Reforming NHS Dental Services: A Political Economy Perspective

Abstract

This thesis seeks to understand why NHS dentistry is yet to effectively respond to the changing demographic and epidemiological distribution of dental disease in the UK. The analysis suggests that the current stasis in NHS dentistry requires a broader explanation that situates the dental service within the wider political economy of healthcare reform. Drawing from Michel Foucault's concept of biopolitics and a reformed critique of neoliberalism, it is argued that market logic, individualism and consumerism are holding NHS dentistry in a transformational stasis. As both a scientific discipline and a professional occupation, it is argued throughout that understanding the slow pace of reform in NHS dentistry requires a deeper understanding of how science and practise are shaped by neoliberal prerogatives. An extended critique of state-of-the-art dental science and an extensive qualitative study show that the further extension of the market has been accompanied by an obsessive political drive to quantify science and practise, disallowing a wider debate about the direction of the service. The NHS dental service hangs in a precarious balance as professionals try and manage competing objectives and align or converge with policy discourse. As such the political future of NHS dentistry is understood as the reflection of how professionals re-imagine and enact their roles under the restraints of contemporary political economy, and a new opening for a social scientific understanding of dental reform is outlined. The ultimate synthesis of the work suggests that reform of NHS dentistry must recognise, and work within, these constraints if progress is to be made. Closing with a discussion of a possible way forward, the final chapters seek to move beyond critique to outline how policy can effectively integrate dental policy reform within political economic constraints

Date of Award	1 Aug 2016
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Martin Tickle (Supervisor), Katherine Checkland (Supervisor) & Paul Brocklehurst (Supervisor)