I do wish I had said that…#2 – Is the Boa of Bureaucracy killing Professionalism?

A recent posting on GDP-UK by Tony Kilcoyne

Dear All,

The essence of being a Professional is to put patients’ best interests first, before our own, before any systems we may work within and even before Government Policy and experimentation.

Yet it is clear such Professionalism is under constant attack and being compromised – a classic example in Dentistry is the débâcle of NICE guidelines on dental recalls being imposed upon NHS Dentists, where they have to send as many patients as they can away for two years to help bureaucrats hit centralised dental access targets before 1st April, even though this increases risks of disability, disfigurement and even death for those who can no longer have their Oral Cancer checks annually at their dental check-ups. (BMJ article link here)

Dentistry is a ‘fixed-budget’ service so after fixed-overheads are paid out only then is any funding left to treat the same number of people. Even in Private Practice in these recessionary times this is true, because one cannot simply just raise one’s prices in a free market without suffering less turnover, which has tended to happen with more Dental Practices struggling or even going bankrupt now than at any other time in our history.

So if the fixed costs (incl. bureaucratic) increase, patient funding decreases inevitably – yet what does this Coalition Government do having promised to reduce Bureaucracy for healthcare workers so they can spend more time and resources on frontline care for patients – yes it massively INCREASES the Bureaucratic burden on Dental Practices instead, by imposing the CQC upon an already GDC regulated Profession that was already held accountable for it’s premises and management systems ( GDC Publication here) with plenty of FtP disciplinary cases to show how registrants can be struck off for such breaches.

It was the English DH who made-up the case for the CQC to Ministers on a cost-saving basis, but it now is becoming apparent his was very poorly done and badly judged, if the latest comments by the cross-party Parliamentary Accounts Committee into the catalogue of CQC poor performances is anything to go by.  (Read report here)

The above report concludes the CQC cannot even adequately govern it’s own poor performances, let alone that of others, yet those who gave them Dentistry to govern have no responsibility or accountability for their poor judgement or the knock-on effects at all

There simply isn’t room here to list all the waste & additional meaningless paperwork policies we have been forced to waste limited time and resources with CQC, which ultimately one can only conclude MUST have harmed patient care overall in our fixed-budget systems.

Do I even mention HTM 01-05 and it’s experimental and costly imposition upon Dental Practices too, where hospital systems that kill 3000-5000 people a year are being imposed upon dental practices who kill zero people annually? This then compounds things even worse in other Countries like Northern Ireland who copy and go to further unnecessary extremes, forcing dental practices to lose a Surgery that COULD have been treating patients to create an LDU, or be closed down! Either way precious limited resources are diverted away from providing frontline care and this in a Country where their young child dental health is one of the worst in Europe and set to suffer more.

When I think of National statistics that show the third most common MEDICAL reason for ANY child to be occupying a hospital bed is rotten teeth, (Daily Telegraph article here) yet we are wasting Millions of Pounds and Millions of Professional hours on Bureaucratic experimental folly like above, it makes me want to cry as a caring Professional, yet we are all dis-empowered from stopping such policy-based misery continue year after year

The CQC, RQIA, HIW, HIS and other regulatory bodies are very keen on child protection policies and training within Practices, yet they totally ignore or may even be partly responsible for perpetuating the National-Scale of Child Suffering & Abuse caused by the widespread systematic SUPERVISED-NEGLECT of the dental health of younger children in Society who depend upon Central Policy Planners and Systems, that ultimately ignore and don’t protect them.

Will children born today be still occupying so many hospital beds because of rotten teeth in 5 years time
Almost inevitably, unless we start putting Patients before Paperwork, Scientific-evidence before politicised policy, returning more Professional Freedom instead of the continued tightening Boa of Bureaucratic rules and regulations that pretend to be patient centred ultimately.

What have we learnt from the Mid-Staffordshire Hospital disaster where some 400-1200 extra deaths were caused by unaccountable management systems imposing experimental Bureaucratic policies and centralised targets upon already stretched Professionals? (Daily Telegraph article here)
Nothing it seems and it’s possibly got a LOT worse since then too.

We can wait for a miracle or we can act – where many internal pathways to the DH and politicians are continually met by excuse-making responses to try and justify this continued restrictive trend upon our Professionalism, then we are only left with one option in the Public Interest as a Professional group – Whistleblowing

The Boa of Bureaucracy is ever-entwining and restricting our Professionalism and independence to act in patients’ best interests before those of experimental bureaucrats – whilst we have a little Professional breath left, we need to raise the Alarm so others who have the power to make change externally, can be publically informed and rescue the situation from it’s inevitable demise

The best protection the public have is our Professionalism and independence to raise the Alarm publically – what is bad for Dentists and their Teams is bad for Patients too – that includes the deadly Boa of Bureaucracy in Healthcare.

Yours genuinely concerned,

Tony.

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