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My Life In Bureaucracy

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The CQC demands that all staff should be CRB checked – a requirement I could understand as a youth worker, working often alone with young people, but less so as a dental nurse whose contact with children and vulnerable people is ephemeral, who is never alone with children or young people and in times past would have been considered the chaperone for the dentist, instead of an equally suspected paedophile who has to pay around £44 to prove that I’m not. In case anyone is in any doubt, CRB checks, pushed in the wake of the Soham murders, would not have saved Holly and Jessica because Ian Huntley did not work at their school. His contact with them was enabled by his relationship with Maxine Carr, their teaching assistant, who had a previously clean record and would, therefore, have sailed through a CRB check. I think we can all agree that is £44 well spent.......on top of the annual £80 I pay in personal indemnity in case I accidentally hurt a patient and the annual £120 I pay to the GDC to prove I'm not Harold Shipman MkII. That's despite the ironic and appalling fact that under the watch of the present chief executive of the CQC, well over 1,000 people died as a result of inadequacies and disgusting conditions in hospital in Mid-Staffordshire. A death toll that Harold could only have dreamed about.

It isn’t enough for dental practice staff to regularly check the contents of their emergency drugs kit and keep a log of checks – a check log of the log of checks must also be kept. Just to make sure those divvy dental professionals know how to tick a box. I, as a dental nurse, have to tick a box to state that I have followed the correct procedures for cleaning my surgery at the end of a session. I’m no longer trusted to simply clean my surgery, you see. I have to EVIDENCE it. The evidence of my spotless work surfaces, dental chair, floors and sinks is not at all admissible. My little ticked box, however, is. I must stamp all sealed packets containing dental instruments with the date three weeks hence. After this period of time, the instruments will unaccountably (and I do literally mean unaccountably – despite all the evidence required from dental professionals, the evidence underpinning these requirements is suspiciously absent) become contaminated and need to be re-sterilised even if the packet was untouched and unopened……..unless I was to live in Wales rather than England, where micro-organisms take a whole seven days longer to contaminate sealed instruments. Moreover, if we had a vacuum autoclave, sealed instruments would become contaminated after 60 days in England, whereas Northern Irish micro-organisms become highly dangerous within a sealed packet after only 30 days. How amazing that the government has discovered those pesky bacteria behave differently depending on their geographical location. Of course, aside from the sheer tiresomeness of these pointless rituals , they ensure I spend far less time than I used to in the dental surgery assisting my dentist, looking after and reassuring our patients and doing…...well……my job.

As if that wasn’t enough to contend with, all dental professionals must be well versed in the law regarding child protection and have knowledge of the contents of the Mental Capacity Act (MCA) – a controversial piece of legislation which states that even the most obviously mentally incapable patient should always be treated as capable of making decisions relating to their dental treatment unless they, in the small time frame in which we get to see them, act in a specific way – or even dress in a specific way - which suggests otherwise.
It's interesting to note that Jonathan Aquino, a care worker at Ash Court care home in London, would doubtless have been well versed in the MCA and other relevant legislation, all of the safeguarding policies that the CQC would have demanded his employers implement and knew how to tick all the right boxes. He would, in all probability, have contributed to the 'excellent' rating given to Ash Court care home following a CQC inspection. Yet in April 2012, Jonathan Aquino was convicted of the violent assault of an 80 year old resident of the care home. Four other care workers had also been sacked in relation to the case. It is even more interesting to note that it was a relative of the abused resident who uncovered the full horror of what was happening in Ash Court rather than the CQC, unable - or perhaps unwilling - to look beyond ensuring the correct boxes are ticked and the correct paperwork is in order.

Don’t make the mistake of thinking that dental professionals only need to look after their patients, monitor their physical safety, respect their dignity and go out of their way to ensure they leave the practice happy and pain-free - practices where staff cannot demonstrate knowledge of the MCA are judged by the CQC to be failing at “standards of caring for people safely and protecting them from harm” and even judge patients to be “at risk” from staff who have not undergone safeguarding training, or who have not undergone an enhanced CRB check. You’d think “standards of caring for people safely and protecting them from harm” would directly relate to making sure our standards of infection control are adequate, or that our equipment isn’t about to fall to pieces on them. If you did, you’d be wrong. You’d assume dental professionals are there to look after our patients’ teeth. You’d be wrong.

Dental practices have been dragged into the Brave New World. The world I thought I’d escaped when I left the youth service; the world which chased me into dentistry. There is no escape from the stranglehold of beaurocracy, which has led despairing dental professionals to leave the profession, frustrated that they can no longer focus on what they were trained to do. I constantly consider leaving myself, but the thought that it either already has or will shortly infiltrate all professions depresses me enough to conclude I’d be better off staying put. At least this way I still – sometimes - get to help people and make their lives easier. The way mine isn’t being made easier.

I could go on……but that’s about all I have to say - apart from the fact that every time a CQC apologist reminds dental professionals that they are risking patient’s lives by not attending the optional mandatory safeguarding training (yes, it is both optional and mandatory), somewhere in the world, a dental nurse is one step closer to a cardiac arrest. Now, if that’s not a good reason to check the check log of the check log of emergency equipment, I don’t know what is.