Dentistry has borne the brunt of Tory cuts to the NHS with a failure to even attempt to keep pace with inflation. Since 2010, in real terms, the government has cut the NHS dentistry spend in excess of £500 million. Patients have increasingly plugged this gap through charges – patient contribution to the dental budget has increased from just over 20% to nearly 30%.
If this trajectory continues over the next decade patients will be contributing more to the dental budget than the government. Not only this, but dentists’ payment for NHS dental treatment in some areas is lower than patient charges which have prompted protests from dental professionals that the government has coerced them into becoming stealth tax collectors. A massive hike in charges, well beyond the rate of inflation, stagnant wages and welfare reforms have seen NHS dentistry become inaccessible to large parts of our communities, with nearly half the population in England not accessing NHS dental checks.
That’s why it’s so important that Labour has announced plans in recent days to provide free dental checks to everyone in England and scrap band one dental charges – providing much greater access to dental care free of charge to millions of people.
Official surveys show that 1 in 5 patients have delayed dental treatments due to cost. Dental exemptions have always been complex, with eligibility differing to free prescriptions. This complexity has been compounded with the introduction of Universal Credit – with many of its recipients not eligible for free dental checks. Exemption from dental fees under Universal Credit in fact depends on earnings in the last payment period with threshold values for exemption.
This has created an uncomfortable situation where, instead of delivering care, dental professionals are being forced to use precious work time to quiz people about their earnings. The complicated charging system, coupled with a heavy-handed approach to fines which saw 1.7 million erroneous fines issued to people rightfully claiming free dental treatments and free prescriptions, has created real barriers to care for some of the most vulnerable people in our communities. Consequently, the uptake of free dental treatments has taken a nose-dive, with almost 2 million fewer claimants.
This is particularly impacting lower-income communities. Despite having greater dental need and being at a higher risk of mouth cancer, people living in deprived areas experience more acute dental access problems. Mouth cancer rates in the UK are rising, with a third increase in diagnosis since 2002. Mouth cancer is a silent killer, often starting as a pain-free ulcer, lump or discoloured patch in the mouth.
During a dental check, not only do dentists examine the health of the teeth and gums, but they assess the health of the soft tissues in and around the mouth including the tongue, lips, and cheeks checking for cancer and pre-cancerous changes. Mouth cancer and its treatment can affect eating, speaking, swallowing and can cause severe facial disfigurement but early diagnosis has a significant impact on survival and outcomes. Less than half of the people diagnosed with late-stage mouth cancer will live longer than five years, however five-year survival increases to 90% with early detection – which is far harder without regular dental checks.
Tory reforms are also affecting children, with five million children not attending a dentist for a check-up. Polling by YouGov shows that 1 in 4 parents do not know that check-ups are free for children and 75% do not know that all treatments for children are free. By removing cost barriers for parents, Labour’s policy can hopefully also remove perceived barriers that exist for children.
This is not a minor issue. Last year over 56,000 children in England had a hospital operation to have their teeth removed under general anaesthetic. The majority of these extractions were due to wholly preventable tooth decay. Dental extractions are the most common reason children aged 6-10 years old are hospitalised in England with an estimated NHS cost of over £50 million.
The cost of dental care deters people from accessing dentistry from the right place, aggravating the already pressured GP and A&E services. Around 380,000 patients with toothache are choosing to head to their GPs who cannot provide dental treatment, costing the NHS over £20 million a year. The NHS would also make significant savings even if some of the estimated 135,000 people with dental problems attending A&E could access a high street dentist.
Dental infections can spread quickly which may lead to life-threatening conditions such as Ludwig’s angina and sepsis. In these instances, antibiotics need to work. Antibiotics do not work for toothache and current research shows that lack of access to dental services is a key reason for people being prescribed antibiotics inappropriately by their GPs, who are not trained to treat dental conditions. Patients’ safety is undermined when antibiotics are resistant to infections, so once again the knock-on benefits of Labour’s free dental policy could be very significant indeed.
Senior NHS figures have reminded workers across the health system that this week’s antibiotics awareness campaign is the first of a new five-year UK National Action Plan to reduce antibiotics resistance through reducing inappropriate antibiotic prescriptions. The World Health Organisation has detailed the compromised success of modern medicine such as cancer chemotherapy and surgery in the absence of effective antibiotics. The public health threat of antibiotic resistance is such that it is included in the national risk register of civil emergencies alongside climate change.
Tory hikes in dental charges and deep cuts to the dental budget have created grave problems for NHS dentistry. Not all of them will be solved by free dental checks. However, the Labour Party is the only political party that is addressing what the British Dental Association is calling ‘the missing piece’ in our health service. With the ultimate vision to scrap all dental charges, Labour is proposing to realign the NHS with its founding values of a public, universal and free service – and in doing so, is dealing with one of Britain’s most underreported health crises.