting about a brave new world for water fluoridation. But if talk of fluoridation is more than a distraction tactic, government must allocate funding for this vital work.
As a dentist in Birmingham – an area lucky enough to benefit from programmes since the 1960s – I know this could be game-changer, improving health outcomes while saving the NHS millions. But over that weekend we began hearing talk that new laws would stop councils from being ‘roadblocks’ to reform.
“The real block on fluoridation has always been a lack of dedicated funding.”
The real block on fluoridation has always been a lack of dedicated funding. The Water Act back in 2003 aimed to simplify things, but the facts remain no new authority has taken forward plans since the 1980s. We can and should make the process easier, but costly public consultations and feasibility studies will always limit uptake, particularly when local public health budgets have been cut to the bone.
We know – from
the government’s own modelling – that any money spent here would quickly pay for itself. Yet until we see that up-front investment from Westminster any benefits to either public health or the public purse will remain purely theoretical.
We need to see a joined-up approach to prevention. Oral health inequalities look set to widen, and even commitments here can’t be at the expense of dental services or wider public health programmes, including supervised brushing that Ministers have long pointed as a way forward.
Moving from competition to integration
The Health and Social Care Act of 2012 put competition at the heart of the NHS. Competition may not be quite dead, but the emphasis is set to shift firmly toward integration of health services, an approach with the potential to offer joined-up services that could benefit patients. The devil, of course, will be in the detail.
“Reports of tendering’s death appear to have been greatly exaggerated”
The White Paper states new laws will “remove much of the transactional bureaucracy that has made sensible decision-making and collaboration in the system harder." But reports of tendering’s death appear to have been greatly exaggerated. Where procurement will “add value” it seems it will continue.
Integrated Care Systems (ICS) will however likely see the pooling of budgets across primary care, and there are questions where smaller and lower profile areas may fit. Clinical leadership will be vital here. Dentistry will inevitably be a smaller voice among many, and we will need to ensure this profession is heard, together with some protection of the resources devoted to our patients’ oral healthcare.
And we will need to see protection for existing providers of care. Current open-ended NHS contracts have provided a degree of security. Any change will need to ensure providers are able to make long term decisions (and necessary investment) to support the delivery of high-quality care.
Promises to tackle red tape and regulation
The General Dental Council is going to change, that much is clear. What it changes into though is where we will need to apply our efforts.
“It opens the door to a super-regulator.”
The paper pledges a clearing of the decks of byzantine legislation that has held all professional regulators back. We will see streamlined approaches in areas like Fitness to Practise to ensure a more proportionate, less bureaucratic approach. However, it opens the door to a super-regulator, by making it easier to amalgamate the functions of several health watchdogs – potentially even all – into a new body.
We’ve long been sceptical about the merits of merger. A new name, new logo and new offices will not translate into a cost-effective regulator that actually understands dentistry. That remains the prize that has eluded us for so long.
These are uncertain times for us all. The impact of the pandemic on our businesses and our lives is going to be felt for many years to come. This White Paper may offer a glimmer of hope in getting a better deal for dentistry.
But from my long experience dealing with government, any hope needs to come blended with a healthy dose of scepticism.
Dentistry was already in crisis pre-COVID, and now faces huge backlogs, ongoing disruption, and deep uncertainty. That’s why we’re working to ensure the government’s ‘build back better’ mantra is applied to dental services.
As your trade union we will continue to fight for dentistry’s voice, which we know is so often forgotten, and try to get the best deal for our members.
BDA Board Chair