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Resolving the crisis in children’s dentistry

During the Labour Party conference, policymakers and experts assembled at a roundtable event to discuss how paediatric dental services might be reformed.

The UK’s dental profession is in decline. Between 2010 and 2022, during a string of successive Conservative governments, the NHS dentistry budget fell by 8 per cent in real terms. Today, there is only enough funding to provide basic dental services to about half the population. This makes the UK the worst performing country in the G7 for oral health spending per capita.

The situation is hitting children especially hard. Less than half of the UK’s children saw an NHS dentist between 2022 and 2023, while tooth decay is the most common reason for children aged six to ten to be admitted to hospital. In July, the Health and Social Care Committee called for “urgent and fundamental reform”, amid reports that people had resorted to pulling out their teeth with pliers.

These topics were in focus at a roundtable event called “A child’s smile: Protecting NHS dentistry for the next generation”. Hosted by the New Statesman in association with Bupa Dental Care, the event was part of the Labour Party conference fringe events programme in October. It brought together policymakers and experts to discuss how they might resolve the “crisis” in paediatric dentistry.

A Bupa Dental Care expert began by outlining the problem: spending on children’s dentistry has fallen by 10 per cent, while the poorest children are three times more likely to have dental decay than those who are better off. “We think that NHS dentistry for future generations is really under threat if we don’t take some action collectively,” they said.

They mentioned Labour’s pledge to set aside £111m a year to “rescue” NHS dentistry. This plan could provide an extra 700,000 urgent dental appointments a year, incentivise new dentists to work in the areas with the greatest need, and introduce supervised tooth brushing in schools.

Bupa Dental Care has suggested that the government could also create a £200m Future Oral Health Fund, which would be financed with a 1p increase in alcohol duty, tobacco duty and the sugar tax. Coupled with the rescue plan, it would double spending on children’s dentistry.

An MP remarked that, rather than simply commissioning more children’s NHS dental contracts, it would be better to “fundamentally change the way the contract is put together”. This would involve better monitoring and data collection. “We do not know how many people are out there in dental misery, because there is no data that is joined up,” they said.

An industry representative argued that we simply don’t have enough dentists, which could be addressed by welcoming more professionals from abroad and by removing the cap on dental school places. An academic added that, while many overseas paediatric dentists have trained in this country, they can’t stay and work here because of restrictions on the number of people taking their professional exam.

Removing this blockage should be a priority, agreed the panellists, who flagged up several further obstacles to NHS dentist recruitment and retention. A parliamentary candidate suggested that dentists are being turned off the NHS because of the perception they’ve “got to run the business as well as being a dentist”. An industry representative added that most dentists work part-time, which exacerbates the staffing shortages. 

An academic suggested that dental therapists might be deployed in children’s practice, as they are in New Zealand. “It’s such a good model if it’s set up the right way,” they said.  

The panellists noted that the dental profession itself should play an active role within decision-making. “What work has been done with the paediatric dentistry workforce to look at the challenges and potential solutions – have they been co-designed and shaped?” said a parliamentary candidate.  

While NHS dental provisions have always coexisted with the private sector, the panellists agreed that that the current state of play is unsustainable. As one parliamentary candidate put it, the cost-of-living crisis has involved cutting back on the fundamentals, and “it feels like dentistry was one of the first things to go”. An MP added that the reforms have a simple aim: “It’s about making sure that everyone who needs to see an NHS dentist gets access to it.”

The speakers agreed that solving the problems is as much about systemic change as it is about funding. As a Bupa expert put it: “The frustrating thing is a lot of the answers are staring us in the face and they probably don’t cost much money. It’s just reorganising things and having the political will, and the gumption to see it through.”

[See also: Can Keir Starmer transform the sickness service?]

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