Filling the gaps

Just a few short weeks ago at the Labour party conference in Brighton, Keir Starmer MP in his keynote speech said: “We would shift the priority in the NHS away from emergency care, towards prevention. We can catch problems early. And at the same time, we can use the resources of the NHS better.”

NHS dentistry should be at the very heart of this. However, NHS dentistry is currently in crisis. Before the Covid-19 pandemic struck, NHS dentistry was already in a vulnerable and precarious position and the effect of Covid-19 over the last 18 months on this service has been disastrous.

For context, 30 million NHS dental appointments have been lost since the start of the pandemic, access to urgent treatment has been delayed and waiting lists to join an NHS practice continue to have a detrimental impact on those seeking dental treatment.

But it is not only infection control measures that are restricting access to the vital services that dentists provide. There are also problems caused by the current, discredited target-based dental contract, which, coupled with chronic underfunding, is hitting dental providers hard.

In addition, morale amongst NHS dentists is at an all-time low and we are facing a potential exodus of dentists from the NHS. British Dental Association research shows that almost half of Britain’s dentists plan to stop providing NHS services or reduce their NHS commitment, whilst over a quarter plan to move to fully private provision in the next 12 months.

Problems in accessing NHS dental services vary across the country and this has a disproportionate impact on patients. For example, the most recent Oral Health Survey undertaken in 2019 showed that 36 per cent of 5-year-olds in Bradford had tooth decay – this makes them more than four times more likely to suffer from poor oral health than children in Lewes, the constituency of the new minister responsible for dentistry, Maria Caulfield MP.

There is a growing consensus across the public health sector that oral health is an essential component of overall health. Poor oral health affects not only people’s physical health, but their overall wellbeing, confidence, and mental health too.

In children, problems with teeth can impact their ability to sleep, eat, speak, play, and socialise with other children, as well as their school readiness – both through loss of school days and because of pain and difficulty sleeping affecting the ability to learn.

Studies also show that later in life having poor dental health can impact a person’s ability to find a job, with a YouGov poll for the British Dental Association showing that having decayed, discoloured, broken or missing teeth makes it twice as hard to compete in the job market than being overweight or dressing inappropriately.

NHS dentistry is chronically underfunded – it is the only part of the NHS in England that went into the pandemic operating on a lower budget, in cash terms, compared to what it received in 2010.

Since the current government took office, its unspoken policy has been to force dental practices to rely increasingly on patient fees, leaving many dentists having to make the terrible decision to stop providing NHS services altogether.

The government has used unprecedented inflation-busting increases in patient charges to plug the gap in falling funding for NHS dentistry. Patient charges have increased by 5 per cent each year for the last five years – this is a total increase of 28 per cent in the last five years. This discourages many people from attending the dentist, particularly those on lower incomes, and leaves low-income families facing a double whammy – unable to find local NHS dentists with open lists, and more to the point, unable to afford the high cost of private treatment.

Reform of the current NHS dental contract is critical. Taxpayers’ money could and should be spent more effectively.

The current dysfunctional contract sets quotas on patient numbers, fails to incentivise preventive work, and implicitly places an ever-growing reliance on dental practices to pursue private charging as a means of staying afloat. The contract also penalises dentists for taking on patients with high and complex needs and covertly encourages the cherry picking of patients with better oral health needs.

Any new contract must ensure NHS dentistry is available to all those who need it.

I am proud to have played my part in influencing the Labour party to commit in our last manifesto to free NHS dental check-ups for everyone in England. These checks would have taken pressure off GPs and A&E departments who are now regularly dealing with untreated dental problems.

But I believe that we can and must go further. Labour must ensure that we work to achieve a fully funded dentistry service, where NHS dental services are available to all. Good oral health must not be restricted by either postcode or wealth.

We cannot allow oral health and dentistry to remain the Cinderella service of our NHS.

This piece forms part of our Prescription for Fairness blog series. Read the publication and take a look at the rest of the series.