Batchelor Paul
Community Dent Health. 2009 Jun;26(2):66-8.
A decision by any government to intervene in dental care requires that accountability arrangements exist and that the public has faith in them. Such arrangements require a range of governance mechanisms that in turn create routes of accountability. If accountability is to have meaning an appropriate probity system is necessary. Existing probity arrangements in the NHS dental care system are far from ideal: the checks on claims are far less vigorous than under the previous contractual agreement. While the Dental Reference Service continues to refine its probity activities there are few, if any, assessments of the quality of diagnosis and treatment planning let alone the quality of the treatment provided, along with financial shortfalls. The nature of the contract introduced in April 2006 means that, even with compliance, its use as a quality assurance mechanism is substantially weaker. To address these shortfalls requires improvements in the governance arrangements a key element of which is clarity in accountability. Accountability provides an understanding of how a delivery system works, the pressures and incentives facing its actors and allows for better reform design and implementation. If a public dental service is to have excellent outcomes, be fair and equitable and offer value for money the present failings must be addressed. As has been identified in other public services: "...certain assumptions appear to be based on a belief that these standards were general throughout the public sector and would be maintained or adapted during periods of change. Little attention was given to what compromises the standards, how they are perceived and implemented across the public sector and who monitors or polices them, particularly in times of change." (Doig, 1995). The development of improved probity arrangements and a suitable contract through which the service delivered is specified would be a starting point. Perhaps then both the public and the profession can begin to strengthen their faith in a delivery system and improve their trust in the political system. This in turn will help give rise to a modern and dependable care system, something the present government has been attempting and failing to achieve for over 10 years.
任何政府干预牙科护理的决定都需要有问责安排，并且公众要对这些安排有信心。此类安排需要一系列治理机制，而这些机制反过来又创造了问责途径。如果问责要有意义，就需要一个适当的廉洁制度。国民保健制度牙科护理系统现有的廉洁安排远非理想：对报销申请的审查力度远不如前一份合同协议。虽然牙科参考服务机构继续完善其廉洁活动，但几乎没有对诊断和治疗计划质量的评估，更不用说所提供治疗的质量以及资金短缺情况了。2006年4月引入的合同性质意味着，即使合规，将其用作质量保证机制的效力也大大减弱。要解决这些不足，需要改进治理安排，其中一个关键要素是问责明确。问责能让人了解交付系统的运作方式、其参与者面临的压力和激励因素，并有助于更好地进行改革设计和实施。如果公共牙科服务要取得优异成果、做到公平公正并物有所值，就必须解决目前的不足。正如在其他公共服务中所指出的：“……某些假设似乎基于这样一种信念，即这些标准在整个公共部门是普遍适用的，并且在变革时期会得到维持或调整。很少有人关注哪些因素会损害这些标准、它们在整个公共部门是如何被认知和实施的，以及谁来监督或监管它们，尤其是在变革时期。”（多伊格，1995年）。制定改进的廉洁安排和一份规定所提供服务的合适合同将是一个起点。或许到那时，公众和专业人士都能开始增强对交付系统的信心，并提高对政治系统的信任。这反过来将有助于形成一个现代且可靠的护理系统，而这正是本届政府十多年来一直试图实现却未成功的目标。
