Saturday, 6 August 2016

Pulling teeth


Many thanks to those readers of this blog who have written to me commiserating with the dental problems I talked about in my last post. Treatment is still ongoing.
But it seems that I am lucky in having a dentist who offered me the choice of root canal treatment rather than an extraction. Because it is reported today that many dentists now extract teeth unnecessarily as they receive the same amount from the NHS as for more lengthy and expensive treatments such as root canal surgery. NHS dentists are paid per ‘unit of dental activity’ and both extraction and root canal surgery constitute three units of dental activity. But since an extraction takes on average half the time of root canal surgery, there is an incentive to extract.
Here we have a very precise illustration of the perverse effects of targets, discussed on p.33-34 of the book, and the nature of bureaucratic dysfunctionalism. Like so much else that I write about in the book, the issue is not just one of the technicalities of organizational systems. Rather, dentistry in the UK has fallen apart for ideological reasons. Unlike other NHS services, it is no longer free at the point of use and quite hefty charges have to be paid. Indeed in many parts of the UK it is impossible to get access to an NHS dentist at all.
The roots (hah!) of this go back to the 2006 dental contract, the high watermark of New Labour infatuation with quasi-market and managerial solutions to the provision of public goods. In the intervening period there have been numerous complaints and reports, but nothing much has changed so that in March 2016 the British Dental Association (BDA) said:
​“The 2006 dental contract is not fit for purpose. It rewards dentists for hitting government targets for treatment and repair, not for improving their patients’ oral health. It was meant to improve access to NHS dentistry and put prevention at the heart of the service, but it has failed on its own terms. It has deskilled and demoralized the profession, and received criticism from patient groups, government, the Health Select Committee and the Chief Dental Officers for England and Wales.”
It’s important to understand that behind the bloodless formulation of being ‘not fit for purpose’ lie real people and real suffering. The consequence is self-dentistry, meaning, to be blunt, people extracting their own teeth with pliers. This in one of the richest countries in the world.

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