The bureaucratization of the dental health services in Britain : a study of the interaction between government and the dental profession and the effect this has had on the provision of dental care under the National Health Service
Despite an annual expenditure of the order of £400 million and administrative arrangements which in a number of respects are significantly different from the other arms of the National Health Service, the dental health services have attracted little scholarly attention. The recent Royal Commission on the National Health Service drew attention to this point (Report, para. 9.1) and in a sense the thesis represents an attempt to fill this particular lacuna. The central question addressed is why the performance of the dental health services has neither realised the more general goals (such as equal treatment for all or the relating of access to treatment to need) which were behind the assumption of public responsibility for health care nor overcome the more particular problems associated with the provision of dental services. The thesis seeks to locate the answers in the particular approach adopted to public supply and to this end some considerable space has been given to both the origins and character of this approach. An examination of the pressures that led to public involvement in the provision of dental care is followed, in the main part of the thesis, by an account of the implementation and subsequent operation of the services. Using material from the files of the Ministry of Health and the British Dental Association as well as the numerous public enquiries which have focussed on different aspects of the services, an attempt is made to relate the shortcomings in performance to the adopted approach to supply and more particularly to the inadequacies of the assumptions which underpinned it. The central conclusion is that problems associated with both the power of those involved in the services and the values inherent in the processes of public administration have been responsible for the untenability of these assumptions and that in consequence neither the administrative capacity nor the degree of political control on which policy achievement had been postulated have in fact been realised. The whole policy has become centred on the arrangements for paying individual practitioners in which wider community goals have generally been ignored and in which considerations other than equity or dental need have governed both the supply of, and access to, the available treatment.