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It’s good news week
22nd Oct 2008
Barry Cockcroft is in an upbeat mood when we meet in his office on the 11th floor of the DoH building on London's South Bank. The office is surprisingly compact, but with a view overlooking the Thames that more than compensates. The response to the Commons Health Select Committee is due out in four days time, but he's giving little away.
For a man of little available time, the CDO can spare an hour before catching a train to Warwickshire in his role as chief dental advisor to the government and where he practised for most of his dental career.
Is Friday 3 October a good day?
‘It's been a great week,' he says. He's just completed a whistle-stop tour of the UK – out in the field, meeting dentists, opening new practices and promoting pioneering government initiatives on oral health – taking in Market Harborough, Nottingham, London, Durham, Darlington, Leeds and back again to London.
‘It's a lifestyle that is hard work, but very rewarding,' he insists. It's a role he has held almost three years to the day (appointed 1 October 2005 initially as acting CDO) and also one that takes him away from his family home in Rugby a lot of the time. He has lived there since 1979, spending weekdays at his flat on the Isle of Dogs whilst seeing his wife only at weekends.
‘We have more intelligent conversation now than we did when I was at home,' he jokes.
He enjoys Bolton Wanderers FC, rugby union, theatre and live music, listing guitarist Mark Knopfler, ballet dancer Darcey Bussell, heartland rock legend Bruce Springsteen and the obscure folk musician Eliza Gilkyson among the entertainers he's seen live to date this year.
Travelling extensively – and needing to be contactable at all times – has meant he's submitted to the all-essential BlackBerry that he both loathes and stubbornly spent two years rejecting. But he obviously values the time spent at home with his wife and family (his three children are not far away).
When asked for the three things he would take to a desert island, his answers are: ‘My wife (I better say that), a radio and a boat but definitely not my BlackBerry.'
Singing praises
He finishes off an email, apologising profusely for the delay, even though the scheduled time for the interview is 15 minutes away. He is courteous and chatty, but remains on his guard. He admits he is wary of the dental press, dismisses the national press, but sings the praises of the local newspapers who, he believes, don't just focus on the woes of dentistry, but ‘do cover the good news, the new NHS surgery openings etc'. And you better believe him – he has a pile of cuttings as evidence to prove it.
The CDO is keen to promote the DoH preventive initiatives on oral health, the numerous openings of NHS practices across the country and the general ‘feel good' factor when he's out and about among ‘real dentists'.
It is his duty to defend to the hilt the April 2006 contract – and as chief advisor to the government, he has some urgent questions that need answering in less than a week. He says he sees the new contract now moving into another phase: less rigid, more localised and flexible with dentists and PCTs working together for the greater good etc… He constantly leaps from his desk, gathering evidence of these new government initiatives, calling on his PA, Joyce, to copy documents and fetch CDs and generally collate and offer up the ‘good news' NHS dentistry has to offer.
What's the next stage of the April 2006 contract, bearing in mind the criticisms in August's damning report by the Commons Health Select Committee?
‘We took where we were in April 2006 and set up a formulaic trasition to a local contracting system – now – it can move into a more flexible phase with PCTs and dentists working together to create specific dentistry for specific areas – the fundamental is stability with growth.'
Although the report says the government's goal of improving patient access had ‘not been realised', the MPs involved did acknowledge assertions from Barry that the situation had stabilised and improvements would soon be seen.
He is keen to expand upon this, and maintains that with PCTs being given additional funds (that must be spent on dentistry) they would soon be meeting targets for patients and access.
That said, will all PCTs do this adequately? He admits ‘some are better than others' but that ‘there are some outstanding PCTs'.
The government is on a mission to work with PCTs. So far, there have been three out of four planned NHS road shows on ‘Delivering Better Oral Health', promoting the use of an evidence-based toolkit for prevention aimed at all interested parties. The move is to promote a more preventive form of dental treatment and 100 PCTS out of 150 so far have heard the message. Their job will be to implement this population-based preventive programme and commission ‘appropriate NHS primary dental services to meet local oral health needs'.
This, he says, is ‘not rigid and not target-based' and insists that ‘dentists need to work with PCTs for it to work', a sentiment echoed by the British Dental Association.
‘It's got to be done locally,' he adds.
He cites the groundbreaking dental initiative, trialled at a west-London branch of Asda, as a perfect example of the NHS reaching out to people – children mostly – some of whom have never seen a dentist. ‘This initiative is not about treatment, it's about making a link,' he says.
Earlier this year in Hounslow – an area of low take-up and hard-to-reach families – dental professionals pitched up in the supermarket and saw some of the area's poorer children.
‘Out of those children who visited, 85% hadn't ever seen a dentist,' Barry explains. They piloted it for a week (Hounslow is health minister Ann Keen's constituency) and plan to roll it out over the next few months with a view to educating those parents who have, until now, never taken their kids to the dentist. The radical government plan also involves a fluoride varnish for all children.
Barry says: ‘There is oodles of dentistry in London. The capital is well-served by dentistry, but the uptake is poor.
‘We have the best oral health in Europe in terms of children. It's about education, via doctors, health visitors – and everybody involved in the healthcare of children, including parents. We need to educate the educators.'
And what's to happen to the ‘unworkable' child-only contracts?
‘The Health Select Committee said “We don't like them and we don't want them”. It really is an issue for PCTs locally but we don't see a long-term future for restrictive contracts lilke these.'
He repeatedly expresses his weariness over the national press's penchant for ‘creating the perception that there are no dentists'.
‘Probably because of its profile, dentistry is very important to people and it's in the news a lot,' he accepts. ‘But in Hull, like many other areas, they can offer a choice of an NHS dentist in a week. Also, NHS dentists are now advertising for patients, and many PCTs working with their dentist can now place the NHS logo outside practices to make them more visible. There should not be any uncertainty,' he says, adamantly.
Pulling no punches
If NHS dentistry is on the up – and the good feedback that's he getting from NHS dentists is to be believed – then how does he see the future of NHS dentistry and private practice co-existing in the dental market?
‘I think the important thing is we give patients an informed choice,' he says. ‘I do have an issue when people have cosmetic dentistry that is not in their best interests. People should have it explained to them. Some private practitioners have been critical of services on the NHS and this is disappointing. But if you're a long-established private practice with a good cohort of regulars, then you have nothing to fear,' he adds.
But he pulls no punches when he points out that NHS dental care is both ‘cheaper and regulated' and that many private practices now ‘want NHS contracts' again.
‘And with a recession possibly just around the corner, private dentistry may not be popular for a while,' he adds. He also seems amused at any threat of competition from dentists abroad offering a cheaper, alternative service to the NHS. According to his sources, he says, the much-publicised UK tour of an inflatable dental surgery staffed by Hungarian dentists – looking to attract dental tourists – has so far only provided transport packages for a handful of patients, and is really competing with the private market in the UK.'
Does he enjoy his role? ‘Dentistry at the moment is high profile: most of it in a good way. You need a thick skin, but I constantly get out and meet real dentists doing a real job and it's good.'
When he initially took up the gauntlet, he continued practising for a while, until this became too much of a challenge.
‘Now when I'm out shopping at the supermarket, former patients come up to tell me how they've seen me on the television,' he smiles. And finally, when did the country's chief dental officer last see a dentist? Very recently, and yes, he ‘goes NHS'. And he's laughing when he confesses the irony that he did once receive emergency dental treatment for a cusp fracture from one of his biggest critics – although as to exactly who, well… he's keeping his mouth firmly closed!
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