We are concerned that some of our members have been facing new charges for some dental treatment since the start of the year. Last Friday (24.10.14) Dan Farthing, Haemophilia Scotland CEO and Philip Dolan, Chairman of the Scottish Infected Blood Forum and the West of Scotland Haemophilia Group met with Margie Taylor, Scotland’s Chief Dental Officer to discuss the issue.
Mr Dolan had met with her previously and she has also held meetings with Dr Mike Winter, Medical Director of National Service Division, following representations from Haemophilia Scotland. It is the clear view of the patients we have spoken to that there shouldn’t be any new dentistry charges for people with bleeding disorders.
The new changes are the result of the Community Dental Services and the Salaried General Dental Services in Scotland being merged to created Public Dental Service. When this change took affect in January 2014 it became clear that people were being charged differently for essentially the same treatments. The new Public Dental Service is keen to make the system fairer. They are also concious that more and more people are living with long term medical conditions and that they are living for longer with those conditions.
Margie Taylor explained that her analysis was that there are a spectrum of dental needs for people with bleeding disorders which fell into three groups.
- Those whose bleeding disorder didn’t cause them any problems which couldn’t be dealt with by their normal General Dental Practitioner. Lots of people already just use a local dentist already and are happy with that arrangement. They are subject to the same charges as anyone else.
- Those who need a lot of involvement from their Haemophilia Centre and are subject to comparatively complex dental interventions. The most appropriate place for their treatment is in a specialist services and their will continue to be no charge of this work.
- Those who are in the middle and require varying degrees of Haemophilia Service involvement and a combination of community based and hospital based dentistry.
It is this third group where the difficulties have been occurring. Margie Taylor was at pains to make it clear that this was where work was being focuses to try and address the problems which have been raised. Specifically, a new care pathway is being developed which will set out what procedures should and shouldn’t be charged for. Dr Mike Winter is currently developing an initial pathway and has already assured us he will be consulting on it to get the patient point of view.
The pathway will probably start from the assumption that everyone has a General Dental Practitioner. At the meeting both Philip and Dan highlighted that people have found it difficult to get a dentist in the community in the past because of the sigma around HIV, Hepatitis C or vCJD. Margie Taylor said that General Dental Practitioners are no longer allowed to refuse a patient on these grounds.
Philip cautioned against dividing access to care up by the severity of bleeding disorder. He said that when a person with mild Haemophilia has a bleed it is just as serious, painful and damaging as a bleed for someone with severe Haemophilia.
Dan highlighted the danger of creating a perverse financial incentives in the system. Over the years people with bleeding disorders have been encouraged to move from hospital based dentistry into community based dentistry. However, if they had resisted that move they wouldn’t now be facing charges. If the objective is to encourage greater use of General Dental Practitioners then surely it does not make sense to charge those who make the switch more than those who haven’t. Margie Taylor responded by stressing that everyone had to take responsibility for their own oral health and that the best outcome for people with bleeding disorders was to have good teeth and not require interventions such as extractions. Tooth decay is caused by the presence of plaque and sugar in the mouth and everyone has a responsibility to take action themselves to prevent it. She also stressed that everyone in Scotland is entitled to a free dental check-up.
Philip highlighted the system that has been introduced in Ireland which means that those affected by the contaminated blood disaster don’t have to pay any healthcare charges. It was agreed that this element of the issue might be dealt with best as part of the Scottish Government response to the Penrose Inquiry when it has produced its Final Report.
Philip’s final point was that if the intention behind the changes was to make the system fairer than that should not be done by levelling down the service by introducing new charges but instead by levelling up so that everyone benefits. Margie Taylor resisted that analysis of the situation saying that in her view it was not a question of levelling up or down but it was really about setting the right policy based on evidence.
Find out more
Details of Scotland’s dental charges and exemptions can be found at: