Whether you prefer the Australian description of ‘rorting’ (abusing or taking unfair advantage of) a system, or the colloquial British version of ‘ripping off’, many improbable yarns have been spun in recent weeks about sharp practices in healthcare.
Dentists – as ever – capture the headlines on the basis that some dentists charge more than others. Now there’s a thing! I must have missed the Daily Mail’s investigation of restaurants and hotels that don’t all charge the same amount, all over the country, all year round. In modern, progressive free market, capitalist economies like Russia and China, who know about these things, differential pricing would raise no eyebrows at all these days. Indeed, our own government purportedly champions free market economics and consumer choice so this faux-surprise expressed by the media and consumer bodies that dentists don’t all charge the same is starting to sound like a broken record.
For younger readers I use the word ‘record’ in the sense of the fashionably retro shellac or vinyl discs that preceded the CDs and compact discs that were popular during the Neolithic period. It also reminds me of another ‘Rip’ – Van Winkle – who fell asleep for 20 years and awoke to a world he did not recognise. Do these ill-informed journalists not realise that the days of almost universal NHS care, with patient charges fixed by the state, flat rate across the country, have gone? Long gone. Perhaps they should be introduced to the reality that for charge-paying NHS patients, they pay for the first filling and then get all the others free. It won’t take long before a creatively bereft investigative journalist asks why patients are being unfairly and excessively charged for the first filling when the correct charge is zero.
Typos come free
Joyce Robins, co-director of Patient Concern, concluded: ‘Patients are being ripped off’. Don’t bother visiting the Patient Concern website for further explanation of why she believes this, because it has been taken down and carries only a statement (complete with the spelling mistake in the fifth word): ‘Sorry, but due to circumstanses [sic] this website Patient Concern is no longer available.’ Meanwhile, Katherine Murphy (chief executive of the Patients Association) was shocked that different dentists charged different private fees. ‘This is not right and it’s not fair’ she proclaimed. ‘This means that there is a huge gulf between the haves and the have-nots.’ She started life in medical nursing but was clearly a thwarted comedian. She added: ‘The inequality of a postcode lottery is just another kick in the teeth.’ Very good Katherine, very good.
Clearly Rip Van Winkle had no problems sleeping, but unless you are a registered insomniac, I doubt whether you will have seen the latest dental commissioning figures published by the English Department of Health (for the quarter July-September 2016). The headline story is that commissioning has been delivering the strict control and stability that the government has always wanted and needed, after years of wrestling to regain control over the spend on dentistry. The total UDAs commissioned at a macro level has hardly flinched for the last seven of the 10 years since the UDA system was introduced. At a micro level there are variations between regions and there are very modest trends over time. Fewer UDAs are being commissioned in London and central Midlands, while the reverse is true in the west Midlands and especially in the east.
Overall, slightly fewer UDAs are being commissioned compared to a year ago but these differences are not the story. The lack of difference is the real story, because as time passes less and less of UK dentistry is being delivered through the NHS.
This is probably most obvious in London, but this is by far the biggest of the regions and the one where private dentistry is a realistic option for more of the people. It is a silent victory for the government with no damage done at the ballot box, and leaving dentists to take the blame in the media when different overheads and other factors lead to different prices from different providers. You pays your money and you takes your choice, while the NHS still provides price control for those still receiving NHS care.
You may have seen that yet another story has unfolded of a former CEO of an NHS hospital Trust – this time Miles Scott of the St George’s University Hospital Trust serving SW London – winning the lucrative healthcare managers lottery. He left the trust six months ago in the face of criticisms of the leadership, governance and deteriorating patient safety standards and not least a record budget deficit of £52.6 million. The CQC has just placed this Trust into special measures. Mr Scott’s successor lasted less than a fortnight after concerns emerged regarding her own historical performance while in a senior position at another Trust.
In recognition of his services, Miles Scott himself moved on to – wait for it – NHS Improvement, where he has been seconded to help other underperforming trusts to raise standards. And St George’s continues paying him his £220,000 pa salary through all of this. You just couldn’t make it up, could you? John O’Connell is the CEO of the Taxpayers Alliance and this is what he had to say: ‘There is a worrying trend of impunity in the public sector where fat cat salaries don’t seem to reflect performance and nobody is held accountable for the failure to provide taxpayers with the service they pay for and expect.’ And what, we ask, does Katherine Murphy have to say on behalf of patients this time? Nothing, apparently. But if Miles Scott had been a dentist…heaven help him.