' Struggling dentists' pull more teeth
By David Fletcher Health Services Correspondent
DENTISTS are pulling out patients' teeth unnecessarily as they struggle to maintain living standards under a new Government contract, a survey showed yesterday.
Two out of three dentists said they had extracted teeth that they might have filled before the contract was introduced.
More than half said their pay last year had not increased, or even fell.
The survey of 866 dentists in the dental journal The Probe, says: ' When dentists were asked whether they had extracted, or referred for extraction, any teeth which they might not have done before the introduction of the 1990 contract, 61 per cent said they had, while nearly 37 per cent said they had not. '
Mr Jeremy Cowan, journal editor, said the contract's practical effect was to reduce preventive dentistry in favour of more extractions.
The conclusions were challenged by Mr Joe Rich, chairman of the British Dental Association's General Dental Services Committee, who said it was' probably true ' that more teeth were being extracted because dentists were seeing more patients.
Dentists had no financial incentive to extract teeth, he said.
The extraction fee was 9 but the filling fee could be ' almost anything ' depending on the work needed.
Mr Rich said many dentists were concerned that not enough money was being made available by the Government to implement the contract and he had approached Mrs Bottomley, Health Secretary, to arrange a meeting.
Misconduct case GP to appeal
Dr Robert Jones, the Essex general practitioner suspended for eight months for serious professional misconduct, is to appeal against his conviction.
Dr Jones, of Coggeshall, was found guilty by the General Medical Council last month, which heard that he failed to detect a serious case of appendicitis, prescribing instead indigestion and ulcer tablets.
' The NHS is not for sale ' Virginia Bottomley talks to George Jones in her first interview since joining the Cabinet
By GEORGE JONES
THE NEW Health Secretary, Mrs Virginia Bottomley, set herself an ambitious target yesterday  to ' take the politics' out of the National Health Service.
But her desire to provide a period of stability for nearly one million people employed by the NHS is coupled with a fierce determination to maintain the momentum of reform, with the overwhelming majority of hospitals becoming self-governing trusts by the mid-1990s.
Labour sought to turn the general election into a referendum on the NHS, asking voters for a mandate to reverse the changes.
Mrs Bottomley is convinced the Tory victory provides the opportunity to entrench the reforms  and to give doctors, nurses and managers the confidence to make them work.
In her first full interview since being appointed Health Secretary, she said the election result, and Mr Major's unequivocal commitment to the NHS, had finally ' nailed the lie ' about privatisation of health care.
' The NHS is not for profit.
It is not for sale.
It will continue to be true to its founding principles, available to all and free at the point of delivery, ' she said.
She recalled a promise made by Mr Major when he became Prime Minister: that he would work for a nation at ease with itself.
' I want to see a health service at ease with itself  optimistic and confident about its essential work.
Health is something which touches every individual and family in the country, ' she said.
' But there must be changes.
An organisation that doesn't change fossilises.
Health needs to develop and alter. '
By next year, she is confident that two thirds of hospitals will have become self-governing trusts within the NHS.
She pledged that the Government would safeguard those that did not opt for trust status, but she expected this to be a minority.
The Government will also encourage more family doctors to hold budgets to ' buy ' services for patients, and is looking at ways to enable smaller practices to team up to secure the advantages of fund holding.
The election result has given the Conservatives five years in which to press ahead with the changes.
Most people are likely to judge the reforms on how long they have to wait for treatment  the issue behind the ' Jennifer's ear ' controversy during the election campaign.
Mrs Bottomley stressed her commitment to the Patient's Charter, which has already eliminated almost all waits of more than two years for NHS operations.
The next step is to ensure that, from March, no one should have to wait more than 18 months for a hip or knee replacement or a cataract operation.
A national standard will also be set for outpatient waiting times.
Mrs Bottomley's first big test as Health Secretary will come this summer with the annual public spending round, which will be conducted against a background of concern over high Government borrowing and pressure from the Tory Right for public spending cuts.
The Conservative manifesto contained a commitment to increase, year by year, the level of ' real resources' committed to the NHS  though it put no figure on the extra money to be allocated.
Mrs Bottomley, representing ' caring Conservatism ', will face Mr Michael Portillo, the new Treasury Chief Secretary, who is equally keen to establish his Right-wing credentials by demonstrating he can keep keep a tight grip on the public purse strings.
She acknowledged that there could be difficult times ahead.
' It will always be the case that the holder of my office will need to fight the corner of the health service and there will always, inevitably, be more than we can do. '
But she stressed there would be no let-up in the search for greater efficiency.
As well as fighting for more money, her task was to ensure that ' every last pound ' was spent as effectively as it could be.
Her priorities include giving more encouragement to medical research; emphasis on preventive health to make the NHS a ' health as well as a sickness service ', with the publication shortly of new national targets for reducing deaths from heart disease and cancers; and pressing ahead with care in the community.
As a former psychiatric social worker, Mrs Bottomley is determined to improve standards of care for mentally ill and handicapped people.
' It is not acceptable to have people who require a home confined to long-stay institutions when they could be in more domestic settings.
That is a real challenge, ' she said.
Mrs Bottomley's rise to the top has been swift, with only four years between her first ministerial post and a seat at the Cabinet table.
But she bridles at suggestions that the inclusion of two women  Mrs Gillian Shephard at the Department of Employment and herself  has excluded more able men from the Cabinet.
' Prime Ministers always have to consider balance in the Cabinet  and at least we now have the same number of women as old Etonians in John Major's team, ' she said.
Friday Matters: Marital strife comes out in the wash
By SUZANNE LOWRY
FRENCH magazines love telling their women readers that while French lovers may be romantic, French husbands are scruffy, barely domesticated louts who don't clean their teeth, don't shave at weekends and won't use deodorants.
The direst accusations always seem to centre on husbandly refusal to wash or change underwear and a tendency to wear socks in bed.
If there is any truth in this colourful myth, how do the women stand it?
How about their own standards?
The French, notoriously obsessed with appearances, are disinclined to wash their dirty linen in public.
But sociologist Jean-Claude Kausmann has found out what they are doing with it in private in a major piece of research that takes the lid off the French marital laundry basket.
He has definitively discovered what happens to socks and underwear once the wearers have been persuaded to shed them, how co-habiting men and women care for their most intimate garments, and how couples come to joint terms with the washing machine  or fail to.
His two-year study of 20 couples reveals that the humble, often smelly male sock is indeed at the centre of a secret linen war being waged up and down the land.
' The sock is a highly sensitive conjugal object, ' he declares in La Trame Conjugale (a cunning title; la trame means framework, it can also mean linen).
Socks are often at the centre of the mini-wars at which couples engage.
For instance, one of the bitterest reproaches from a wife to an untidy husband is: ' You might at least put away your socks. '
Socks smell and get lost.
They are also slightly ridiculous and can turn anger and tears to laughter very quickly.
But beware, says Kausmann.
This laughter may not be a safety valve reducing tension, but a device to conceal an urge to violence.
Kausmann is not a fetishist and is much more interested in the couple's relationship than in the efficiency of soap powder.
But he believes that linen is the ideal instrument by which to probe the hidden depths of marital life.
Linen ' is everywhere, all the time, stuck to the couple like their skin ', he writes.
It is' a reminder of the feminine role modified by ideas of equality '.
It symbolises the subjugation of the individual to the joint personality.
At all times, he claims, linen bears the traces of the war between the partners.
Dirty washing makes an equal division of tasks impossible, even for those couples who wish to achieve it.
Kausmann shows how far we have come from the 19th century, when a girl's linen box, full of beautifully embroidered monogrammed sheets, was part of her dowry.
(Shreds of these hoards can now be picked over in provincial brocante shops, brave remnants of another, more confident age.)
Such brides had cared for their treasure.
These days laundry should be easier thanks to machines.
Even a man can do it.
Ironing is another matter.
Given that Paris shop windows are piled with ever more beautiful bed and table linen, there must be plenty of that to do.
Young bourgeois wives, I am told, solved the problem by heaving the basket home to mother, who is still likely to have a bonne to wash it.
Some of Kausmann's female subjects did likewise, others actually liked washing; some even ironed socks.
But most others were desperate to avoid it.
One was even teaching her husband to do it.
Some women in the study were obsessional about cleanliness and tidiness.
One insisted on cleanliness but didn't care about tidiness, while her husband didn't care about cleanliness but was fanatical about tidiness.
Sabine begins the day by making her husband look at a pile of dirty washing by the bed.
Anne-Sophie, on the other hand, lives a life wracked by doubt because she can never decide whether a garment is dirty or not.
Each time she tries to judge she suffers' a feeling of agitation and indeed anguish '.
Her chief horror is to have clothes lying around that are neither one thing nor the other.
She inspects the scene, she smells the garment.
Eventually she puts it away, deciding not to wash it because she hates ironing.
But the malaise persists and all day she feels' destabilised '.
One of the most vexing problems is when and how to mingle the male and female laundry.
Some couples mix it, some don't.
One couple, alas, put too much strain on their new relationship by buying a washing machine.
But then they couldn't bear the clothes to go in together.
They tried having two machines but never had enough laundry to justify running them both.
They could reach no sane accommodation about sharing and are, Kausmann reports, no longer together.
Other families also experience other territorial difficulties.
Elaine can not bear the thought of her husband using her handkerchief.
While Sabine sees no need to wash table napkins after one party: ' That would be stupid.
They are not dirty because people have spat on them once. '
Leon and Madelaine, meanwhile, have chairs on either side of their bed on which to put their respective clothes.
They pile up.
Madelaine refuses to put Leon's away.
This bothers him deep down.
He believes it is her job.
Out loud, he complains about the pile on her chair.
She resents this.
When tasks are shared, it can be even worse: Anne and Pat both do the laundry but have waged a nine-year guerrilla war over the temperature of the water in the machine.
Anne wants it at 30 degrees, Pat at 60 degrees.
The dispute now ' rules their existence '.
Although they rarely speak about it.
Pat puts his work clothes aside, so he can wash them at 60 degrees.
But Anne then does them at 30 degrees.
After she has washed, dried and ironed the clothes, he quietly puts them all back in the machine at 60 degrees.
Jean-Claude Kausmann doesn't get involved in laundering in his own home  but he does do all the shopping and cooking.
And far from showing that the couple is going out of fashion in France, he feels his research demonstrates that it is still at the centre of people's dreams.
It is just more and more complex and difficult to achieve the right water temperature.
Friday Matters: CALLED TO ORDER
SUE BELGROVE had to tackle a wilderness when she married a farmer and moved into his 350-year-old cottage on the borders of Oxfordshire and Buckinghamshire.
Mrs Belgrove, a 32-year-old agricultural graduate, started by hacking down trees and giant weeds, under which were plants such as sedum and aquilegia which had been hidden since before the First World War.
Over the next four years, she also dug a wide herbaceous border down one side for traditional plants such as foxgloves, bleeding heart and Papaver Orientale.
During this time her two-year-old daughter died.
To soothe her grief, Mrs Belgrove, who had just had a little boy, designed an all-white garden beyond the lawn.
' About 18 months later, my mother joked that we should open to the public.
The idea stuck in my mind and I contacted the local NGS organiser, who suggested we open the following year.
After that, it was a mad dash to get ready. '
The hectic preparation, coupled with looking after two small children (by then the Belgroves had had another daughter, Alice), was worth it.
On her first opening day, 300 visitors made their way up the farm's single-track drive.
Last year, there were 400 in one afternoon.
' I don't plan to open more than twice a year, otherwise you garden with a view to what others will think. '
The Belgroves' garden is open on May 3 and July 12, 2 pm-6 pm.
