key: cord-0066015-e4xta9rs
authors: nan
title: No turning back to broken system in Wales
date: 2021-07-23
journal: Br Dent J
DOI: 10.1038/s41415-021-3301-8
sha: df43c0b05bc35c47704888a57657a72f22fa56a8
doc_id: 66015
cord_uid: e4xta9rs

nan

In his allegory of the cave, Plato describes a group of prisoners, shackled in a cave since their childhood. Only able to gaze at the cave wall, their view consists solely of the shadows cast onto it by a fire lit behind them. For the prisoners, these shadows are reality. In truth, they are made by objects out of their sight.

One prisoner is freed, but the light of the fire hurts their eyes. They run back to the place where they are comfortable, back to their shackles. Then a prisoner is brought outside of the cave and allowed to become accustomed to life beyond. They learn to appreciate the outside world and become aware of how little they understood beforehand. In their new position of enlightenment, the freed prisoner runs back into the cave to try and assist his former colleagues in joining him out in the sun. However, the cave's darkness leaves him blinded, and the rest of the prisoners assume that his journey has harmed him and resist his attempts to lure them outside. While the prisoner who has left the cave understands that the shadows on the walls don't represent reality, those left in the cave have no desire to leave because they know no other life.

The story of the cave, like all allegories, can be interpreted in a multitude of ways, but how does a piece of philosophy from over 2,000 years ago relate to twenty-first-century dentistry?

Imagine, for example, the prisoners are a group of dentists who have only ever worked in the NHS under the UDA system. They know no other way of being remunerated for the dentistry they perform; know nothing but the rules of the NHS. Their reality is three UDAs for one filling or ten. Twelve for a denture or a mouth full of crowns. Those outside looking in understand that abject absurdity of the system, but those stuck with it are reluctant to change because it's all they know.

Or it could be a profession whose leaders are predominantly older white men, who pass their mantle onto younger white men. A handful of prisoners escape and understand the advantages of more diverse leadership, but those still in the cave ignore these now outsiders because their current way of life works for them and always has.

Maybe it's all of us, stuck in our ways using materials and techniques that are old-fashioned and outdated. Despite several chances to update our skills, to use newer, more successful methods, we fall back into our old ways of working. We're more comfortable with what 'works in our hands' even though we remember the successes but never the failures.

The cave is ultimately a story of being willing to accept new information when it's presented to us, not without question but after careful analysis and reflection. It tells us to set aside our sacred cows, for us all to grow as people, and for dentistry as a profession. We all have our caves. It's time to move out.

Shaun Sellars continues this exciting and essential series on ethical dilemmas in dentistry which appears in every second issue of the BDJ.

The British Dental Association (BDA) Cymru lauded the statement published on 1 July from Baroness Morgan, 1 which indicated there will be no return to the failed system of NHS dentistry operated prior to COVID-19.

The widely discredited target-based contract for high street dentistry, in operation since 2006, was effectively suspended at the onset of lockdown. It capped patient numbers, failed to reward preventive work, and fuelled both access problems and a collapse in morale among the profession.

The Minister has pledged to ensure that all the gains experienced within the variation to the General Dental Services contract will be preserved as Wales moves out of the pandemic recovery of NHS dentistry.

An evolutionary approach to reform has been working well under the leadership of the Chief Dental Officer (CDO) Dr Colette Bridgman, and the BDA sees this partnership with dental branch continuing as it heads towards the next phase of contract reform in April 2022.

Dr Bridgman retires this month and she has ensured that continuity plans are in place until her successor is appointed. The BDA has stressed its commitment to work with the new CDO to ensure that the profession is fully consulted every step of the way towards a reformed NHS contract that works for the profession and patients.

Access to NHS dental services faced crisis prior to the pandemic. Back in 2012, 37% of practices in Wales were accepting new NHS patients, but by 2019, fewer than 16% were able to take on new adults.

Russell Gidney, Chair of the BDA's Welsh General Dental Practice Committee, said: 'This is welcome news for families across Wales. It means there will be no turning back to a failed system that put government targets ahead of patient care.

'In Wales at least we are assured that the mantra of build back better is actually being applied to our health services. '

Written Statement: NHS Dentistry -recovery and system reform