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Big ambitions but no action: What government has to say on reform

The Health Committee offered an instruction manual to save NHS dentistry. Ministers appear unwilling to commit to the first and most fundamental step.

Shawn Charlwood
Shawn Charlwood Chair, General Dental Practice Committee

“NHS dentistry should be accessible and available for all those who need it” claims the new Health Secretary Victoria Atkins.

A laudable goal, but the plain facts are we are yet to see any evidence of the reforms or the resources to realise that ambition.
2023 was the year we saw the return of sights not seen in England for a generation. Queues outside practices. Mass closures at corporate giant BUPA. Hard won gains on oral health heading into reverse.

Against this backdrop the House of Commons Health Committee completed its inquiry into NHS dentistry. Armed with evidence from our members, it set out proposals for urgent and fundamental change to ensure this service can have a future.

The Government’s response – some three months overdue – saw the Health Secretary stress she was “fundamentally aligned” to this ambition of access for all. But the gulf between words and actions has never looked wider. Here’s what she had to say:

Skipping the main course

Where the Committee backed fundamental contract reform, the Government’s equivocal response is: “partially accept.”

The Health Committee offered a coherent plan to fix NHS dentistry, but the Department of Health appear to have viewed it as an a la carte menu. The Secretary of State seemed content to pass on the main course: a decisive break from a failed NHS contract.

The current access crisis is a workforce crisis, and without action to fix what’s fuelling the exodus from this service, any real progress will remain impossible. It’s a view shared by the Committee, and its chair Steve Brine MP, a former minister for dentistry, who stressed “steps taken will still not go far enough.”

When I gave oral evidence to the inquiry, I warned Ministers were yet to move beyond rearranging the deckchairs. So we are back in live (but glacial) negotiations with NHS England on further ‘tweaks’, that cannot and will not deliver on the Government’s headline goal.

The UDA remains the elephant in the room, but it’s not even up for debate.

The UDA remains the elephant in the room, but it’s not even up for debate.

Raiding squeezed budgets

Rebuilding a sustainable service and expanding patient access: logic dictates these goals cannot be achieved on a standstill budget.

Somehow the Government dodged calls for clarity on the future funding of NHS dentistry.

Despite questions from MPs there were no answers on why this country spends the smallest share of its health budget on dentistry of any European nation. No clarifying the oft cited £3 billion budget, that hasn’t changed in a decade, and only funds care for half the population.

However, the Health Secretary at least admitted what she previously strenuously denied: that pledged ring fences are being torn down to help Integrated Care Boards balance their bottom line.

We have already heard from ICBs basing their plans for the year ahead on eye-watering levels of dental clawback. And during an access crisis this is frankly jaw-dropping.

Funding clearly matters, as cash is underpinning the Government’s choices on reform.

The Health Secretary was at pains to reject the capitation model endorsed by the Committee. We continue to share the Committee’s view that the system has the potential to deliver the prevention-based and person-centred care we need.

The prototype model was well received by both patients and the profession. The evaluation meanwhile seemed designed to be written to please Treasury officials.

Learning from that system must be utilised. Because at the end of the day the missing piece was always the resources to make it work.

Funding clearly matters, as cash is underpinning the Government’s choices on reform.

More than muddling through

If universal access is the Government’s goal, then the Nuffield Trust are having none of it.

In new analysis the respected think tank state that universal coverage to the service is now effectively dead. Authors point the finger at a preference from successive governments for “muddling through” over sound policy.

The report reads like the last rites for NHS dentistry, and we’ve told the Secretary of State both patients and this profession deserve some honesty here. Is she willing to meet bold ambitions with tangible action? At present even a modest objective - keeping what remains of NHS dentistry afloat - feels out of reach. We’ve set out what we need to see.

Progress requires a ‘recovery plan’ worthy of the title. We have pressed for real commitment, but understand earlier versions were held up in the Treasury some six months ago.

The plan is set for publication in the new year. At bare minimum the final version must give colleagues thinking twice about their futures a reason to stay in the NHS.

Longer term the Health Secretary says she is busy “laying foundations of change”. We’ve spelled out the reality, that the negotiations we’re in have no prospect of arriving at meaningful reform.

If the officials on the other side of the table from us have no latitude or desire to create a contract that is fit for purpose, this service will remain built on sand. And it risks being swept away.

An election year

Some of the Government’s response was pure sophistry.

The Secretary of State attempted to ‘correct’ MPs citing wholly accurate figures on the decline in NHS dentists since lockdown. She preferred to look at the increase since 2010.

“We are moving in the right direction” claimed Ms Atkins. The right direction if you move the goal posts.

The Government reached for official figures showing that three quarters of people who tried to get an NHS appointment in the last two years were successful. Good news surely? Well not quite.

What that data actually revealed is that millions of desperate people have simply given up trying to access care. That unmet need for NHS dentistry now amounts to one in four of England’s adult population.

This service is at a tipping point, and our patients cannot afford any more “muddling through.”

We will keep pushing both the Government and opposition parties to do the right thing.

We’re on the road to a general election. We don’t know who will form the next government. But we will do everything in our power to win the argument for reform.

MPs from all parties tell us this dentistry has become an issue on the doorstep. We’ve fought to get dentistry to the front and centre of political and media debate.

We’re securing pledges on reform. But ultimately it will take deeds, not words to save this service.