Sir Chris Whitty has quoted a Mirror front page story and warns of the long term impact of children not accessing an NHS dentist and getting regular check-ups
Sir Chris Whitty has warned children not being able to access dentists is “setting them up for lifelong poor dental health”.
England’s chief medical officer quoted from a Mirror front page story this week, showing almost a quarter of five-year-olds have tooth decay, and warned of the impact on the nation’s children. Sir Chris and NHS boss Amanda Pritchard have both declared the NHS dentistry payment contract is “not fit for purpose”. The two most high profile health leaders agreed with the statement giving evidence to a Parliamentary committee as new data showed NHS dentistry is being “kept afloat” by subsidies from private fee paying patients.
Sir Chris said children not getting NHS dental check ups meant they were building up significant tooth decay. He said: “It is a very sad reality that the commonest procedure that the children go to hospital for is for extraction of teeth due to severe dental caries, which sets them up for lifelong poor dental health.”
The Mirror has launched the Dentists for All campaign calling for a return to universal NHS access. We reported that 96% of practices are not taking on new adult NHS patients.
The British Dental Association provided evidence a decade of Government funding “cuts with no precedent anywhere in the NHS” means dentists make a loss on many procedures. Its analysis was presented to the Public Accounts Committee’s first hearing of its ‘Fixing NHS dentistry’ inquiry.
Sir Chris said: “Everybody on this side of the table, as indeed everyone on the committee is extremely concerned about dentistry. This has been a problem which has been slowly getting worse since the early 1990s. To be clear, this is not a recent problem. It’s been steadily getting worse.
“All of us see the harrowing stories in the press. Multiple governments would say that the NHS dental system is very weak and has got weaker over time. This is a problem, particularly for those who find it difficult to get dental services when they need them in states of emergency.” He added: “This has been a long standing problem that has been getting worse for decades, and it’s got worse since the pandemic”.
The £3 billion NHS dentistry budget for England has seen a £1 billion real terms cut over the last decade due to inflation. Overall it has remained flat despite population growth. The BDA estimates the budget is only enough to fund care for less than half the population.
The BDA modelling of average dental surgery costs including staffing and equipment indicates that a typical practice makes a loss of £7.69 on a patient exam. A molar and root canal results in a £21 loss while making and fitting a denture sees them make a £42.60 loss. It means dentists are doing more private dentistry to keep them financially sustainable.
Currently if an NHS dentist treats more patients than their NHS contract target then they receive no payment for it – effectively capping the numbers able to access a dentist. Sir Chris and Ms Pritchard were both asked whether they agreed with a statement that the contract was “not fit for purpose”. Ms Pritchard answered “yes” while Sir Chris said “I broadly agree with that”.
The Mirror’s story this week included an editorial from Stephen Kinnock, care minister with responsibility for dentistry. Sir Chris said: “Ministers have made it clear that they want dentistry to be part of their [NHS] plan. They fully recognise all the problems that are there. If I could maybe read out something which came from Minister Kinnock which he wrote in the newspapers this week was that ‘we’re bringing forward fundamental change that can get the sector back on its feet’.”
The committee heard that the Tories’ botched dentistry rescue plan last year provided zero additional NHS appointments. Ms Pritchard told MPs: “This was not a successful plan.”
Labour has vowed to tackle the “flawed” NHS dental contract but the BDA says it has made “no progress” since entering government last year. The contract pays dentists the same amount for three fillings as 20. The committee was told there are “patients that it is not attractive to treat on the NHS”. Professor Whitty said: “The structure of the dental contract has been a disincentive to do some of the more complex work.”
Lack of dentists means practices are unable to hit their planned number of units of dental activity (UDAs). Under the NHS dentistry contract they are then fined tens of thousands of pounds. This has meant almost a third of the NHS dental budget is having to be returned unspent in some areas. This is making it harder to recruit more dentists as more opt to move into more lucrative private work.
A spokesman for the BDA said: “Practices that cannot fill vacancies because they cannot offer competitive pay and often do not even break even on some NHS treatments find it impossible to deliver their allocated activity.”
Professor Whitty added: “The number of dentists has actually gone up. The number of dentists doing NHS work has come down. So it’s not purely just a number of dentists question. It is actually how many are going into the NHS.”
Shiv Pabary, chair of the British Dental Association’s general dental practice committee, said: “Government says it’s ‘going for growth’, but Treasury policy is doing the exact opposite for dental care. The coming spending review will either sink or save NHS dentistry. Rachel Reeves doesn’t want to see her signature on the death warrant of a service millions depend on.”
