SO LONG, FAREWELL, AUF WIEDERSEHEN, GOODBYE

By Rob Hendry
Contact the author by e-mail at roberth@mddus.com

I once had a patient who believed that the mystery of JFK’s assassination could be solved by numerology. When I started to write this piece I was afraid I too was entering the twilight world of conspiracy theorists. But I keep reading the papers.

Going to the dentist was always one of the unpleasant aspects of childhood, but it was generally considered a standard part of the care the NHS offered to the population. I turned round one day and it was gone. Apart from some quaint flurries in the local press NHS dentistry has almost completely disengaged from the public arena in Scotland in a remarkably short time. No one with anything but the most modest of incomes can really expect not to pay for the care of their teeth nowadays. There was no debate in Holyrood about scrapping free proper dental care for the populace, no Act of Parliament reforming the system nor any promise in a political manifesto to unburden the taxpayer of this service. It just melted away like the defenders of a doomed fortification. Traces of the service remain in the poorer areas of our towns and cities, but in the main the workers’ teeth are left to rot whilst those who want Hollywood style super white smiles are offered the opportunity to buy the very latest high tech treatments in sparkling palaces of dental excellence.

The historian A J P Taylor said that when faced with a crisis politicians stumble forward in what generals describe as the fog of war. When the fog lifts they are often surprised where they find themselves. I don’t generally subscribe to conspiracy theories as I have said, but is this all chance as a result of blundering in the fog? Or is it perhaps a master stroke of political cunning that provides the blue print of how the NHS is to be brought under control by whoever inherits the greatest monolithic organisation the world has ever seen.

Just like a Republic of Soviets where everyone contributed according to ability and received according to need, the NHS sounds like a really nice idea. It all sounds great, but of course the results in the real world move grown men to tears and nations to bankruptcy. The NHS simply will never work because we will never be able to afford it. No country could ever afford such a system. But of course no politician with hopes of a future can say so. In our secular society we humble mortals cling to the belief that only the NHS can save our bodies since we now have no souls. We know we all must die but believe the NHS will come close to immortalising us with its expanding bag of tricks if only the wicked politicians would properly fund it. With our money.

So what would you do if you were a senior civil servant at the Department of Health? A glance at what your colleagues have done with NHS dentistry would provide some useful clues. You don’t have to kill it. Just let it wither on the vine. Let it slip into the sepia tinged folklore memory. Start with general practice. People remember with affection the days when they felt ill or were concerned about their health and went to see their doctor. Sigh at the innocence of this picture. Their doctor? Whose health service do they think it is? No, they can see one of your doctors – remember you employ lots of salaried practitioners now.

Really you don’t want the public to go seeing doctors if at all possible. Let them see nurses or better still healthcare technicians instead. If a little learning is a dangerous thing, just think how much harm properly trained GPs can do. Better to have workers with no experience. They find it so much easier to follow your protocols and guidance.

What will become of all the doctors? Curiously few dentists mourn the demise of NHS dentistry. Might the emergence of private general practice, once an anathema to many, actually be the dawn of a new era for medicine, when real patient choice will reward quality and encourage innovation? All you have to do is divide the number of pages in the new contract by the square root of the date of birth of Andy Kerr and multiply the result by 1948 to get the answer.

Other online articles by Rob Hendry can be found at:
hoolet edition 45 - Goodbye...
hoolet edition 45 - The Knife Man
hoolet edition 43 - Strength Through Joy
hoolet edition 32 - The Drugs War

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.