One the main signs of our current democratic system’s failure is the way it ignores the pressing concerns of its voters. This is happening in many, if not all, areas but this article is about just one of them – dentistry. North Devon Council has set up a scrutiny panel to look into the state of dentistry in our area and the results is shocking, even for people, like me, that thought they knew how bad it was.

The Problem

Every child in the UK is entitled to free treatment by a dentist, but there are too few dentists to treat them. Many people on benefits, pregnant women and recent mothers also have this right to an unobtainable service. These rights are guaranteed, until you seek to exercise them. Why is the situation so bad?

Shortage of dentists 

The number of active NHS dentists in England is at its lowest in a decade, despite a growing population, according to figures released earlier this year by the BDA (British Dental Association) which represents the profession. It found that 23,577 dentists carried out NHS work in the 2022/23 financial year, down by more than 1,100 on the pre-pandemic level and the lowest number since 2012/13. Overall, 80% of practices in the UK are no longer taking on new child NHS patients, and about 90% are refusing new adult patients. The latest figures from the NHS Devon tell us that 6,287 people on NHS dental waiting lists in North Devon and Torridge, with 1,183 of them children. The corresponding figures for Devon are 98,378 and 20,096.  

NHS Devon sent me a link to their website listing all NHS dental practices. I could not find one that would take a new NHS dentist. This helped to contribute to the situation where fewer than 4 in 10 adults in Devon visited a NHS dentist in a year, and only half Devon’s children.

So there are fewer dentists with long, and growing, waiting lists for those few practices still accepting NHS patients.

Payment system

There’s no mystery about why the service is vanishing. If dentists treat patients on the NHS they lose money, because state funding does not cover their costs. And it is getting worse because funding for NHS dental services has been cut in real terms by 4% a year. Dental inflation driven by the rising costs of lab bills, energy, wages and materials, is about 11% a year.

The strange payment system imposed by the government mean dentists received the same payment from the NHS for a patient who required 10 fillings as for a patient who required one filling. Treating a patient earns three Units of Dental Activity (UDA) points, regardless of the length and expense of the procedure. Every practice has to meet an annual UDA target. So there is no incentive to practise preventive dentistry, and every incentive to exclude the patients with the greatest needs.

To make it even worse the NHS allocates dental funding to areas, like Devon, on the assumption that about one in six people won’t need any care and about one in three are treated privately. So funding is given for half the population, and the money per person isn’t enough to pay for their treatment. Here is an example given to us by a dentist in North Devon:

“I agreed to see the early 20s age son of one of my NHS registered families. He hadn't been for a few years but I agreed to see him on the NHS because his parents have been patients for years and he was my patient as a child. He needs something like 2 teeth out and many fillings to get him dentally fit. His treatment will take 3 or 4 hours of surgery time plus filling materials etc. Had I seen him on a private basis, his treatment would have brought around £1,500 into the practice to cover wages/materials/overheads. The NHS will pay the practice £150 for the same treatment! It will actually be costing the business and me personally money to do the treatment for him. Whilst it's nice to do a nice thing for people occasionally, you can't keep a business afloat like that!”

If a practice were to want to expand their NHS provision they could only do so if there was space in the local budget. There rarely was since no new money was being added to the pot, instead the pot has been shrinking. For some years many of the available NHS contracts were hoovered up by corporate groups who offered to do the contracts for a smaller amount of money than an individually owned practice could.

This is also a large part of the reason that there is no orthodontist in North Devon. A large group took the contract off the old established practice by offering to do it cheaper. They did this by not employing a full time orthodontist but having Therapists doing most of the day to day work and having a "supervising" orthodontist drive down from about 100 miles away. He got fed up with the drive and they haven't found anyone else prepared to do it. because of the low value of their contract they can't afford to offer a full time job to get someone new to move to the area, and the two orthodontists that live in North Devon don't want to work for them as they used to run the practice that lost the contract. That means there is no one to adjust a child’s braces as their mouths grow.

Impact

So apart from the pain, suffering and disfigurement borne by the many people that can’t afford private treatment, and the great expense to those that have found the money, what other impacts are there of our failing dental service? 

In a post on X, formerly Twitter, the BDA said: “Oral cancer claims more lives than car accidents. But NHS dentistry is still waiting on a promised recovery plan.” More than 3,000 people in England died from mouth cancer in 2021, compared with 2,075 in 2011, according to figures by Oral Health Foundation (ORF) first reported by the BBC, representing an increase of 46%. The ORF, Toothless in England (TIE), a group that campaigns for free dentistry, and the BDA said the rise was a direct result of cuts to NHS dentistry.

I have also found that some of the Ukrainian refugees temporarily living in North Devon fly back to their home country for dental treatment because they can find it here. Flying into a war zone is preferable to finding dental care in the sixth largest economy in the world.

As for the quality of the dental care provided, it has also dropped. The number of complaints received by the health services ombudsman Rob Behrens had increased by 66% in five years. From 1,193 in 2017/18 to 1,982 in 2022/23. Over the same period the proportion of complaints upheld by the ombudsman has increased from 42% to 78%. He says that the 78% figure is “significantly more” than for any other area of NHS care, such as GP, hospital, mental health care where the overall average is 60%.

What should you do?

Brush your teeth, floss regularly and keep your fingers crossed. And remember that it shouldn’t have been allowed to get to this! It’s the job of governments to do far better than this, but both our local MPs in North Devon and Torridge & West Devon have just voted in Parliament against a dental rescue plan – remember this when you next vote.

John Patrinos
November 2024