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Vulnerable NHS dental patients will no longer be seen as fraudsters

Blog Author Charlotte Waite

Blog Date 04/07/2019



In Parliament's Committee Room 8 on 1 July, a system that has doled out penalty charges to millions of innocent NHS dental patients finally began to give.

Westminster's influential Public Accounts Committee - well versed in tearing chunks out of ministers, mandarins and contractors - summoned the Permanent Secretary of the Department of Health, and leaders from the Business Services Authority and NHS England. 

The witnesses were tasked with justifying a regime so complex and so unfocused that on their watch 1.7 million fines (all £188 million-worth) had been withdrawn because the 'fraudsters' on the receiving end were actually fully entitled to claim support towards NHS dental or prescription charges. 

In short, they were there to defend the indefensible, and the key reason they faced scrutiny was the pressure coming from this profession. 

Amid the inquisition, and concealed in fairly technical language, we saw a breakthrough. 

Brendan Brown, Director of Citizen Services, NHS Business Services Authority confirmed the government would be abandoning the discredited 'fines first' approach with patients. A policy based on the presumption of guilt would end "within months". 

It's welcome news. Because in the last two years we have worked hard to give a voice to some of our most vulnerable patients. 

The people who faced a £100 bill for ticking the wrong box on a claim form. The families who didn't know the benefit status of their vulnerable relatives.

I gave evidence to the Committee on behalf of the BDA, and this profession. I shared what I and many colleagues will have seen first-hand. 

The confusion and questions over exemptions that eat into clinical time. The posters that do more to discourage attendance rather than inform with slogans like 'Don't assume you're entitled'. 

And the net result, which has been a collapse in attendance among people entitled to free NHS care.

I told the Committee about agencies that singularly failed to do their homework on this policy. That it's not enough to talk tough on fraud. That any government has a duty to be targeted and effective in its approach and that this policy failed decisively on both counts. 

Assembled MPs took health bosses to task and accused them of "breath-taking complacency" over their failure to acknowledge the patent flaws in the system. Missteps were described as "staggering".

They rightly mocked the fact that when completing the two page dental claim form, the 'Easy Read' guide to its completion, runs to 21 pages.

And Committee Chair Meg Hiller, stressed the unusual consensus among her Committee, drawn from parties on left, right and centre of British politics, on the abject failure of this system. 

We have been pressing for change. For England to follow the lead of Scotland and Northern Ireland, to stop treating every query over exempt status as fraud and give all our patients the benefit of the doubt.  

And it seems that now that within months automatic fines will be history. 

In their place a letter, inviting patients to document their entitlement, or to pay the patient charge, if they have made an honest mistake. It is system that works, and that in Scotland actually raises more revenue than penalty charges. 

We have been the driving force in exposing the impact of these fines. But reform needs a clear timetable. 

We still lack a clear system that patients can navigate with confidence, a system that identifies people with conditions like learning difficulties at the outset, and removes them from any fines system.

It's real progress, but there is more work to do.

Charlotte Waite, Chair
England Community Dental Services Committee


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