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When Peter Mandelson, then President of the Board of Trade, went to bed on December 22 he was said to have been determined to fight on despite newspaper reports of an undisclosed interest-free loan which he used to buy a house. However, a glance the following morning at the front pages of the national newspapers — and at his front step, swarming with reporters — was sufficient to convince him to go.

The impact of this decision has been considerable. Alan Milburn, previously the Minister for Health, has joined the cabinet. His eventual promotion was never in doubt, but he was not expected to become Chief Secretary to the Treasury at this time and in such circumstances.

Whether he will rise further in the Treasury, and whether Mandelson really is, as some have suggested, a future Chancellor of the Exchequer, are questions for the rather more distant future.

John Denham, who takes over from Alan Milburn, also appears to be a favoured 'new' Labour man. He is experienced at handling tough jobs; as a junior minister at Social Security he was responsible for fraud, pensions, national insurance and long-term care. In the July reshuffle, he took over Frank Field's old job of Social Security Minister and oversaw the Government's pensions review — seen by many as Labour's most important project, and certainly an area of policy requiring a strong but extremely careful political operator.

Fluoridation

At the time of writing, there is no indication whether the expected strategy for NHS dentistry will be delayed. Outlined by Alan Milburn at the 1998 BDA National Dental Conference, the strategy is expected 'in the New Year'. Tessa Jowell's White Paper on Public Health is also imminent and this is expected to outline, finally, the Government's policy on water fluoridation.

The likelihood of fluoridation being extended to those socially deprived areas of the country which need it most was given a boost by another news item during Christmas week. Water UK, the new body representing Britain's water suppliers, announced a package of proposals representing 'the way forward' on the issue. Its proposals bring the water companies' policy on fluoridation in line with the BDA's — and the 38 other organisations currently comprising the National Alliance for Equity in Dental Health — that health authorities should make decisions on water fluoridation, following extensive public consultation.

It is to be hoped that the Government will either accept the recommendations of the fluoride lobby and the water companies or come up with an equally imaginative policy itself.

Water UK also called for public health legal indemnities against any actions brought by anti-fluoridation campaigners. This issue has been the major sticking point ever since the poorly-worded Water (Fluoridation) Act was passed in 1985. It is to be hoped that the Government will either accept the recommendations of the fluoride lobby and the water companies or come up with an equally imaginative policy itself.

Self regulation

The Government's NHS Bill — expected to be in force by July 1 at the latest — will, among other things, abolish GP fundholding and create Primary Care Trusts. It will also focus on raising standards in the quality of care and contains a proposal to strengthen existing systems of professional self-regulation.

The idea is that, in future, the Dentists Act will be amended by Order. This is quicker than introducing a Bill to amend the Act, because orders are simply voted on by the Commons and the Lords before becoming law.

In its response, the BDA has recognised the need for improved accountability to increase patient confidence and has stated that the system of self-regulation needs to be robust and open to scrutiny. The BDA wants to work with the Government and the regulatory bodies (the GDC and the Faculties of the Royal Colleges) to ensure that the most effective machinery is in place.

Investing in Dentistry

John Denham's new role will involve dealing with the government's troubled Investing in Dentistry (IiD) initiative. The BDA has been lobbying hard on this issue and has protested at the reels of red tape involved in the application process, the apparently random allocation of funds and the lack of speed with which those funds are approved.

Only £7m of a promised £19m has been awarded so far. Perhaps more importantly, the Association's evidence to the Doctors' and Dentists' Review Body included calculations which show that, to be effective, IiD needs to amount to £50m each year for the next three years.

How hopeful dentists and other health practitioners can be remains to be seen. One word of caution comes from a report in The Independent, following Alan Milburn's promotion, which quoted a friend of the former Health Minister. Apparently he is expected to give his successor a hard time over money because he feels he was 'over-generous' towards the doctors last year.