Questions for government: Shawn Charlwood's speech to the LDC conference 2022
10 June 2022
Touching on the burning questions facing the profession, Shawn Charlwood, General Dental Practice Committee Chair, gave the following speech at the 2022 Annual Local Dental Committee Conference this year:
Colleagues. It is an absolute pleasure to address you here in Wales – and in three dimensions for once.
I am grateful to Local Dental Committees from all four corners that have joined us here. It reflects the gravity of the issues that I, and others, will be speaking on today.
The Minister was set to address this conference. Sadly, just hours after the evidence I gave in Westminster last month her office explained she would have to pull out, stressing urgent government business.
It's unfortunate. I think I share the view of this room, of Healthwatch England, of a growing number of MPs from all parties, large swathes of the media, and of patients across the country that dentistry today is urgent business.
And it is doubly unfortunate because I – like many of you – had some key questions. Had she – or colleagues from the Department of NHS England been here – we would all be seeking clarity.
So, I hope you will indulge me that some of those questions underpin my update today. Where we have answers, I will share them. Where we don't, I would hope you will share our collective frustration.
Because what we are doing both inside and outside of formal negotiations is attempting to secure the best possible deal for this profession, and the millions we treat.
I'm not going to tell you that the glass is half full, or half empty, just to state the obvious. That the stakes are high, and the future of the service is in doubt.
I will start with a question that I know many of you were asking as soon as the IPC was withdrawn from government websites two weeks ago. Are we back to business as usual?
It's a simple question. With a simple answer: No.
Real burdens remain. For any of you who've had the chance to read through the belated comms from NHS England, practices will continue to comply with much of recent guidance.
Maintaining screening, triaging and separate pathways and approaches for patients with symptoms of respiratory infection.
New guidance places an emphasis on ensuring practices have adequate ventilation and PPE.
However, as colleagues in England will know, and all private colleagues can attest – it's one thing for officials to place an emphasis here, it's quite another for government to offer anything in the way of meaningful support.
But business as usual is not just about the hoops we have to jump through. It's the fact that dentistry is still light years from where it was before March 2020. Over 43 million appointments lost in England alone.
Oral health inequality set to widen. And a backlog that will take years to clear. But where things are very much returning to business as usual is finance. And this – unfortunately – is going to feature across this update.
We went into this pandemic operating on a budget lower in real terms than it was a decade ago. Lower in cash terms if you count government contributions.
It would take an extra £880m per year to restore resources to 2010 levels. But money is what's been driving the rush back to normality. Because the Treasury has had to fill the gap left by a collapse in patient charge revenues.
State contributions - that have fallen year on year - have had to go in the other direction for once.
And pressure to bring 'normality' back has underpinned the choices made across government, whether it's on targets or on the future direction of reform.
Why does the government keep coming back to the £50m? Certainly, were the Minister here I would be asking why the Department keeps coming back to a policy that many rightly regarded as a PR stunt.
A drop in the ocean based on recycled money. We are still awaiting the full figures, but what we do know was uptake was slight.
And again it reflects the need for real, long-term commitments, not a short-term fix. But sadly that's what we're getting used to, as the pressure continues to build on government.
What does 'levelling-up dentistry' even mean? Whether it's widening inequality, charities stepping in where the NHS has failed, or the latest on the access crisis the same phrases are being thrown back at us by government press officers.
I would have liked to have asked the Minister, if she were here, how she would respond to those specific demands for dental funding that meets the needs of all who wish to access NHS care, rather than the current 55% that can.
And why the continued reluctance to move away from the discredited UDA system?
Does government feel vindicated for the choices made in the last year?
But stepping back I'm sure many colleagues here today would have liked a sense of whether the government feels it made the right calls since the first targets were imposed. Again we can guess the response.
We all know it's been a long haul. It's been a bruising period for our teams, and we are still counting the cost.
And to be frank, the imposition of an 85% target during omicron was beyond a joke, that we never ceased to remind officials of.
The retrospective fall in that target to 75% was much belated recognition of its futility.
But the 95% target now in place is equally perverse. Again we could hope for candour on where we're going in Q2, but colleagues can hazard an educated guess.
The data shows what we've long said: this is setting practices up to fail.
These choices have come at a cost. Because – as I'll pick up later – it's already abundantly clear the government is set to reap what it's sowed when it comes to the workforce.
So, the next question is where next? The language of 'quick wins' emerged long enough ago from NHS England that I won't bother repeating it here.
What we are looking at are modest, and marginal changes to the current flawed system.
Changes which we all expected to be with us by now, but are still stuck in the machine.
And I will not use the word 'reform' here as that would feel overgenerous.
Nothing here will come as much of a surprise. And as I have repeatedly stated when final proposals arrive from NHS England, they will be taken to GDPC first for consideration.
Where's the government's ambition? Given I have been around the table with senior officials from the Department of Health and NHS England, this is the question I find it hardest to answer myself.
Yes, we've had soundbites, but there remains no tangible evidence of a desire to affect the scale of change we need to see.
Beyond the tweaks, the next phase should run to fundamental system reform.
NHS England's six aims are there for all to see. But I would again draw attention to item 6: that reform must be affordable within NHS resources made available by Government.
Because however laudable the others – improving access, addressing inequality, making prevention a reality – they will be impossible to deliver if they are predicated on an inadequate, standstill budget, that delivers care to half the population.
So the cogs are in motion. Something resembling formal negotiations is set to begin.
But we are clear that until our opposite numbers have the freedom to have honest conversations we will struggle.
However – and again my thanks to colleagues – we have had to hand the clear signals you sent at the last conference.
Each of the motions passed by LDC conference remains in our minds as we approach negotiations.
Does NHS dentistry have a future? It's a difficult question. It's certainly withering on the vine and the jury's out. NHS dentistry is in intensive care, and the government's resus team seem to be dragging their heels.
And the answer will hinge on the choices this government make in the year ahead. I told Jeremy Hunt and his committee colleagues that I feared a slow death for this service. Or perhaps not so slow given recent data.
Yes we've lost some 3000 NHS dentists since lockdown, the direct result in my view of the choices made by governments for over a decade.
However, beneath the surface there is a bigger shift taking place. Our surveys suggest that for every dentist leaving ten are reducing their NHS commitment by significant margins.
And that is how this service will die. When there simply isn't the goodwill left to compensate for a broken system and chronic underfunding.
It's plain to see. The tectonic plates in this service are shifting. There is now an existential threat to the service if we don't design an attractive NHS system for professionals and soon.
However, for the first time in over 15 years, there is a genuine negotiating process on NHS system reform. And we will not let this opportunity pass.
Whether it is at the negotiating table, or working with partners, politicians or the press, we will continue to spell out the human cost of inaction.
Conference, let me close by telling you again that I am genuinely disappointed the Minister could not join us today.
It is my desire to seek solutions, not confrontation. I'm a pragmatist and I'm a problem solver. All dentists are.
And were she here today I would have thanked her for the comments she made in January.
Speaking to her own local radio station she said: "Unless we deal with the contract, dentists are not going to feel valued for the work that they're doing, and they're not going to be properly paid either"
She also said, "there is no doubt that unlike most of the NHS - that's having record levels of funding - dentistry hasn't seen that same level of investment".
The Minister diagnosed the problem and offered a solution: contract and investment.
In the year ahead we will see if her government is ready and willing to do what needs to be done. But you have my word we will not stop pushing for those solutions on your behalf.
Shawn Charlwood, GDPC Chair