A war of words

The jury is still out on the question of what (in particular) prompted the Department of Health to release the story in mid-October that dentists were recalling healthy patients more often than was really necessary and ‘playing the system’ in order to pick up UDAs for little or no extra work. Given that the enhanced data set has only been collected for courses of treatment completed in the past six months, it seems somewhat premature to have formed and gone public on such a sweeping opinion.  Prior to that, a ‘Band One’ claim did not necessarily
imply that a check up had been carried out.

The same reports refer obliquely to evidence of ‘splitting’, i.e. breaking up what is essentially one course of treatment (attracting one patients charge) into several phases (attracting new patients charges each time). I spotted no mention of any suggestion that ‘splitting’ was more prevalent in the treatment of patients who did not pay NHS dental charges.

Systems that are reasonable, fair and logical, and properly funded (and recognised as being so), do not invite ‘gaming’ to anything like the extent that one sees in a system which is perceived as being unfair, unreasonable, illogical and inadequately funded. Why is, then, that the finger of blame always points at the people who are forced to work within a clearly flawed system, rather than those who designed it in the first place?

The ‘spin’ was elegant (as always) in suggesting that if all the naughty dentists behaved a little better, time could be freed up to see additional patients and patients might pay less in NHS charges.

A number of reports in September had preceded Barry Cockcroft’s statements, including one from Engage Mutual (following a survey of consumer behaviour commissioned by that financial services firm). This survey of almost 2,000 UK adults suggested that families with children under the age of 16 had been worst hot by the recent economic downturn, with 70% of them (and 60% of pensioners) saying that they were being forced to cut back sharply on any non-essential healthcare costs. Another study suggested that one in four of the adults surveyed could no longer afford dental check ups.

Only the best

So, was this a pre-emptive strike by the Department of Heath, anticipating more gloom and doom headlines about the difficulties of finding an NHS dentist, and of paying the NHS charges even if you do happen to have struck lucky? You might think so when considering the detail of the story as reported by the national press.

A Department of Health source said: ‘Abuse of the system is believed to be more prevalent in the South where access to NHS dentists is more difficult. These dentists are seeing the same healthy patients a lot. Instead of recalling them every year or two years they are coming back every three or four months. Dentists are required by law to provide the best possible healthcare to their patients. If a patient has reason to believe that this has not happened, then they can report them to their local primary care trust.’

Within 48 hours of the Department promising dental patients ‘the best possible healthcare’ then, Sir Ian Kennedy stated (in the latest report from the Healthcare Commission, which he chairs), ‘We are a lot closer to getting core standards in place across the NHS, but there are still too many trusts that are not there. Performance is not universally good.’

Whatever happened to ‘the best possible healthcare’ that everyone is entitled to? What about encouraging patients to complain if they are not getting it? Or is this reserved for primary dental care?

Mixed messages
The Commission’s Report concludes that six out of 10 acute and specialist trusts are not meeting Government standards on managing infections and are failing to hit a target to cut MRSA infections by at least 60% over three years.

So who had briefed Gordon Brown for his open letter to all NHS staff just four weeks earlier, in the wake of the Report from the Health Protection Agency? In this letter he had stated: ‘The rate of MRSA in our hospitals is now down by more than a third in just the last year. We can confirm that the NHS has exceeded its long-standing target to halve the rate of MRSA.’
It would seem that evidence-based medicine has been temporarily suspended, or alternatively that these contradictory sound bites – all conveniently couched in general terms – are designed to leave plenty of wiggle room. But not enough, I would suggest. What it increasingly seems like to the casual onlooker is that all these ‘headline’ statements are plucked out of fresh air. Probably the same fresh air in which the NICE guidelines on recall intervals were incubated.

But I would hate to end this column with you thinking that all the news in healthcare is depressing. Far from it! I am pleased to report that a new centre has opened in Blackburn for five evenings a week. This project is a joint Health and Work & Pensions initiative costing the taxpayer £400,000 a year, to offer manicures, massages, hairdressing, yoga and Tai Chi to individuals with a drugs or alcohol dependency. The concept is to offer an alternative to medically based treatment, involving the use of methadone and similar medication-based
therapies. The service will be free at the point of delivery.

If you are struggling to calculate how many Band One check ups or illicit UDAs that’s equivalent to, might I suggest that you contact the Department of Health and ask to speak to the same mathematician who produced their recent MRSA figures? 

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