Dental Tribune UK Edition, September 20-26, 2010, Vol. 4 No. 22

L ord Howe has had a long involvement with health issues, having been opposition spokesman for health since 1997. Although never a specific responsibility of Howe’s, dentistry is some- thing that has been a part of the general issues surrounding healthcare. “I have always been well aware of the general issues that the area of dentistry in- volved; it was no accident that my party colleagues and I, in preparing our manifesato, made specific promises about dentistry. As the minister now charged with looking after den- tistry I am very pleased that I have this responsibility. Key Representatives “Although I have only been here for a few months I have made it my business to have meetings with key representatives from the profession to bring myself up to speed. I’ve met the BDA twice and I attended a reception in Westminster where I spoke with a number of stakeholders. I have met Prof [Jimmy] Steele informally, and I am due to meet him again within the next few weeks. In addition, I’ve re- ceived a number of invitations to visit dental providers and have already visited a clinic in Cambridge, which was extreme- ly valuable to me.’’ The political place dentistry seemed to hold in this year’s General Election shows exact- ly how much of a key issue for the voters it is. “I think dentistry is as much a priority for us as it is for the public. It’s become more salient as a health issue for the voter than maybe it was a few years ago, we certainly sensed this when we were in opposition. Dentistry on the radar “The importance of oral health in terms of how it plays into gen- eral health is certainly not lost on us and I hope you will have felt from the Health White Pa- per that dentistry is very much on our radar. Of course we have got to work out exactly how the system is configured but we are clear that we want an architec- ture for the health service that promotes quality, that promotes the prevention agenda and that gives consistency in commis- sioning services.’’ Lord Howe is by no means immune to the size of the task facing dentistry in tackling the oral health inequalities that still exist around the country, calling it ‘the biggest challenge’. He is keen to see the adop- tion of a number of approaches to improve the picture in terms of child oral health, many fo- cusing directly on the dental contract. “The statistics that I have seen on children, which is a particular area of concern that I have, are quite encourag- ing in that oral health in chil- dren seems to have improved much over the last 20 years. Yet if you drill down into those figures you do see a pretty hor- rific picture in terms of those children whose oral health is poor and I think that there are a number of approaches we can adopt to this. “The reform of the dental contract lies at the centre of this. You will have seen in our elec- tion manifesto that we built in an undertaking to reform the dental contract. I have asked of- ficials to take that work forward - obviously it can’t happen in- stantly - but the principles on which a new contract should be built are there. “There needs to be a pro- nounced emphasis on preven- tion and a move away from un- intended perverse incentives. Although the current contract was formulated with extremely good intentions - one mustn’t de- cry its good features - I’m afraid there have been some perverse consequences arising from it and I think both dentists and patients have been aware of these. End of UDAs? “Does that spell the end of UDAs? We’re looking at all of that. I think that the Steele re- view had a great deal of informa- tion in it which will inform the work we do on modifying the contract; on the whole the Steele review met with a good response. So, I am taking stock of all that before deciding in any detail how we are going to take the reform forward.” Of course time is a major factor in the reforms and Howe is very conscious of the balance between getting things done and rushing the process. “One can never do things as quickly as one wants because there are so many things that are sub- ject to consultation and detailed work - it can’t be done in a hurry. I can’t tell you that in a year’s time we will be on the brink of as new contract, that would be too soon, because any new contract will have to be piloted, we have to be sure it is going to do what we all want it to do, so we’re looking rea- sonably far down the track in terms of this Parliament. By the middle of this Parliament I would hope to be very much further with the new contract.” Centralised control The biggest topic that has been discussed over recent times is the White Paper and the im- plications that it will have for dentistry. Speaking of the pro- posed return to more centralised control over dental commis- sioning Lord Howe said: “The point of that proposal is that we should first of all have a com- missioning mechanism designed to ensure consistency, as I mentioned, and in the stand- ard of consistency. One of the commissioning board’s tasks will be to promote equality and access, and its access to a service that delivers quality that I think lies at the heart of this. “Also I think that we felt that it wasn’t appropriate to give GP consortia the commission- ing responsibility for dentistry. I think that it sits more logi- cally with the board as it does with services like Pharmacy and we’re looking at other areas which may more logically sit with the NHS commissioning board, nothing to do with den- tistry. How the board configures itself is a matter for them. But I would be surprised if it didn’t consider regional outposts so that services such as dentistry are commissioned with a view to the needs to a local population.” One of the major fears ex- pressed over the new proposals is what is going to happen in the period between PCT control and the taking over of the reigns by the NHS Commissioning Board. Many practitioners are concerned about how they’re going to be able to interact with their PCTs in the interim period, and Lord Howe was quick to reassure: “This is a very im- portant question and it’s one that we’re looking at across the piece. I would like to reassure practitioners that we are alive to the risks in all of this but we believe it to be manageable and we have time in which to make sure that nothing slips between the cracks, not least dentistry. “PCTs are clear as are stra- tegic health authorities that they have a very important role to play in making sure that this transition works smooth- ly, we will be setting up the NHS Commissioning Board in shadow form quite soon, so that by the time it starts its role for real we should have sorted out most of the transfer functions. Of course we don’t plan to abol- ish PCTs until we are absolute- ly sure that the transition has occurred. I can understand the anxiety of dentists but I think they need to be assured that I am very much with them on this. I am not going to take risks with the way that NHS dentistry is made available to patients and there certainly will be no hiatus in terms of administration.” HTM 01-05 Another controversial topic in dentistry is the issue of cross infection control and the HTM 01-05 guidelines. Lord Howe, though reluctant to revisit the guidelines, did say he believed that they needed more clarity: “HTM 01-05 is going to stay in force as it is, but the messaging has to be clear because there has been a lack of clarity in this. Clearly, patients expect to be treated in a safe environment, and dentists and dental staff ex- pect to work in a safe environ- ment, that I don’t think is a mat- ter for argument. ‘‘Currently the HTM 01- 05 guidance sets out two dis- tinct things; it sets out essential quality requirements, which practices have to achieve by the end of this year. Now I have looked at this in some detail with CDO Barry Cock- croft’s help and I’m absolutely clear that no self- respecting dentist would wish to do any- thing other than to meet essen- tial quality requirements and actually the HTM 01-05 guid- ance does no more than reflect existing guidance. The essen- tial quality requirements differ One Lord a talkin’ - exclusively to DT Dental Tribune recently met with Lord Howe, Parliamentary Under Secretary of State (Department of Health) with responsibility for dentistry, and asked him about his feel- ings about the current dental system and where he feels improvements could be made. ‘One can never do things as quickly as one wants because there are so many things that are subject to consultation and detailed work.’ page 8DTà Lord Howe: I think dentistry is as much a priority for us as it is for the public 7InterviewSeptember 20-26, 2010United Kingdom Edition