Orthodontic consultant service
On 19th September 1949 the Western Area Committee of the South West Metropolitan Regional Hospital Board decided to recommend that ‘an orthodontist of consultant status be appointed in the Bournemouth area with laboratory facilities at his disposal and that this appointment be advertised forthwith.’
To understand what led to this decision, we need to look at the situation in 1948 when the NHS began. At the time there were only 10 dedicated orthodontic practices in the whole of the UK. The majority of orthodontic treatment was delivered by GDPs using removable appliances, which were thought to be an affordable and effective way of delivering an orthodontic service within the NHS. Fixed appliances were time consuming and expensive. Import restrictions after the War meant Edgewise brackets could not be imported from America so every part of the appliance had to be made by hand. This, combined with fitting bands on the teeth, meant fitting a fixed appliance would take several hours. Teaching Hospitals were the only source of advice and the only place more complex cases could be referred to but these were inaccessible for the majority of practitioners.
Once included under the provisions of the NHS, the demand for orthodontic treatment increased dramatically. In 1948 only 100 orthodontic cases were treated, but this had increased to 53,000 cases by 1954 and a solution to meeting this increasing demand needed to be found. Orthodontic trained increased with the first postgraduate course starting in 1948 at the Eastman with Clifford Ballard appointed as Head of Department. Interestingly, his father, Frederick Ballard, a dentist and advisor to Aneurin Bevan, first proposed an orthodontic consultant role. He suggested that there should be one hospital based
orthodontic specialist who would work alongside an oral surgeon for every 500,000 of the population.
So why was this decision taken in Bournemouth? In 1921 Walter Crane, a dentist with an interest in orthodontics, and several others had established a voluntary dental clinic at the Royal Victoria Hospital in Bournemouth. With the advent of the NHS, Crane gave up work in the clinic to concentrate full time on his private practice. The combination of the availability of dental work in the clinic and his Crane’s orthodontic practice led to a demand for orthodontic treatment.
The Bournemouth Town Council became aware of this need and in June 1949 submitted a request to the Western Area Committee of the South West Metropolitan Regional Health Board.
Authority for facilities to carry out specialist orthodontic treatment in their town. This was referred to the new Dental Advisory Committee which had only been established in December the previous year by the Western Area Committee at the suggestion of the Minister of Health. And in September 1949 the Western Area Committee accepted the Dental Advisory Board’s recommendation that an orthodontic consultant be appointed to the Royal Victoria Hospital.
An advert for the role was published in the January 1950 edition of the British Dental Journal and the role was given to John Hooper.
Hooper qualified from the Royal Dental Hospital before joining the Red Cross on the outbreak of the Second World War. He was captured in Dunkirk in 1940 and was kept as a prisoner of War for the next 5 years. On his return to Britain in 1945 Hooper rejoined the Royal Dental Hospital as a member of the orthodontic teaching staff before applying for the consultant post in January 1950. He started the role in October 1950.
It was originally envisioned that consultants would be employed by Regional Hospital Boards to advise GDPs and school dental surgeons on treatment of cases and they would run clinics to which the more difficult cases could be referred¹. Hooper, writing in 1955, found some difficulty with this arrangement as he found that the majority of GDPs were reluctant to carry out orthodontic treatment, preferring to refer cases to consultants.
Providing advice to practitioners was an important part of the consultant role. This was delivered in clinics, or, following Hooper’s example, through lectures and courses. Hooper gave a series of lectures to local GDPs each year in Bournemouth. His first set was so popular that it had to be given twice.
The majority of the consultants had patients being referred from GDPs and community dentists. In 1952 the majority of Hooper’s cases were being treated with removable appliances. Of the patients under treatment at the end of that year, 354 were being treated with removable appliances, while 169 were being treated with fixed appliances.
The consultant model established by Hooper continues to be used in hospitals. To mark the 70th anniversary of Hooper’s appointment, the museum carried out a series of oral history interviews with orthodontic consultants appointed from the 1960s to the present day.
¹ Hooper JD. Orthodontics in the hospital service. Transactions of the British Society for the Study of Orthodontics 1955; 41: 43-55.