Education, regulation, IN BRIEF • Elucidates the principal roles of the key boards, committees, associations, GENERAL representation and remuneration societies and councils related to dentistry. • Provides a useful resource for those applying to higher specialist training, in dentistry – who does what? as well as those with an interest in the dental political arena. S. Tabiat-Pour,1 T. Pepper2 and N. L. Fisher3 • Empowers the reader to understand who does what in the business of dentistry. VERIFIABLE CPD PAPER Dentistry in the United Kingdom demands a wide range of supportive and regulative bodies, the roles of which are inter- twined, overlapping and changeable. The interaction between these bodies is not always clear, and often the present-day role of the body is far removed from its original purpose. Consequently, the system can appear daunting and opaque. Even so, a thorough understanding of this topic is requisite for those considering applying for higher specialist training, and pertinent for practitioners with an interest in the dental political arena. We hope this paper goes some way towards unravelling the tangle of boards, committees, associations, societies and councils that commonly influence dentistry, and provides a starting point for those interested in increasing their knowledge of the profession at the strategic level. INTRODUCTION landscape. In the interests of simplicity, not each of whom has areas of responsibility In the current politicofinancial climate, all all detail has been given for each country related to their appointment (for instance, public sector organisations – in particular the of the UK, but wherever possible we have the Parliamentary Under-Secretary of State NHS – are experiencing a period of unprec- outlined the distinguishing factors. for Public Health is responsible for public edented change.1 Within this turbulent and health measures such as fluoridation, while evolving environment is the organisational DEPARTMENT OF HEALTH (DH) the Parliamentary Under-Secretary of State machinery engaged with the day-to-day The Department of Health is the UK gov- for Quality is responsible for dentistry, education, regulation, representation and ernment department with overall responsi- among other things). The DH’s Permanent remuneration of dentists in the UK. However, bility for health and social care in England. Secretary is a civil servant who does not the interaction between these bodies is not The devolved governments of the United play a political role, does not change with always clear, and often the contemporary Kingdom each have their own health governments, and is responsible for the role of the body is disparate from the pur- departments, namely the Department of overall efficient running of the DH. The pose for which it was originally conceived. Health and Social Services (Welsh Assembly majority of healthcare in England is deliv- Despite these difficulties, a thorough under- Government), the Health Directorates (The ered by NHS bodies, and this close link standing of this topic is requisite for those Scottish Government), and the Department between the NHS and the DH is reflected in considering applying for higher specialist of Health, Social Services and Public Safety the fact that the NHS Chief Executive – the training and pertinent for practitioners with (Northern Ireland Executive). While every government’s principal adviser on all NHS an interest in the dental political arena. department is responsible for elements issues – also works for the DH. This paper aims to outline the prin- of its own health policy and service, the There are six chief professional officers cipal roles of the key boards, commit- DH deals with non-devolved matters and working for the Department of Health, of tees, associations, societies and councils issues common to all systems. which the Chief Dental Officer (CDO) is one related to dentistry, as well as the interplay The DH does not deliver care services (the others being Chief Medical, Nursing, between them, in order to confer a broad directly but develops policy according Health Professions, Pharmaceutical and understanding of this somewhat nebulous to decisions taken in Parliament. The Scientific Officers). The CDO is the profes- Secretary of State for Health, a Cabinet sional head of dental staff and provides the 1*Specialist Registrar in Restorative Dentistry, Guy’s appointment, is responsible for the DH and government with expert knowledge on all Dental Hospital, 2Consultant in Restorative Dentistry, Guy’s & St. Thomas’ Hospital NHS Foundation Trust, accountable to Parliament. He or she is matters relating to dentistry in England, as Guy’s Hospital, Great Maze Pond, London, SE1 9RT; appointed by the Crown after nomination well as providing leadership and dissemi- 3Medical student, King’s College London, Guy’s Campus, London, SE1 1UL by the Prime Minister. The Department nating policy to the profession through let- Correspondence to: Ms Sara Tabiat-Pour is led by the various Health Ministers*, ters and CDO Update. Separate CDOs work Email: [email protected] for the devolved governments in Scotland, Refereed Paper *Minister of State for Health, Minister of State for Care Wales, and Northern Ireland. Accepted 9 December 2010 Services, Parliamentary Under-Secretary of State for DOI: 10.1038/sj.bdj.2011.340 Quality (Lords), and the Parliamentary Under-Secretary A series of 25 National Clinical Directors ©British Dental Journal 2011; 210: 431-438 of State for Public Health (also known as tsars) work for the DH. They BRITISH DENTAL JOURNAL VOLUME 210 NO. 9 MAY 14 2011 431 © 2011 Macmillan Publishers Limited. All rights reserved. GENERAL essentially spearhead change, each over- England consists of ten regional§ Strategic independent from SHA and DH control seeing the implementation of a National Health Authorities (SHAs), which hold and represent one element of the govern- Service Framework‡ or strategy for key their local NHS Trusts – Primary Care ment’s decentralisation of public services. health issues (such as cancer or diabetes), Trusts, Acute Trusts, Ambulance Trusts, Approximately two thirds of hospitals or key patient groups (for example, chil- Care Trusts and Mental Health Trusts – to have currently achieved Foundation Trust dren). In this role they also work with the account for their performance. SHAs are status; the g overnment’s aim is for all Royal Colleges to ensure that changes in directly accountable to the DH and NHS NHS Trusts to become Foundation Trusts health and social services are reflected in Chief Executive, and are responsible for by 2013. Foundation Trusts are regulated training and education. developing plans to improve health ser- by Monitor,|| a body that reports directly The future role of the Department vices in their area as well as ensuring that to Parliament and that has been proposed of Health is proposed to feature a radi- DH directives and policy are integrated to become a full economic regulator for cal reduction in NHS functions, thereby into local health service plans. the NHS.1 allowing greater focus on improving At the time of writing, approximately public health.1 80% of the £100 billion NHS budget is NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE (NICE) directly allocated by the DH to primary NATIONAL HEALTH SERVICE (NHS) care trusts (PCTs). PCTs are responsible for The National Institute for Clinical The NHS began operating in July 1948 with assessing the needs of their local population Excellence was established in 19995 with the ambition that ‘Everybody, irrespective and ensuring that there is a comprehensive the aim of promoting clinical excellence in of means, age, sex or occupation shall array of primary care and public health England and Wales and establishing parity have equal opportunity to benefit from services available (for example, dentistry, across regions with regard to the range the best and most up-to-date medical and pharmacy and optician services). PCTs also of treatments available, thereby abolish- allied services available… services should play a large role in commissioning second- ing the so-called postcode lottery that was be comprehensive and free of charge…’.2 ary care. In 2006 their number was reduced apparent at the time. In 2005 NICE merged However, within a few years the cost of from 303 to 152 with the aim of combining with the Health Development Agency6 to providing a fully comprehensive service services and reducing costs. Six of these become the National Institute for Health had soared beyond the Government’s most PCTs are Care Trusts – agreements between and Clinical Excellence – a special pessimistic predictions. In an attempt to the NHS and local authorities resulting in health authority (SpHA, an Arm’s Length mitigate its effect, patient charges were a close relationship between health and Body – see Table 1) of the NHS in England implemented for dentistry, prescriptions, social care. While the services that PCTs only. Its future role will include develop- and spectacles. deliver are all NHS-funded, they may be ing quality standards for adult social care.7 Today the NHS is the world’s largest pub- provided by private companies (for exam- NICE publishes guidance in three areas: licly-funded healthcare service. Although ple, Independent Sector Treatment Centres). health technologies (for example, ozone funded centrally from national taxation, A health White Paper1 proposes to phase out treatment), clinical practice (for example, the devolved administrations manage their PCTs and SHAs by 2013, moving respon- dental recall intervals), and public health NHS services separately.3 Strictly speak- sibility for commissioning the majority of (for example, smoking cessation services). ing, the health service in England solely health services to consortia of GP practices The decisions it makes with regard to its carries the title ‘NHS’, with the other UK (who will likely buy in support from other guidance are intended to be apolitical, being services designated ‘NHS Wales’, ‘NHS organisations, such as local authorities, vol- based entirely on clinical efficacy and cost- Scotland’, and ‘Health and Social Care untary organisations and the independent effectiveness.