The Monday Morning Quote #155

“If you have ten thousand regulations you destroy all respect for the law.”

Winston Churchill

Most dentists not ready for compulsory EPCs…say Frank Taylor Associates

More TLAs…..

Here’s a link to the FTA blog.

The majority of those dentists who are looking to sell their dental practices in 2012 are not ready for new legislation in regard to EPCs according to Andy Acton of Frank Taylor and Associates and Phil McCabe of the Forum of Private Business. The new changes will come into force on 6th April and mean that:

  • An energy performance certificate will be required on all marketing for all properties that are to be sold or let
  • The responsibility for the EPC will rest with the ‘relevant person’ – defined as either the owner or the agent. Both will have a duty to ensure an EPC is commissioned before marketing a property
  • Trading Standards Officers will have new powers to force sellers and agents to produce copies of EPCs for inspection
  • It will also be a mandatory requirement for air conditioning inspection reports to be lodged on the central Non Domestic EPC Register
  • EPCs will need to be attached to written details of the property – the option to include the asset rating will no longer apply. The first page of the EPC must be included
  • Andy commented, “This legislation may slip under the radar as it seems to have been announced quite quietly and we want to ensure that dentists are aware of this. Put simply, after the 6th April, the marketing of a dental practice just cannot happen without an EPC.”

Phil McCabe, Senior Policy Adviser at the Forum of Private Business added, “Any costs like these are an extra burden for small businesses to bear. The EPC scheme is essentially a watered down version of the unpopular Home Improvement Pack (HIP) scheme, which was dreamed up by the last Government but quickly abandoned by the Coalition after it came in to office for being unnecessary and costly. We would say the same of the EPC.

Aside from the cost implications, there’s also the extra paperwork that will be involved. More red tape and yet more form filling for businesses at a time the Government is pledging to cut bureaucracy is just not necessary.”

The Monday Morning Quote #154

“Never mistake activity for achievement.”

John Wooden

(Too much activity has led to inaccuracy and low achievement this week – hence this is late!)

Transplant jaw made by 3D printer claimed as first

From BBC website makes me wonder where this technology is taking us and its possible use in “routine” restorative dentistry

Transplant jaw made by 3D printer claimed as first.

A 3D printer-created lower jaw has been fitted to an 83-year-old woman’s face in what doctors say is the first operation of its kind.
The transplant was carried out in June in the Netherlands, but is only now being publicised.
The implant was made out of titanium powder – heated and fused together by a laser, one layer at a time.
Technicians say the operation’s success paves the way for the use of more 3D-printed patient-specific parts.
The surgery follows research carried out at the Biomedical Research Institute at Hasselt University in Belgium, and the implant was built by LayerWise – a specialised metal-parts manufacturer based in the same country.

Articulated joints

The patient involved had developed a chronic bone infection. Doctors believed reconstructive surgery would have been risky because of her age and so opted for the new technology.
The implant is a complex part – involving articulated joints, cavities to promote muscle attachment and grooves to direct the regrowth of nerves and veins.
However, once designed, it only took a few hours to print.
“Once we received the 3D digital design, the part was split up automatically into 2D layers and then we sent those cross sections to the printing machine,” Ruben Wauthle, LayerWise’s medical applications engineer, told the BBC.
“It used a laser beam to melt successive thin layers of titanium powder together to build the part.
“This was repeated with each cross section melted to the previous layer. It took 33 layers to build 1mm of height, so you can imagine there were many thousand layers necessary to build this jawbone.

Once completed, the part was given a bioceramic coating. The team said the operation to attach it to the woman’s face took four hours, a fifth of the time required for traditional reconstructive surgery.
“Shortly after waking up from the anaesthetics the patient spoke a few words, and the day after the patient was able to swallow again,” said Dr Jules Poukens from Hasselt University, who led the surgical team.
“The new treatment is a world premiere because it concerns the first patient-specific implant in replacement of the entire lower jaw.”

Screw-in teeth

The woman was able to go home after four days.
Her new jaw weighs 107g, just over a third heavier than before, but the doctors said that she should find it easy to get used to the extra weight.
Follow-up surgery is scheduled later this month when the team will remove healing implants inserted into holes built into the implant’s surface.
A specially made dental bridge will then be attached to the part, following which false teeth will be screwed into the holes to provide a set of dentures.

Printed organs

The team said that it expected similar techniques to become more common over the coming years.
“The advantages are that the surgery time decreases because the implants perfectly fit the patients and hospitalisation time also lowers – all reducing medical costs,” said Mr Wauthle.
“You can build parts that you can’t create using any other technique. For example you can print porous titanium structures which allow bone in-growth and allow a better fixation of the implant, giving it a longer lifetime.”
The research follows a separate project at Washington State University last year in which engineers demonstrated how 3D-printer-created ceramic scaffolds could be used to promote the growth of new bone tissue.
They said experiments on animals suggested the technique could be used in humans within the next couple of decades.
LayerWise believes the two projects only hint at the scope of the potential medical uses for 3D printing.
Mr Wauthle said that the ultimate goal was to print body organs ready for transplant, but cautioned that such advances might be beyond their lifetimes.
“There are still big biological and chemical issues to be solved,” he said.
“At the moment we use metal powder for printing. To print organic tissue and bone you would need organic material as your ‘ink’. Technically it could be possible – but there is still a long way to go before we’re there.”

The Monday Morning Quote #153

“Never waste a crisis. It can be turned to joyful transformation.”

Rahm Israel Emanuel

(from an article in the New York Times -March 17th 2009)

Sugar tax needed, say US experts

From the BBC.

Sugar is as damaging and addictive as alcohol or tobacco and should be regulated, claim US health experts.

According to a University of California team, new policies such as taxes are needed to control soaring consumption of sugar and sweeteners.

Prof Robert Lustig argues in the journal Nature for major shifts in public policy.

The Food and Drink Federation said “demonising” food was not helpful as the key to health was a balanced diet.

Several countries are imposing taxes on unhealthy food; Denmark and Hungary have a tax on saturated fat, while France has approved a tax on soft drinks.

Now, researchers in the US are proposing similar policies for added sugar and sweeteners, amid concern about the amount of sugar in the diet.

The consumption of sugar has tripled worldwide over the past 50 years, with links to obesity, high blood pressure and diabetes.

In a comment in the journal Nature, Prof Lustig, a leading child obesity expert, says governments need to consider major shifts in policy, such as taxes, limiting sales of sweet food and drinks during school hours, or even stopping children from buying them below a certain age.

The professor of paediatrics at the University of California, San Francisco, told the BBC: “It [sugar] meets all the criteria for societal intervention that alcohol and tobacco meet.”

The researchers acknowledge that they face “an uphill political battle against a powerful sugar lobby”.

But they write in Nature, that “with enough clamour for change, tectonic shifts in policy become possible”.

“Take, for instance bans on smoking in public places and the use of designated drivers, not to mention airbags in cars and condom dispensers in public bathrooms.

“These simple measures – which have all been on the battleground of American politics – are now taken for granted as essential tools for our public health and well-being. It’s time to turn our attention to sugar.”

‘Realistic approach’
Barbara Gallani, director of food safety and science at the UK Food and Drink Federation, said they recognised the worldwide health burden of non-infectious diseases and agreed action was needed.

“However, the causes of these diseases are multifactorial and demonising individual food components does not help consumers to build a realistic approach to their diet,” she explained.

“The key to good health is a balanced and varied diet, in the context of a healthy lifestyle that includes plenty of physical activity.”

Commenting on the Nature commentary, Dr Peter Scarborough of the British Heart Foundation Health Promotion Research Group at the University of Oxford, said taxing certain food products was something policymakers should consider.

But he said taxing only one type of food could have unintended consequences, such as people cutting back on fruit and vegetables to save money for other purchases.

He told the BBC: “If you only tax one aspect of food like sugar you can have unintended consequences.

“If you tax fat, salt and sugar, combined with subsidies for fruit and vegetables, you’ll get healthier diets.”

Care Quality Commission: a case study in poor regulation – an MP agrees

From Steve Barclay’s blog, Steve is the Conservative MP for NE Cambridgeshire.

Yesterday’s Public Accounts Committee hearing was on the Care Quality Commission, the regulator for the National Health Service set up in April 2009 bringing three predecessor organisations together: the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission.  It has a budget of £139 million.

The hearing was like a case study in what went wrong in the last Government’s approach to regulation. The Care Quality Commission is an organisation that the National Audit Office concludes does not provide value for money; diverted huge resource to registration (yet failed to complete this on time); and did not undertake a single new investigation between May 2009 and June 2011 (its first two years). It has not launched a single prosecution because the hospitals it regulates are too big to fail and it has no audit system to ensure that there is consistency in the inspections it undertakes.

It also has no effective controls regarding the training of its inspectors, many of whom are reviewing clinical areas without any clinical qualification. It remains unclear exactly how many inspectors working for the Care Quality Commission have a clinical background and the Chief Executive has agreed to send the Committee a note providing a detailed breakdown. Given that just ten days of training was provided to inspectors in 2009/10 (some of which was e-learning) and that many inspectors work from home, I remain concerned as to whether inspectors are largely reviewing processes rather than having the expertise to question clinical staff. Where clinical staff are working for the CQC, there was no evidence to confirm that their clinical discipline relates to the issues they are inspecting.  For example, a dentist has a clinical qualification but will be less effective, I suspect, in inspecting the deaths of babies on a maternity unit than someone with clinical experience of working on such a unit.

One of the most glaring faults with the Care Quality Commission which I highlighted yesterday is the conflict between its role as a regulator that promotes whistleblowing and a culture of openness within the NHS, and the gagging clauses imposed on departing CQC staff by its own Chief Executive. It is quite remarkable that a distinguished member of the CQC’s own board, who has 11 years experience as a Mental Health Commissioner, stated “My endeavours to provide robust scrutiny and challenge led to my professionalism being challenged.  Doubt was cast on my mental health and my performance.”

Another of yesterday’s remarkable revelations was that a regulator responsible for improving the quality of healthcare nationally has, in the view of the Permanent Secretary of the Department of Health, a flawed strategy: the management information provided of its own board is solely quantitative, not qualitative. In short, they are simply measuring how many boxes they tick rather than the quality of the work they do. If they cannot get their own strategy and management information right, what authority do they have when telling those they regulate how to do things?

Another disturbing revelation was that senior management, in order to protect their own reputation, changed the regulator’s approach to news management by ensuring information was circulated on a local and regional basis rather than nationally.  This had the effect of playing down problems, when wider circulation of the lessons to be learned could have helped patients in other areas of the country.

Yet another failure was the decision by the Chief Executive of the CQC Cynthia Bowers to scrap the dedicated whistleblower line, previously manned by investigators.  Instead, whistleblowers were put through to a general helpline where we know that calls were missed. One such case led to the Panorama investigation of Winterbourne View where abuse was taking place and CQC ignored more than one call from a whistleblower. We do not know how many other scandals were missed where abuse might still be continuing.

As readers of my blog will know, I have been campaigning for some time for a change in the Department of Health policy as it applies to whistleblowers. At yesterday’s hearing, the Permanent Secretary at the Department of Health, Una O’Brien, agreed to look again at the circulars sent out by her department in 2004 which allows health bodies to sign gagging clauses to silence staff.  She has agreed to send a note to the Committee within the next week and I hope she will take the opportunity to finally change their policy

It was also far from impressive to hear – from the Chief Executive of the CQC – that Parliament had been misled when it was told in the Annual Report that twice as many inspections had been carried out as was in fact the case. The Chief Executive of the CQC suggested that this was a typo. Yet, she was still unable to say when Parliament was informed of the correct information. An error relating to an additional 7,500 inspections is sufficiently large that it is reasonable to expect that it would be spotted. She has said that she will write to clarify the chain of events.

In short, the registration process applied by CQC was flawed. Not a single major investigation was undertaken in the first two years. By contrast, one of their precursor organisations, the Healthcare Commission, undertook 16 major investigations in 5 years identifying significant issues such as the importance of C-difficil. The number of inspections was half the actual number claimed and no prosecutions have been undertaken. The dedicated whistleblower line was scrapped and the news management has sought to play down issues, in order to avoid bad publicity for the NHS. Despite its evident problems, the CQC management underspent against its budget in 2009/10.

For providing leadership to this organisation, Cynthia Bowers is paid £198,000 annually in salary and currently has a pension pot of £1.35m which, bizarrely, has gone up by £421,000 in real terms in the last two years. Ms Bowers suggested this was another typo or error in the Annual Report.

The Monday Morning Quote #152

“Man is made by his belief. As he believes, so he is.”
Johann Wolfgang von Goethe
1749-1832

Ever wondered what Bridge2Aid does?

I met Jem Patel of JSP at Manchester Airport Hilton on Thursday where we were both part of the BKH meeting. He was telling me about the film that he has produced for Bridge2Aid about what actually goes on in Tanzania. I recommend it to you and hope that it might well encourage you to take the step to support Bridge2Aid.

For more on Bridge2Aid take a look here.

GDC updates advertising regulations

The General Dental Council has updated its rules on advertising, I wonder how many websites will need to be amended to comply?

Please don’t shoot the messenger.

www.gdc-uk.org/Dentalprofessionals/Standards/Pages/Ethical-advertising.aspx

EFFECTIVE FROM 1 MARCH 2012

Guidance on ethical advertising

All information or publicity material regarding dental services should be legal, decent, honest and truthful.

Advertising by dental professionals can be a source of information to help patients make informed choices about their dental care. But advertising that is false, misleading or has the potential to mislead patients is unprofessional, may lead to referral to fitness to practise proceedings and can be a criminal offence.

Patients may be confused and uncertain about dental treatment so you should take special care when explaining your services to them. This includes providing balanced, factual information enabling them to make an informed choice about their treatment. Do not exploit the trust, vulnerability or relative lack of knowledge of your patients.

Misleading claims can make it more difficult for patients to choose a dental professional or dental services and this can lead to expectations which cannot be fulfilled and, in more serious cases, can put patients at risk of harm from an inappropriate choice.

Patients can check with us that their dental professional is registered and whether they are on a specialist list, but they are more likely to rely on information that you provide such as practice leaflets or certificates on the practice wall.

The onus is on you to be honest in your presentation of your skills and qualifications. If you make misleading claims, you may have to justify your decisions to the GDC through our fitness to practise procedures.

Advertising services

Whenever you, your practice, or any place where you work as a registrant, produce any information containing your name, you are responsible for checking that it is correct.

You must:
i) ensure information is current and accurate;

ii) make sure that your GDC registration number is included;

iii) use clear language that patients are likely to understand;

iv) back up claims with facts;

v) avoid ambiguous statements; and

vi) avoid statements or claims intended or likely to create an unjustified expectation about the results you can achieve.

Advertisements and other practice publicity must make clear whether the practice is NHS, mixed or wholly private.

Only recommend products if they are the best way to meet a patient’s needs.

If you wish to offer services which your training as a dental professional does not qualify you to provide, make sure you undertake appropriate additional training to attain the necessary competence. Do not mislead patients into believing that you are trained and competent to provide other services purely by virtue of your primary qualification as a healthcare professional, but make clear that you have undertaken extra training to achieve competence.

Websites

In line with European guidance(1), for all dental professionals providing dental care mentioned on the site the following information must be displayed:
i) their professional qualification and the country from which that qualification is derived; and

ii) their GDC registration number.

Dental practice websites must display the following information:
i) the name and geographic address at which the dental service is established;

ii) contact details of the dental service, including e-mail address and telephone number;

iii) the GDC’s address and other contact details, or a link to the GDC website;

iv) details of the practice’s complaints procedure and information of who patients may contact if they are not satisfied with the response (namely the relevant NHS body for NHS treatment and the Dental Complaints Service for private treatment) and

v) the date the website was last updated.

Update the information showing on your website regularly so that it accurately reflects the personnel at the practice and the service offered.

A dental practice website must not display information comparing the skills or qualifications of any dental professional providing any service with the skills and qualifications of other dental professionals.

Specialist titles

Only dentists who are on a GDC specialist list may use the title ‘Specialist’ or describe themselves as a ‘specialist in….’

Dentists who are not on a GDC specialist list should not use titles which may imply specialist status such as Orthodontist, Periodontist, Endodontist etc.

There are no specialist lists for dental care professionals. Dental care professionals should ensure that they do not mislead patients by using titles which could imply specialist status, such as ‘Smile specialist’ or ‘Denture specialist’.

Registrants who are not on a specialist list should not describe themselves as ‘specialising in…’ a particular form of treatment but may use the terms ‘special interest in..’, ‘experienced in..’ or ‘practice limited to..’.

Honorary degrees and memberships

Patients may reasonably believe that if you put a qualification after your name, it has been ‘earned’, that is, it represents a particular level of academic achievement. This may not be the case where a degree is honorary. Listing memberships or fellowships of professional associations or societies can also mislead. The letters may imply to the public that a registrant has attained a certain level of skill which in fact may not be the case.

(1) The Council of European Dentists’ (CED) EU Manual of Dental Practice contains extensive information on oral health systems as well as legal and ethical regulations across the EU. In particular this includes the Code of Ethics for Dentists in the EU for Electronic Commerce which covers the content of websites
General Dental Council 37 Wimpole Street London W1G 8DQ T +44 (0)845 222 4141 F +44 (0)20 7224 3294 E information@gdc-uk.org W www.gdc-uk.org