Wednesday, 29 July 2015

Toxic Tory Policies - a case review


The trickle down effect of  Toxic Tory Policies is effecting all levels of UK society turning decent people cynical and the already cynical into pretty venal, self interested and nasty people who do not give a shit because it is clear the UK Government does not and is only interested in generating big cash jobs for its MPs and other Oxbridge types from the correct schools and colleges.

Case Study:

In 1988, in an attempt to raise standards in UK dentistry ever higher, the UK Dental Profession agreed to the top slicing of the NHS dental budget (in effect taking a pay cut) to fund vocational training schemes for newly qualified dentists to work in a salaried position within an NHS practice so there was no need for them to churn and burn from day one to meet principals targets for monthly gross income. The original scheme was decently funded and a success, liked and appreciated by both training practices and Vocational Trainees.

Then somebody decided the scheme should no-longer be voluntary but compulsory for all newly qualified dentists while the top sliced percentage to pay for the increased provision, from the NHS dental funding, stayed the same. This was feasible because the number of dentists required in the UK NHS would be decreasing, according to a DoH survey and projection. Further, as a number of UK Dental Schools were being closed there would be fewer UK dental vocational trainees by the year 2000 so all would be well.

In 1990 a sizable number of the UK Dental profession pointed out to the then Tory Government, they were talking a load of old bollocks and their actions would destroy NHS Dentistry. The Tory Government gave them the two finger salute and told them to get their grubby noses back on the NHS dental grindstone, where they belonged, and NHS Dentists should be grateful they were even being paid for the honour of working for a Tory Government - after all where else could these UK NHS dentists go, private practice?

In July 2015 an article in a Dental Professional magazine had a headline 'NHS Vocational Trainees facing a 'Dutch Auction' for training places'. The article went on to explain the difficulty newly graduated dentists were having finding vocational training places in England as a result of the number of dentists practicing privately and no longer having an NHS contract number. The funding package for NHS dental principal's was now so bad that a few of the remaining NHS Vocational Trainers had started asking trainees how little they were willing to work for, in effect top slicing the supposed salary trainees were to receive. The article pointed out that where multiple applications for places were received these unscrupulous trainers were asking the interviewees to put their 'bids' in sealed envelopes then selected those willing to work for the lowest pay. Worse, this selection system was becoming increasingly common across NHS England. Vocational Trainees are complaining the level of supervision and support offered by Vocational Trainers is next to non existent except for a few exceptions.


On first glance this is just another unethical, greedy dentist tale where a system I was involved in trialing and launching in 1988, for NHS England, is being abused by unscrupulous dentists for their own ends.

This is a simplistic view and ignores the reasons why unscrupulous NHS contracted dentists have ended up as NHS Vocational Trainers, the impact this is having on retention of young UK trained dentists in the UK in general and what this means for the future of NHS dentistry across the UK - not just England where this is reported as happening.

  1. As the percentage top sliced for VT training has not changed since the 1988 trial and the overall NHS England dental budget has not kept up with the true costs of delivering dentistry the VT funding package, in 2015, is now worth around 30% of the value present in 1988, in real terms. This clearly has an impact on funding available for VT training in Scotland as a 'Barnett' consequential
  2. Many of the original VT trainers took the Tory Government's two fingered hint in 1990, exited NHS dentistry and, because they were amongst the most competent, had few problems converting their practices from NHS to Private contract. As a result they could no longer accept NHS VT's as they did not 'do' enough NHS work. A result of this was a sudden need to recruit extra NHS dental practices as VT trainers and a fall off in selection criteria to meet a UK Government political imperative of providing VT places for all new UK graduates
  3. In 2015, even in Scotland, a lot of NHS dental provision is provided by a private company, Integrated Dental Holdings. IDH are not interested in VT's as they are not productive enough nor cost effective. The company prefers to employ young dentists from Eastern Europe who can work in the NHS without any VT training as 'assistants' on low salaries, no UK dentists would accept. This reduces the core number of available NHS practices for UK VT trainees. Without VT Training certification, UK dentists can not get a NHS contract number. This combination of walls and mirrors has increasingly seen recent UK graduates being recruited to posts in the USA, Australia, Canada and New Zealand where the standard of training UK dental students receive is highly regarded, status within the community is higher and the working conditions are far better.
  4. The problem of the retirement of the 'Baby Boomers' born between 1940 and 1960 means there are big holes now appearing in overall numbers. This is being seen across the NHS in general with the number of GP practices struggling to replace retiring senior GPs and the increasing number of unfilled GP vacancies. The same is true of UK NHS dental practices. This problem dates back to the manpower review undertaken in the mid 1980's by the Tory Government which did not account for the mass retirement of so many health professionals over a ten to twenty year time span, starting in 2000, nor the increased numbers of female graduates (over 50% of UK medical and dental grads are now female) who it was likely would take a break to have children in their thirties and be more likely to return to the workplace in a job share role until their late 40's and even then they may not return to full time work.
  5. It is this environment created by political interference and incompetence regarding the NHS over the last four decades where 'cost effectiveness', 'value for money', 'targeted care' and 'tightened budgets' have become the be all and end all, the modus operandii of these dental VT trainers should be viewed. They have a product 'Vocation Training Place' which are limited in number in England and chased by more people than the places are available for. This is market place NHS in the raw, a commodity trade where the seller is looking to maximise their 'investment', a good bit of Tory, get ahead on the backs of other, dogma. The NHS dentists feel they are being screwed over by the UK Government so it seems OK to screw over NHS VTs. This is simply another product of neo-liberal 'trickle down' theory.

The venal and unethical actions of these supposed vocational mentors of young dentists are non-contestable unforgivable and unprofessional but are a direct result of the failed NHS policies of a succession of Tory and Labour Governments over the last forty years, turning working for the NHS from a vocation to just another job and the inevitable do the hours, work the minimum you can get away with, take the money, go home and shut the door attitude from the NHS workforce in general.

The real toxicity of UK Government policy on the NHS since the 1980's is this attitude is increasingly seen in the professions who are the spine of the NHS simply because they are human and there is only so far you can push any human before they simply turn on their heel and walk away. This is increasingly true of the younger members of the health care professions who have knowledge, abilities and skills others value more highly than the UK Government.

The real amazement is so many remain committed to work in a NHS system which consistently disregards them as human beings, abuses their professional commitment to the NHS on a daily basis and routinely blames them for all the NHS failings either out of ignorance (patients and families) or to protect their own scrawny political arses whether at Westminster, Holyrood, in the plethora of NHS quangos or in the NHS Towers of Mismanagement.

The question for all Scots is just how much longer can the Scottish Government cover the increasing short falls in NHS Scotland funding (as a result of 'Barnett' consequentials) from an overall Scottish Government budget which is also being cut savagely year on year. A reality which is being played up with the current Conservative and Labour Unionist Party line of 'How are the SNP going to protect Scotland from Westminster's austerity policy.'

The reality is the SNP can only rob Peter to pay Paul so far within their restricted budget. The only answer that fully deals with the contrary claims and assertions of the toxic Conservative and Labour Unionist Party is independence.


The British taxpayer pays to train these people it should force them to work for the NHS, surely this is the answer?

Currently the average dental and medical student on graduating has around £40,000 of debt in student and other loans hanging around their neck which rather asks just what have the taxpayers actually paid for. The vocational training schemes were originally planned and designed to help with NHS retention by easing new graduates into the pressures of work within the NHS.

In Scotland a golden handshake was offered to dental students by the Libdem/Labour coalition to persuade them to stay in Scotland. The impact of this golden handshake was the dental students who were going to stay in Scotland got a nice tax free sum for doing what they were going to do anyway. There was no evidence that students who were planning to head off elsewhere changed their plans.

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