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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

Getty
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The New Times: Brexit, globalisation, the crisis in Labour and the future of the left

With essays by David Miliband, Paul Mason, John Harris, Lisa Nandy, Vince Cable and more.

Once again the “new times” are associated with the ascendancy of the right. The financial crash of 2007-2008 – and the Great Recession and sovereign debt crises that were a consequence of it – were meant to have marked the end of an era of runaway “turbocapitalism”. It never came close to happening. The crash was a crisis of capitalism but not the crisis of capitalism. As Lenin observed, there is “no such thing as an absolutely hopeless situation” for capitalism, and so we discovered again. Instead, the greatest burden of the period of fiscal retrenchment that followed the crash was carried by the poorest in society, those most directly affected by austerity, and this in turn has contributed to a deepening distrust of elites and a wider crisis of governance.

Where are we now and in which direction are we heading?

Some of the contributors to this special issue believe that we have reached the end of the “neoliberal” era. I am more sceptical. In any event, the end of neoliberalism, however you define it, will not lead to a social-democratic revival: it looks as if, in many Western countries, we are entering an age in which centre-left parties cannot form ruling majorities, having leaked support to nationalists, populists and more radical alternatives.

Certainly the British Labour Party, riven by a war between its parliamentary representatives and much of its membership, is in a critical condition. At the same time, Jeremy Corbyn’s leadership has inspired a remarkable re-engagement with left-wing politics, even as his party slumps in the polls. His own views may seem frozen in time, but hundreds of thousands of people, many of them young graduates, have responded to his anti-austerity rhetoric, his candour and his shambolic, unspun style.

The EU referendum, in which as much as one-third of Labour supporters voted for Brexit, exposed another chasm in Labour – this time between educated metropolitan liberals and the more socially conservative white working class on whose loyalty the party has long depended. This no longer looks like a viable election-winning coalition, especially after the collapse of Labour in Scotland and the concomitant rise of nationalism in England.

In Marxism Today’s “New Times” issue of October 1988, Stuart Hall wrote: “The left seems not just displaced by Thatcherism, but disabled, flattened, becalmed by the very prospect of change; afraid of rooting itself in ‘the new’ and unable to make the leap of imagination required to engage the future.” Something similar could be said of the left today as it confronts Brexit, the disunities within the United Kingdom, and, in Theresa May, a prime minister who has indicated that she might be prepared to break with the orthodoxies of the past three decades.

The Labour leadership contest between Corbyn and Owen Smith was largely an exercise in nostalgia, both candidates seeking to revive policies that defined an era of mass production and working-class solidarity when Labour was strong. On matters such as immigration, digital disruption, the new gig economy or the power of networks, they had little to say. They proposed a politics of opposition – against austerity, against grammar schools. But what were they for? Neither man seemed capable of embracing the “leading edge of change” or of making the imaginative leap necessary to engage the future.

So is there a politics of the left that will allow us to ride with the currents of these turbulent “new times” and thus shape rather than be flattened by them? Over the next 34 pages 18 writers, offering many perspectives, attempt to answer this and related questions as they analyse the forces shaping a world in which power is shifting to the East, wars rage unchecked in the Middle East, refugees drown en masse in the Mediterranean, technology is outstripping our capacity to understand it, and globalisation begins to fragment.

— Jason Cowley, Editor 

Tom Kibasi on what the left fails to see

Philip Collins on why it's time for Labour to end its crisis

John Harris on why Labour is losing its heartland

Lisa Nandy on how Labour has been halted and hollowed out

David Runciman on networks and the digital revolution

John Gray on why the right, not the left, has grasped the new times

Mariana Mazzucato on why it's time for progressives to rethink capitalism

Robert Ford on why the left must reckon with the anger of those left behind

Ros Wynne-Jones on the people who need a Labour government most

Gary Gerstle on Corbyn, Sanders and the populist surge

Nick Pearce on why the left is haunted by the ghosts of the 1930s

Paul Mason on why the left must be ready to cause a commotion

Neal Lawson on what the new, 21st-century left needs now

Charles Leadbeater explains why we are all existentialists now

John Bew mourns the lost left

Marc Stears on why democracy is a long, hard, slow business

Vince Cable on how a financial crisis empowered the right

David Miliband on why the left needs to move forward, not back

This article first appeared in the 22 September 2016 issue of the New Statesman, The New Times