We have a new Government and with it a new opportunity to look at the National Health Service. The backdrop is one of the biggest budget deficits in the world and the need to drastically cut public spending for the foreseeable future.
The new health secretary has already had to comment on the NHS following the Stafford Hospital inquiry. He indicated that he would get rid of the targets for emergency departments. This is in response to the public outcry when it became known that hundreds of people had probably died unnecessarily over a few years.
Dentistry is clearly not high profile as far as safety is concerned but the same target driven culture pervades the NHS dental services. Will Mr Lansley be brave enough to get rid of the perverse target ridden culture and in particular the UDA?
Where have these targets taken patients in the past few years? It is probably true that a small number of patients have gained access to NHS treatment because some dentists need to take on new patients. On the other hand patients seem to be receiving less treatment. Patients with high treatment need are not being seen and more teeth are being extracted. Many practices do not provide high cost treatments involving lab work at the same rate as they did before the new contracts came into place. Ask your local dental technician how many crowns are now being made.
We have Steele pilots about to start looking at potential alternatives to this perverse system but is there time to run these in the face of public spending cuts at a scale we have not seen since the 1980s?
If we look next door in Ireland the state has capped the expenditure in the state funded Medical Card scheme which offered a core dental service. Overnight many dentists faced huge reductions in their turnover and the poorest patients have lost access to all but the most basic of emergency dental services. Whilst unlikely to happen on the same scale in the UK, it is an indication of the degree of cuts that can be necessary.
The real beneficial outcome of the previous contract is that the health department now controls the amount of expenditure in NHS dentistry. However the distribution of funds within the system is grossly unfair with a huge variation in UDA values between PCTs and between dentists.
So Mr Lansley has two challenges ahead: how can he introduce a system that produces good health outcomes and are adequately resourced, and; how can he produce a system without the perverse incentives and unfairness that have been endemic in NHS dentistry for far too long. The answer lies in a well-funded core service with a safety net system for those patients who need significant restorative care. Hopefully the health secretary will abandon the political dogma of his predecessors and take a hard look at what the country can afford and what is in the best interests of patients.