It is a truth universally acknowledged that you can’t have NHS dentistry without NHS dentists.
Well, not quite universally. Ministers and officials in all four UK nations seem to be taking a very different view.
Across the UK, patients are facing an access crisis, impacting millions. And, at the very same time, NHS dentists are walking away from a service that’s both underfunded and overstretched.
The net result is – as damning new BBC research shows – 9 in 10 practices nationwide cannot take on new adult patients. Researchers couldn’t reach a single practice taking on new adults in over a third of the UK’s local authorities.
Why should this matter? It’s only teeth, after all.
Well, it does. Dentistry is not a nice to have or an optional extra. Since the birth of the NHS it has been a core part of the health service, but too often it has been treated as a poor relation.
Dental pain is pain like no other. Our teeth are hardwired to the brain, so it’s no surprise the impact it can have on our health – both physical and mental – and our productivity. There’s a reason why toothache is the number one cause of overdoses from paracetamol.
Failure here also puts real pressure on other parts of the NHS, as every single day GPs and A&E staff are inundated with desperate patients in dental pain, who they are often neither trained nor equipped to help.
Meanwhile, those who feel they have no options are taking matters into their own hands, armed with a bottle of gin and a set of pliers. We are seeing cases of “DIY dentistry” that have no place in a wealthy 21st century nation.
[See also: The cost-of-living crisis is pricing people out of breathing]
Don’t assume for a minute that the access issues facing patients in England are inevitable. These are problems made in Westminster, within both the Department of Health and Social Care and the Treasury.
Since 2006, NHS dentists in England have been forced to work to a contract that puts government targets ahead of patient care. It’s a system that funds care for just half the population, where the pay dentists receive bares little relation to the work they actually do. It’s a model that serves not to reflect demand or patient need, but to cap the amount of NHS work a dentist can do, and the amount the Treasury puts in.
A decade and a half on – and having faced huge pressures during Covid-19 – a demoralised workforce is rapidly losing hope of change. We are facing an exodus of dentists from the NHS, with thousands having left the service since the start of the pandemic.
Yet a contract dubbed “unfit for purpose” by MPs in 2008, which both major parties pledged to bin in 2010, somehow lives on. At the same time, dentists have seen savage cuts with no parallel in our NHS. “Do more with less” has been taken to the nth degree.
The government recently made some marginal tweaks to this failed contract, but the fundamentals remain unchanged. We have lost more than 44 million NHS appointments since lockdown – more than a year’s worth of dentistry – and not a penny of new investment has been pledged to underpin the recovery and rebuild.
The fear now is we have reached a tipping point, where the losses are such that any recovery will prove impossible. I sincerely hope we have not reached the point of no return, and if we are going to make any progress, we need ministers to do more than rearrange the deckchairs.
The solution lies in real reform and fair funding, and it won’t wait.
For a decade, ministers have pulled off a neat trick of cutting their contributions while ramping up NHS charges well beyond inflation. A “let patients pay more so the government pays less” policy has no place in our NHS.
But we need fair funding to meet demand and the mounting costs of delivery of care. We are now at a point where some practices, particularly those in high needs areas, find themselves delivering NHS treatment at a financial loss.
So, ultimately, the Treasury will determine whether this crisis ends. The government has set worthy goals on reform, improving access, embedding prevention and making the NHS an attractive place to work. But none of these can be achieved on a wholly inadequate, standstill budget.
On both funding and reform, we have welcomed passionate support from MPs on both sides of the House. Unprecedented numbers have secured a debate in September, calling on the government to take decisive action. This shouldn’t be a partisan issue, but it now represents a political open goal.
We are heartened by the noises we have heard from the opposition. It is difficult to argue with their assessment that the government has been “asleep at the wheel”. This is an issue now flooding MPs’ postbags. The Liberal Democrats identified dentistry as one of the leading factors that tipped Tiverton and Honiton from blue to yellow.
Now we need to see concrete plans and real urgency. Politicians will be punished for a failure to end this crisis. After all, our patients have been punished for long enough.