Conspicuously inconspicuous

Weakness comes in many forms, some of which are more unexpected than others. For me, not being able to face someone and have a difficult discussion is one such weakness, a weakness that was on full display at June's first in-person meeting of the LDC Conference since the pandemic arrived.

At the first LDC Conference I attended some years ago in Birmingham, we had representatives from the offices of the Chief Dental Officers for England, Scotland, Wales and Northern Ireland. The panel discussion was interesting, lively, challenging and ultimately informative. I remember that while most in attendance weren't satisfied with the answers they were given, at least they had answers in some form, and there was a level of respect for having such a debate.

At this year's conference, in his opening speech, Shawn Charlwood, chair of GDPC, said 'The Minister was set to address this conference. Sadly, just hours after the evidence I gave in Westminster last month her office explained she would have to pull out, stressing urgent government business.

'It's unfortunate. I think I share the view of this room, of Healthwatch England, of a growing number of MPs from all parties, large swathes of the media, and of patients across the country that dentistry today is urgent business.

'And it is doubly unfortunate because I - like many of you - had some key questions. Had she - or colleagues from the Department of NHS England been here - we would all be seeking clarity.'

It was left to Chief Dental Officer for Wales, Andrew Dickenson, joining us virtually from holiday in Germany, to be the sole representative of decision-makers within NHS and ministerial circles, and while it gave those in attendance an idea of the potential direction of travel, the nature of the presentation and format meant too many questions were left unanswered.

At a crucial juncture for practitioners in the four nations, disappointed doesn't even come close to describing the absence of these key players in discussions about dentistry in a post-COVID-19 world. Contract reform was understandably on everyone's lips, and after the day concluded, unfortunately remained there. I had to chuckle at Charlwood's presentation on the opening morning, depicting an empty chair. It wasn't quite a melting ice sculpture, but its message was just as loud and poignant. Why is it, that after so many years of beating the drum about the necessity of contract reform, those responsible for delivering it too often dodge the difficult discussions with those most perturbed by the state of the profession?

From conversations I had with those not even remotely close to negotiations on contract reform, the word most often used was one Charlwood used: clarity. In the immediate aftermath of the conference, comments from Minister Maria Caulfield MP in the House of Commons suggested announcements on reform of the failed NHS dental system will be made this side of Parliament's summer recess. What would they be? When exactly would they be? Would they actually happen, or is it a dangling carrot designed to placate some of the ill-feeling generated by the no-show? Given that it happened hot on the heels of Health Secretary Sajid Javid claiming the BDA was the co-author of the discredited NHS contract fuelling the current crisis in NHS dentistry, good will is rightfully in short supply. Practitioners need answers, and misleading statements such as this does nothing to inspire confidence that meaningful contract reform is being considered, let alone close. The absence of anyone who could answer questions meant the vacuum of understanding was filled with annoyance and more uncertainty. It is the last thing the profession wants, or indeed needs.

Perhaps it is our collective expectations that are too high. Perhaps we expected too much. Perhaps we don't. Whatever your personal stance, the bare minimum should be that those in discussions about contract reform and the future of the profession should be available to be held accountable for words, actions, or in this case inaction. While Charlwood wrapped up by stating there is a genuine negotiating process on contract reform, I cannot help but feel we have been here before. A little reassurance, not a display of weakness, was perhaps the better course of action. ◆