The costs of new dental regulations

April 01, 2011 9:49 AM

Andrew Lansley’s health reforms have proved to be a big source of debate. One area of healthcare that has been subjected to the full force of the reforms is primary dental care - and they will have adverse financial affects on every dental practice in England, taxpayers and the 25 million patients in England who use this service every year.

Alongside ring-fencing healthcare spending, the Secretary of State has said that efficiency savings of £20billion must be found – but at the same time Andrew Lansley has forced through regulatory and bureaucratic changes to the way dental practices are run. This will cost at least £391 million to fully implement with yearly running costs of £280 million according to estimates published by Denplan, the largest dental payment plan specialist.

[caption id="" align="alignright" width="222" caption="Another inefficient regulator?"][/caption]

In England the health regulator in this area is the Care Quality Commission (CQC). In Wales, it’s the Healthcare Inspectorate Wales. But there is a big disparity in the fees charged for regulation. In Wales the current fee that a private dentist pays to the regulator is £50 a year, but in England the CQC will charge sixteen times more: £800 a year. This is a stark difference in bureaucracy and regulation. The English have a bloated, inefficient regulatory system. The Welsh, meanwhile, spend far less on regulation and this helps offset the cost of free prescriptions and hospital parking. We hear so much about cutting red tape, but the Government must follow through on this in England.

The Department of Health (DoH) in England gives two main reasons for expanding regulation and imposing a second major regulator on dental practices. Firstly, they suggest that more regulation will reduce the risks of cross infection, but they have been unable to produce any credible evidence of cross infection having happened in recent times.  Secondly, when the proposal to extend regulation was put out to consultation, the DoH said that the “vast majority” wanted increased regulation. This is simply incorrect: 96 of the 230 respondents wanted increased regulation of primary dental care. It also says something about “hidden” consultations affecting millions of people and thousands of professional staff that they only received 230 replies mainly from parties with a vested interest in expanding regulation. It is shameful that the Coalition should rely on just 96 responses to justify this costly expansion and ignore the almost unanimous concerns of the professionals involved.

The CQC is charged with monitoring all health and social care providers, measuring outcomes and maintaining standards. However, the CQC seems to have some problems of its own. The chief executive Ms Cynthia Bower is the former head of West Midlands Strategic Health Authority, responsible for overseeing the “appalling conditions” at Stafford Hospital. Andrew Lansley – then in opposition – criticised her appointment to the CQC, but to date she remains in post. In 2010 a CQC staff survey highlighted rock bottom morale with 86 per cent of respondents having no confidence in decisions made by the executive board. There are reports of staff being reduced to tears and being forced to push through registrations to meet deadlines regardless of quality or safety issues.

In April 2011 it will be a legal requirement for all dental practices to be regulated by the CQC, but this is an expansion too far. Dentistry is currently and primarily regulated by the General Dental Council. It sets standards of dental practice, conduct and assesses dental education. Other regulators involved cover medicines and equipment, radiology, and NHS services. It is argued by respected opinion that UK dentistry is already the most regulated in Europe.

The CQC regulations were originally designed for large institutions such as hospitals, and social care services with large and specialist management structures. These regulations will apply across the board and no allowance has been given for the fact that the vast majority of dental practices are small and without the management resources to implement them.

The taxpayer contributes approximately £2.25 billion towards the cost of running the NHS dental service in England alone. The costs of this additional and unnecessary regulation will eventually be passed on to the taxpayer and add more than 10 per cent to this bill. Taxpayers should ask, at this time of austerity and major cuts, how this regulatory expansion could possibly be justified.Andrew Lansley’s health reforms have proved to be a big source of debate. One area of healthcare that has been subjected to the full force of the reforms is primary dental care - and they will have adverse financial affects on every dental practice in England, taxpayers and the 25 million patients in England who use this service every year.

Alongside ring-fencing healthcare spending, the Secretary of State has said that efficiency savings of £20billion must be found – but at the same time Andrew Lansley has forced through regulatory and bureaucratic changes to the way dental practices are run. This will cost at least £391 million to fully implement with yearly running costs of £280 million according to estimates published by Denplan, the largest dental payment plan specialist.

[caption id="" align="alignright" width="222" caption="Another inefficient regulator?"][/caption]

In England the health regulator in this area is the Care Quality Commission (CQC). In Wales, it’s the Healthcare Inspectorate Wales. But there is a big disparity in the fees charged for regulation. In Wales the current fee that a private dentist pays to the regulator is £50 a year, but in England the CQC will charge sixteen times more: £800 a year. This is a stark difference in bureaucracy and regulation. The English have a bloated, inefficient regulatory system. The Welsh, meanwhile, spend far less on regulation and this helps offset the cost of free prescriptions and hospital parking. We hear so much about cutting red tape, but the Government must follow through on this in England.

The Department of Health (DoH) in England gives two main reasons for expanding regulation and imposing a second major regulator on dental practices. Firstly, they suggest that more regulation will reduce the risks of cross infection, but they have been unable to produce any credible evidence of cross infection having happened in recent times.  Secondly, when the proposal to extend regulation was put out to consultation, the DoH said that the “vast majority” wanted increased regulation. This is simply incorrect: 96 of the 230 respondents wanted increased regulation of primary dental care. It also says something about “hidden” consultations affecting millions of people and thousands of professional staff that they only received 230 replies mainly from parties with a vested interest in expanding regulation. It is shameful that the Coalition should rely on just 96 responses to justify this costly expansion and ignore the almost unanimous concerns of the professionals involved.

The CQC is charged with monitoring all health and social care providers, measuring outcomes and maintaining standards. However, the CQC seems to have some problems of its own. The chief executive Ms Cynthia Bower is the former head of West Midlands Strategic Health Authority, responsible for overseeing the “appalling conditions” at Stafford Hospital. Andrew Lansley – then in opposition – criticised her appointment to the CQC, but to date she remains in post. In 2010 a CQC staff survey highlighted rock bottom morale with 86 per cent of respondents having no confidence in decisions made by the executive board. There are reports of staff being reduced to tears and being forced to push through registrations to meet deadlines regardless of quality or safety issues.

In April 2011 it will be a legal requirement for all dental practices to be regulated by the CQC, but this is an expansion too far. Dentistry is currently and primarily regulated by the General Dental Council. It sets standards of dental practice, conduct and assesses dental education. Other regulators involved cover medicines and equipment, radiology, and NHS services. It is argued by respected opinion that UK dentistry is already the most regulated in Europe.

The CQC regulations were originally designed for large institutions such as hospitals, and social care services with large and specialist management structures. These regulations will apply across the board and no allowance has been given for the fact that the vast majority of dental practices are small and without the management resources to implement them.

The taxpayer contributes approximately £2.25 billion towards the cost of running the NHS dental service in England alone. The costs of this additional and unnecessary regulation will eventually be passed on to the taxpayer and add more than 10 per cent to this bill. Taxpayers should ask, at this time of austerity and major cuts, how this regulatory expansion could possibly be justified.

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