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Dental Governance on a Human Scale?

Dental Governance on a Human Scale?

I have been reading coverage and watching interviews about the latest book by Steve Hilton. Apparently, he is the favourite political guru of David Cameron and therefore his ideas are ones we might expect to be implemented in the next five years. You might find a perusal of @stevehiltonguru on Twitter to be interesting, his TV appearances suggest he has been coach to “Call me Dave” in the way Chris Barrow has been a polarising national coach to the UK dental profession.

Our profession has massive frustrations with our daily lives and the restrictions which are all around us, reaching out to almost affect our pattern of breathing. Steve Hilton argues that what has happened, as our information society has developed, is that it has become easier and easier for systems which we must follow to be written and then codified. I believe our dental profession has been trapped by this codifying of systems, almost trying to make every dentist work and behave in the same way, with the same paperwork, the same records. The words I am using here could be used for every field in the UK, ask your spouse, your friends, professional colleagues, business people, all are being stifled by the weight of the state's hefty duvet of regulation.

In the 20th century, Hilton argues, due to the way communications worked, only the people in the centre were able to make decisions, and these rippled out, in some cases enforced. Before the Industrial Revolution, decisions were taken locally as the communications of the times meant a distant ruler in the capital city may impose large scale decisions such as war and taxation. The King in the castle could not micro-manage the daily actions of subjects hundreds of miles away, the local lord, or sherrif imposed their version for their area.

Can the philosophy of applying those systems allow us to be trusted again with making our own decisions, our own leadership, rather than being force fed by the nanny state?

Nationally, this broad idea encompasses powerful, executive, city mayors. This concept is being taken forward, we will see this as more and more city mayors take office across the UK. The benefits will be a translation of what may be a well meaning law or regulation emanating from a Whitehall Minister's desk, into what this means in a locality, where a well argued, seemingly sensible, national edict may be counter intuitive to the situation on the ground.

If there are to be more and more local mayors, or decision makers, could this idea be applied to dentistry? Many agree that the whole profession is frustrated daily by the national edicts which do not fit in with how we run things on the ground, in our own practices, or in our own areas?

In oral health provision, the needs of differing areas do vary widely. Truly local decisions will help people on the ground, the providers of healthcare working together with the recipients of this care. How can we move the profession away from political control, away from the politicos who are able to speak publicly and utter soothing platitudes, but when devising and enacting changes, they seem to be regularly and plainly wrong? But our decision makers must be of the people, possibly elected, and definitely not from the present Dental Public Health elite who continue to drive change in their narrow eyed image.

Decision making for the future of our profession needs to be more human, more involving, and not just showered onto dentistry from the top down. This itself will mean different things to different people, but will allow concepts from grass roots to flourish, we have many mechanisms for communication, to set the agenda, and make the changes. The age of imposing change must now be over.

My call now is for our largest trade union, the BDA, to take this forward to this new Government on terms that fit in with their style, their politics, their understanding,  in order to make a change to the top down mindset. This is about freedom, modern politics, and a move away from the paternal style of the last century, using modern coimmunications but not only in a single direction.

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Comments 2

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Anthony Kilcoyne on Thursday, 21 May 2015 09:11
Top-Down remote Hierarchy

I agree TJ, the past Decade+ of top-down dictatorial experimentation has failed Patients and the Profession.

It's time to acknowledge the current problems/failures fully openly and transparently, so that from a good diagnosis, a good treatment plan can be formulated that is more BESPOKE to local needs, with more freedom/power devolved locally to allow different approaches where needed.

Isn't this what is being tried in Manchester soon?

Limited funding/resources are a reality - acknowledge this and plan accordingly so the harm is minimised and the most vulnerable prioritised, with others informed/empowered to prevent/reduce future needs too, which Dentistry lends itself very well to significant prevention!

Yours agreeably,

Tony.

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I agree TJ, the past Decade+ of top-down dictatorial experimentation has failed Patients and the Profession. It's time to acknowledge the current problems/failures fully openly and transparently, so that from a good diagnosis, a good treatment plan can be formulated that is more BESPOKE to local needs, with more freedom/power devolved locally to allow different approaches where needed. Isn't this what is being tried in Manchester soon? Limited funding/resources are a reality - acknowledge this and plan accordingly so the harm is minimised and the most vulnerable prioritised, with others informed/empowered to prevent/reduce future needs too, which Dentistry lends itself very well to significant prevention! Yours agreeably, Tony.
Keith Hayes on Thursday, 21 May 2015 17:55
Human scale yes, but which humans?

I agree, wouldn't it be nice if we could take the clock back and have a dental profession which was responsible and self governing. Where the GDC genuinely put patients first by regulating professionals fairly and using a set of goal posts that where actually in the right position with the cross bar at the same height as all our peers have agreed.
Wouldn't it be nice if we had a more sensible payment system which whilst cost controlled, still enabled everyone to access a good standard of care and left people free to choose more expensive items if they wished.
Wouldn't it be nice if we had a CQC who regulated every practice the same way to the same agreed standards using a measurement which they published.

Well the Government has now tasted having complete control of the whole of dentistry and appointed civil servants and lawyers to every position where our profession used to have a say. I would have said that they wouldn't want to ever give up this position of power until recently. However, maybe even the Government is able to see that just repeating old disasters is not going to bring about an improvement and I am beginning to wonder if they are on the brink of making some bold decisions to give back some of the autonomy to professionals. We have the Manchester experiment, we have a new CDO, we have the GDC making noises about a fairer system and we have the CQC trying out its more focused approach and even listening. I have even experienced an occasions an Area Team has asked to work with a dentist to improve standards as opposed to turning a blind eye or dumping a load more UDA's to make the situation worse. We now have the Faculty offering open access to standards and the BDA even seems to have found a set of teeth in the making in its bottom drawer and may yet get to the bite and try in and even finish its business with the GDC.

Could there yet be a light at the end of this long tunnel, and hopefully not an oncoming new UDA Express train.
Maybe I'm just hopelessly optimistic or had a wee dram too many.

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I agree, wouldn't it be nice if we could take the clock back and have a dental profession which was responsible and self governing. Where the GDC genuinely put patients first by regulating professionals fairly and using a set of goal posts that where actually in the right position with the cross bar at the same height as all our peers have agreed. Wouldn't it be nice if we had a more sensible payment system which whilst cost controlled, still enabled everyone to access a good standard of care and left people free to choose more expensive items if they wished. Wouldn't it be nice if we had a CQC who regulated every practice the same way to the same agreed standards using a measurement which they published. Well the Government has now tasted having complete control of the whole of dentistry and appointed civil servants and lawyers to every position where our profession used to have a say. I would have said that they wouldn't want to ever give up this position of power until recently. However, maybe even the Government is able to see that just repeating old disasters is not going to bring about an improvement and I am beginning to wonder if they are on the brink of making some bold decisions to give back some of the autonomy to professionals. We have the Manchester experiment, we have a new CDO, we have the GDC making noises about a fairer system and we have the CQC trying out its more focused approach and even listening. I have even experienced an occasions an Area Team has asked to work with a dentist to improve standards as opposed to turning a blind eye or dumping a load more UDA's to make the situation worse. We now have the Faculty offering open access to standards and the BDA even seems to have found a set of teeth in the making in its bottom drawer and may yet get to the bite and try in and even finish its business with the GDC. Could there yet be a light at the end of this long tunnel, and hopefully not an oncoming new UDA Express train. Maybe I'm just hopelessly optimistic or had a wee dram too many.

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