Neil Carmichael is the former Conservative MP for Stroud 2010–2017 and the Executive Chair of the Association of Dental Groups, the trade association representing dental groups whose members are delivering NHS and private dentistry across the UK.
Every MP from across the political divide will have heard the growing crisis in access to NHS dentistry from their constituents this year. As Government grapples with the meaning of “levelling up” it is clear that equitable access to NHS dentistry has long been left behind.
In response to the tax rises to clear the NHS backlog in September a voter from Blyth, speaking to LBC stated, “it still won’t help get me an appointment or see a dentist.” These are the real world voter expectations that have to be met in the next two years as the stories of “DIY dentistry” mount.
The findings of Public Health England’s report Inequalities in oral health in England published this year are stark – for example, relative inequalities in the prevalence of dental decay in five-year-old children have increased from 2008 to 2019. These inequalities will only now be deepening as the impact of the pandemic becomes clearer – latest figures show around nine million children in England have missed dental treatment in the 12 months to March 2021.
The report also confirms a North/South divide exists running through the former “Red Wall” (together with pockets of deprivation in London and coastal communities in the South). It is at its worst in rural and coastal communities, as highlighted by MPs from Lincolnshire, Norfolk, Cumbria and Yorkshire in recent parliamentary debates. The challenge for a Government so committed to “levelling up” is clear.
There is no one simple explanation for this divide. Over the last 10 years, government net spend on NHS dentistry has been flat with no increase with inflation, which in real terms represents a cut. However, current NHS spending can be used more wisely. It is widely accepted, all the way to ministerial level that the current NHS dental contract of UDA activity is broken and the time has clearly come for more local flexible commissioning for hard to reach groups such as children and care homes.
But the immediate crisis is in the workforce – 951 dentists across the whole of England chose to cease NHS activity last year, many due to burnout and the NHS contract. Recruitment is no longer a “local” problem. We agree with Jeremy Hunt who argues for proper long term workforce planning by the NHS and incentives for dental teams to raise outcomes where need is highest. Put simply, “we need more dentists.”
MPs in Lincolnshire, the Isle of Wight and Yorkshire have called for new dental schools. But training a dentist takes over five years. To date, recruitment challenges have been met through overseas professionals coming to work in UK dentistry. This will remain part of the solution in dentistry and healthcare as a whole. A Global Britain should attract the best clinicians from the rest of the world. However, the registration process administered by the General Dental Council for overseas dentists to work here has been suspended for two years due to the pandemic, choking off recruitment. It urgently needs reforming and restarting.
Finally, nearly a decade has been lost whilst responsibility for water fluoridation stagnated at local authority level. Now the Government is following the example of New Zealand and taking powers directly to roll out fluoridation this can change. The British Society of Paediatric Dentistry estimate that water fluoridation could reduce tooth extractions in children by as much as two thirds in the most deprived areas.
Lack of access to NHS dentistry is a real and visible example for communities that sense they are “left behind” and addressing this must be part of “levelling up” health. Failing to do so will see dentistry become the next workforce crisis in the headlines. Doing so will begin to narrow the gap of inequality and “put the mouth in the body” across the whole country.