The Covid-19 pandemic has demonstrated how the social and economic circumstances of people’s lives affect their health. As such, the widely publicised Marmot report calls for the nation’s health to be placed as the highest government priority to build back fairer. Access to comprehensive healthcare, including dental care must be part of this fairer vision of Britain.
Funding and access to NHS dentistry have remained a low priority for successive governments. Dental charges were introduced just three years after the inception of the NHS — a policy Bevan vehemently opposed. Today, dentistry is the only part of the NHS that receives a lower budget than 2010. Therefore, it has not kept pace with increasing costs and population growth and this long-standing underfunding has made NHS dentistry less able to wither the storm of the pandemic.
Recent research by Healthwatch England showed that since the Covid-19 lockdown, 80% of patients are struggling to access timely NHS dental care with people asked to wait up to three years for an appointment. It is estimated that over 19 million appointments have been delayed since the first lockdown and 14.5 million fewer procedures are taking place.
Those lucky enough to get an appointment struggle to pay the ever-increasing dental charges. To plug the successive dental funding shortfall, patient charges have increased by over 40% since 2010. Even during the pandemic, dental charges have continued to increase at a rate higher than inflation.
Dental charges have been shown to be one of the biggest barriers to accessing dental care, even for those who are entitled to free care. This is because eligibility for free dental care is complex and differs from free prescriptions. Official surveys consistently show that over a quarter of respondents struggle to pay dental charges, and this leads some people to avoid dental care altogether. Mirroring the effects of the pandemic, those on low incomes and people from ethnic minority communities are most affected by the lack of appointments and dental charges.
So, it is welcome news that the Scottish government is moving towards the direction of free dental care. Young people in Scotland, aged 18-25 years are now eligible for free dental care. However, the availability of appointments remains an issue. Treatments delivered by NHS dental services in England are at a quarter of pre-Covid levels. The pandemic resulted in 9 million children missing out on free NHS dental care. As such, the British Dental Association has requested capital funding from the government for ventilation equipment. This would enable dental practices to reduce the time between treatments to deliver care safely and restore patient access to pre-covid levels.
However, the scale of oral diseases and barriers to dental care are such that it needs a radically different policy approach. Access to free dental care should be available to everybody at the point of need. With costs of up to £282.80 in England and £384 in Scotland, a lot of people simply cannot afford NHS dentistry.
As well as affordability, policy and investment must consider equitable availability of care. Even before the pandemic, people from working-class and ethnic minority communities struggled to access the dental care they are entitled to. Children who are unable to access timely dental care often need hospital treatments. Dental extractions are the leading cause of hospital admissions amongst UK children. Working-class children are four times more likely to be admitted. Children from ethnic minority communities are also more likely to experience dental decay.
Dental pain, sleepless nights and hospital appointments lead to missed school days affecting educational attainment and life chances. Pain and the stigma of missing and decayed teeth can have mental health consequences for adults and children alike. For adults, this can affect the ability to fully participate in the labour market which reinforces the cycle of poverty and poor health.
Several policy shifts are needed to increase the availability of NHS dentistry. Firstly, there simply needs to be more dental practices in deprived areas of high dental need; dental practices are too often predominantly located in affluent areas. This is due to a historical legacy of inequitable healthcare commissioning practices and an NHS dental contract that does not consider the needs of high-need groups living in deprived areas.
Secondly, dental reforms must secure labour rights for NHS dental teams. Research shows that dentists with higher NHS commitments have higher rates of burnout and mental health issues. This is both due to a target-based NHS dental contract and the challenges dental professionals experience in providing timely high-quality care for their patients in an under-funded system.
Thirdly, the NHS dental contract must be prevention focused and deliver equitable care for all groups. This includes giving dental teams the contractual time and resources needed to deliver high-quality care for vulnerable groups.
The neglect of dentistry has impacts on overall health, the wider NHS system, and people’s social and economic circumstances. With the poorest and ethnic minority communities hit the hardest, Healthwatch England has described the ‘twin crisis of access and affordability’ in NHS dentistry a social justice and equity issue.
Therefore, investment and access to dental care should no longer be considered an optional extra if health is to be placed as the highest priority. And if we are to build back fairer, access to dental care must stop being dictated by people’s social and economic circumstances.