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Ministers refusing to let go of NHS fines regime as attendance continues to collapse among vulnerable groups

29 August 2019


  • Official stats show low income patients continuing to turn away from NHS treatment in face of aggressive penalty charge policy
  • Dentists accuse Government of backtracking on end to automatic fines for patients who make honest mistakes navigating complex system for claiming free NHS care. 

The BDA has expressed grave concerns that the Department of Health is backtracking on pledges to break with its discredited policy of automatically fining patients accused of 'misclaiming' free NHS dental care, as new data shows this heavy-handed approach is continuing to fuel a collapse in attendance among vulnerable and low-income groups. 


NHS Dental Statistics show a fall of 2.2 million treatments delivered to patients exempt from NHS charges since 2013/14 – falling by a quarter (25%) in 5 years, and a drop of over 200,000 since 2017/18.


8,818,170 free courses of treatment were provided in 2013/14 compared to 6,616,325 in 2018/19. 


Dentists have led calls for reform of the system which has seen nearly 400,000 patients a year, including those with learning disabilities, receive £100 fines, some for simply ticking the wrong box on a form. The government has overseen a tenfold increase in fines issued since 2013/14, and has been criticised by MPs for running campaigns effectively discouraging patients from making claims. 


The National Audit Office revealed earlier this year that 30% of healthcare fines issued since 2014 – 1.7 million notices, with a cash value of £188 million – were withdrawn because a valid exemption was confirmed to be in place following a challenge. However, officials cannot tell how many claimants paid a fine they should not have received, or distinguish between fraud and commons errors in the complex forms. 


In July the Department of Health pledged to a Public Accounts Committee inquiry into penalty charges in healthcare that they would end the process of automatic fines, and to adopt a 'three stage process' to patient communications. In Scotland and Northern Ireland patients are given the benefit of the doubt with an initial letter, inviting them to document their entitlement or to pay the charge if they have made an error. In Scotland this approach raises more income than follow up fines.


But recent comments by ministers indicate the Department of Health is now set to continue the practice of fining patients by default for making potentially honest mistakes. The BDA has had no responses to its calls on the Department to set a timetable for reform, or to feed into the process.


The BDA has called on health bosses to clarify their plans, to definitively remove the presumption of guilt when an anomaly is identified, and to simplify the byzantine claims process for those who are unclear on their entitlement. 


Dentists have also called on government to redouble efforts to engage with hard to reach families, as today's data reveals the number of children failing to see an NHS dentist in the last 12 months has remained unchanged at around 41%, with 4.9 million missing out in last year. The NHS has spent £205 million on child tooth extractions in hospitals in the last 5 years. The BDA has urged ministers to build on ideas such as supervised brushing in nurseries and schools set out in the recent Green Paper.  


The Government contribution to NHS dental budget has fallen by over £500 million since 2010, while patient charges have increased by over 30%. Nearly 1 in 5 patients have delayed treatment for reasons of cost according to official statistics.


Charlotte Waite, Chair of the BDA's England Community Dental Services Committee said:


"Vulnerable patients will keep turning away from check-ups as long as Ministers refuse to let go of their failed fines policy. 


"Reform cannot mean sticking with practices MPs have condemned for 'putting the frighteners' on NHS patients. People will keep falling foul of a system that offers confusion, but won't give an inch if you make an honest mistake. 


"Sadly the adults and children failing to attend are precisely those who could benefit most. Ministers should be rolling out the red carpet for these patients, not providing reasons to bottle up oral health problems.


"If this government is really serious about prevention, it's time to change gear."


House of Lords - Debate on NHS: Dentistry Services, 25 July 2019

The policy proposed for England appears to stand in stark contrast with those in operation in other UK nations. In Scotland and Northern Ireland patients do not receive fines for mistakenly claiming support for NHS care. Those whose exemptions are in doubt are invited to provide evidence, or simply to pay the relevant charges in full. Fines are only issued to those who fail to respond to an initial letter. 


It appears authorities in England are adopting their own version of the three stage process, whereby those who have claimed support in error cannot simply pay charges, and will receive a fine. 


Baroness Barran told the Lords: "The Government announced then our intention to revise our current process for dealing with unpaid prescription and dental treatment charges. We are now introducing a three-stage process for penalty charge notices, and doing so as quickly as possible. This means that, in the first communication people receive from us telling them that they have not paid when we think they should have, we will invite them to get in touch and let us know if our information is wrong. A penalty charge notice would not be issued at this stage, but would if the person either is confirmed as ineligible for free treatment or does not respond to the initial communication."