Access to what?

Probably because my local hospital (Colchester) had its chairman removed and another in Essex (Basildon) hit the headlines because of serious ‘under-performing’, I began to take an interest in the problems of hospitals and their inspection. The latter had been rated ‘good’ by the Care Quality Commission (CQC) but was condemned for having ‘blood-spattered walls’, among other problems.

Then the health information firm Dr Foster published very different figures from those supplied by the CQC. A dozen NHS trusts were described by Dr Foster as ‘significantly underperforming’ in basic safety measures, despite nine being recently rated ‘good’ or ‘excellent’ by the CQC. The

Conservatives called for a ‘massive overhaul’ of the inspection regime, saying the data highlighted an ‘extraordinary contrast’ between the Dr Foster verdict and ‘box ticking’ official assessments.
Box ticking seems to be the problem with hospital trusts saying how well they had done, or rather how well they had ticked the boxes. Andrew Lansley, shadow secretary for health, said: ‘It should not be possible for managers to put a tick in a box marked “target met” while patients are pushed off to a ward and left to die.’ Is this what is happening to NHS dentistry?

When I last spoke to the chief dental officer he seemed very happy about the recently published figures for access. These showed that in the two years ending last September 27.9 million patients had been seen, an increase of 200,000 from the numbers seen in the previous two year period ending in June. However, the figure is less than the 28.1 million patients seen in the 24-month period ending 31 March 2006.

Put simply, by the end of 2009 we will be back at the position we were when the contract was introduced. This is better than the 1 million fewer in June 2008, so perhaps the CDO has some cause to be happy, but there has been no increase in access to NHS dentistry in the four years since the contract was introduced with the promise to improve matters.

In other words, the CDO and PCTs have ticked the right boxes – ‘access improved’ but what would an independent inspection say? What would patients say? Access – yes. But access to what? More extractions, fewer teeth saved, a different dentist seeing you every time you attend. Would patients see these as improvements?

The whole stress of Dr Warburton’s thinking now seems to be to see people less frequently, so that we can see more of them. This may well tick the boxes, but will it improve the service? Patients may want to see their dentist every six months, which does not please the box tickers.

But isn’t the NHS supposed to be run for patients, not managers?

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