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Wisdom teeth

Can't find an NHS dentist? Don't despair, it may soon be easier than you think. Private dentists, it

patient: How much to have this tooth pulled?

dentist: £180.

patient: £180 for just a few minutes' work?

dentist: I can extract it very slowly if you like.

Jokes about going to the dentist used to be about the pain of tooth extraction, but in 21st-century Britain they're more likely to be about the pain to our wallets. An estimated one in five people in Britain is deterred from going to the dentist because of the cost; eight million of us have refused a course of treatment because it was too expensive. The seemingly inexorable decline of affordable National Health Service dentistry, and the growth of private practice (the most expensive in Europe), have certainly hurt our pockets.

But could it be that, after years of decline, the tide is turning? You wouldn't think so, judging by newspaper headlines reacting to newly published figures showing that more than one million patients in England have lost access to free dentistry since the introduction of the government's new NHS dental contract in April 2006.

The figures, according to Susie Sanderson, chair of the British Dental Association's executive board, were "further evidence of the persisting problems with the 2006 NHS dental reforms". But look a little closer. There were 655 more dentists doing NHS work in 2007-2008 than there were in the previous year, an increase of 3.2 per cent. NHS dental treatments also rose last year by nearly one million, to 36 million. And while Sanderson and her organisation attack the government for introducing a "crude, target-driven system", there is growing evidence that the BDA's members don't share this disdain.

The government's chief dental officer, Dr Barry Cockcroft, cites the example of Cornwall Primary Care Trust, which, when asking for tenders for four new NHS practices, received more than 80 applicants. "When primary care trusts ask for tenders for new services, dentists are falling over themselves to bid for them," he says.

It seems that some dentists are deciding that the NHS contracts, which provide dentists with a guaranteed salary of roughly £80,000 a year for three years and a 5 per cent reduction in their workload, are not such a bad deal after all. The economic slowdown could also be helping the return of dentists to the fold. Dr Mark Harris was among 2,000 to resign from the NHS prior to the introduction of the new contracts. Now he has applied to Devon Primary Care Trust to provide NHS care for adults at his Totnes practice. "I think when there isn't much money about, the best arrangement is a mixture of NHS and private work," he admits.

The dramatic decline of NHS dentistry can be traced to the decision of John Major's government to cut the fees payable to NHS dentists in the early 1990s - something to remember during the current wave of nostalgia for the former Conservative prime minister. The decision led to an exodus of dentists from the NHS into private practice. In 1990, before the cuts, only 5 per cent of dentists' earnings came from the private sector; today it accounts for more than half. And as private practice has grown, so the overriding commitment of the dental profession and its governing body to the NHS has weakened.

Throughout the 1990s, one could not question the fervency of the BDA's support for the NHS, but today the emphasis appears to have changed. In her speech to the BDA's May conference in Manchester, Sanderson enthused over the merits of private dentistry. "For many [here], private dentistry has given you the opportunity to work the way you want to, without any sense of compromise," she said. "It has given you freedom." She went on to express scepticism as to whether the NHS could ever meet the "expectations of patients and users".

It is hard not to detect a certain air of defeatism - Sanderson claimed last year that the future of NHS dentistry was "increasingly fragile" - and the BDA's disenchantment with NHS reforms has been seized upon by those opposed to the very idea of NHS care. In its own words, Nurses for Reform, a pro-privatisation pressure group, wants "to see NHS dentistry totally collapse".

"We want customers to be angry at how little they are getting for their taxation, and we want them to defect to a burgeoning private dental sector," writes the group's director, Dr Helen Evans, whose anti-NHS polemic Who Cares for the NHS? was published by the Institute of Economic Affairs earlier this year. "Already, in many [politicians'] minds, the NHS is dead," Evans claimed, having previously described the service as a "Stalinist embarrassment".

Open wide (your wallet)

The favoured gambit of the private dentistry lobby is to make NHS dentistry seem like a lost cause and the complete privatisation of dental care inevitable. If this all sounds familiar, then cast your mind back to the early 1990s when the same "the system's so broke it can't be mended" arguments were made by free-market think tanks lobbying for British Rail's denationalisation.

But nothing is inevitable until it happens - and there is nothing inevitable about the demise of NHS dentistry. The return of dentists to the NHS fold is a fact that fits neither Nurses for Reform nor the BDA's doom-laden prognosis. The increased number of places for training NHS dentists also gives grounds for optimism, as does the government's decision to increase funding for NHS dentistry by 11 per cent next year. And all three main parties remain formally committed to increasing provision.

In the final analysis, the future of NHS dentistry will be guaranteed only if voters raise their voices to urge that more resources be spent on improving access to the service. And the importance of expanding NHS dentistry cannot be overestimated if we care about both our teeth and our wallets: the decline in NHS provision over the past two decades has led to a major deterioration in the nation's oral health. In some parts of the country, tooth decay rose by 50 per cent between 1993 and 2003; mouth cancer has risen by around 25 per cent, with more than 4,700 new cases being diagnosed in the UK each year. The replacement of NHS dentistry with a wholly private system, as free-market pressure groups desire, would prove as catastrophic as the privatisation of the railways has been.

If we want to know what a Britain without any NHS dentistry would be like, we need only look to the United States, where more than 100 million people are without dental insurance and 27 per cent of children and 29 per cent of adults have cavities that go untreated. Last year, a child in Mississippi and another in Maryland died from infections caused by decayed teeth.

When the NHS was formed, exactly 60 years ago this summer, it promised to provide "all medical, dental and nursing care". Free NHS dental care may only have lasted until 1951 - the first year that NHS charges were introduced - but for more than 40 years the NHS provided Britons with access to good-quality and affordable dental treatment. The question that needs to be asked of the free-market ideologues who are already gleefully writing its epitaph is a simple one: if Britain could afford - and operate - a comprehensive NHS dental system in the austerity years of the 1940s and the recession-hit 1970s, why on earth can't we do the same today?

We'll know for sure that we've stopped the rot when dentist jokes are once again about extracting teeth, and not extracting money.

The roots of modern

dentistry

    The ancient Sumerians believed that tooth decay was caused by the "tooth worm". As did Homer and Guy de Chauliac, 14th-century inventor of the "dental pelican", which pulled teeth out sideways

    In Elizabethan times, teeth were cleaned with powdered pumice stone, brick and coral, removing the enamel in the process. Placing turnip parings behind the ear was said to cure bad breath. A bad tooth could be replaced with one from the mouth of a pauper, a dog, a sheep, a baboon . . . or a dead soldier

    Before the 18th century, dentistry was the preserve of barbers, blacksmiths - and others even less capable. Unsurprisingly, extraction could be fatal, as practitioners dislocated teeth from their sockets and pulled out the roots

    As well as hippopotamus bones, one of the first materials used for false teeth was celluloid - which proved extremely flammable

    In Britain in 1968, 79 per cent of the elderly had no natural teeth, partly explained by the trend, in the early years of the NHS, of replacing all your teeth with a nice new set of dentures

CLIVE BARDA
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The lost magic of England

The great conservative journalist Peregrine Worsthorne reflects on a long life at the heart of the establishment.

In a recent editorial meeting, our subscriptions manager happened to mention that Peregrine Worsthorne was still a New Statesman subscriber. A former editor of the Sunday Telegraph and, during a long Fleet Street career, a self-styled “romantic reactionary” scourge of liberals and liberalism, Worsthorne used to be something of a pantomime villain for the left, a role he delighted in. He had close friends among the “Peterhouse right”, the group of High Tory intellectuals who gathered around Maurice Cowling at the small, conspiratorial Cambridge college. He was a frequent contributor to Encounter (which turned out to be funded by the CIA) and an ardent cold warrior. His social conservatism and lofty affectations offended lefty Islingtonian sensibilities. On several occasions he was the Guardian’s reviewer of choice for its annual collection of journalism, The Bedside Guardian, and he invariably delivered the required scornful appraisal while praising its witty television critic, Nancy Banks-Smith. There is no suggestion, he wrote in 1981, that the “Guardian ever sees itself as part of the problem; itself as having some responsibility for the evils its writers described so well”.

His prose style was Oxbridge high table, more Walter Pater than George Orwell. It was essential not to take Worsthorne too seriously, because he delighted in mischief-making and wilful provocation – one of his targets for remorseless ridicule was Andrew Neil, when Neil edited the abrasively Thatcherite Sunday Times. He ended up suing Worsthorne, who was famous for his silk shirts and Garrick Club lunches, for libel; he was awarded damages of £1, the then cover price of the Sunday Times.

“I wrote that in the old days editors of distinguished Sunday papers could be found dining at All Souls, and something must have changed when they’re caught with their trousers down in a nightclub,” Worsthorne told me when we met recently. “I had no idea he was going to sue. I was teasing. I occasionally run into him and we smile at each other, so it’s all forgotten and forgiven.”

After his retirement in 1989, Worsthorne, although he remained a resolute defender of aristocracy, seemed to mellow, and even mischievously suggested that the Guardian had replaced the Times as the newspaper of record. In the 1990s he began writing occasionally for the New Statesman – the then literary editor, Peter Wilby, commissioned book reviews from him, as I did after I succeeded Wilby. Like most journalists of his generation, Worsthorne was a joy to work with; he wrote to length, delivered his copy on time and was never precious about being edited. (Bill Deedes and Tony Howard were the same.) He might have had the mannerisms of an old-style toff but he was also a tradesman, who understood that journalism was a craft.

Shortly before Christmas, I rang Wors­thorne at the home in Buckinghamshire he shares with his second wife, Lucinda Lambton, the charming architectural writer. I asked how he was. “I’m like a squeezed lemon: all used up,” he said. Lucy described him as being “frail but not ill”. I told him that I would visit, so one recent morning I did. Home is a Grade II-listed old rectory in the village of Hedgerley. It is grand but dishevelled and eccentrically furnished. A sign on the main gates warns you to “Beware of the Dog”. But the dog turns out to be blind and moves around the house uneasily, poignantly bumping into objects and walls. At lunch, a small replica mosque in the dining room issues repeated mechanised calls to prayer. “Why does it keep doing that?” Perry asks. “Isn’t it fun,” Lucy says. She then turns to me: “Have some more duck pâté.”

As a student, I used to read Worsthorne’s columns and essays with pleasure. I did not share his positions and prejudices but I admired the style in which he articulated them. “The job of journalism is not to be scholarly,” he wrote in 1989. “The most that can be achieved by an individual newspaper or journalist is the articulation of an intelligent, well-thought-out, coherent set of prejudices – ie, a moral position.”

His Sunday Telegraph, which he edited from 1986 to 1989, was like no other newspaper. The recondite and reactionary comment pages (the focus of his energies) were unapologetically High Tory, contrary to the prevailing Thatcherite orthodoxies of the time, but were mostly well written and historically literate. Bruce Anderson was one of the columnists. “You never knew what you were going to get when you opened the paper,” he told me. “Perry was a dandy, a popinjay, and of course he didn’t lack self-esteem. He had a nostalgia for Young England. In all the time I wrote for him, however, I never took his approval for granted. I always felt a tightening of the stomach muscles when I showed him something.”

***

Worsthorne is 92 now and, though his memory is failing, he remains a lucid and engaging conversationalist. Moving slowly, in short, shuffling steps, he has a long beard and retains a certain dandyish glamour. His silver hair is swept back from a high, smooth forehead. He remains a stubborn defender of the aristocracy – “Superiority is a dread word, but we are in very short supply of superiority because no one likes the word” – but the old hauteur has gone, replaced by humility and a kind of wonder and bafflement that he has endured so long and seen so much: a journalistic Lear, but one who is not raging against the dying of the light.

On arrival, I am shown through to the drawing room, where Perry sits quietly near an open fire, a copy of that morning’s Times before him. He moves to a corner armchair and passes me a copy of his book Democracy Needs Aristocracy (2005). “It’s all in there,” he says. “I’ve always thought the English aristocracy so marvellous compared to other ruling classes. It seemed to me that we had got a ruling class of such extraordinary historical excellence, which is rooted in England
almost since the Norman Conquest.

“Just read the 18th-century speeches – the great period – they’re all Whig or Tory, but all come from that [the aristocracy]. If they didn’t come directly from the aristocracy, they turned themselves very quickly into people who talk in its language. Poetic. If you read Burke, who’s the best in my view, it’s difficult not to be tempted to think what he says has a lot of truth in it . . .”

His voice fades. He has lost his way and asks what we were talking about. “Oh, yes,” he says. “It survived when others – the French and Russians and so on – were having revolutions. It was absolutely crazy to set about destroying that. There was something magical . . . the parliamentary speeches made by Burke and so on – this is a miracle! No other country has it apart from America in the early days. And I thought to get rid of it, to undermine it, was a mistake.”

I ask how exactly the aristocracy was undermined. Even today, because of the concentration of the ownership of so much land among so few and because of the enduring influence of the old families, the great schools and Oxbridge, Britain remains a peculiar hybrid: part populist hyper-democracy and part quasi-feudal state. The Tory benches are no longer filled by aristocrats but the old class structures remain.

“Equality was the order of the day after the war,” Worsthorne replies. “And in a way it did a lot of good, equalising people’s chances in the world. But it didn’t really get anywhere; the ruling class went happily on. But slowly, and I think unnecessarily dangerously, it was destroyed – and now there are no superior people around [in politics]. The Cecil family – Lord Salisbury, he was chucked out of politics. The Cecil family is being told they are not wanted. The institutions are falling apart . . .

“But there were people who had natural authority, like Denis Healey. I’m not saying it’s only aristocrats – a lot of Labour people had it. But now we haven’t got any Denis Healeys.”

Born in 1923, the younger son of Alexander Koch de Gooreynd, a Belgian banker, Worsthorne (the family anglicised its name) was educated at Stowe and was an undergraduate at both Cambridge (Peterhouse, where he studied under the historian Herbert Butterfield, the author of The Whig Interpretation of History) and Oxford (Magdalen College). “I have always felt slightly underprivileged and de-classed by having gone to Stowe, unlike my father who went to Eton,” Worsthorne wrote in 1985.

Yet his memories of Stowe remain pellucid. There he fell under the influence of the belle-lettrist John Davenport, who later became a close friend of Dylan Thomas. “He was a marvellous man, a famous intellectual of the 1930s, an ex-boxer, too. But in the war he came to Stowe and he was preparing me for a scholarship to Cambridge. He told me to read three books, and find something to alleviate the boredom of an examiner, some little thing you’ll pick up. And I duly did and got the scholarship.”

Can you remember which three books he recommended?

“Tawney. Something by Connolly, um . . . that’s the terrible thing about getting old, extremely old – you forget. And by the time you die you can’t remember your brother’s name. It’s a terrible shock. I used to think old age could be a joy because you’d have more time to read. But if you push your luck and get too far, and last too long, you start finding reading really quite difficult. The connections go, I suppose.”

Was the Connolly book Enemies of Promise (1938)?

“Yes, that’s right. It was. And the other one was . . . Hang on, the writer of the book . . . What’s the country invaded by Russia, next to Russia?

Finland, I say. Edmund Wilson’s To the Finland Station (1940)?

“Yes. Wilson. How did you get that?”

We both laugh.

***

Worsthorne is saddened but not surprised that so many Scots voted for independence and his preference is for Britain to remain a member of the European Union. “What’s happening is part of the hopelessness of English politics. It’s horrible. I can’t think why the Scots would want to be on their own but it might happen. The youth will vote [for independence]. This is part of my central theme: the Scots no longer think it’s worthwhile belonging to England. The magic of England has gone – and it’s the perversity of the Tory party to want to get us out of the European Union when of course we’re much more than ever unlikely to be able to look after ourselves as an independent state because of the quality of our political system.

“The people who want to get us out are obviously of an undesirable kind. That the future should depend on [Nigel] Farage is part of the sickness. I mean the real horror is for him to have any influence at all. And when you think of the great days of the Labour Party, the giants who strode the stage – famous, lasting historical figures, some of them: Healey, Attlee, who was probably the greatest, [Ernest] Bevin. I’m well aware that Labour in the good days produced people who were superior.”

He digresses to reflect on his wartime experience as a soldier – he served in Phantom, the special reconnaissance unit, alongside Michael Oakeshott, the philosopher of English conservatism who became a close friend, and the actor David Niven, our “prize colleague”.

“I remember Harold Macmillan saying to me, after the Second World War, the British people needed their belt enlarged; they’d done their job and they deserved a reward. And that’s what he set about doing. And he wasn’t a right-wing, unsympathetic man at all. But he didn’t – and this is what is good about conservatism – he didn’t turn it into an ‘ism’. It was a sympathetic feel, an instinctive feel, and of course people in the trenches felt it, too: solidarity with the rest of England and not just their own brotherhood. Of course he didn’t get on with Margaret Thatcher at all.”

Worsthorne admired Thatcher and believed that the “Conservatives required a dictator woman” to shake things up, though he was not a Thatcherite and denounced what he called her “bourgeois triumphalism”. He expresses regret at how the miners were treated during the bitter strike of 1984-85. “I quarrelled with her about the miners’ strike, and the people she got around her to conduct it were a pretty ropey lot.

“I liked her as a person. I was with her that last night when she wasn’t prime minister any more, but she was still in Downing Street and had everything cut off. The pressman [Bernard Ingham] got several of us to try to take her mind off her miseries that night. There’s a photograph of me standing at the top of the stairs.”

In the summer of 1989, Peregrine Wors­thorne was sacked as the editor of the Sunday Telegraph by Andrew Knight, a former journalist-turned-management enforcer, over breakfast at Claridge’s. He wrote about the experience in an elegant diary for the Spectator: “I remember well the exact moment when this thunderbolt, coming out of a blue sky, hit me. It was when the waiter had just served two perfectly poached eggs on buttered toast . . . In my mind I knew that the information just imparted was a paralysingly painful blow: pretty well a professional death sentence.”

He no longer reads the Telegraph.

“Politically they don’t have much to say of interest. But I can’t put the finger on exactly what it is I don’t like about it. Boredom, I think!”

You must read Charles Moore?

“He is my favourite. Interesting fellow. He converted to Catholicism and started riding to hounds in the same week.”

He has no regrets about pursuing a long career in journalism rather than, say, as a full-time writer or academic, like his friends Cowling and Oakeshott. “I was incredibly lucky to do journalism. What people don’t realise – and perhaps you don’t agree – but it’s really a very easy life, compared to many others. And you have good company in other journalists and so on. I was an apprentice on the Times, after working [as a sub-editor] on the Glasgow Herald.”

How does he spend the days?

“Living, I suppose. It takes an hour to get dressed because all the muscles go. Then I read the Times and get bored with it halfway through. Then there’s a meal to eat. The ­answer is, the days go. I used to go for walks but I can’t do that now. But Lucy’s getting me all kinds of instruments to facilitate people with no muscles, to help you walk. I’m very sceptical about it working, but then again, better than the alternative.”

He does not read as much as he would wish. He takes the Statesman, the Spectator and the Times but no longer the Guardian. He is reading Niall Ferguson’s biography of Kissinger, The Maisky Diaries by Ivan Maisky, Stalin’s ambassador to London from 1932 to 1943, and Living on Paper, a selection of letters by Iris Murdoch, whom he knew. “I get these massive books, thinking of a rainy day, but once I pick them up they are too heavy, physically, so they’re stacked up, begging to be read.”

He watches television – the news (we speak about Isis and the Syrian tragedy), the Marr show on Sunday mornings, and he has been enjoying War and Peace on BBC1. “Andrew Marr gave my book a very good review. He’s come back. He’s survived [a stroke] through a degree of hard willpower to get back to that job, almost as soon as he came out of surgery. But I don’t know him; he was a Guardian man.” (In fact, Marr is more closely associated with the Independent.)

Of the celebrated Peterhouse historians, both Herbert Butterfield (who was a Methodist) and Maurice Cowling were devout Christians. For High Tories, who believe in and accept natural inequalities and the organic theory of society, Christianity was a binding force that held together all social classes, as some believe was the order in late-Victorian England.

“I was a very hardened Catholic,” Worsthorne says, when I mention Cowling’s book Religion and Public Doctrine in Modern England. “My mother was divorced [her second marriage was to Montagu Norman, then the governor of the Bank of England] and she didn’t want my brother and me to be Catholic, so she sent us to Stowe. And I used to annoy her because I read [Hilaire] Belloc. I tried to annoy the history master teaching us Queen Elizabeth I. I said to him: ‘Are you covering up on her behalf: don’t you know she had syphilis?’

“Once I felt very angry about not being made Catholic. But then I went to Cambridge and there was a very Catholic chaplain and he was very snobbish. And in confession I had to tell him I masturbated twice that morning or something, and so it embarrassed me when half an hour later I had to sit next to him at breakfast. I literally gave up going to Mass to get out of this embarrassing situation. But recently I’ve started again. I haven’t actually gone to church but I’ve made my confessions, to a friendly bishop who came to the house.”

So you are a believer?

“Yes. I don’t know which bit I believe. But as Voltaire said: ‘Don’t take a risk.’”

He smiles and lowers his head. We are ready for lunch. 

Jason Cowley is editor of the New Statesman. He has been the editor of Granta, a senior editor at the Observer and a staff writer at the Times.

This article first appeared in the 11 February 2016 issue of the New Statesman, The legacy of Europe's worst battle