The crisis in National Health Service (NHS) dentistry is part of a wider health disaster being forced on working people across the country. Years of underfunding and privatisation, coupled with the criminal herd immunity policy in dealing with the coronavirus pandemic, has crippled the National Health Service (NHS).
According to a freedom of information (FOI) request by the Association of Dental Groups, the number of dentists providing NHS care in England fell from 23,733 at the end of 2020 to 21,544 at the end of January this year, the lowest figure for a decade. Every NHS dentist must provide care to around 2,000 NHS patients. The dire shortage of practitioners has left an estimated 4 million people without access to NHS dental services.
As a result, thousands of people are forced to suffer or must seek private dental care, paying exorbitantly high fees for their oral health needs. Press reports include people compelled to pull their own teeth in desperation, as in Victorian times. This happens as the Conservative government is spending billions expanding its war machine as junior partner in NATO’s proxy war against Russia in Ukraine.
After a decade of austerity and budget cuts, the British Dental Association (BDA) estimate that “NHS dentistry would require an additional £880 million per year simply to restore resources to 2010 levels.” According to Shawn Charlwood, Chair of the General Dental Practice Committee, “no other area of healthcare has had its budget slashed as much as dentistry over the last decade.” During the same period, NHS dentists have seen their take-home pay falling by 40 percent in real terms. Dentists say they are not paid fairly for the work they do as NHS workers.
Dentists have been compelled to work under very challenging conditions over the last two years. They are “fed up with the broken system” and morale has “hit the rock bottom,” Charlwood said. These conditions have played a crucial role in dentists moving away from providing NHS dental care. Some 3,000 dentists have ceased to see NHS patients with oral health problems since the start of the pandemic.
Charlwood wrote: “Our latest research also shows three-quarters of dentists say they are now likely to reduce–or further reduce–their NHS commitment in the next 12 months, with 45 percent saying they are likely to go fully private.”
Speaking to the House of Commons Health and Social Care Committee, Charlwood warned of the “growing exodus”, and if no action were taken by the government this would mean “the death of NHS dentistry.” He told the committee that in 35 years of practising, he had “not seen the state of NHS dentistry this bad” and that his colleagues were “genuinely struggling.”
Charlwood told the parliamentary committee, chaired by former Tory health secretary Jeremy Hunt, who bears major responsibility for the current crisis, “At the end of the day, working chasing NHS targets, dentists feel like they've been chewed up and spat out.”
“Nearly 9 in 10 say they have experienced symptoms of stress, burnout, or depression in the last 12 months, with the majority having received physical or verbal abuse from patients who do not understand why they can't be seen on the NHS.”
Since the first lockdown in March 2020, over 40 million NHS dental appointments have been lost, which equals a years’ worth of dentistry before the pandemic, he told the committee.
Some areas are regarded as “dental deserts” with people struggling in vain to find an NHS dentist. In North Lincolnshire there are only 32 dentists for 100,000 people, and just 37 in North East Lincolnshire and the East Riding of Yorkshire, with a total population of 760,000. In Thurrock, Essex, only just over a quarter of adults and almost a third of children have seen a dentist in the past two years, with figures not much better in several other areas.
On the Isle of Wight, NHS England has been unable to find anyone to take up a new dental service contract, under conditions where thousands of residents currently wait months for an appointment. One person who moved to live on the Isle of Wight six years ago has been unable to register with an NHS dentist in that time.
The British Dental Association warns that most practices in Scotland were likely to reduce their commitment to provide NHS dentistry, with many practitioners considering retiring, while Wales and Northern Ireland face similar problems.
Tooth decay is one of the most common oral health problems in the UK, with a third of adults suffering signs of tooth decay and around one-in-four (24 percent) five-year-olds. People from socially deprived areas are more likely to suffer tooth decay and be admitted to hospital because of more serious complications.
Good oral hygiene and regular dentist visits help avoid tooth decay but also eliminate the risks of serious gum diseases and some heart problems developing. They can also help the early diagnosis of mouth cancers.
Private dental treatment is extraordinarily expensive in the UK. Just a clean and polish can cost up to £85 in the private sector. Root canal treatment from a private dentist can cost up to £970, whilst a tooth extraction can be £370. Having a crown, dentures or bridges can cost between one week to two months wages—£355 to £2,520 for an average worker!
Providing private dental care in the UK is a lucrative business worth £5 billion. The sector is expected to expand and rake in more profits from the present dentistry crisis. A market research report by IBISWorld on UK dental practices is headlined, “Filling a gap: Demand for private dental care is likely to rise in 2021-22 due to long NHS waitlists.”
While children, and those receiving certain welfare benefits can receive free NHS dental treatment, everyone else must pay.
NHS dental treatments are categorised into 3 bands. Band 1 covers an examination, diagnosis, and advice, this can include X-rays, a scale and polish, and planning for further treatment; it costs £23.80. Band 2 includes all treatments in Band 1, plus additional procedures such as fillings, root canal treatment and removing teeth (extractions); and costs £65.20. Band 3 dental care costs £282.80 and covers Bands 1 and 2, plus more complex procedures, such as crowns, dentures, and bridges.
The situation in dentistry only highlights the fact that in Britain, once regarded as the model of a “cradle to grave” welfare system, accessing vital health services is a class question. While the wealthy minority can afford the best private medical care, working-class families face months waiting for vital treatments and rising health costs.
Writing in the Financial Times recently, chief data reporter John Burn-Murdoch, wrote, “One in 14 of Britain’s poorest households now incurs ‘catastrophic healthcare costs’ in a typical year—where costs exceed 40 percent of the capacity to pay. This is up from one in 30 a decade ago, coinciding with a period in which the share of the poorest who feel their healthcare needs are going unmet has risen from 1 to 5 percent.”
“British healthcare is quietly inching into the private sector, and what is most concerning is that it is increasingly those least able to pay who are being forced away from the NHS,” he concludes
With wages stagnating and inflation passing 11 percent, working people are being deprived of their basic health care needs by a Conservative government hell-bent on pressing forward with the privatisation of vast swathes of the NHS, including dentistry.
Universal access to a dentist, as with a doctor, is a social right. Access to the best dental treatment available must be fought for as part of the struggle to defend the NHS from privatisation and break-up. Billions of pounds must be made available for NHS dentistry, including for the training of thousands more dentists in every community. All the resources of society must be placed in the hands of the working class and used for the benefit of all—not the enrichment of a few—including the necessary funding of the NHS.