Monday 8 September 2008

Wisdom Teeth

Neil Clark's article in the New Statesman is so good that it is well worth reprinting in full here:

patient: How much to have this tooth pulled?
dentist: £180.
patient: £180 for just a few minutes' work?
dentist: I can extract it very slowly if you like.

Jokes about going to the dentist used to be about the pain of tooth extraction, but in 21st-century Britain they're more likely to be about the pain to our wallets. An estimated one in five people in Britain is deterred from going to the dentist because of the cost; eight million of us have refused a course of treatment because it was too expensive. The seemingly inexorable decline of affordable National Health Service dentistry, and the growth of private practice (the most expensive in Europe), have certainly hurt our pockets.

But could it be that, after years of decline, the tide is turning? You wouldn't think so, judging by newspaper headlines reacting to newly published figures showing that more than one million patients in England have lost access to free dentistry since the introduction of the government's new NHS dental contract in April 2006.

The figures, according to Susie Sanderson, chair of the British Dental Association's executive board, were "further evidence of the persisting problems with the 2006 NHS dental reforms". But look a little closer. There were 655 more dentists doing NHS work in 2007-2008 than there were in the previous year, an increase of 3.2 per cent. NHS dental treatments also rose last year by nearly one million, to 36 million. And while Sanderson and her organisation attack the government for introducing a "crude, target-driven system", there is growing evidence that the BDA's members don't share this disdain.

The government's chief dental officer, Dr Barry Cockcroft, cites the example of Cornwall Primary Care Trust, which, when asking for tenders for four new NHS practices, received more than 80 applicants. "When primary care trusts ask for tenders for new services, dentists are falling over themselves to bid for them," he says.

It seems that some dentists are deciding that the NHS contracts, which provide dentists with a guaranteed salary of roughly £80,000 a year for three years and a 5 per cent reduction in their workload, are not such a bad deal after all. The economic slowdown could also be helping the return of dentists to the fold. Dr Mark Harris was among 2,000 to resign from the NHS prior to the introduction of the new contracts. Now he has applied to Devon Primary Care Trust to provide NHS care for adults at his Totnes practice. "I think when there isn't much money about, the best arrangement is a mixture of NHS and private work," he admits.

The dramatic decline of NHS dentistry can be traced to the decision of John Major's government to cut the fees payable to NHS dentists in the early 1990s - something to remember during the current wave of nostalgia for the former Conservative prime minister. The decision led to an exodus of dentists from the NHS into private practice. In 1990, before the cuts, only 5 per cent of dentists' earnings came from the private sector; today it accounts for more than half. And as private practice has grown, so the overriding commitment of the dental profession and its governing body to the NHS has weakened.

Throughout the 1990s, one could not question the fervency of the BDA's support for the NHS, but today the emphasis appears to have changed. In her speech to the BDA's May conference in Manchester, Sanderson enthused over the merits of private dentistry. "For many [here], private dentistry has given you the opportunity to work the way you want to, without any sense of compromise," she said. "It has given you freedom." She went on to express scepticism as to whether the NHS could ever meet the "expectations of patients and users".

It is hard not to detect a certain air of defeatism - Sanderson claimed last year that the future of NHS dentistry was "increasingly fragile" - and the BDA's disenchantment with NHS reforms has been seized upon by those opposed to the very idea of NHS care. In its own words, Nurses for Reform, a pro-privatisation pressure group, wants "to see NHS dentistry totally collapse".
"We want customers to be angry at how little they are getting for their taxation, and we want them to defect to a burgeoning private dental sector," writes the group's director, Dr Helen Evans, whose anti-NHS polemic Who Cares for the NHS? was published by the Institute of Economic Affairs earlier this year. "Already, in many [politicians'] minds, the NHS is dead," Evans claimed, having previously described the service as a "Stalinist embarrassment".

Open wide (your wallet)

The favoured gambit of the private dentistry lobby is to make NHS dentistry seem like a lost cause and the complete privatisation of dental care inevitable. If this all sounds familiar, then cast your mind back to the early 1990s when the same "the system's so broke it can't be mended" arguments were made by free-market think tanks lobbying for British Rail's denationalisation.

But nothing is inevitable until it happens - and there is nothing inevitable about the demise of NHS dentistry. The return of dentists to the NHS fold is a fact that fits neither Nurses for Reform nor the BDA's doom-laden prognosis. The increased number of places for training NHS dentists also gives grounds for optimism, as does the government's decision to increase funding for NHS dentistry by 11 per cent next year. And all three main parties remain formally committed to increasing provision.

In the final analysis, the future of NHS dentistry will be guaranteed only if voters raise their voices to urge that more resources be spent on improving access to the service. And the importance of expanding NHS dentistry cannot be overestimated if we care about both our teeth and our wallets: the decline in NHS provision over the past two decades has led to a major deterioration in the nation's oral health. In some parts of the country, tooth decay rose by 50 per cent between 1993 and 2003; mouth cancer has risen by around 25 per cent, with more than 4,700 new cases being diagnosed in the UK each year. The replacement of NHS dentistry with a wholly private system, as free-market pressure groups desire, would prove as catastrophic as the privatisation of the railways has been.

If we want to know what a Britain without any NHS dentistry would be like, we need only look to the United States, where more than 100 million people are without dental insurance and 27 per cent of children and 29 per cent of adults have cavities that go untreated. Last year, a child in Mississippi and another in Maryland died from infections caused by decayed teeth.

When the NHS was formed, exactly 60 years ago this summer, it promised to provide "all medical, dental and nursing care". Free NHS dental care may only have lasted until 1951 - the first year that NHS charges were introduced - but for more than 40 years the NHS provided Britons with access to good-quality and affordable dental treatment. The question that needs to be asked of the free-market ideologues who are already gleefully writing its epitaph is a simple one: if Britain could afford - and operate - a comprehensive NHS dental system in the austerity years of the 1940s and the recession-hit 1970s, why on earth can't we do the same today?

We'll know for sure that we've stopped the rot when dentist jokes are once again about extracting teeth, and not extracting money.


Free dental, and eye, treatment must be restored. That is the policy of the British People's Alliance. Do get in touch - info@britishpeoplesalliance.org.uk

5 comments:

  1. Neil Clark's opening lines suggest that he knows nothing about NHS dentistry charges. You will not be charged £180 by an NHS dentist for extracting a tooth. You will be charged £44.60. There are now three charge bands for NHS dental treatment, and £180 is not one of them - the highest charge is £198, which covers the most complex procedures. It is very easy to find this out. You could look at the relevant page of the NHS Direct website (easy to find - I googled "dentistry charges") or, if you need to have a tooth out, you could go to the dentist. If you are writing an article about NHS dentistry, you should certainly check your facts with someone.

    If Neil Clark is wrong about this, when it's such an easy thing to check, why should I bother reading the rest of the article?

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  2. " You will not be charged £180 by an NHS dentist for extracting a tooth."

    Not yet.

    Which is the point.

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  3. 'stephen': don't be such a twerp-try re-reading beginning of the article again.

    The joke was about the exorbitant cost of private dentistry in Britain (the most expensive in Europe)-and not about NHS charges.

    and then I wrote:
    The seemingly inexorable decline of affordable National Health Service dentistry, and the growth of private practice (the most expensive in Europe), have certainly hurt our pockets.

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  4. Neil, thanks for responding - I'll just say that it is not at all clear from the context that your "joke" refers to private rather than NHS dentistry - as David's subsequent comment proves.

    I would respond at greater length, but David has already declined to publish one (perfectly civil) comment I have left on this thread. After bitter experience on other blogs, I don't participate in conversations where comment moderators selectively remove contributions. Sorry about that. And sorry about the fact that, given the above, you will probably not have the opportunity to see this brief response to you.

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  5. Neil! Good to see you. How goes the campaign for the BPA?

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