NHS dental care and the issues of public service ethos, governance, accountability and probity.
A decision by any government to intervene in dental care requires that accountability arrangements exist and that the public has faith in them. Such arrangements require a range of governance mechanisms that in turn create routes of accountability. If accountability is to have meaning an appropriate probity system is necessary. Existing probity arrangements in the NHS dental care system are far from ideal: the checks on claims are far less vigorous than under the previous contractual agreement. While the Dental Reference Service continues to refine its probity activities there are few, if any, assessments of the quality of diagnosis and treatment planning let alone the quality of the treatment provided, along with financial shortfalls. The nature of the contract introduced in April 2006 means that, even with compliance, its use as a quality assurance mechanism is substantially weaker. To address these shortfalls requires improvements in the governance arrangements a key element of which is clarity in accountability. Accountability provides an understanding of how a delivery system works, the pressures and incentives facing its actors and allows for better reform design and implementation. If a public dental service is to have excellent outcomes, be fair and equitable and offer value for money the present failings must be addressed. As has been identified in other public services: "...certain assumptions appear to be based on a belief that these standards were general throughout the public sector and would be maintained or adapted during periods of change. Little attention was given to what compromises the standards, how they are perceived and implemented across the public sector and who monitors or polices them, particularly in times of change." (Doig, 1995). The development of improved probity arrangements and a suitable contract through which the service delivered is specified would be a starting point. Perhaps then both the public and the profession can begin to strengthen their faith in a delivery system and improve their trust in the political system. This in turn will help give rise to a modern and dependable care system, something the present government has been attempting and failing to achieve for over 10 years.
Batchelor
Paul
P
D003752:Dental Health Services / Q000458:organization & administration*; D006075:Governing Board; D012941:Social Responsibility; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom