Keir Starmer’s announcement of a sweeping new plan for addressing the NHS dentistry crisis was welcome news to those of us who have long been campaigning on this issue. Labour has pledged a £111 million-a-year funding package to “rebuild the service” after years of decline, in which some parts of the country turned into effective ‘dental deserts’ with no health service provision at all.
The plans include a fundamental reform of the NHS dentistry contract, which many practitioners believe creates perverse incentives in which high-needs patients are the least welcome. Under the new contract, dentists would be incentivised to work in areas of the greatest need for dental care. Addressing the enormous appointment backlog has also been flagged as a priority, with Labour promising to facilitate an extra 700,000 urgent visits to the dentist.
Of course, with all these measures the Devil will be in the detail – and hopefully the Party conference will offer some clarity. Nevertheless, this is a substantial commitment, and it stands in marked contrast to a government which has been asleep at the wheel on this issue for a long time.
In July, the Health and Social Care Committee inquiry into NHS dentistry published its recommendations for how to save this ailing sector. Speaking for the government, Neil O’Brien promised that “fundamental reform” is the way, however we have yet to see any concrete steps since. The government’s official response to the inquiry’s findings is now three weeks overdue.
System-wide reform has been needed for a long time. Last year, the BBC reported that 9 in 10 dental practices across the UK were not accepting new adult patients for treatment under the NHS, with 8 in 10 were not accepting child patients either. This has created an enormous backlog for dental appointments, with some patients having to wait almost three years for a routine check-up.
These spiralling backlogs have also led to increasingly difficult working conditions in the industry. In May, I wrote about how a significant proportion of dental practitioners have been driven out of the health service altogether, reflected in the 44% increase in dentists leaving the NHS for private practice. In addition, 50.3% of dentists in England have reduced their NHS work since 2019, and 74% intend to reduce their amount in the coming 12 months.
This exodus has only contributed to the backlog, creating an unvirtuous circle in which both practitioners and patients lose. The effects of this on the public can be seen in various “horror stories” related to DIY dentistry, whereby desperate patients have been forced to perform risky operations on their own mouths.
Fundamental reform of the sector is clearly needed; however, Labour is right to flag the importance of preventive measures in the short-term as well.
One of the measures announced was the introduction of supervised toothbrushing in schools, whereby children aged 3-5 years old will be regularly walked through the process by their teachers. This is well-supported by clinical research. Evidence shows that making kids brush daily at school can be effective at preventing tooth decay, and can help to instil positive oral health habits for life.
Indeed, in 2014 the National Institute for Health and Care Excellence (NICE) published a set of guidelines recommending supervised brushing in early years’ settings: “[Local authorities should] consider supervised tooth brushing schemes for nurseries in areas where children are at high risk of poor oral health”.
On other preventative tools, the usual mantra of the dental community remains the same: brush regularly, floss, visit the dentist (when possible), and make good dietary choices that won’t harm the teeth. Choosing low-sugar alternatives to sweet snacks can help, as can regularly chewing sugar-free gum – which has additional oral health benefits as well.
A recent study by Frontier Economics estimated that if most people regularly chewed sugar-free gum three times a day, it could prevent 180,000 fillings. This could save the NHS over £50m per year, and help nip in the bud dental issues before they snowball into serious problems requiring intervention.
The bottom-line is that prevention can be an effective, low-cost, and evidence based way to improve oral health outcomes – and it’s encouraging to see Labour giving it so much air time.
Of course, simply promising reform from the opposition pulpit is one thing, and actually delivering on those promises in government is quite another. If Labour wins next year’s election, the Party will face an uphill battle trying to fix a system which has veered so drastically off-course. A good analogy might be trying to turn a tanker around in a hurricane.
Nevertheless, it’s reassuring to see the crisis finally being taken seriously in Westminster, with many parliamentarians starting to realise that simply tinkering around the edges of the problem will not be enough. Until major reforms are made, more and more people will be left stranded in the dental wilderness with no support. Fixing this should be top priority for any incoming government.