7 Aug 2015  •  Blog, NHS  •  3min read

Rubik’s NHS Blog No. 1

Whether you have memories from those early days or are one of the newer converts, anyone who has tried to tackle a Rubik’s Cube knows how frustrating it can be. Careful concentration can result in getting a handful of pieces in the right place before you then see all your hard work unravel as you try to sort out the next section. It’s no wonder it’s become a helpful analogy to use to illustrate the complexity of problems in many varied fields.

Take, for example, one of the many challenges facing those tasked with designing the ideal NHS dental contract of how to imbed the concept of prevention in the most appropriate way. A care pathway has been piloted with this in mind that incorporates a (relatively) lengthy oral health assessment that will result in a RAG (red, amber, green) status being assigned to the patient. With the aim of ensuring taxpayers’ money isn’t wasted on treatment that fails due to poor oral hygiene, some care provision for ‘red’ patients will be conditional on them improving their status as monitored in subsequent visits.

Although the intention is to encourage and motivate patients to look after their oral heath, Professor Rebecca Harris has put forward an alternative view that it might inadvertently discourage some patients, particularly those from lower socio-economic groups, from attending the dentist and therefore have the completely opposite effect to that intended. The fear is that patients may be put off by the fear of being assessed as ‘red’ and the potential feelings of inferiority that would accompany such a verdict. There is also the concern that those on low incomes but not exempt from charges may find the new approach more financially intimidating.

Professor Harris argues that the danger is the pathway approach, with the requirements for health improvements before receiving care, could lead to a widening of health inequalities rather than a reduction, as is surely the intention.

This casts a different light on the whole concept of conditional healthcare which is gaining some traction throughout the NHS where care might be conditional on improvements in lifestyle, health and habits. As a more subtle form of rationing, it makes sense from a financial point of view and many would argue that imbuing people with a sense of responsibility for their own well-being is long overdue. However, the wider ramifications for society will be interesting to watch.

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