It's one of nature's little jokes, that those of us (of a certain age) who like to look backwards more than we used to (or should do), suffer from advancing restriction around our atlanto-axial joint (between the first and the third cervical vertebrae – but you knew that, didn't you?).
The result is that the young, who (we think) should spend more time metaphorically looking over their shoulders, are well equipped, anatomically speaking, to do so, but don't, while I can only manage a quick squint backwards, and have to do my reflecting in print.
Anyway, what set me off this time was the use of the words 'No dreaded UDAs' spoken by Earl Howe at the BDA Conference at the end of April. That a minister should use a phrase such as that reflects his Government's distaste of the 2006 contract methodology is not too surprising. He can always blame it on the last lot. But when you think who writes (or at least assists in writing) his speeches for him – well, surely that must include some who had a hand in that contract's introduction?
But then, if we go back to December 2010, the official newsletter from the health department broke new ground in its own way, when it said: 'Prevention should be seen as part of the measurement of quality of a service, not the activity. Beyond the lack of appropriateness of UDAs there are many aspects of prevention–based services that require change...' (my italics).
So the death knell for the UDA was sounded officially over two years ago. That contrasts rather well with the bold statements, headlined: 'Benefits the new system will bring', which set out the aspirations for NHS dentistry as seen by the health department back in 2005.
Its guidance said then, of Item of Service arrangements that 'Dentists are paid for providing treatments but not for prevention or advice'. That assertion is contrasted with the promise that: 'The new arrangements will enable dentists to undertake prevention work and to exercise clinical judgement without being penalised financially'.
Now scanning that guidance publication in hindsight (neck strain again) brings to light a number of promises: for instance that PCTs would be: '... enabled to provide assistance and support, including financial support, to providers of primary dental services' (my italics again). Maybe that happened, somewhere, to someone, but I see that an April 2012 survey by Lloyds TSB reveals the less than palatable truth that 43 per cent of dentists have, in fact, had 'negative' financial support in the form of clawback in the past financial year.
What other heady promises were given back in 2005? Well, dentists 'Will be free to provide the treatments they consider to be clinically appropriate'. Specifically, the guidance draws attention to the fact that tooth-coloured fillings as opposed to amalgams were not previously permitted. So, were lots of posterior composites subsequently provided I wonder?
Moreover, seniority pay would be replaced by a 'new framework that rewards dentists' skills, competence and expertise in the provision of oral healthcare'. I must have missed that one.
I guess that I could be taken to task for omitting to mention that clinical data shows that over 550,000 prescriptions for fluoride toothpaste were issued by dentists in 2011, and that upwards of 800,000 courses of treatment delivered under the NHS included the application of topical fluoride. Sadly, 91 per cent of children's treatment courses did not benefit from this latter measure.
So it seems that the politics of optimism often comes to grief on the rocky shore of reality. Looking back is not always helpful then, as a guide to what subsequently happens.
Nowhere has that been more true, as I have written before, than on the topic of the Care Quality Commission. I happened across a letter written, in August 2010, by the Secretary of State, Andrew Lansley, to a fellow MP on the subject of a constituent dentist's anxieties over the forthcoming registration and regulation of dentists by the CQC. In concluding his letter of reassurance, Mr Lansley wrote:
'The CQC is currently developing its methodology for the application process and monitoring ongoing compliance.... It intends to test this with providers and is keen for those with an interest to work with it. I am determined that these discussions lead only to an essential minimum requirement for record keeping and information from dental practices.'
Looking back, you might want to read that again, and see what you think.