Unimaginably imaginable

Governments primarily, but other institutions and organisations too, often schedule the publication of news that might put them in a poor light to times when attention is likely to be elsewhere. Just as a parliamentary session comes to an end perhaps or during the summer holidays. The hoped for, and often achieved, consequence is that the eyes of the media are diverted and before anyone has realised the moment has passed and it is old news.

I don't think this tactic applies to the Nuffield Trust, whose credentials are sound. It is a charitable trust established in 1943 by Lord Nuffield, the founder of Morris Motors Ltd, and it aims to improve social wellbeing by funding research and innovation projects in education and social policy. Thus, as an independent body, it is not in their interest to attempt to duck public awareness. Quite the contrary. It is therefore something of a disappointment that their most recent report on the state of NHS dentistry was launched last December. Inevitably the messages, although briefly reported, then got suitably jingle-belled and tinselled off the front pages and relegated by Christmas Specials to television's bottom drawer.

The authors of Bold action or slow decay? The state of NHS dentistry and future policy actions, named as a policy briefing, might be congratulated for taking the first word of its title as their overriding imperative.¹ For bold it is. The headlines that it did make, variously quoted its opening salvo that ‘NHS dentistry in England is at its most perilous point in its 75-year history'.

While the Trust is not known for holding back, it is also not particularly regarded as a radical player, so when it states that ‘worsening problems in accessing a dentist, a funding squeeze, the COVID-19 pandemic, and growing inequalities in oral health have created a widespread crisis', it also quotes and embraces Parliament's Health and Social Care Select Committee's call ‘for fundamental reform to end the crisis of access'. It also notes that the government has promised a dental recovery plan but as we know so well, there are no signs whatsoever of this either being worked on or being shared; even at a time to dodge attention. To be frank, the increasing stack of reports, MPs' questions, comments, news items and entreaties for the government to ‘do something' has now reached the state of being unimaginably imaginable. Put more simply, it would be unbelievable if we weren't in the process of witnessing it.

It might prove that Nuffield has added its voice at precisely the right time.

Being older has some downsides but also a few benefits, one of which is being able to remember. For example, a morning in 1993 attending a Nuffield press briefing together with the previous BDJ editor in which they launched a report into the education and training of personnel auxiliary to dentistry. Deftly swapping the word auxiliary, it was the first time we were conscious of hearing the term dental care professional (DCP) and of the notion of registering all such colleagues. My recollection is that it all seemed rather futuristic and somewhat unlikely.

Clearly my lack of belief at the time was misplaced. Here we are these 30-odd years later with not only their predictions having come to pass but being accepted as part of daily life and yet more, being built upon in various ways for the benefit of oral health. As in advice before investing that past performance is no guarantee of future results, things might not come into being as predicted. But the government would be ill advised to pay anything other than diligent attention to the findings in Bold action or slow decay? lest in another 30 years history will condemn it, as we do now, for its ineptitude in managing this crisis. The report states that ‘even immediate actions that can be taken to tackle the problems we identify in this report will not deal with the reality that universal dental care has likely gone for good'.

As Shawn Charlwood, Chair of the General Dental Practice Committee, remarked: ‘the report reads like the last rites for NHS dentistry, and we've told the Secretary of State both patients and this profession deserve some honesty here […] at present even a modest objective - keeping what remains of NHS dentistry afloat - feels out of reach'.

Perhaps publishing the report pre-Christmas will have a more profound outcome than I feared. In the UK, we will have had to have had a General Election by this time next year. A battle that is already pressing the attention of politicians; it might prove that Nuffield has added its voice at precisely the right time. For our many non-UK readers, I offer something of an apology for what must seem like a never-endingly woeful story, but in doing so caution that if this seems an unimaginable situation…allow yourselves to just imagine.