Dental Tribune United Kingdom Edition

9InterviewUnited Kingdom Edition March 26-April 1, 2012 N K: The last year saw a huge rise in legisla- tion. What does the immediate future hold with regards to legislation? Are there any signs that things will get better or is it now here to stay? SS: There’s a whole raft of stuff, isn’t there, that we have to demonstrate compliance to. I suppose you’re probably talking about the things which have been on most people’s minds over the last two or three years, and that’s HTM 01-05 and the CQC regulation. CQC and HTM 01-05 should be proportionate, evidence based, relevant, cost effective; they should actually be demonstrating in their ap- plication that they’re improv- ing patient safety or prevent- ing harm. I don’t think either of them yet have published a comprehensive evidence base that confirms that. Both of them are based on risk evalu- ation and the problem with that is the level of risk which is deemed to be acceptable. Outcry At the moment the approach appears to be that in den- tistry nobody should be harmed at any time in any way, no matter what it costs to do that. And the cost benefit analysis is an im- portant exercise to conduct. There is so much immediate communication through vari- ous media now when some- thing goes wrong there’s im- mediately a public outcry and a demand that something is done about it. Failures in patient safety in health services get a lot of pub- licity. Dentistry is a low hang- ing fruit – it’s a very easy area to access to implement regula- tion. Everybody knows where we are and we’re in small units. Now the fight that we’ve been making and the noise that we’ve been making and the in- fluence that we’ve been trying to sway over the last few years is that even in dentistry, where we are so easily identifiable, regulation must be propor- tionate. There is no point in spending hours and hours and thousands of pounds on something which is very, very low risk. Com- mon things commonly happen – now let’s target the common things first, let’s get it proportionate, let’s deal with the things that are likely to happen and be realistic about the things which aren’t likely to happen. I actually think the changes in the antibiotic prescription for bacterial endocarditis is that sort of sensible approach. Let’s weigh up the risks, the bacteriologists said, and quite rightly a decision has been made based on the risk and benefit to the patient. That’s a great example of some really good, proportion- ate thinking, but the fight it took to get that through was just enormous. So that’s been our thrust through all this – challenging CQC at every point to say: why are you concerned about this, what is it going to do to improve patient safety? I don’t think that any dentist at all would be concerned about doing something which gen- uinely will improve patient safety – a demonstrated risk of harm which could commonly happens. Conundrum I’ll tell you one of our conun- drums. HTM 01-05 does have some evidence based areas and there is well publicised challenge in some areas– such as bagging instruments: ri- diculous, silly things which take a member of staff hours in the day to do. We all intui- tively think, what on earth is the point of that? Well the De- partment of Health is obliged to know that we’re right in our intuition, so they’re doing the research. It would help our ef- forts if we could confirm that all dental professionals are fol- lowing guidance as far as they are able to though. We know that the majority are but there are occasionally reports of poor practice which let us all down. NK: So effectively, dealing with those at the bottom, rather than hampering those people who are trying. SS: It’s the bottom two per cent, isn’t it and the disproportion- ate amount of resources we all spend being tarred with the same brush. . Regulation is built on correcting the small amount of failures, which in turn creates detriment for those who are already getting it right. Risk mitigation arises because of out of the ordinary events like Dr Shipman, the Bristol Babies and the Alder Hey body part scandal. You get one high profile episode which then rolls out and you get a dis- proportionate regulatory load on top of that. The BDA is for and about dentists, all the time, and I will protect and support and look after all our members to the end, but actually everybody needs to take what really needs to be done seriously as well. DT In my next article, Susie Sanderson answers questions on dental nurses. In the second part of this four-part series, Neel Kothari talks to Susie Sanderson about dental regulation Make regulation proportionate ‘Dentistry is a low hanging fruit – it’s a very easy area to access to implement reg- ulation. Everybody knows where we are and we’re in small units’ About the author Neel Kothari qualified as a den- tist from Bristol University Dental School in 2005, and currently works in Sawston, Cam- bridge as a princi- pal dentist at High Street Dental Prac- tice. He has completed a year-long postgraduate certificate in implantol- ogy and is currently undertaking the Diploma in Implantology at UCL’s Eastman Dental Institute. Susie Sanderson CQC and HTM 01-05 should actually be demonstrating in their application that they’re improving patient safety or preventing harm