Even in these current tumultuous times, dentistry maintains a significant political profile. Barely a day goes by without another story from across the UK about patients struggling to access NHS care. We have worked with media outlets on many of these stories, including the recent substantial BBC access study, ensuring that the voice of the profession is front and centre in the ongoing debate.
Priorities and portfolios
In Westminster, the new Secretary of State for Health, Thérèse Coffey included dentistry in her 'ABCD' list of priorities for the NHS, reinforcing the status of oral health. We've had nine parliamentary debates on dentistry in the last year, with another back-bench debate anticipated this autumn. We expect that the Commons' Health and Social Care Committee will also launch its own inquiry into NHS dentistry.
As is normal in Westminster, the Health Secretary has asked one of her other ministers to look after the dentistry portfolio. In this Government, that task falls to Will Quince. It may seem a relatively minor point, but he is one of the more senior members of the ministerial team. It is perhaps a mark of the relative importance of dentistry that we now have a Minister of State in charge, rather than a more junior role as has recently been the case.
It is also encouraging that I've had the chance to (virtually) meet twice with Will Quince during his first month in post. That is hopefully a sign that he is taking the challenge of preserving NHS dentistry seriously.
Open minds
The new ministerial team has talked up their desire to address the stark challenges that Eddie Crouch and Shawn Charlwood highlighted recently. It seems there is nothing off the table in terms of potential solutions. This open approach is refreshing and encouraging, however, there are some important caveats to temper any optimism.
money is going to be extremely tight across the public sector.
The most important is the obvious point that money is going to be extremely tight across the public sector. We are hearing the mantra that there is no new money, but in our view the stated ambition to improve NHS retention and maintain, or even enhance, access on a standstill budget is a logical impossibility.
But we will continue to articulate the need for investment in dentistry and the benefits it can bring.
The same 'no new money' statement has been made consistently for dentistry across the last decade. Of course, we need to be realistic and recognise the current unprecedented pressure on public finances. But we will continue to articulate the need for investment in dentistry and the benefits it can bring to individual patients, population health and the wider health service. We are always ready to assist in developing the case for necessary investment.
Value for money in constrained times
We must recognise the necessity to deliver value for money for the taxpayer, and to meet demonstrable patient need. Dentistry is unique among all NHS services, going into the pandemic with less Government money behind it than it saw a decade ago. Then, as now, that position is unsustainable, and it would take an extra £880m a year simply to restore the resources we had in 2010.
In the absence of sustainable funding, the Government needs to be realistic and begin considering what services are offered by the NHS. The current situation is simply not sustainable. Any such restriction would be a miserable position to reach. To go down that road would be formal recognition that NHS dentistry is neither comprehensive in scope nor universal in scale. That may well be the reality of where the service is today, but it is a dangerous road, and we can only imagine how it will be read by the public and a growing number of MPs.
What is meant by 'access'?
Alongside funding, the other fundamental political constraint appears to be preserving access to NHS care. This is going to be a huge challenge without the investment required to attract and retain the required workforce.
It also raises an important question about what we mean by 'access' in this context. There are metrics to hand, covering those who want, need, or use NHS dentistry. Is activity important? Is it patients seen? Is it care to those who require urgent treatment? These are very substantial issues, as are the profound inequalities of access running through any plausible measures.
It is vitally important that a consensus is achieved on what access will look like going forward. If there is no financial flex, it is difficult to see how historic definitions of access can serve the Government's purposes. Perhaps there is a way to find common ground on defining access that can help in delivering a future for NHS dentistry.
Fighting your corner
We have made the point to Government that the recently announced marginal changes to the NHS contract in England are wholly insufficient to meet its objectives in all these areas. There remains a need for real urgency. Our own surveys suggest that for every one dentist leaving, ten are reducing their NHS commitments by significant amounts.
the recently announced marginal changes to the NHS contract in England are wholly insufficient to meet its objectives in all these areas.
The crisis in NHS dentistry isn't going away soon. We look forward to working with the new Minister and his team to see if we can collectively find a way ahead before it's too late.