Disguised privatization pushing dental services out of reach of the poor

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Like other healthcare professions, experienced dentists have been in a prolonged state of anxiety since the pandemic, as we watch how quickly dental services can return to normal after two years of disruption.

Unfortunately, any positive expectations we might have had have been dashed by the publication of new findings from Healthwatch, the NHS body representing patients.

Healthwatch surveyed 2,000 adults in England and then sought input from local NHS teams. It revealed that only half of respondents had visited an NHS dentist in the past two years. Of these, 41% said it was difficult to make an appointment; 20% said they could not access the treatment they needed; and almost 20% felt compelled to pay privately.

But the most worrying finding was this: more than a fifth (21%) said they had wanted NHS treatment but could not find NHS dental services locally. The accompanying cover featured harrowing stories of do-it-yourself dentistry: abscesses pierced with needles, teeth extracted at home, and more.

Fortunately, such stories remain the exception, but they are becoming more and more common. And the cost of living crisis can only exacerbate the problems. “There is a worsening crisis,” commented Louise Ansari of Healthwatch England. “With millions of households bearing the brunt of the escalating cost of living, 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, warming up and having teeth – people in pain, unable to speak or eat properly because they can’t find a cure.

The tragedy is that dental problems are not equal opportunity afflictions. The latest statistics from Public Health England show that inequalities in tooth decay between the most and least deprived five-year-olds increased dramatically between 2008 and 2019. It’s as shocking as it is shameful.

My personal view is that basic health care, and especially relief, should not be a commodity that is bought and sold in a market, but rather a human right. In contrast, what we see in dental services is creeping privatization through the back door. The government will refute that, of course, but that is what its current policies are all about.

The reasons for the current difficult situation in dental services are, as always, many, varied and complex. The coronavirus pandemic has undoubtedly had a huge and lasting impact on supply. In 2020, 19 million fewer dental appointments were taken by the public (NHS and private), half the number in 2019 (40 million). NHS dental services were operating at just 25% capacity.

Things have improved but capacity remains limited. 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 drop of 4 million adults compared to the previous year and 6 million compared to the previous year.

Dental care is not the only part of the NHS in trouble either. According to NHS statistics, in February less than one in two people (41%) were able to see their GP on the same day they requested an appointment. In the worst performing region, Gloucestershire, almost 100,000 patients waited longer than eight days.

But in dentistry, there are more tangible reasons for the backlog; and being tangible, they should be more easily addressable.

Oral Health Foundation CEO Dr Nigel Carter points to Brexit and dentists’ dissatisfaction with NHS contracts which means too few new dentists are being trained which inevitably leads to a shortage of places in NHS surgeries. “We had a perfect storm,” according to Dr. Carter.

Talk to any dentist and NHS dental contracts will appear within the first 10 seconds. They will tell you that unrealistic goals are the main reason dentists leave the NHS for private practice, or only work part-time for the NHS.

The most cynical among us will say that this effect is intentional and not accidental. Having realized they could neither afford nor run NHS dentistry properly, the government is privatizing it by preventing dentists from providing good service without running a loss.

Whatever the government’s motives, a new deal will need to be struck if we are to increase the availability of NHS appointments and reduce the inherent bias against poorer patients.

In the meantime, my fellow dentists and I will continue to emphasize the wisdom of preventive measures – brushing, flossing and sugar-free chewing gum. These interventions have been proven to work, but they must go hand in hand with regular examinations by accessible dental professionals. Regular appointments and pain relief should never be left at the mercy of the market.

Professor Liz Kay MBE is President-Elect of the British Dental Association, Trustee and Fellow of the College of General Dentistry, former President of the Oral Health Foundation and founder of the Peninsula Dental School.

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