Dental service in isles is full of problems, response to draft strategy claims

A dentists’ committee has alleged there is a gaping hole in tooth care in Shetland in its response to a draft strategy for dental health.
There are said to be shortcomings in treat­ment for children with bad teeth, massaged waiting lists, poor staff morale and a lack of communication within the service.

The NHS Area Dental Committee (ADC) has claimed that 30 per cent of children with dental caries (decay) have not been seen in the last year while some 28 per cent of children with gross caries (serious decay to gum level) have not had an appointment for a year.

The situation threatened to reverse the “positive trends” in children’s tooth care that had been achieved over the last two decades. The document was leaked to The Shetland Times this week before its signatory, Montfield dentist Steve Lamb, was muzzled by his boss. NHS staff are contractually obliged not to discuss business with the press.

The six-page document for the attention of interim dental director Pippa Arbon was sign­ed by Mr Lamb, who is the ADC vice-chair­man, but represents the views of all 10 NHS dentists on the ADC. The Shetland Times did not receive the document from Mr Lamb.

Health chiefs denied there was any evidence of a crisis in dental care in the isles and claimed that the Dental Strategy for 2012 was an important step forward in improving health services and that staff consultation was ongoing and thorough.

The figures quoted by the ADC are based on the NHS’s own R4 computer data for Brae, Lerwick and Yell and also show, the ADC claims, that 39 per cent of patients in these practices have not been seen at all in the last 12 months. After a major push in the last year, adult registration in Shetland is only five per cent below that of the Scottish average.

Mr Lamb had been willing to discuss the document with The Shetland Times, but his office later called to say that he would not be getting in touch after having been contacted by NHS Shetland director of clinical services Simon Bokor-Ingram.

Earlier, Mr Bokor-Ingram could not confirm the statistics quoted in the response, but said that the claims could be “highly damaging” to the strategy and questioned the motivation of anyone leaking such a document in the early stages of consultation.

Shetland NHS Board chief executive Ralph Roberts added: “The pleasing point about it is that the ADC is agreeing with our direction of travel in the dental strategy and want to be involved in working through it. If we are going to improve the service we have to acknowledge where we are coming from.

“We have to say we have been making progress in general and this consultation is really helpful in involving the public and our staff in discussions.”

Mr Roberts acknowledged that some of the information on the consultation could perhaps have been given in a clearer way and that the board would “learn from that and move on”.

The response also states that only 28 per cent of children with caries had an appointment in the last three months of the statistics while only 30 per cent with gross caries had been seen in the same period.

It goes on to allege: “There are also many ‘current’ patients on the R4 system who have not had appointments since the salaried service administration system was computerised (about five years ago).”

The report claims that owing to overcapacity, patients are being taken off waiting lists for an inspection and going on to a second waiting list for treatment.

It states: “This is very frustrating for all staff who want to get on with providing treatment. It is also a concern for patients who have been given an indication of their particular need for dental care, but are left waiting for their next appointment.

“This gives the impression of the system simply trying to massage the figures – removing one waiting list to produce another will always raise suspicion.”

Private dentist Ian Tinkler, who left the Alan Owen practice to the join the Dental Shetland practice in the Toll Clock Shopping Centre when the Owen practice was taken over by the NHS, said that the state of affairs highlighted in the response was “highly unsatisfactory”. An independent dentist would be “struck off” if found guilty of massaging waiting lists.

He said: “I am more worried about the implications for children than adults. Adults can look after themselves, but a child could remain in great pain for a long time.”

Mr Tinkler said he had considered remaining with the Owen practice and working for the NHS but had disliked the 44-page contract that he would have had to sign and the “gagging order” terms that would have meant he could not publicly discuss the dental service or NHS board which NHS staff are currently bound by.

The ADC response indicates that while the committee appreciated the attempts made to involve staff in the consultation, promised feedback from a November session was still being waited for “and this compounds the perception that views are not considered and staff involvement is just to ‘tick a box’.”

Effective communication was also identified as a key point needing improvement. “There is a general feeling that no-one has any real idea what is going on and this is having a very negative effect on staff morale,” the report adds.

Mr Bokor-Ingram emphasised that the consultation could only lead to improvements in dental care and that the figures and claims were unverified as he had only received the document on Tuesday. However, they did not tally with the generally positive public response to the state of dental service in Shetland.

He added: “If that is the case then we need to put things right, but we are not hearing that in terms of complaints and feedback from the public.”

Mr Bokor-Ingram also denied that there was a lack of communication within the service and said the “fantastic, detailed” response from the ADC was evidence of that. He stressed that there had been an excellent turnout at the staff consultation in Islesburgh on 15th February and that the board’s employment of 10 NHS dentists was hardly evidence of neglect while the dentists’ willingness to join indicated that morale was good and that there was no problem with recruitment.

Mr Bokor-Ingram pointed out that the practice of putting people on a waiting list before registration contradicted claims that the service was registering patients and then abandoning them, in order to create a false impression of progress.

“I do not know if this is someone trying to discredit the service,” he said. “Some of what they are saying and what I have read in the letter does not appear to tally with our national data. If someone has chosen to be malicious that is a very serious issue and you have to question what motivates them.”

Mr Roberts said he did not believe anyone was trying to massage waiting list figures and explained that there had been an attempt to register as many people as possible over the past year so that they could be examined and the state of dental health in Shetland properly assessed.

The shortfall in people on the dentists’ books and the fact that certain people may have been with a private practice had meant a shift in emphasis to registration in recent times, Mr Bokor-Ingram said, but the objective was to treat as many people as quickly as possible.

“We have never said that waiting times were where we would want them to be,” he added.