Speaking at the Health and Care Innovation Expo on March 3, Sir David Nicholson, outgoing chief executive of NHS England said the NHS will be condemned to a ‘managed decline’ without radical change. He added: “Those who say we can muddle through for two or three years as we are and sustain the NHS are wrong.”
Two or three years? Dentistry has been muddling along ever since the full impact of an ineptly designed contract became apparent in 2006. And it looks likely to be muddling along for at least Sir David’s timeframe.
At the Dentistry Show, a Department of Health spokesperson said candidly that to expect a ‘great new system’ in 2015 was not on the cards, and that implementation was a ‘little way in the future’. So much then for those who believed that we were on the cusp of transformational change in dentistry. Are we sleepwalking into a period where detail is more important than outcomes? While no-one, least of all the professions, would wish to see the kind of scramble that took place in the months leading up to April 2006, there needs to be a greater sense of urgency.
We need to work hard and fast to engender a major change of perspective both within dentistry and in the wider public. ‘Repair and repeat’ simply cannot be afforded in the years to come.
But the alternative has its own dangers too. A preventive approach is accepted as the only route to survival, but as the latest NHS Pilots Learning and Outcomes Review almost suggests, prevention may turn out to be more expensive, in terms of resource and process, than the alternative.
To be in any way effective, a preventive approach must be collaborative. ‘There is nothing that the dental team can do that will overcome what the patient won’t do’ as the old adage has it. We have to change the public’s views and expectations of dental care.
Collaboration also needs an acceptance of team working within the professions. Without effective delegation throughout the dental team, we simply cannot achieve a cost-efficient approach. And finally we need collaboration between the public and private sectors, both of which have a real and valuable role to play. There will always be those who cannot afford even a modicum of disposable income to pay for private care. Equally there will always be those who will seize the additional choice and personalisation that such care can bring.
Both deserve ‘quality’ in the true sense of the word, in a clinical situation where the patient is truly at the centre of care. Prevention is also a misnomer: what we should be talking about is really ‘preservation’, a term which I think Professor Nairn Wilson originated. That means the effective management of existing disease, to slow or even halt its progress and to maintain a functional dentition for the ageing population.
I’m fond of quoting the words ‘we know enough’ which were written in a handbook of preventive dentistry (the reference escapes me) in 1975. We do know enough, enough to prevent the majority of dental disease and disfiguration, even though the microbiology and the aetiology is not nailed down at the edges.
What matters is whether we have the bottle to seize the moment and do something about it, because it seems no-one else will, and muddling through is not, it seems, an option any more.