Fiona Ellwood: ‘It has been a wonderful journey on the whole'

By Kate Quinlan

©Artur Debat/Moment/Getty Images Plus

Introduction

As BDJ Team celebrates its tenth anniversary in 2024, to help mark the occasion we caught up with some important people within dentistry to reflect on the past decade and look forward to the next.

This month we meet Fiona Ellwood BEM, Executive Director and Emeritus Chair of the Society of British Dental Nurses (SBDN), Acting Chair of The National Oral Health Group and a BDJ Team reader panellist.

About Fiona

Fiona Ellwood MEd L.M, PG Cert HF, PG Cert PH, PG Cert MDent, BA (Hons) Ed S, PGCE, a Doctoral Researcher, acts as a key opinion leader and is an advisor for oral health education and preventative programmes across the dental arena, as well as infection prevention and control and professional practice. She has been an examiner for NEBDN and writes prolifically, including many articles for BDJ Team. Fiona was the first dental care professional (DCP) to be awarded an (Hon) Fellowship by the Faculty of General Dental Practice and an early recipient of a Fellowship of the Dental Trainers Faculty from RCS Edinburgh; she also holds a Fellowship of the Royal Society of Public Health.

Fiona is a trained mentor, the founder of Dental Mentoring Network and a member of Dental Mentors UK. She is an External Examiner in Ireland and a GDC Education Associate and Registration Panel Member. She holds an MSc PG Cert in Human Factors for Patient Safety and leads the Human Factors in Dentistry Group. During the pandemic Fiona was a driving force behind Mental Health Wellness in Dentistry and is Co-Chair of the Mental Health Wellness in Dentistry Group and the founder of the Dental Professional Alliance. She is a part-time Academic Lead and Moderator for Dental Nursing at Bangor University Bangor and is a co-investigator as part of an NIHR research project at Newcastle University, as well as an Expert Witness.

Fiona is a trustee for Dentaid and a co-founder of the International Federation of Dental Assistants and Nurses (IFDAN). She was hugely honoured to receive a Queen's Honour in 2019 and has become a dental nurse historian.

Interview

Do you have positive early memories of attending the dentist? Growing up, did your family emphasise the importance of looking after your teeth?

My parents were particular about our teeth and our diet, although I was quite a fussy eater and never really liked sweet foods, sweeties or fizzy drinks. I do recall one gran always arriving with sweeties and the other one didn't. My earliest memories of the dentist were the dentist and the assistant who used to come into school and quite oddly, I recall the wooden spatula they used to keep your tongue out of the way. It was dreadfully uncomfortable. The dentist was a very happy man and his assistant very smart, but quite formal and was always writing.

I do recall the first time I had treatment; the room had a certain smell about it that made me very anxious. My second visit sometime later was for a general anaesthetic for extractions for crowding on the lower arch. Having had one tooth removed under general anaesthetic, I wasn't going back. I still have the tooth that wasn't extracted and my midline has drifted. I was warned, but it seemed a small price to pay. I remained terrified of the dentist for years from that experience. I was fortunate enough not to need treatment again; I was able to have check-ups but that was it. I wish I could say it was a positive childhood experience, but it certainly wasn't. I did discover later that it was the smell and a fear of the unknown that caused the dental anxiety that I had developed, right up to being a teenager.

On day one, we had no patients - I was the nurse, the receptionist, and the cleaner and once we had patients, I would cast models before I left for home.

What led you to dental nursing in the mid-1980s?

I would like to say it was a planned move to work in the dental arena, but like many dental nurses, I simply fell into it. When we were looking at career options the school had relationships with some of the local businesses and people who accepted work experience students. None of the opportunities interested me and the only one that wasn't taken by other students was dentistry. I really enjoyed my time there and took up a Saturday job in a local practice, but with no intention of taking this any further. I had intended to join the military and had undertaken the initial entry tests. I was advised to follow a career and then look to train as an instructor. I decided dental nursing could become the trade I needed and applied initially for a local job which was brand new. On day one, we had no patients - I was the nurse, the receptionist, and the cleaner and once we had patients, I would cast models before I left for home. This stop gap was the beginning really and I never left the profession. Forty-two years later and 38 years of being qualified I still have much to accomplish.

Although you didn't have to take the professional qualification then, I was keen to study and take the examination. However, there wasn't a dental school within two hours of my hometown and there were no evening schools available either, so I applied to all of the dental schools for a place to train and was fortunate to be accepted at several of them.

How long were you a practising dental nurse before branching out into other activities?

Shortly after qualifying in Manchester, I began teaching and training initially after work. Teaching and training also became part of my clinical role in a number of practices over the years until I moved to the Midlands where I found it difficult to get a clinical job because nobody wanted a qualified dental nurse because you had to pay them more. Then I set up a training business and later joined forces with another dental nurse because the demand was high. Most of this was evening work on top of the clinical days. I took numerous teaching qualifications and successfully gained the assessing and internal quality assurance qualifications too. I then joined the Nottingham team on a part-time basis so that I could remain clinical. I also joined the out-of-hours service and did a little bit of bank working and locum working whilst my sons were very young. The balance never really tipped until 2014, but even to this day I keep my hand in so that I never become too detached from the everyday activities of dental nursing and I think that is important. I was however a perpetual student and still am, as I love learning.

I thoroughly enjoyed the role of dental nurse and the vast breadth of the clinical experience that I was lucky to achieve was amazing. The range of treatments that I experienced in general practice then are not the same today. Every day was a different day; they were extremely busy and we only stopped for lunch if we were fortunate. I would leave home in the dark and return home in the dark once I moved to Manchester because I had to get two buses to work and back. I was fortunate to work with a practitioner who took on challenging cases and oral surgery was the field I enjoyed the most for most of my clinical life. I turned to public health later on.

How did your career progress from there? You have an astonishingly long CV!

Gosh, that is a challenging question. Even I have to look at my CV because I have enjoyed a great career with some amazing people. I sometimes feel that I have had a journey of self-discovery as interests have popped up and opportune moments and each one of those seemed to ignite the next. Although my career has been extensive, I have carefully navigated the twists and turns and if I was turned away because I wasn't a general dental practitioner I found another way. Each educational qualification has a link to another and together they do make me a more rounded person and enable me to be heard at busy tables. It wasn't just the qualifications, awards or accolades; more than anything it has been about collaborative working, about the good and effective dental teams and people who are recipients of the care we give.

I have been warmly welcomed and privileged over the years to boards, panels, and committees and continue to hold posts with the regulator and attend stakeholder meetings. I also have roles in the other nations and internationally and as a co-founder of the International Federation of Dental Assistants and Nurses.

My qualifications have given me a certain level of command of education and facilitating learning, leadership and management, mentorship, human factors, and public health at master's level and beyond as a doctoral researcher. I was the first DCP to receive the (Hon) Fellowship of the Faculty of General Practice and an early recipient of the Royal College of Surgeons Edinburgh Fellowship of the Faculty of Dental Trainers and I was awarded a British Empire Medal (BEM) for my commitment to dentistry and other awards such as being given a fellowship from the Royal Society of Public Health. I am a trustee for Dentaid and I support the Mouth Cancer Foundation and of course I was behind the team push, along with Roz McMullan, to bring the Mental Health Wellness in Dentistry (https://mhwd.org/) work to fruition and celebrate the evolution of the Dental Professional Alliance (https://sbdn.org.uk/dental-professional-alliance/). This is not to omit being one of the founders of the Society of British Dental Nurses in 2015.

It has been a wonderful journey on the whole, but it is important to emphasise it hasn't always been positive; there have been some challenges occasionally.

What have been the highlights of your career so far?

There are so many given how long I have been in the industry. In no particular order: the Mental Health Wellness work, setting up the Society, working internationally, being invited to be an (Hon) President of the British Society of Dental Hygiene and Therapy, being part of setting up an oral health programme in Nepal, a recent trip to Pennsylvania with the university, the launch of the book, meeting Prof John Gibson on his walk to raise awareness of suicide and establishing the human factors group and delivering with colleagues the Welsh dental nursing programme as starters for ten. I have really enjoyed my work with the GDC too.

How do you balance your many different roles, interests and activities?

I am very good at compartmentalising my days and weeks and have to be organised, especially as I have horses and dogs at home. I like to use the analogy of de Bono's hats, but I also have an excellent group of people in the Society who share some of the load. My diary does sometimes get extremely busy and I have to be strict with myself so that I get some quality down time.

What are the most significant developments you have seen for dental nurses over the past 10-20 years?

There have been so many, but the developments over the last 18 years especially have been extensive. With registration came an outlined scope of practice and additional duties, and windows of opportunity are now surfacing for dental nursing. Whilst dental nursing has changed in many ways, there is still a long way to go. Dental nurses are making their way into roles and posts only held by others previously. To be invited to present things to the minister in a visit to Westminster is not an everyday occurrence. I am hopeful that there is more to come.

Perhaps the advancement of technology, techniques and materials has been the most impressive.

Do you think statutory registration for dental nurses has earned dental nurses the status, working conditions and recognition within the dental team that they deserve?

I have very mixed feelings about this and I wonder if we had the time again, the same decisions would be made and for the same reasons. I was nursing when it happened and involved on the peripherals at that time. It is interesting that the Nuffield Report said ‘for the safety of patients' and yet it appears - or has done until now - that it was done without any future scoping and resembling the professionalising of occupations without intention. Dental nurses are simply being left behind and commonly not being recognised or valued for the skill sets that they have. There continues to be talk year on year about retention but I wonder if workplace conditions were better if we would maintain our workforce. When it comes to the wider picture we are still seeing dental nurses with two jobs or more to make ends meet and some are using food banks.

The Society are a proactive rather than a reactive group and are always out and about. Although we go to the dental shows our work goes far beyond this. We have a “can-do” approach and look for opportunities not problems.

The Society of British Dental Nurses (SBDN) is nine years old this year. Can you describe how the Society came about?

The Society launched in November 2015 after a period of extensive planning by a number of people. There was a big push for a personable approach to supporting dental nurses and a way of delivering and facilitating learning to ensure their growth professionally and there simply wasn't anything in place. Many of the group had tried to establish this elsewhere but it wasn't deemed important. Before the Society launched some of the founding team visited the key stakeholders to discuss the intention to set up the Society and it was welcomed by everyone. The field of dental nursing is currently standing around 64,000 and it is important that all of the needs of the dental nurses can be met. This is why the Society was established and why it has gone from strength to strength: no one organisation can serve such a large sector. Equally, the team believed that those involved needed to have a clear understanding and experience of being a dental nurse and that the Society needed to have dental nurses who worked across every setting and own this level of expertise when at the end of phone calls, queries and the helpline and across all four of the nations. The Society are a proactive rather than a reactive group and are always out and about. Although we go to the dental shows our work goes far beyond this. We have a ‘can-do' approach and look for opportunities not problems. We focus on current matters but also on the future, and we will never let our past be forgotten or rewritten - that is why we have also established the Dental Nursing Historian Group and we have been working with others to explore this area. The Society also set up the Alumni group for Dental Surgery Assistants in memory of Dame Margaret Seward who sadly passed away in 2021.

What is your current role at the Society?

I am currently the Executive Director and was given Emeritus status which the team felt was important to futureproof the Society. Although all of the committee, council and honorary fellows are volunteers we have an enormous level of commitment to the Society, but this way we can be sure that the monies of the Society benefit the running of the Society for the good of the membership. Not only do I have a great deal of responsibility which comes with accountability, I am also involved in the development of new volunteers and the design and application of strategies to continue the success of the Society and the day to day running of things. Being a registrant, I am also involved in the delivery of continual professional development, supporting dental nurses. We all have our specialist fields too and so I also lead on a couple of the groups.

We take pride in working with dental nurses to foster and become their professional self and to create a professional identity to be proud of.

Why should dental nurses join the Society?

The Society was developed because of a huge gap for support for dental nurses who now must be qualified to work chairside and with patients, there is a need to be able to speak to any field of dentistry and to allied healthcare colleagues, which the Society does well. We have to think differently and that is along the lines of collaborative working, patient-centred care and shared decision making. We are affiliated with other professional groups and have strong relationships in the wider healthcare settings, both nationally and internationally. Whilst we offer indemnity that is competitive, we are far more than sellers of indemnity, we are accountable registrants and work hard to provide the best service for our members. There are numerous member benefits, but benefits that support the working dental nurse, the student dental nurses and the returners to work. We take pride in working with dental nurses to foster and become their professional self and to create a professional identity to be proud of. We have tackled equality, diversity, inclusion, belonging and sustainability head on, and we are enormously proud to have members of our male dental nurses group who are tasked with challenging us on gender matters. This is a professional group that was designed by dental nurses, brought to fruition by dental nurses, is run by dental nurses for dental nurses and that celebrates dental nurses at every opportunity.

Are you pleased with what the Society has achieved for dental nurses after nine years?

Incredibly so and we are so grateful to everyone who has been on this journey with us and who believed in the founding group at the time and also the (Hon) Fellows who are our advisors and fonts of knowledge to turn to. It has been hard work at times, there is no denying that - there have been no pots of gold at the end of rainbows and no sponsors or funders that others have relied on and benefitted from, but it has been worth it and at times of adversity we simply become stronger. We could never have imagined being this far on, planning for our 10^th anniversary.

What's coming up for the Society?

Well plans are beginning for the 10^th anniversary. We always have an eye on succession planning, to keep the teams and groups current; we are keen to grow new people for the committee and council roles and hope that people continue to be interested in seeking votes for the posts.

We have more international work lined up and hope to pick up where we left off prior to the election announcement with the work in Westminster. We have a number of live discussions with the GDC that we will be following up too. We will continue to keep mental health wellness on all agendas and the work on inappropriate behaviour in the workplace. We had a number of requests for collaboration at the recent meeting and so we are looking forward to wider working opportunities.

The only thing that ever stops us is the number of hours in the day and occasionally the extensive workloads. The minute we stop being motivated and excited about today and the future is the minute we stop being different in our eyes.

We are full of hope, aspirations and vision for dental nurses who have so much ability to do more and play a greater role in patient care and treatments.

What are your hopes and aspirations for dental nurses over the next ten years?

We are full of hope, aspirations and vision for dental nurses who have so much ability to do more and play a greater role in patient care and treatments. Some of our current discussions are already pushing at doors, but if we want to keep the excellent dental nurses that we have, there is a need to start to think differently, to be more inclusive, more respectful and to value them for the skills they have and what they bring to the team. They are individuals, they are skilled, adaptable and flexible and deserve to be recognised and rewarded accordingly. They should be able to grow within dental nursing and excel; their qualifications should be of a good level and transferable and decisions made about them should not be made without them.

We are delighted to see more and more dental nurse-led clinics and ways of working with more autonomy and to see dental nurses being part of multidisciplinary teams.

We need to see a shift in the dial and consider the discourse around dental nurses and dental nursing and more than anything it is time to think ‘team', as the smooth running of services and clinics and the quality of care that patients receive rely on the dental nurses.

The Society will share a piece of work hopefully at the end of the year with the future in mind, but it is very much in the early stages at the moment.

More generally, what developments within dentistry do you hope to see evolve or emerge looking to the years ahead?

The annual survey always shows similar things: better working conditions, greater opportunities, more autonomy, better remuneration and rewards, more responsibility, flexible working, greater understanding for working mothers.

The Society is keen to explore different ways of working, linking oral health teams with improvement teams and the provision of care to patients in need, by the right person, with the right skills, at the right time.

We would like to see a reduction in bureaucracy and red tape and a shared ambition to include dental nurses who are the largest workforce. We would like to see investment in dental nurse research and academia and in the education systems.

Do you think the future is bright for the dental team?

The dental team is resourceful, but goodwill is running thin. We are still hearing of burnout, exhaustion and fatigue and none of this makes for a happy workforce or a well one. There is a need to consider psychological safety and the general wellbeing of the team and how a service can best be delivered that is inclusive of the whole team, that sees them fulfilled, rewarded, and thriving, and only then will we see care delivered at its best. We have no way of knowing currently what will come of the election results and the impact the results will have, but what we do know is that the provision of dentistry and the investment in prevention are key going forward and of course, addressing inequalities and the care for the most vulnerable in society and something has to give, if the dental contract is part of the solution then it must it be addressed.

How do you switch off after a busy day?

Each day is different for me, I can be anywhere in the country and sometimes not even in the UK. I like to be with the dogs and the horse, I enjoy eating out in fabulous places and I like to read. I have always enjoyed art and the theatre, but more recently I have taken up photography. When I really want a break you are most likely to find me in Portugal.

Do you have any further career goals you can share with us?

I have had the most wonderful career on the whole, with very few regrets and I recognise that I have accomplished a lot. I am keen to continue supporting others to achieve their goals and to work closer to the dental charities. I have become involved in some of the research groups and in some of the public health work and I am hopeful that these will support me in bringing the National Oral Health Promotion Group back as a representative body, this was a promise to a colleague who is no longer with us.

I have a number of personal goals; two that spring to mind are around both the Mental Health Wellness work and the Human Factors in Dentistry group and their further development. I would like to finish my doctorate and then I may call time on academic studying. I would also like to give more time to MindSet UK and the Dental Nursing Historian Group.

Thank you so much for your many contributions to BDJ Teamthese past ten years and for continuously flying the flag for and supporting dental nurses and the dental team!