Tariq Drabu Dentist Mercury Treaty is a Sensible Way Forward

I welcome the latest UN Treaty which seeks to reduce mercury pollution. It is called the Minamata Convention and will be adopted later this year in Japan. It is named in memory of the victims of mercury poisoning from industrial pollution that occurred when residents of the Minamata Bay ingested contaminated fish and shellfish in the 1950s. The treaty will require nations to phase down the use of mercury containing dental amalgam fillings over an appropriate time period relevant to each country’s national requirements.

As dentists we are involved with the use of mercury in dental amalgam fillings but mercury has wide uses in other spheres of life for example thermometers, energy-saving light bulbs and uses in the mining, cement and coal-fired power sectors. We work with mercury in a highly controlled and structured manner within rigorous safety guidelines. There was a widespread worry amongst the dental profession that the treaty would call for the total withdrawal of dental amalgam fillings over a short timeframe. In the end lobbying from various organisations including the British Dental Association proved to be persuasive against this approach. It was argued that more time was needed for oral health prevention programmes to be implemented and produce effects, and also time was needed for suitable alternative dental filling materials to be developed.

We as a profession must look harder at reducing the use of mercury in dentistry and we must always seek alternative cost effective materials that can be used. In terms of the future of dental amalgam some of the highlights include:

• National governments to set the pace of the phase down according to local domestic requirements.
• There should be a focus on public health programmes designed to reduce the incidence of dental disease.
• Using non mercury based filling materials should be encouraged and research into such materials should be encouraged.
• Best practice measures should be used to minimise the load from waste dental amalgam.

It looks as though the lead on dental amalgam mercury reduction is going to be taken forward at a European level by the council of European dentists – the CED. Within our current National Health Service structure dental amalgam is and continues to be the most cost effective material to use for our patients. This applies to many other countries in the world where the cost of alternative filling materials that are not mercury based is prohibitively expensive and cannot be justified. Pulling the plug on dental amalgam in an abrupt and dogmatic way would be very destabilising for patient care and I am glad that the UN Treaty does not seek to do this. They have taken a very pragmatic and sensible view. A steady move away from dental amalgam fillings is dependent on good, cost effective, evidence based materials being brought forward.

As dentists we always seek to put the health, safety and well-being of patients above all else. We use dental amalgam under strict conditions of safety and support the progressive phase down over an agreed time frame. Dental amalgam is a cost effective and proven material and until viable cost effective alternatives are developed it will remain the material of choice within our health care systems.

Dr Tariq Drabu Affairs at Stafford - Part 2

It is time to usher in a culture of real accountability and an admission of responsibility from managers and clinicians and staff within the National Health Service when things go wrong.

This follows the highly critical report published this week into the care provided by Mid Staffordshire NHS Foundation Trust. The Inquiry Chairman, Robert Francis QC, concluded that patients were routinely neglected by a Trust that was preoccupied with cost cutting, targets and processes and which lost sight of its fundamental responsibility to provide safe care. The report can be seen here. It has been widely reported in the press and media and is considered to be probably the worst scandal regarding patient care to have affected the NHS since its inception.

Reading this report and its contents I was shocked and appalled that patients could be treated in such an inhumane and uncaring manner. I personally worked Stafford Hospital in 1987 in the oral surgery department and found it to be a wonderful place to work. That is why I find the contents of this report particularly painful. It is reported that as many as 1,200 patients are feared to have died from neglect at Mid Staffordshire NHS Trust between 2005 and 2008 with thousands of others subject to ‘inhumane’ and ‘degrading’ treatment.

What worries me on reading this report is the fact that there is no accountability or responsibility. There is no mention of names of personnel involved. Although the report has some 290 recommendations there is no mention of Sir David Nicholson, who got promoted and is now the current head of the NHS but who was previously at the strategic health authority responsible for Stafford and Cannock Chase hospitals at the time that these appalling events took place.

I find it incredible that Cynthia Bower who was head of the West Midlands Strategic Health Authority (SHA) which was responsible for overseeing the trust at Stafford at the time of this scandal was promoted to head the Care Quality Commission (CQC) the body which is responsible for inspecting health care facilities such as care homes, hospitals and dental practices. While disgraceful and reprehensible medical practice was going on under her watch at the SHA which she was either unaware of or ignored, she then gets promoted to head a regulatory body that seeks to ensure clinical quality and patient safety. You could not actually make this up it is so shambolic. Martin Yeates who was the chief executive of the Mid Staffordshire Trust resigned in 2009 and left with more than £400,000. He gave no evidence to the Francis inquiry as he was reported to be too ill to be cross-examined over the scandal at a public inquiry. I am utterly astounded that he now has a job as chief executive of a health charity, Impact Alcohol and Addiction Services, which hold contracts with the NHS. When managers who have let the public down so badly get promoted then it gives the impression that within the NHS there are strong rewards for failure. This culture has to change. The culture of the NHS for these senior managers seems to be that it is one long rotating conveyor belt – if you get thrown off at one point you can simply hop back on elsewhere and carry on as if nothing ever happened.

It is of course possible as the report does to blame ‘the system’ or talk about the need for a ‘fundamental culture change’ at the Trust, or putting ‘patients, not numbers’ first, and a ‘zero tolerance’ approach to breaches of care. However without holding people to account over these gross and negligent failings closure cannot be achieved. Not one member of staff has been disciplined or struck off following this scandal. More than 80 medical staff have been accused of failings at the hospital since the scandal was exposed in March 2009. It is reported that the General Medical Council (GMC) stated that of 42 doctors who have been investigated by the GMC – four face public hearings in the next few months and four more are still under investigation. The remainder have just received warning letters or had their cases dismissed. The Nursing and Midwifery Council report that 41 nurses had been investigated. Ten are awaiting public hearings, and one is subject to an interim suspension. Two nurses who have had public hearings escaped sanction despite being found guilty of misconduct. 

The Francis report highlighted a culture of failed management where poor medical practice was ignored and patient complaints and concerns were either dismissed or ignored. This was all against a background of target driven spending cuts. Within the current NHS dental system we are working in a target driven culture where we have to hit targets for treatment or face financial penalties all within a progressively reducing spending envelope. Processes rather than care are at the forefront. This mentality has to change. It worries me for the future of NHS dentistry that targets are what we are required to achieve given the events at Stafford.

At Langley Dental Practice I am proud to encourage an open and honest culture amongst all my staff where they should feel able to come forward without fear or favour. All staff at Langley Dental Practice undergo a system of annual appraisals and objective setting. These objectives tie in with the short medium and long term aims of the business. We are all aware that within the NHS we are working in financially difficult times where value for money is vitally important. However we must remember that our primary duty is to care and look after our patients to the best of our ability. This is something that was forgotten at Stafford from the frontline right up to senior management. At Langley Dental Practice we instill a culture of duty of care to patients into all our staff from day one. Quality and high standard starts from the grass roots at the front line. Here at Langley Dental Practice we have been members of the British Dental Association Good Practice Scheme since 2011 and last year we had a positive inspection report from the Care Quality Commission (CQC). We are also an approved training practice by the North West Deanery for new dental graduates. We are always prepared that our practice could be inspected at any time so we do our best to maintain our standards day in and day out.

It is simply not enough just to blame the system and the culture. Ultimately that system has people working in it and those people have to take responsibility for their actions. If mistakes are made and mistakes will be made then they must hold their hands up and try and rectify those errors. However when there are major inherent failings and poor medical practice then it is not enough to look at systems, processes and culture. At the frontline people have to take responsibility for their actions, higher up the chain management and the Department of Health need to remember that patients come before profits and at a national level the regulatory bodies need to win public confidence and trust by acting decisively and removing those individuals from the field of medical practice so that they cannot harm patients ever again.

Dr Tariq Drabu Affairs in Stafford Must Make us all Reflect

Affairs and events at Stafford need to make us pause and reflect.

 

This follows the highly critical report published this week into the care provided by Mid Staffordshire NHS Foundation Trust. The Inquiry Chairman, Robert Francis QC, concluded that patients were routinely neglected by a Trust that was preoccupied with cost cutting, targets and processes and which lost sight of its fundamental responsibility to provide safe care. It has been widely reported in the press and media and is considered to be probably the worst scandal regarding patient care to have affected the NHS since its inception.

 

As somebody who believes fundamentally in the values and the ethos of the National Health Service I was shocked, sickened, devastated and demoralised to read the contents and finding this report. I personally worked Stafford Hospital in 1987 in the oral surgery department and found it to be a wonderful place to work. That is why I find the contents of this report particularly painful. I come from a family that has been honoured and privileged to have served and worked in the NHS since the 1950s. My father is a retired general medical practitioner and my two sisters and brother have worked in general medical practice and hospital medicine. I personally am proud to be an NHS dentist in an area of high social deprivation and high needs. I have built my practice and its reputation over the past 15 years providing high-quality care to my patients irrespective of their background.

 

It seems as though the flame of care and compassion was extinguished from the corridors of Stafford Hospital at the time when these terrible tragic events took place. The fundamental duty of care appears to have been abandoned by the staff concerned. As a registered dentist with the General Dental Council it is my duty to put the interests of my patients above all else. This also applies to my nursing and support staff who are also registered. Failure to do so could end up with us facing disciplinary procedures from our regulatory body. The over arching and paramount duty of care to our patients is something that we do not forget every single day when we come to work.

 

The management structures at the hospital came in for criticism in the report as well. The Francis report highlighted a culture of failed management where poor medical practice was ignored and patient complaints and concerns were either dismissed or ignored. This was all against a background of target driven spending cuts. As a team leader, manager and a director of Langley Dental Group I encourage an open and honest culture amongst all my staff where they should feel able to come forward without fear or favour. All staff undergo a system of annual appraisals and objective setting. These objectives tie in with the short medium and long term aims of the business. We are all aware that within the NHS we are working in financially difficult times where value for money is vitally important. However we must not lose sight of the fact that our primary duty is to care and look after our patients to the best of our ability. This is something that appears to have been forgotten at Stafford.

 

The local health services and inspectors also faced criticism in the Francis report. It appears that failings in the inspection system were rampant right up to the highest level. Quality and high standard starts from the grass roots at the front line. Here at Langley Dental Practice we have been members of the British Dental Association Good Practice Scheme since 2011 and last year we had a positive inspection report from the Care Quality Commission (CQC). We are always prepared that our practice could be inspected at any time so we do our best to maintain our standards day in and day out and not just when we know inspectors are coming.

 

This report pointed to failings at a large hospital - failings that went right up to the door of government and to the Department of Health itself. We are just a small dental practice in Manchester. However I believe that all organisations within the the NHS must remember at all levels whether large or small that compassionate care of patients is at the forefront of what we do. If we all take time to reflect and refocus on these essential core values we will then be able to try and do the best for our patients at all times.

 

Tariq Drabu Affair Around Cosmetic Practice

It is time for the better regulation of non surgical cosmetic treatments such as Botox and dermal fillers. I write in response to a report published on 29 January from the Royal College of Surgeons of England.

The report entitled "Professional Standards for Cosmetic Practice" states that surgeons should provide cosmetic surgery and only doctors, dentists and nurses who have undertaken appropriate training should provide non-surgical cosmetic treatments such as Botox, Currently certain cosmetic treatments can be administered by anyone, anywhere with no medical training. The report can be found at http://www.rcseng.ac.uk/publications/docs/professional-standards-for-cosmetic-practice.

Regrettably for some people nonsurgical cosmetic treatment is not seen as a medical procedure. This has led to events such as Botox parties where non-qualified non-trained members of the public can inject other members of the public with a drug and a chemical with no regulation, license or inspection. This is a situation that has to be stopped and cannot continue for safety of the public. This is not about cost and any arguments that are put forward to advance that are missing the point. This is simply about public safety.

If you are working in an unregulated environment where you do not have to worry about hygiene, safety, inspections and regulations you will be able to provide this procedure at a cheap cost. There are no issues of training or continuing professional development or education involved. In this way you are putting your health at risk and those people who administer these treatments they are a danger to the public and must be stopped. I am not saying that doctors and dentists provide these treatments cheaper. However at least you know that you will be treated in a safe, clean, hygienic environment to the highest standards by a professional whose job is to put your safety above all else. I support the position that only trained doctors, dentists and nurses should provide nonsurgical cosmetic treatments.

At Langley Dental Practice we have been offering treatments such wrinkle smoothing and dermal fillers for almost 10 years with excellent results. Currently non-surgical procedures such as laser treatments or injectables can be administered by people with no healthcare qualifications whatsoever. I was quite astounded when I read that you do not need to be medically trained to administer these types of procedure. Regulation of these procedures is important and I hope that the government will act swiftly and decisively.