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Modernising NHS Dental Services in Scotland: Analysis of Responses
CHAPTER 2: THE CONSULTATION PROCESS
Timing of consultation
The consultation became "live" on 20 November 2003 and closed on 2 April 2004. Originally timetabled to end on 5 March 2004, this consultation period was subsequently extended in response to several requests by consultees for more time to respond. The scale of the consultation was wide in terms of distribution to stakeholders and the detail of responses. The significant interest in the consultation is reflected in the substantial number of responses received. Staff in the Primary Care Division of the Scottish Executive's Health Department supported the exercise.
Nature of consultation
The consultation document comprised 22 pages (plus covering letter). The document set out the background and policy context to the consultation. It highlighted the areas where change is needed and outlined the aspects of a modern Scottish dental service previously identified by patient and professional groups.
Possible changes to the system were presented for comment and to stimulate further ideas. These centred around 3 broad themes:
What sort of dental services should be provided under the NHS?
How should dentists' contractual arrangements look if they are to support the delivery of these services?
How should patients contribute to the cost of the service?
Distribution and advertising of consultation document
During the course of the consultation over 5000 documents were distributed. After a launch distribution of around 2000 copies, further documents were issued in response to requests, and more copies were distributed along with invitations to a series of consultation events around Scotland. The consultation was also made available on the Scottish Executive website. This ensured a comprehensive coverage of dental practices and practitioners, educational establishments, NHS Boards, Trusts and other bodies, patient and professional representative organisations, specialist organisations and members of the public.
Who were the respondents?
The full list of respondents is documented at
Annex 2. Respondents could be grouped into broad categories as shown in Table 1.
Table 1: Respondents by Category
Respondent Category | No. | % of total |
Practice/practitioners | 89 | 44 |
Professional Representative Organisations/Bodies | 36 | 18 |
NHS Boards/Bodies | 27 | 13 |
Individuals/Public | 24 | 12 |
Patient Representative Groups/Organisations | 20 | 10 |
Educational/Research Organisations | 4 | 2 |
Political | 1 | (..) |
Local Government | 1 | (..) |
Unknown category | 1 | (..) |
Total | 203 | 100 |
(..) Less than 0.5%
NB May not total 100% exactly due to rounding
The largest group of respondents comprised dental practices and practitioners (44% of total). Professional representative organisations and bodies formed the next largest category (18%).
Gaps in Respondent Type
A scan of the consultee list along with a review of the respondent organisations revealed no obvious gaps. The consultation attracted a sizeable volume of responses from a wide spectrum of respondents representing a variety of perspectives. Remote, rural and urban locations were also represented amongst respondents. However, possible "silent voices" were, perhaps, those of young people and those of members of minority ethnic communities. This observation is consistent with respondent gaps noted in other similar consultation exercises.
Nature of responses
The structure of the consultation document provided a significant steer in promoting some consistency in form of response. The majority of the 203 responses were organised broadly around the key questions and issues posed in the consultation document. Responses ranged from one paragraph submissions to relatively long arguments sent with supporting attachments. The consultation was characterised by a mix of professional and individual, lay responses. Many of the responses were issued by organisations or individuals who based their views on their professional experience and insight into the issues. Others were submitted by members of the public with particular points to make relating to their personal experience. With a few exceptions, the general mood of responses was one of concern over current trends and developments in contemporary NHS dentistry and a desire to address these concerns promptly.
Reflections on the consultation process
The Research View
The consultation attracted a substantial volume of responses from a wide range of respondents representing both professional and lay views. Although responses tended to follow the broad framework of issues and questions for discussion, some introduced further topics or focused on one specific aspect of NHS dentistry and expanded on that. A few responses contained commentary rather than any firm recommendations on potential changes.
The Respondents' View
Several respondents from a range of different respondent categories commented on the consultation document itself and/or the consultation process.
The terms used to describe the different category of respondent are as follows:
Dent | (Dental practices/practitioners) |
Pub | (Members of the public) |
Educ | (Educational/Research Organisations) |
Bod | (NHS Boards and Bodies) |
Pat Rep | (Patient Representative Groups and Organisations) |
Prof Rep | (Professional Representative Organisations and Bodies) |
Pol | (Political Respondent) |
LG | (Local Government Respondent) |
Anon | (Unknown category) |
A representative selection of positive comments is below:
"
there has been some lateral thinking with regard to the solutions" (Dent 1) "
the document is finally saying something which dentists working in Scotland have been thinking for a long time" (Dent 23) "
first impression of the document was one of relief that the problem within the NHS dental service has been addressed in what appears to be a fairly open manner" (Dent 33) "
I feel that it (the document)
is going in the right direction" (Pub 12) "
this is clearly an important opportunity to reshape and redesign the delivery of dental services in Scotland" (Educ 4) "
the Board and the profession locally have welcomed the opportunity to contribute….positive first step in the long process of developing a modernised NHS dental service in Scotland" (Prof Rep 17) "
comprehensive and readable document" (Pat Rep 9) "
refreshing to see your forward thinking consultation document" (Prof Rep 6) |
Criticisms were also made of the document and process. These tended to focus on perceptions of:
Lack of reflection of life at the sharp end "
if you were at all sincere in wishing to improve the provision of dental services you might have considered finding out from those of us at the sharp end of things what is really going wrong before producing your dossier" (Dent 31) Lack of mention of funding "
consultation barely mentions funding but this is a key issue" (Dent 65) "
the availability of NHS care is entirely dependent on funding, of which little mention is made in the document" (Educ 2) "
makes no commitment to add funding. Without this it's difficult to see how many of the aspirations in the paper can be realised" (Bod 15) Lack of Clarity and Information "
the consultation expresses points in a woolly fashion and sometimes does not sufficiently illustrate them with examples" (Prof Rep 29) "
need more detail on some aspects in order to prepare an informed comment" (Pat Rep 8) "
paper is at times confusing and contradictory" (Dent 79) Scepticism that no changes will follow "
previous reviews do not appear to have benefited the service" (Pat Rep 5) |
Despite such reservations of a minority of respondents, there was considerable evidence that some respondents had put much effort into widening the consultative process by, for example, consulting a public panel of 500 people, set up to help shape local health services (Bod 7); collecting comments from workshops held at a staff meeting (Bod 29); issuing a questionnaire to collect comments from the 50+ age group (Pat Rep 6); discussions at group and practice meetings (Pat Rep 4); discussions at professional committee meetings and issuing a template questionnaire to all members (Prof Rep 14). Many other examples existed of such wider distribution and discussion of the document and demonstrate a broad respondent base and significant depth of engagement with the consultation exercise.
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