The rising north–south divide in health in the UK

Posted on August 18, 2017 by Alun Rees

This doesn’t make great reading.

….in the past 20 years, age- and sex-adjusted excess mortality has increased by as much as 46 percentage points in people aged 35–44 years in the north of England compared with the south, and by 27 percentage points in people aged 25–34 years…

….One cause of this higher mortality is an increase in suicide in young people since the 2008 recession, mostly in the north of England. This has been linked to increases in unemployment, associated with poverty, inferior social welfare, educational attainment, and poorer health outcomes. Rates of drinking, smoking, and obesity are also comparatively higher in the north and are at least partly driven by more fast food shops on northern high streets….

The Lancet

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Peter Ward exposes the NHS(E)’s “Cunning Plan”

Posted on June 9, 2017 by Alun Rees

Nice editorial in the BDJ from BDA Chief Exec Peter Ward. HERE

Edited highlights only

Death by commissioning

….That master plan looks like a determined effort to wrest away NHS dental care from small autonomous units. That model that has been supplied by a legion of conscientious practitioners ever since the beginning of the NHS. This applies both in salaried dental service and in general practice.…….

….’Savings’ is the name of the game. That coupled with ongoing ‘efficiency’ signals a race to the bottom, as each year becomes more and more squeezed than the last. It can’t be long before the social enterprises seek freedom from the obligations of NHS terms and conditions – think about the savings to be had there!…..

…..So, it is clear that the NHS in England stands to gain by ‘going large’ in all its areas of practice. But its gain is at the expense of the dentists who serve it. In essence, the wholesale dismantling of access to NHS terms and conditions provides the opportunity for savings. Proposing such a move overtly would be met with horror and outrage. Doing it stealthily and by downstream consequence may be less dramatic but the result is the same. It is not a good result for either dentists practising in England, or for patients expecting enduring, high quality care…

If only it was as easy to dismiss as Baldrick…

 

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The Painful Truth About Teeth (USA)

Posted on May 20, 2017 by Alun Rees

From The Washington Post

SALISBURY, Md. — Two hours before sunrise, Dee Matello joined the line outside the Wicomico Civic Center, where hundreds of people in hoodies, heavy coats and wool blankets braced against a bitter wind. Inside, reclining dental chairs were arrayed in neat rows across the arena’s vast floor. Days later, the venue would host Disney on Ice. On this Friday morning, dentists arriving from five states were getting ready to fix the teeth of the first 1,000 people in line. Matello was No. 503. The small-business owner who supports President Trump had a cracked molar, no dental insurance and a nagging soreness that had forced her to chew on the right side of her mouth for years. “It’s always bothering me,” she said. And although her toothache wasn’t why she voted for Trump, it was a constant reminder of one reason she did: the feeling that she had been abandoned, left struggling to meet basic needs in a country full of fantastically rich people.

As the distance between rich and poor grows in the United States, few consequences are so overlooked as the humiliating divide in dental care. High-end cosmetic dentistry is soaring, and better-off Americans spend well over $1 billion each year just to make their teeth a few shades whiter. Millions of others rely on charity clinics and hospital emergency rooms to treat painful and neglected teeth. Unable to afford expensive root canals and crowns, many simply have them pulled. Nearly 1 in 5 Americans older than 65 do not have a single real tooth left. Over two days at the civic center, volunteer dentists would pull 795 teeth. A remarkable number of patients held steady jobs — a forklift operator, a librarian, a postal worker — but said they had no dental insurance and not enough cash to pay for a dentist….

….Trump’s assurance that he would build a “beautiful” health-care system to serve every American, a system that would cost less and do more. But nearly four months into Trump’s presidency, Matello sees Trump backing a Republican health care plan that appears to leave low-income people and the elderly worse off…..

….“I am hearing about a number of people who will lose their coverage under the new plan,” Matello said. “Is Trump the wolf in grandma’s clothes? My husband and I are are now saying to each other: ‘Did we really vote for him?’ ”…..“Was he just out to get our votes?”

Full article here

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The second life begins…when the drill is hung up.

Posted on April 14, 2017 by Alun Rees

 

I encountered this quote from Confucius in the FT, coincidentally in the week where I was reading The Path an interesting book on Chinese Philosophy and whilst still coming to terms with the fact that since March 18th I can no longer sing the Beatles’ song which starts, “When I get older losing my hair” in the future tense.

“A man has two lives. The second life begins when he realises he only has one.”

The article in the FT was about Charles Eugster who forsook his ” middle aged, self satisfied lump of lard” and took up competitive rowing at 63. Dissatisfied with falling muscle tone and wanting a beach body he started body building aged 87.  The next challenge was competition needing coordination and performance, this led to an interest in sprinting and long jumping and his setting world records for his age group at 97.

Read the whole piece HERE it’s fascinating and inspiring if one retired dentist can do it why not others? I wonder when he’ll consider golf?

 

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To Prevent Rheumatoid Arthritis, Look Past the Joints to the Gums. In Case You Missed It- TGBSL#27

Posted on March 19, 2017 by Alun Rees

An explanation of TGBSL

To Prevent Rheumatoid Arthritis, Look Past the Joints to the Gums

The mouth may seem like a strange place to search for a culprit in a disease that primarily affects the joints. But a recent collaboration by a group of multidisciplinary researchers suggests that one type of oral bacteria may be an important trigger in about half of rheumatoid arthritis (RA) cases. Continues

Some Neanderthals were vegetarians who used natural forms of penicillin and aspirin as medicine

‘Apparently, Neandertals possessed a good knowledge of medicinal plants … the use of antibiotics would be very surprising, as this is more than 40,000 years before we developed penicillin’ Continues & here

Root canal treatments overhauled through new device to detect untreated bacteria

A new method of detecting bacteria during root canal treatments could eradicate the need for follow up appointments and prevent treatments from failing, according to a study published in the Journal of Dental Research. The SafeRoot device, created by a team of researchers at King’s College London, enables rapid bacterial detection inside the root canal, ensuring the procedure has been successful and reducing the need for tooth extraction or surgical intervention. Continues.

Tooth loss linked to an increased risk of dementia

In a study of 1566 community-dwelling Japanese elderly who were followed for 5 years, the risk of developing dementia was elevated in individuals with fewer remaining teeth. Continues

Can oestrogen therapy lead to healthier teeth and gums?

A new study finds links between estrogen therapy and reducing tooth and gum diseases in postmenopausal women. Estrogen therapy is known to help women manage a variety of menopause-related issues: improving bone density and heart health and reducing hot flashes, to name a few. As such, many women choose to take hormones to treat the numerous symptoms associated with menopause. Continues

Review confirms link between drug use and poor dental health

A new review published online in the scientific journal Addiction has found that dental patients with substance use disorders have more tooth decay and periodontal disease than the general population, but are less likely to receive dental care. With drug use increasing by approximately three million new users each year, this is a problem that won’t disappear anytime soon. Continues

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Why Dentistry Is Separate From Medicine – and the possible consequences

Posted on March 14, 2017 by Alun Rees

Why Dentistry Is Separate From Medicine 

The divide sometimes has devastating consequences.

Doctors are doctors, and dentists are dentists, and never the twain shall meet. Whether you have health insurance is one thing, whether you have dental insurance is another. Your doctor doesn’t ask you if you’re flossing, and your dentist doesn’t ask you if you’re exercising. In America, we treat the mouth separately from the rest of the body, a bizarre situation that Mary Otto explores in her new book, Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America.

Specializing in one part of the body isn’t what’s weird—it would be one thing if dentists were like dermatologists or cardiologists. The weird thing is that oral care is divorced from medicine’s education system, physician networks, medical records, and payment systems, so that a dentist is not just a special kind of doctor, but another profession entirely.

But the body didn’t sign on for this arrangement, and teeth don’t know that they’re supposed to keep their problems confined to the mouth. This separation leads to real consequences: Dental insurance is often even harder to get than health insurance (which is not known for being a cakewalk), and dental problems left untreated worsen, and sometimes kill. Anchoring Otto’s book is the story of Deamonte Driver, a 12-year-old boy from Maryland who died from an untreated tooth infection that spread to his brain. His family did not have dental benefits, and he ended up being rushed to the hospital for emergency brain surgery, which wasn’t enough to save him.

A thought provoking read which continues here.

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Pharmacists – another endangered species?

Posted on October 26, 2016 by Alun Rees

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The Minister for Community and Social Care (Alistair Burt) spoke in Parliament on 24 May 2016 a few days before he silver tongued the BDA conference with similar words after which I wrote, “Much of his speech we have heard before and it did little to convince me that (NHS) dentistry is anything other than an irregular irritation in the big picture of health. There will be no more funding in the foreseeable future, no matter what sort of contract is produced, be prepared to deliver it with a tighter belt.”

Hansard has the full transcript of May 24th here but I have selected the phrases (reminiscent of Bullshit Bingo) that chimed with me, thinking back to his speech in Manchester.

We want to empower primary care health professionals to take up opportunities to embrace new ways of working with other health professionals to transform the quality of care that they provide to patients and the public. In particular, we want to free up pharmacists to spend more time delivering clinical and public health services to patients and the public in a range of settings.

I have seen at first hand the fantastic work that pharmacists are doing from within community pharmacies, such as in healthy living pharmacies and other settings, and colleagues have also paid tribute to that work. Pharmacy-led services, such as the recently recommissioned community pharmacy seasonal influenza vaccination programme, can help to relieve pressure on GPs and A&E departments……

The fund is set to rise by an additional £20 million a year. By 2020-21, we will have invested £300 million in addition to the £31 million that NHS England is investing in funding, recruiting and employing clinical pharmacists to work alongside GPs to ease current pressures in general practice and improve patient safety.

The chief pharmaceutical officer, has commissioned an independent review of community pharmacy clinical services to make recommendations on future models for commissioning pharmacy-led clinical services. Clinical pharmacists will offer complementary skills to GPs, giving patients access to a multi-disciplinary skill set, and helping GPs manage the demands on their time and provide a better experience for patients. This is a great opportunity for pharmacists wanting to make better use of their clinical skills and develop them further.

Sweet words indeed, after Alister Burt, who seemed to me to be a pragmatic and likeable (unlike his boss Mr Hunt) moved to the back benches post Brexit vote, the words are transformed into reality.

Pharmacy plan ‘could lead to High Street closures’ BBC website (October 20th 2016)

The Department of Health said it wanted to reduce the £2.8bn a year pharmacy bill by more than £200m over the next two years.
…It has been suggested cuts on this scale could lead to up to 3,000 of the 11,700 pharmacies being closed.
Currently, the average pharmacy receives £220,000 a year from the NHS.
This accounts for between 80% and 90% of their income and includes a flat rate of £25,000, which nearly all pharmacies receive.
The changes being announced scrap that and put much more emphasis on performance-related funding, with ministers understood to see the current system as outdated and inefficient…

I repeat….There will be no more funding …. no matter what sort of contract is produced, be prepare to deliver it with a tighter belt.

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