In common with other caring professions, senior dentists have been in a state of prolonged anxiety since the pandemic, as we watch to see how quickly dental services can return to normal after two years of disruption.
Sadly, any positive expectations we might have had were given a knock with the publication of new findings from Healthwatch, the NHS body representing patients.
Healthwatch surveyed 2,000 adults in England and then sought feedback from local NHS teams. It found that only half of respondents had visited an NHS dentist in the past two years. Of these, 41% said it had been difficult to book an appointment; 20% said they could not access the treatments they required; and nearly 20% felt pressured to pay privately.
But the most worrying finding was this: more than a fifth (21%) said they had wanted NHS treatment but were unable to find NHS dental services locally. The accompanying coverage contained harrowing stories of DIY dentistry: abscesses lanced with needles, teeth extracted at home, etc.
Thankfully, such stories remain the exception, but they are becoming more commonplace. And the cost-of-living crisis can only exacerbate problems. “There is a deepening crisis,” commented Louise Ansari of Healthwatch England. “With millions of households bearing the brunt of the escalating living costs, private treatment is simply not an option. It needs urgent attention”, she said.
Senior dentists agree. We too see daily cases of people choosing between eating, heating and teeth – people living in pain, unable to speak or eat properly because they cannot find treatment.
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The tragedy is that dental problems are not equal opportunity afflictions. The latest Public Health England statistics show that inequalities in tooth decay between the most and least deprived five-year-olds increased significantly between 2008 and 2019. That is as shocking as it is shameful.
My personal view is that basic health care, and particularly relief, should not be a commodity that is bought and sold in a marketplace, but akin to a human right. In contrast, what we are seeing in dental services is creeping privatisation by the back door. The government will refute this, of course, but this is what its current policies amount to.
The reasons for the current predicament in dental services are, as always, many, varied and complex. The coronavirus pandemic undoubtedly had a huge and lasting impact on provision. During 2020, 19m fewer dental appointments were taken up by the public (NHS and private), half the number in 2019 (40m). NHS dental services were running at only 25% of capacity.
Things have improved but capacity remains constrained. The latest NHS statistics for England show that a third of the population (15.8 million adults) were seen by an NHS dentist in the 24 months to December 2021 — a fall of 4m adults from the previous year, and 6m from the year before that.
Nor is dental care the only part of the NHS that is struggling. According to the NHS statistics, during February, fewer than one in two people (41%) were able to see their GP on the same day they asked for an appointment. In the worst performing region, Gloucestershire, nearly 100,000 patients waited more than eight days.
But in dentistry, there are more tangible reasons for the backlog; and being tangible, they should be more easily addressable.
Dr Nigel Carter, CEO of the Oral Health Foundation, points to Brexit and dentists’ dissatisfaction with NHS contracts which mean that too few new dentists are being trained, leading inevitably to a shortage of places in NHS practices. “We’ve had a perfect storm,” according to Dr Carter.
Talk to any dentist and NHS dental contracts will crop up in the first 10 seconds. They will tell you that unrealistic targets are the number one reason why dentists are leaving the NHS for private practice, or only doing NHS work part-time.
The more cynical among us would say this effect is intended, not accidental. Having realised they can neither afford nor manage NHS dentistry adequately, the government is effectively privatising it by making it impossible for dentists to provide a good service without running at a loss.
Whatever the government’s motivations, a new settlement will need to be reached if we are to increase the availability of NHS appointments and alleviate the in-built bias against poorer patients.
In the meantime, my dental colleagues and I will continue to highlight the wisdom of preventative measures – brushing, flossing and chewing sugar-free gum. These interventions are proven to work, but they need to work in tandem with regular check-ups by accessible dental professionals. Regular appointments and pain relief should never be left to the mercy of the market.
Professor Liz Kay MBE is president elect of the British Dental Association, a trustee and fellow of the College of General Dentistry, past president of the Oral Health Foundation and founder of the Peninsula Dental School.