Criticism of Mick Armstrong’s private email that was published in the media is missing the point, argues Kevin Lewis.

Throughout my professional life I have tapped into the rich seam of answers and amazing insights to be found in the thinking and writing of Edward de Bono, who had started out by studying medicine. The world is a healthier place for the fact that he did not restrict himself to medicine. De Bono is a very thought-provoking writer and lecturer and speaker. You knew you were listening to someone really special. Recent events prompted me to recall one particular quote from his massive body of published work: ‘In a sense, words are encyclopaedias of ignorance because they freeze perceptions at one moment in history and then insist we continue to use these frozen perceptions when we should be doing better.’

Any GDP will know the frustration of loss-making ‘no shows’ by patients. The NHS GDS/PDS system in England and Wales is designed to ensure that dentists bear the cost of this out of their own pocket and also to make it impossible for more than around half of the population to access NHS treatment in any given year. It suits the state for charge-paying patients to attend NHS practices in greater numbers than the exempt or charge-remitted groups. These decisions are made by politicians, not dentists.

Irregular attenders come from all parts of society but for some practices, especially those in socially deprived areas or those with transient populations, the relentless cycle of unproductive hours with fixed overheads still to be met feels incredibly unfair. Frustration can soon spill over into outright exasperation. Against that background, a loose comment made in a private email on this subject by Mick Armstrong, chair of the BDA’s Principal Executive Committee, was leaked to the national press by a politician. As untidy and unfortunate as the use of the term ‘no hopers’ was, Mick Armstrong does at least continue to spend his time treating patients at the disadvantaged end of society – as he has always done, I gather. Like so many other dentists who still work in the NHS, he gives up plenty of his time for little or nothing. Is that worse than not giving up your time for nothing, to ensure that these patients have access to dental care? Because, hand on heart, many dentists who work exclusively in the private sector are a long, long way from offering treatment to any of the patients in question.

I do not doubt the sincerity, nor the compassion, of those who profess to care deeply about the plight of the homeless and others who are marginalised by society. But while Mick must wear the criticism for his injudicious choice of words – now that his private email has been placed in the public domain for reasons best known to those responsible – there is no basis whatsoever to suggest that he doesn’t share the same concern as many of those who have been so quick to criticise him and/or who have fallen over themselves to join the chorus. Thankfully as choruses go it has been quite restrained.

Some have even suggested that saying something unfortunate in a private email somehow brings the profession into disrepute, which strikes me as a very strange contention indeed. It is the deliberate leaking of a private email to the press when you would know or suspect that you were not an intended recipient, that is designed to bring the profession into disrepute. And even if that is collateral damage inflicted in the pursuit of other goals, some of them more admirable than others.

Unimpeachable track record

It is often said that it is difficult to get younger colleagues interested, let alone involved, in what one might call ‘dental politics’ or at least, representative work on behalf of the profession. This is often categorised as a reflection of generational change and especially of the characteristics of Generation Y/Millenials. But I remember those very same concerns being voiced in the early years of my own professional career and my generation is certainly nearer to the front of the alphabet than ‘Y’. I got quite involved in my local BDA section and at branch level and was treasurer of my LDC within a few years of graduating, but I am sorry to report that it didn’t last. Like today’s recent graduates, life overtook me. A four or five-year degree course leaves you with a lot of catching up to do, financially and personally, let alone professionally.

But if the price people pay for their willingness to give up shedloads of their time for little reward, and for putting their head over the parapet, is the feeding frenzy that greeted Mick Armstrong’s momentary lapse, we can forget about trying to get people involved in dental politics.

Mick Armstrong’s track record in representing his professional colleagues is unimpeachable. If he had even 10p back for every hour he has spent at every level of the BDA and on his years of LDC work, he would have retired already. He chaired the National Conference of LDCs, which is an honour reserved for very few members of the profession. He is not a shy, retiring and time-serving lapdog who nods when called upon to do so. He is plain speaking and outspoken, direct and sometimes blunt – and thank goodness for that. If ever there was a time when the BDA has needed a really forceful persona to lead the BDA’s Principal Executive Committee, this must surely be it. The added bonus you get with Mick is a genuine commitment to the NHS and to giving patients the care they deserve.

Silence isn’t golden

Dentistry is under threat, dentists are facing unprecedented challenges and the current plight of the NHS in England and Wales is so extreme that we could not and would not respect the BDA if it fell silent at this point. Isn’t it ironic, then, that it has been the BDA that has been setting the pace in trying to remove the obstacles that the NHS and its wretched commissioning strategy has created for the homeless and disadvantaged and those who struggle to get access to dental care? The BDA has come up with heaps of suggestions including some very innovative ones, but it appears to have fallen on deaf ears or into the ‘too hard’ or ‘too expensive’ basket.

It happens to be a campaigning Labour politician who placed Mick’s comment in the public domain, and ironically it happened to be a Labour Government that gave us the 2006 GDS/PDS contract changes and the UDA system in the first place. But this is not a political point, because the Conservative governments of the past eight years or so have been quietly content for the UDA system to continue because it is almost perfect from a political perspective. It is unfair to patients and grossly unfair to dentists, but it gives the Treasury and the Government absolute control of the spend and the agenda. So, 12 years on, why would any government want to change it? Commission the occasional report to promote the appearance that something is happening, restructure the service every few years to create a diversion, run some pilots and prototypes and take your time over analysing the results. And of course, point the finger of blame at dentists at every opportunity in the meanwhile and leak stories that discredit dentists.

Life would be so much easier for several parts of the healthcare ‘establishment’ if the BDA and its key spokespersons like Mick were to be silenced. He speaks inconvenient truths, and does so loudly and passionately. Mick has apologised both publicly and privately to relevant colleagues and committees for his one ill-chosen word amongst thousands of well-judged comments and that should be the end of it. We should all be clear that anyone trying to prolong the aftermath is doing it for entirely different and probably self-serving reasons. It is missing the point and wasting time that could and should be spent on fixing the underlying problem, which is the unfairness and discrimination caused by the UDA system and the way that NHS dental services are being commissioned and propped up by patient charge revenue.

Mick and many other dentists like him are providing dental care for the disadvantaged, not by courtesy of the NHS system but despite it. He wants to make the service better, not score cheap political points and it needs more people to speak out in private and in public to raise the debate. Nothing is ever achieved by doing and saying nothing at all, but that starts to look like the safer option.

Someone with the same amazing breadth of intellect and skills as Edward de Bono was the celebrated American, Benjamin Franklin, who from 300 years ago has a message for both Mick and his detractors: ‘As we must account for every idle word, so must we account for every idle silence.’