APPENDIX 11
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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