BAOS President’s Newsletter, September 2021
BAOS Presidency & Covid-19
My term of office is complete and I am delighted to be handing over the BAOS Presidency to Dr Julie Burke. It is a huge privilege and responsibility to hold the role and I have thoroughly enjoyed my past two years of service to the BAOS membership. I offer Julie my best wishes as she takes on the leadership of the BAOS. I know that she will do a terrific job and lead the specialty ever forward.
I am grateful for the work and commitment of the BAOS Council members of whom I am very proud. I believe that our BAOS members, and the patients that they serve, have valued our leadership more than ever during the last eighteen months. The Covid-19 pandemic has challenged health systems around the world and governments have responded in different ways, and at different speeds, with seemingly little interest in learning from each other. The UK initial response was particularly slow.
You will remember that the NHS initial view, when the spread of infection was rapidly escalating, and we had no scale of testing, was that clinical teams including dentists and oral surgeons should continue to provide routine care as long as patients were asymptomatic. It was obvious that asymptomatic patients might well be infectious and yet dentists and oral surgeons were unable to use appropriate PPE because of lack of availability. It was appropriate that the BAOS was vocal about this and engaged in earnest discussion with stakeholders and authorities to ensure safe practice and to limit the spread of infection. It was of interest to note that our Position Statements and publications were used beyond the UK. We also produced advise around urgent care, domestic violence during lockdowns, resumption of practice, and much more.
Cabinet reshuffle, Health Ministers and Waiting Lists
Boris Johnson has just undertaken a major reshuffle of his government resulting in new Health Ministers. Whilst Secretary of State for Health and Social Care Sajid Javid remains in post, many other Health Ministers have moved or departed. Jo Churchill MP, who held the brief for Prevention, Public Health and Primary Care was amongst those who have departed. I have participated in several meetings over the last nine months with the Minister in my role as an honorary consultant adviser to the Office of the CDO England. Jo was very committed to supporting dentistry and our planned evening one-hour meetings usually lasted two or three hours as we enthusiastically debated how to do things better for patients and the profession. We were all very grateful for her time, passion and influence.
Meanwhile, our Government have a lot more to grapple with, and in particular the waiting times for patients to receive NHS care. Sajid Javid has called for review of the NHS targets stating that they have been set under successive governments long before Covid and some of them are not fit for purpose and they fail to measure what matters most to patients. I agree with that. Many NHS targets measure management processes and efficiency and few measure patient related outcomes that are what really drives the delivery of quality patient care.
The 18-week referral to treatment target (RTT) has not been met since February 2016. NHS England waiting time figures for July 2021 showed that over 1.7 million people were waiting over 18 weeks for treatment, an increase on figures for June 2021. These figures demonstrate the pressure facing the NHS with a record 5.61 million people on waiting lists for treatment in July 2021.
We have heard 18 months of government led media messaging around Covid management strategies to ‘prevent the NHS from becoming overwhelmed’. I personally have been troubled by this messaging and the almost religious fervour that was developed in support of the NHS at the height of the pandemic. If routine dentistry and surgery and even cancer surgery and radiotherapy was being delayed for months because of lack of PPE and because wards were full with Covid patients, then wasn’t the NHS already overwhelmed? When I talk to colleagues around the world, I find that our system is not always, ‘the envy of the world’ as we are repeatedly told. Interestingly however, people believe in the NHS even when it fails them or those around them. This level of public support lessens the urgency in my view for the radical thinking that we need about our UK health system.
Publication of recent figures for Northern Ireland showed that there were 524 cancellations in the week from 3rd to 9th September 2021. Of these, 188 cancellations were ‘red flag’ suspected cancer procedures or confirmed cancer procedures. Are we still saying that the system is not overwhelmed? If we were one of the cancer patients having treatment delayed, then what would we think? I think about this as someone who underwent cancer surgery (very successfully I am pleased to report!) in February 2020. Lucky! If my own surgery had been needed a month of two later then it would likely have been delayed, allowing spread of disease, and perhaps I would not be here now to write this Newsletter!
As radical reform is not due anytime soon, we must work for our patients within the overburdened system that we currently have. More and more funding is being thrown at the problem of growing waiting lists but how will this work? We need more oral surgeons and team members and facilities. Certainly we must ensure that our trainees are involved in any ‘waiting list initiatives’ to support them in much needed catch of missed clinical training requirements as a consequence of redeployment and the slowed pace of clinical work on resumption of services. Our trainees were involved in urgent dental care delivery and around 60% were re-deployed to support the medical response to COVID-19.
Meanwhile there has been much work done on ‘rationalising’ waiting lists. It is right therefore that we have produced our own guide to Oral Surgery prioritisation of patients on waiting lists, to help the consideration of our patients in the inevitable discussions between managers and speciality colleagues when we will all be competing for funding and facilities.
I was pleased that our BAOS ‘Clinical Guide to Surgical Prioritisation of Patients on Oral Surgery Waiting Lists’ was recently made available to you. We worked with the BAOMS and agreed that it would have more powerful as a joint association publication. I hope that you will find it useful. It is based on The Federation of Surgical Specialty Associations Clinical Guide but provides more specific information relevant to Oral Surgery procedures and also includes a colour-coded description of the level of risk of delaying a procedure.
The BAOS Commitment to Inclusion
I am proud that our association has been very public about our serious commitment to inclusion. Our statement is on the front page of our website:
‘Like our patients, Oral Surgeons and their Teams are not all the same. We are committed to confronting discrimination in all its forms and to creating a more inclusive environment in which everyone can thrive to best serve our patients’ interests.’
Statements are of course one thing, but this is really about every individuals’ behaviour. Whilst recognising that we are all on a journey, it does give us a clear statement of intent and expectation of members. One my personal highlights of this year’s Bytesize events was the opportunity to interview Baroness Helena Kennedy QC to hear her views on inequality in surgery. If you missed it then you can find it on our BAOS website!
The sad decision to further delay our face-to-face Conference was based on assessment of the risk of Covid distancing measures being in place in March 2022 which our venue management, at the Assembly Rooms in Edinburgh, believed to be a credible possibility. Such a face-to-face conference with such restricted numbers permitted to attend would bit be financially viable. The BAOS conference will be 3-4 November 2022 at the Assembly Rooms in Edinburgh.
The last US military aircraft departed from Kabul airport on 30 August, marking an agonising end to a dramatic two weeks that saw Taliban fighters effortlessly topple the Afghan government and President Ashraf Ghani forced to flee the country. I like you watched this play out on TV and have been thankful for the stability of life in the West. I took it upon myself to make contact with a small number Afghan colleagues and have been having online meetings every few days. BAOS Council have been very supportive. The lives of these individuals and dependants under threat and all are currently in hiding in Afghanistan. They need evacuation and resettlement but it seems that the UK Home Office is overwhelmed and underprepared. I have sought assistance from the International Bar Association’s Human Rights Institute and my MP, Sir Keir Starmer, amongst others, and hope to provide further more positive information in the future.
Our journal readership is up 49% in 2020 compared to 2019. The special edition made up 18% of the articles read (read 10,945). The most read article of 2020 was, ‘The oral surgery response to coronavirus disease (COVID‐19). Keep calm and carry on?’ by myself. There is a Special edition on wisdom teeth, guest edited by Professor Li Zhigang, and due for release later this year. Thank you to Helen Petersen, our Editor-in-Chief!
So what will I be doing on stepping down from the role of President of the BAOS to the role of Immediate Past President? I will be continuing as Dean and Director at Barts and The London School of Medicine and Dentistry, QMUL. I’m also busy with the leadership of our newly created Barts Centre for Squamous Cancer and I am also hoping to get funding for a domestic violence research foundation. I also have some private clinical practice and a medicolegal practice. One our daughters, Francesca, is buying a general dental practice in Wilmslow, and I am assisting her. Becoming a general dental practice owner is not something that I expected to be doing at this stage of my career! That should be enough to keep me busy, but I will also squeeze in having fun times with family and friends and travelling, whilst also maintaining my Instagram posts!
With best wishes,
Professor Paul Coulthard
PDF version of Newsletter – click BAOS President’s Newsletter Sept 2021