Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by University College London Hospitals NHS Trust: Eastman Dental Hospital (D 33)

  The Eastman Dental Hospital is a former Special Health Authority that became part of University College London Hospitals NHS Trust in 1996. It shares its facilities with the Eastman Dental Institute. It is a postgraduate teaching hospital with 89 dental chairs and offers training in all the dental specialities. A further 22 chairs are dedicated for student dental hygienists and dental therapists.

  The Eastman's role as a provider of specialist dental education and training means that it only accepts patients from general dental and medical practitioners and the Community Dental Services as secondary and tertiary referrals. It does not have a casualty service except for children. Unlike many district general hospitals, contracts with health authorities to see and treat patients amounts to only £2.5 million of its annual budget of £11.8 million. As a result the Eastman does not offer appointments to all patients that are referred. The demand for treatment greatly exceeds the resources and capability of the clinical departments and most departments have established referral criteria for the patients who will be accepted, firstly for consultation and secondly for treatment. These criteria are issued to health authorities and referring practitioners. Acceptance rates for consultation vary from over 95 per cent in oral medicine and oral and maxillofacial surgery to 25 per cent in conservative dentistry. Treatment acceptance varies between departments from 95 per cent and 2.5 per cent. This is different to referral for medical conditions and not surprisingly, patients and referring practitioners are often unhappy when their referral does not result in a consultation.

  The Eastman is concerned that Modernising NHS Dentistry focuses mainly on access to primary dental care. Access to secondary and tertiary dental care is not addressed specifically. The strategy states that all health authorities will be accountable for the delivery of a strategy for dentistry in its area. However traditionally health authorities have not given secondary dental care a high priority. It is not clear what happens to patients who are referred to the Hospital, but who are not accepted for treatment. This does not seem to fit in with the government's plan for a more patient-centred approach to care.

  A further 18 per cent of the Eastman's budget is received for training the professionals complementary to dentistry, dental hygienists, dental therapists, dental technicians and dental nurses. It is the UK's largest provider of training for these groups of staff. The Eastman is pleased that Modernising NHS Dentistry reaffirms the government's commitment to extending skills-mix in the NHS and specifically emphasises the role of the whole dental team. It also endorses the General Dental Council's proposals to extend statutory registration to dental nurses and dental technicians and introduce new categories of professionals to dentistry, orthodontic therapists and clinical dental technicians. The restrictions placed by the 1984 Dentists Act prevent a number of these proposals being taken forward. If the professionals complementary to dentistry are to play the role envisaged in the strategy, the government can take this forward under the provisions of the 1999 Health Act. However the strategy does not set any time scale for these changes.

  Student dental hygienists and dental therapists see over 4,000 patients per annum. These patients are referred from all the Hospital's clinical departments, but otherwise would not receive treatment.

  Despite being the largest provider of PCD training the Eastman is unable to offer appointments to all patients referred. Anecdotal evidence suggests that many of the patients refused treatment do not get the treatment for which they are referred.

  With more advanced treatment such as implant treatment, there is virtually no option other than private treatment if the patient is not accepted for the very limited number of NHS treatments. Patients are often disillusioned, as they still believe essential treatment is available under the NHS. We believe there should be greater clarity and honesty regarding availability of NHS treatment.

  The Eastman Dental Hospital is situated in central London. During the last two years, it has experienced increasing problems recruiting and retaining the professionals complementary to dentistry. There is a shortage of qualified staff, in particular dental nurses and dental hygienists, and the NHS Whitley Council pay scales do not offer competitive salaries to those offered in general dental practice. If this trend continues, the Hospital will be unable to sustain its present level of clinical activity. We hope the government will carry out an urgent review of salaries in this area and provide the funding to cover any increases. The Hospital does not want to see patients' access to treatment further reduced, and as an indirect consequence, a reduction in the numbers of all members of the dental team trained at the Hospital.

January 2001

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