The big lie

the big lieTony Kilcoyne discusses his campaign ‘The big lie’ and explains what he is fighting for after his letter was published in The Telegraph.

On the second of January 2015, over 100 colleagues and myself signed a letter published in The Telegraph (, 2015), to raise concerns that the NHS dentistry system is simply not fit for purpose.

This was not done lightly, but after raising such concerns publicly exactly one year previously, what has really changed or improved centrally?


Sadly the answer seems to be far from positive action, we’ve had more inaction, several major aspects getting a lot worse and the usual hot air and spin from NHS England and what is now being mocked as its department of excuse making.

We have learnt in the last 12 months that the different pilots, taken place over several years, weren’t actually pilots. Centrally their data has been deemed ‘unreliable’ and frankly it’s mostly been a waste of time, because no matter how one tries to do it, you cannot have more quality plus more time plus a higher volume of people through the doors, in a centralised limited system.

We could have told the Government that, without what appears to be a charade designed to keep 90%+ of practices still using the deeply flawed and much criticised units of dental activity (UDA) target system in England past its safe ‘use-by’ date, thus it continues to make the nation sick.

Indeed, it’s not just opinion, the previous set of pilots, 2002-05, showed exactly the same thing (remember primary dental service (PDS)?), when we were similarly strung along and promised ‘options for change’. But we were double-crossed last minute, all pilots were not used and totally experimental UDAs were imposed on 1 April 2006, with a ‘take it or get out of the NHS completely’ ultimatum.

So the scene was set for aggressive conflict with the dental profession, which explains the wider adversarial problems we now experience too.


Now bearing in mind this was during the ‘boom’ period economically too, before the recession started in 2008 – so fast forward to now, our recent options turn out to not be options at all. Indeed, NHS England has said any new contract won’t be any of the pilots, so now they are talking about two or three new pilots starting again, trialling what is in effect units of capitation activity, or UCAs if you like, but volume based targets nevertheless.

So now we seem to have claims all is changing, but the fundamental flaws remain, just repackaged as UCAs within the same ‘limited’ resources, but feeding the public the same big lie by saying: ‘To be clear, nothing in the changes planned is intended to reduce or change the scope of NHS care available to patients.’ (, 2015)

This comes to the heart of the problem that plagues NHS dentistry in England; the disgraceful lack of full openness and transparency from the Government and the Department of Health towards the public, about the real intrinsic limitations of their current fixed-budget system offering unlimited treatment for the clinical needs of the whole nation.

They then go on to claim publicly that all NHS treatments are at least as high a quality as private (unlimited funding) treatments – I suppose if you are going to tell a big lie publicly it may as well be a whopper, but to many in the know it goes beyond spin and is starting to appear delusional.

The dental profession has simply been handed mission impossible, while the Government fosters unrealistic public expectations – is this really mistaken, incompetent or genuinely disingenuous?


Either way, no progress or improvement can be made until the big lie is admitted clearly to the public. Repackaging silly volume targets and confusing quality measures with quantity measures, is just compounding errors and is frankly unacceptable.

To Lord Howe’s credit, when I asked him at question time at the last annual BDA conference if he would do the honourable thing and admit the NHS dental system was limited to the audience present, he said an unequivocal yes. For that I thank him, but NHS England and the wider Department of Health are still stuck in denial it seems, and of course one cannot find such an honourable admission anywhere in writing.

So clearly the scope or the volume has to be reduced if one is to stay in existing limited resources and actually increase quality of care to an acceptable level – this should be discussed now so MPs can be held to account democratically and to test their honesty, frankly.

So this is the bottom line, ladies and gentleman – we cannot trust the Government and the DH to be fully open and honest publicly about the limitations now in NHS dentistry. Therefore to the public what other more complex or crucial areas can we trust the Government and civil servants to be fully honest?

In the next three months, Governments and politicians of all parties, must not be allowed to sweep dentistry’s increasingly chronic problems under the carpet – they should be held publicly and democratically accountable, starting with the most important concern first, that of full honesty and transparency publicly.

References (2015) retrieved 28/01/15 (2015) retrieved 28/01/15

All content is purely personal opinion of the author and totally independent of any other posts or positions held.


  1. 1

    Dear Tony,
    I admire your perseverance. You have been shouting the Emperor is “naked” for the past two years.
    The reality is that dentistry is low key and regardless of a Torry / Libdem. or Labour government in Westminster after the GE in May, things will remain exactly the same or get worse.
    More and more people, including young adults are having “access” to a pair of forceps and ill fitting acrylic dentures instead of preventive dentistry.
    Dental treatment standards are shockingly low in comparison with any other comparable Western European country, with a similarly tax funded dental care system i.e Germany, France, the Netherlands, not to mention the Scandinavian countries.
    The overall oral health of the general public is being jeopardized and an entire generation of newly qualified dentists is being deskilled.

  2. 2

    “UDA’s were imposed on 1st April 2006, with a ‘take it or get out of the NHS completely’ ultimatum”.
    This is so.
    But leaving the NHS was an option. One which our practice took. We are still here, nearly 9 years later, practicing in a decent honest manner without a demeaning scramble for Nectar points.
    I can still remember Dr Cockcroft telling us about the loss of our NHS pensions – and frankly the ’employers contribution’ is all I miss about the NHS. With the changes in pension legislation and SIPP’s, ISA’s etc this can all be mitigated, however.
    IMHO ‘if you sup from the Devils’ cup’………

  3. 3

    Dear Tony, Much as I admire your campaign to correct a hugely flawed system, how can you ever hope to convince the Govt and public that it is so completely unfit for purpose when most dentists maintain that they are still, with only the occasional bad apple, providing their patients with high quality care, sticking to all the unfair rules and yet still earning very large average salaries of £100k plus? It simply cannot be done until we as a profession are prepared to admit to our own large part in the whole affair. Namely that most of us chose to accept the contract voluntarily and then set about making it still work for us financially even though it was to the clear detriment of the patients and their dental health. You deserve huge admiration and respect from the profession for your efforts but sadly I feel they are doomed to failure without the dental profession holding itself to account and admitting its own failings before demanding others do the same. Regards, Alastair Wrigley

  4. 4

    Sure State funded health care is better in Scandinavian countries but the people are happy to pay for It with a higher tax contribution.
    We probably have the highest, of European countries, of feckless work shy individuals who contribute nothing and take everything and drain the public purse of resources better applied to the health services. It’s time to cut benefits and redirect money. If this happened I would be more than happy to pay higher taxes.

  5. 5

    Tony – Thanks for a well constructed article highlighting the number 1 issue facing dentistry in England.
    When an addict does not admit they have a problem , no doctor in the world that can treat them of their illness. Meanwhile family and friends around them suffer.

  6. 6

    Dear All,

    Thank you for your comments here and many messages of support sent privately – it’s good to know many agree and have such deep concerns too, but often as NHS contract holders, feel under pressure and scrutiny as the 1st April approaches and meeting high NHS volume targets (or be punished and have funding cut for other nhs patients etc.) brings with it the usual threats and pressures from above to lower quality/time to rush through the higher numbers, or else !!!

    We need to be crystal clear here that we are raising concerns about a flawed DENTAL SYSTEM being unfit at a National level, with HMG’s agents claiming/misinforming everyone (including MPs???) that ALL clinical needs of the Nation can be properly met fully for everyone (they can’t) and that ALL those clinical needs met for all are at least as high a quality (they’re not) as Private (unlimited resources) alternatives for everything too 😮

    Those continual centralised public claims are about as credible as HMG’s “No return to Boom and Bust” claims were repeated in 2006 too :(

    When you put Good people into a BAD System, one get’s bad outcomes for patients.

    What kind of legacy are we leaving our younger Colleagues – how can one turn a blind-eye and stay quiet publicly or worse, actively deny the obvious truth 😕

    UDAs and their consequences have something in common with AAA derivatives, in more ways than one !!!

    We are not Bankers, we must speak out our genuine concerns now, pre-election, so MPs can have that honesty dialogue with the Public about NHS Dentistry’s growing limitations + the urgent need to go LARGE on Dental Prevention through the Media nationally.

    There is a better way than centralised denial and keeping the public ignorant or mis-informed, frankly.

    Please share this Big Truth widely…….

    Yours still clearly,


  7. 7

    That all sounds great Tony, but you still haven’t explained what exactly the problem is when looked at from the public or Govt’s point of view. They see NHS dentists claiming that they all supposedly providing the full range of NHS treatment and to high quality and they can also see that NHS dentists are still managing to earn very nicely thank you. So what is the problem and why should the system be changed in order to pay the dentists even more???? That is why your Big Lie campaign, however admirable, will never succeed unless the large majority of NHS dentists come clean. The profession as a whole, from top to bottom, needs to at last admit that they actually provide in general a pretty dreadful quality of NHS dental care, routinely ‘game’ patients by declining to provide them the full range of NHS treatment and either neglect them or persuade them to opt for private treatment instead and put their own financial best interests ahead of their patients dental health. That of course is almost impossible for any of them to ever admit to now or in the future and so the charade goes on. We all know the contract is an utter farce, but we also all knew that before we signed the bloody thing and yet so many went ahead and did so anyway! It isn’t rocket science, it is just common sense and honesty – both characteristics that are ignoble profession seems to be increasingly short of!

  8. 8

    Hi Alastair,

    In these Austere times, one is not asking for MORE money , but MORE honesty with the Public that the system is limited NOW and must be improved qualitatively, instead of giving delutional public messages that the ‘system’ is at all, fit for purpose as it’s currently imposed and promoted publicly !!!

    Only once this Big Truth is admitted publicly, can anything improve.

    The improvements needed are ‘Protected Time’ for Clinicians to do a good job consistently at a National level ( not chasing harmful volume targets) and going Large on Dental Prevention in the Media publicly, across all Medical, Social and Educational sectors, not just within Dentistry.

    Every other approach is flawed and Nothing, I repeat nothing can improve Nationally, if Government and it’s agents perpetuate The Big Lie publicly.

    They need our help for this Paradigm-shift, whichever party gets in on the 5th May and going public loud and clear on this pre-election, is the only realistic option left in the public interest IMHO.

    Yours tealistically,


  9. 9


    I work in France and over here (in the UK).
    When I first arrived I have to say I thought no European country could be worse in preventative care than France. I was completely wrong, I honestly did not think this was possible, and I still do not understand how dentists do not get sued for some of the work I see everyday… I know it is caused by the system but I don’t understand how anyone can pursue the quantitative objectives asked of them.
    You should all quit the NHS system at once, I see no point in staying in it, it is counter-productive, in many cases I see, I truly believe doing nothing would have been better…

    Best regards,


  10. 10

    A great success for UK politics and dentistry this week. We started to collect FFT data for NHS England . All our NHS patients love us and would recommend us to a family member – that surely means that NHS dentistry is completely fit for purpose. If not …. It soon will.

  11. 11

    Good discussion.

    NHS dentistry is bad for your teeth. After 42 years of experience working in the field as a dental Technician and recently as a senior dental Mechanic, I have noticed a marked deterioration in public dental health in the past 10 years (From a very low standard)

    My solution, ditch NHS, make dentists compete with each other, like plumbers and builders.

    We will still have the cowboys but the genuine dentists (and I do know some) will start to offer a fair product at a fair price.

    Expand emergency dental service.

    NHS was a good idea at the time. That time is past.

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