Diversionary tactics

It is often difficult to figure out the motivations or agendas of politicians. Are they born of avoidance, connivance, ignorance or beneficence - or are they diversionary? I ask this in light of recent suggestions that in future, new dental graduates might be subject to a 'tie-in' to work for the NHS for a given time period. This comes from the NHS Long Term Workforce Plan which states 'One approach we will consider with government is to introduce incentives or other measures, such as a tie-in period, that encourage dentists to spend a minimum proportion of their time delivering NHS care in the years following graduation.'¹

Before I delve into this, I want to point out that I deeply suspect this is a red herring, a distraction from the main debate about NHS dental resources (or lack of them). While we are busy being consumed by the pros and cons of this tentative sound bite, we can't be discussing the main issues.

The notion of engaging young people in paying back to society is not new. It goes by many names but conscription is always the one that springs most readily to mind. This is controversial worldwide as it primarily involves the military. Some are vehemently opposed to mandatory participation in such a scheme for reasons of religious belief, pacifism and similar. Arguments for and against are well rehearsed and perhaps found their apotheosis in the brilliant television series Yes, Prime Minster when top civil servant Sir Humphrey Appleby explains to a junior staff member how to organise a survey on being for or against National Service and how to elicit the answer you want. Do search for the episode online; you will never believe the results of another survey again. Essentially, using Sir Humphrey's approach, you ask a set of leading questions about the youth of today. Are they wayward and need a period of guidance and discipline? Or are they free-thinkers, creative entrepreneurs for whom a spell of enforced service would do them serious harm? The response is alarmingly but hilariously predictable.

So, the questions running up to seeking an opinion on a 'tie-in' might follow a similar trail. Do you think that young dental graduates as a privileged set of people owe a debt to society which should be repaid by service to the community for a fixed period of time? Or: are you of the view that a fully resourced health service should be staffed by willing professionals, remunerated in accordance with the sacrifices they have made in terms of years of their lives dedicated to training for our benefit? You can have fun making up your own leading questions and trying them out on friends and colleagues.

The situation over the measure of sacrifice has changed markedly in recent years with the advent of student loans. Were it the case that students had their entire education paid for by the state then there would be a reasonable argument for some compensatory commitment. This viewpoint is rather more difficult to defend when the undergraduate is paying (at least in part) for their own course. It also raises the logical question as to whether by the modern clamour for equality it might apply to all new graduates. Should those reading geography have to spend two years drawing maps for the department of transport? Surely those newly qualified in English should have to write short stories, novels and poetry for a 12-month period?

The notion of engaging young people in paying back to society is not new. It goes by many names but conscription is always the one that springs most readily to mind.

The dental profession itself developed and introduced in the 1980s what was then called vocational training, the basis of current foundation training in its varying forms. Conceived as a beneficial way in which to provide mentoring, guidance and experience, it then also became tied-in with the requirement to have completed this as a precondition to becoming a provider under the NHS. While the pragmatism of immediate post-graduate support remains good sense, the desire to be a part of NHS provision is at best sadly lacking and at worst snubbed completely in favour of private practice. This is where getting caught in the diversion is at its most dangerous. Similarly, while the NHS Long Term Workforce Plan has also set out plans to expand the number of dental students by 40%, it has not developed any concrete ideas to stem the demonstrative flow of talent out of the workforce.

If all roads lead to Rome, then regrettably all carriageways also lead back to money. In the absence of finance, we will forever be scrabbling around trying to make up the deficit by encouraging workforce fillips from overseas, attempting to plug gaps by using less qualified personnel and adopting tie-ins. While these might be worth exploring, they are not of themselves the answers. I think it is time for a new series: No, Prime Minister.