Dentists run out of cash for NHS patients

Patients needing NHS dental treatment before the end of the financial year may not be able to get it, the Department of Health has said. Some dentists have already exhausted their budgets for 2006-07 and will have no money to treat NHS patients until the end of March. The Department of Health blamed the dentists, saying that some had been "speeding through their work" rather than spending more time with patients. Such dentists, it suggested, needed help. "The local NHS is working with these dentists to help improve the service they provide," it said. [What bullsh! Efficient dentists are a problem??]

Patients whose dentists cannot treat them have the option of going to other local dentists who have not run out of money - assuming they have appointments available - or contact their local primary care trust (PCT) for emergency care. The problem has been caused by the introduction of the new dental contract, under which dentists agree to provide a number of "units of dental activity" (UDAs) for a price.

Peter Ward, chief executive of the British Dental Association, said yesterday: "We know, from our own research, that three quarters of dentists don't believe that the UDA target they have been given accurately reflects the amount of treatment they are able to give. "There is a real danger that some dentists will run out of funding to provide care. This is a ridiculous state of affairs when there are dentists who are ready to provide additional care, and patients struggling to access it."

This is the second problem to hit NHS dentistry in as many weeks. The Government overestimated the money that would be paid to dentists by patients, who pay a proportion of treatment costs. Dentists are seeing more patients who are exempt from charges than was expected, so income is down.

A survey by Health Service Journal suggests that in each PCT a small number of practices will face problems. In Bradford and Airedale, for example, 10 out of 73 practices are in danger of completing their contracted work too soon. The Cornwall and Isles of Scilly PCT is monitoring a "small number of practices" to try to ensure that they do not complete their contracts early. In Essex, between 15,000 and 20,000 patients could be affected, according to Tony Clough, secretary of the Essex Dental Committee. He said that some dentists were putting off routine checkups until April.

Potentially worse, he said, were those who were underachieving, by up to 30 per cent. [Fast is no good. Slow is no good. How lucky we are to have bureaucrats who know better than the dentists themselves exactly what dentists should be doing] "Their funding for 2007-09 will be reduced, which means they won't be able to treat as many patients in the future. "Dentists struggling to meet their targets are put off big cases. Dentists are looking in patient's mouths and saying: `what targets should I be achieving today?' It's ludicrous."

The Department of Health said that the guidance given to PCTs about how to deal with the problem was available on its website. "The new contracts were designed to give dentists exactly what they asked for - more time with their patients," a spokesman said. "A small minority of dentists say that they are going to deliver their agreed services before the end of the year. This suggests that they may be speeding through their work."

Andrew Lansley, the Shadow Health Secretary, said: "The Government was relying on its hike in NHS dental charges to pay for changes to the system, but all this has done is force patients to the private sector."

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Dutch doctor: why Britain's NHS is failing on superbugs

AS a doctor who has worked in Britain and Holland, Hajo Grundmann could not have a better insight on why the two countries are so far apart in the battle against the superbug MRSA.

While Holland, along with Norway, has emerged as the nation with the lowest rate of MRSA in Europe, Britain has one of the highest, together with Cyprus, Malta and Portugal. In Norway and Holland less than 1% of all bloodstream infections are drug resistant, while in Britain the figure is 44%. Figures compiled by the European Antimicrobial Resistance Surveillance System, which Grundmann co-ordinates, show that Britain has higher rates of the superbug than all comparable European countries, including Germany, France and Spain.

Grundmann, a consultant microbiologist, said the differing levels of cleanliness between Britain and Holland were apparent to anyone entering the hospitals. "In Dutch hospitals, you are struck by their modernity and the design of the wards. This translates into the ability to isolate patients in single rooms and there is certainly greater availability of beds," he said. "Levels of cleanliness in Britain are on the low side when compared to other European standards. Cleanliness explains only a proportion of the transmission of MRSA but it is important because it is a marker for diligence and commitment and shows that staff are taking their work seriously."

Grundmann said overcrowded British hospitals were a big contributor to infection. British hospitals have fewer single rooms and so isolating all infected patients is impossible. As a result, patients with MRSA need to be cared for on communal wards and risk passing on the bug. He said the proximity of beds, the high percentage of beds occupied at any given time and the rapid turnover of patients fuelled the high rates of MRSA in British hospitals. "The drive to bring down the waiting lists by increasing the number of interventions and reducing the average length of stay is not helpful. This imposes a lot of work on an already overburdened system and staff and this always results shortcuts in hygiene," he said.

The inability to isolate patients due to lack of space and pressure to have wards open to keep waiting times down contrasts starkly with the drastic action taken to control MRSA outbreaks in Holland. Grundmann recalls an outbreak in a large Dutch hospital in 2003, affecting 28 patients. Managers reacted by closing two wards, including an intensive care unit, and spent 2 million Euros screening all staff and patients. Staff found to be carrying MRSA were sent home.

Ironically, the process of screening patients for MRSA and isolating those found to be carrying the bug, a technique known as "search and destroy", was devised in Britain. But, in the mid-1990s when the MRSA rates began to soar, managers found it impossible to isolate all infected patients - there simply was not enough space. The latest MRSA bloodstream infection figures, released last week, show that there were 3,391 cases in England from April to September 2006, down 5% from the same period in 2005. However, the figures appear to have reached a plateau, with the rate of decline being too slow to meet the target set in November 2004 by John Reid, the then health secretary, of a 50% reduction in MRSA cases before April 2008.

The number of deaths from MRSA in England and Wales has increased from about 50 in 1993 to 1,170 in 2004. The youngest victim was two-day-old Luke Day, who died at Ipswich hospital in 2005 after contracting MRSA. Sheldon Stone, a consultant in healthcare of the elderly at the Royal Free hospital in north London, said Britain needed to set up special isolation wards where all the patients with MRSA are treated. Failing this, he said, special nurses should be designated to look after only MRSA victims, to prevent the bug being transmitted to other patients. The Department of Health said many NHS trusts had been successful in bringing down the rates of MRSA, especially by encouraging staff to wash their hands. [Brilliant! Finally catching up with Lister -- in the 19th century]

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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