The Incisal Edge

To start this occasional series here’s an excerpt from Beverley Martin’s Blog

My Life In Beaurocracy(sic)

From the age of 14, after reading an article in ‘Mizz’ magazine about career choices, all I knew was that I wanted to help people. I didn’t know how; I just wanted to make lives easier, the way mine sometimes could be made easier. I started studying psychology, from A level to degree level, and although I wasn’t able to use my BSc right away due to starting a family almost as soon as I graduated, knowledge of behavioural science has been immensely useful to me ever since. While my children were little, I worked for voluntary organisations such as the Samaritans and undertook courses in counselling skills, whilst working in retail for the flexible hours and useful extra money. Even my time in retail wasn’t wasted in conjunction with my ‘career plan’. After being taken on by the John Lewis Partnership at the age of 22, I was kept out of sight of the customers for an entire week whilst being rigorously trained in a training suite within the store, which equipped me with the skills to identify and find ways of meeting the needs of the customers I would encounter.

When I began working for the youth service, I loved the idea of identifying specific needs a child or young person may have, in order to be able to meet them  which in turn would help them and make their lives easier. Both my John Lewis and counselling training helped with this. I didn’t love the unfamiliar vocabulary, which sounded disconcertingly like ‘Newspeak’, the language from George Orwell’s novel 1984 to me. However, I acclimatised.  Needs not only had to be identified and met, but outcomes had to be identified, evidenced and documented. Although in fairness, I have no experience of or idea how to effectively manage a countywide youth service, in times of crisis, the youth service response would often paraphrase that of Reg, the leader of the People’s Front of Judea in Monty Python’s ‘The Life of Brian’:  “Right. This calls for an immediate………assessment form”.

Young people, many of whom were blessed with the sort of attention spans of which goldfish would be wildly jealous, found the endless form-filling as tedious as I did. Especially when it rarely led to the outcome they’d been hoping for. “What’s the point of all this” they would ask. If I told you how many times I resisted the urge to reply “I have no idea – but I suspect it’s so you can be fooled into thinking your individual needs count for anything to the government, whilst they can fool everyone into believing they’ve met them anyway.”, you probably wouldn’t believe me.

In around 2007, the local authority decided to roll out an entirely new system, which although was intended to provide a better service for children and young people, had failed spectacularly every time it had been rolled out in other areas – a fact that did not deter them in the least. The centralisation of services, and the centralised assessment form which many users found virtually impossible to fill out accurately, meant that many young people were slipping through the system or being offered services which were inappropriate for them.

At about the same time, the local authority spent many thousands of taxpayers’ pounds forcing youth workers through an NVQ level 3 course in youth work, which involved spending many extra hours of their own time identifying, evidencing and documenting the screaming obvious. Hilariously, just before youth workers realised this was actually mandatory, they had been forced to ‘apply’ to do the course, to justify why they should be allowed to do something they were contractually obliged to do (despite the fact that this was not specifically in any employees contract. Contracts at my local authority were spoken of in the reverent terms usually reserved for the Loch Ness Monster and Xanadu. One employee actually thought they saw one once, which caused great excitement. It turned out to have been a non-contact form).

Many youth workers who had no confidence in their academic skills left the service at this point which was desperately sad for them and the young people for whom they’d been providing invaluable support. However, the local authority were not the slightest bit perturbed, which made sense in 2012 when the entire youth service was deleted……imagine how much more money they would have wasted on those meaningless qualifications if those youth workers had stayed and completed the course! Therefore, despite my love for working with young people, I realised that I was not evidencing or meeting my own personal need; to help them and make their lives easier. I had identified an outcome which I was failing to achieve! The system in which I was working was procedure-based, policy-based, evidence-based and database-based, but not people-based. I was part of a problem, whereas I’d always wanted to be part of the solution.

So I decided to try and fulfil a little daydream I’d had for a while about becoming a dental nurse. It was something that appealed based entirely on the way it would enable me to help people and make their lives easier in certain specific ways, yet appeared to be free of the meaningless beaurocracy involved in youth work.  I was taken on as a trainee by a wonderful, family owned practice whose patient list includes grandchildren of patients who first attended as children themselves. From the moment I first walked through the door, I loved it – it felt warm and caring, and I felt I could do good there. I felt I could help people and make their lives easier, the way mine could sometimes be made easier.

However.

In the three short years since I became a dental nurse, dentistry has become the oral health equivalent of the youth service. An expensive leviathan of a quango, ostensibly a “regulator” (despite that fact that all dental professionals were already regulated by an existing regulator; the General Dental Council) known as the CQC, decided that care homes, hospitals and dental practices were hotbeds of hazard. In an attempt to justify its existence, it demands that dental practice staff have in-depth knowledge of legislation relating to vulnerable adults and children and implement policies relating to everything from infection control (which makes sense) to patient restraint (which does not).

The CQC demands that all staff should be CRB checked – a requirement I could understand as a youth worker, working often alone with young people, but less so as a dental nurse whose contact with children and vulnerable people is ephemeral, who is never alone with children or young people and in times past would have been considered the chaperone for the dentist, instead of an equally suspected paedophile who has to pay around £44 to prove that I’m not. In case anyone is in any doubt, CRB checks, pushed in the wake of the Soham murders, would not have saved Holly and Jessica because Ian Huntley did not work at their school. His contact with them was enabled by his relationship with Maxine Carr, their teaching assistant, who had a previously clean record and would, therefore, have sailed through a CRB check. I think we can all agree that is £44 well spent…….on top of the annual £80 I pay in personal indemnity in case I accidentally hurt a patient and the annual £120 I pay to the GDC to prove I’m not Harold Shipman MkII. That’s despite the ironic and appalling fact that under the watch of the present chief executive of the CQC, well over 1,000 people died as a result of inadequacies and disgusting conditions in hospital in Mid-Staffordshire. A death toll that Harold could only have dreamed about.

It isn’t enough for dental practice staff to regularly check the contents of their emergency drugs kit and keep a log of checks – a check log of the log of checks must also be kept. Just to make sure those divvy dental professionals know how to tick a box. I, as a dental nurse, have to tick a box to state that I have followed the correct procedures for cleaning my surgery at the end of a session. I’m no longer trusted to simply clean my surgery, you see. I have to EVIDENCE it. The evidence of my spotless work surfaces, dental chair, floors and sinks is not at all admissible. My little ticked box, however, is. I must stamp all sealed packets containing dental instruments with the date three weeks hence. After this period of time, the instruments will unaccountably (and I do literally mean unaccountably – despite all the evidence required from dental professionals, the evidence underpinning these requirements is suspiciously absent) become contaminated and need to be re-sterilised even if the packet was untouched and unopened……..unless I was to live in Wales rather than England, where micro-organisms take a whole seven days longer to contaminate sealed instruments. Moreover, if we had a vacuum autoclave, sealed instruments would become contaminated after 60 days in England, whereas Irish micro-organisms become highly dangerous within a sealed packet after only 30 days. How amazing that the government has discovered those pesky bacteria behave differently depending on their geographical location. Of course, aside from the sheer tiresomeness of these pointless rituals , they ensure I spend far less time than I used to in the dental surgery assisting my dentist, looking after and reassuring our patients and doing….well……my job.

As if that wasn’t enough to contend with, all dental professionals must be well versed in the law regarding child protection and have knowledge of the contents of the Mental Capacity Act (MCA) – a controversial piece of legislation which states that even the most obviously mentally incapable patient should always be treated as capable of making decisions relating to their dental treatment unless they, in the small time frame in which we get to see them, act in a specific way – or even dress in a specific way – which suggests otherwise.

Don’t make the mistake of thinking that dental professionals only need to look after their patients, monitor their physical safety, respect their dignity and go out of their way to ensure they leave the practice happy and pain-free – practices where staff cannot demonstrate knowledge of the MCA are judged by the CQC to be failing at “standards of caring for people safely and protecting them from harm” and even judge patients to be “at risk” from staff who have not undergone safeguarding training, or who have not undergone an enhanced CRB check. You’d think “standards of caring for people safely and protecting them from harm” would directly relate to making sure our standards of infection control are adequate, or that our equipment isn’t about to fall to pieces on them. If you did, you’d be wrong. You’d assume dental professionals are there to look after our patients’ teeth. You’d be wrong.

Dental practices have been dragged into the Brave New World. The world I thought I’d escaped when I left the youth service; the world which chased me into dentistry. There is no escape from the stranglehold of beaurocracy, which has led despairing dental professionals to leave the profession, frustrated that they can no longer focus on what they were trained to do. I constantly consider leaving myself, but the thought that it either already has or will shortly infiltrate all professions depresses me enough to conclude I’d be better off staying put. At least this way I still – sometimes – get to help people and make their lives easier. The way mine isn’t being made easier.

I could go on……but that’s about all I have to say – apart from the fact that every time a CQC apologist reminds dental professionals that they are risking patient’s lives by not attending the optional mandatory safeguarding training (yes, it is both optional and mandatory), somewhere in the world, a dental nurse is one step closer to a cardiac arrest. Now, if that’s not a good reason to check the check log of the check log of emergency equipment, I don’t know what is.