NHS dentistry: A cautionary tale of crisis and opportunity

Before you read this blog, please just stop for a moment and take in this quote. Let the enormity of it sink in. 

“As adults we are able to use pliers to extract our own teeth, but I feel that this shouldn’t be something that our children should have to endure.” 

This was feedback shared by a member of the public with Healthwatch England in their state of health and social care report earlier this year. What a depressing picture this single sentence paints. That getting dental treatment has become such a challenge in this country that the best we can hope for is that we shouldn’t have to perform DIY dentistry on our kids!

Now obviously many millions of people do still get access to an NHS dentist, and they get the help they need from hard-working dental professionals to treat problems and help them keep their mouths healthy. 

The problem is that the NHS and successive governments lean on what they are doing as evidence that they are doing a good job, regardless of whether it is actually meeting need or not. And when you listen to patients and communities it is clear that, for many, access to and affordability of dental care is now a very real challenge. 

At a perilous point

Today’s report by the Nuffield Trust sets this out very clearly. Six million fewer courses of NHS dental treatment were provided last year than in 2019/20. And we must remember that pre-pandemic the country was only commissioning enough dental treatment on the NHS for about 50% of the population anyway. 

Among National Voices’ members we see the crystal-clear consequences of this – from Macmillan sharing stories of cancer patients facing delays to vital treatment because they are unable to get the required dental check-ups before they start chemotherapy, to Age UK reporting older people facing astronomical costs for private dentures because they can’t get an NHS dentist. 

Some might try and brush these concerns to one side and point to dental outcomes as a sign that things are actually ok. As the Nuffield report rightly highlights, over the latter part of the 20^th century and the early part of this millennium, the story of dental outcomes is one of “significant and sustained improvement”. Indeed, when you look at the UK compared to the vast majority of our European neighbours, we compare pretty well when it comes to the prevalence of things like tooth decay and gum disease. 

But these improvements are not because of any initiatives from the last 15 years or so. They are the result of decades of work since the birth of the NHS to improve people’s teeth. This includes major public health initiatives, like the fluoridation of water. 

Even with such progress, there are still massive and persistent inequalities across regions and according to socio-economic status. For example, adults living in lower income households or in areas of higher deprivation are more likely to have no natural teeth. 

Time to sit up and act

We are in this sorry state because of significant neglect of dental policy over many years, and the Nuffield report’s authors are right to raise the very unpalatable choices that lay ahead. And decision-makers should sit up and take note of what has happened to dentistry as a vision of what might happen to the rest of the NHS if we make similar missteps. 

But I want to end with a pie in the sky thought for you. What if we stopped considering the future of NHS dentistry in isolation for a moment? What if we built a new health prevention service with dentistry at its heart? We know the NHS wants to shift to a more preventative model in general to tackle major challenges around obesity, smoking and alcohol and to help people manage multiple long-term conditions. As the only true lifelong preventative service currently on offer, NHS dentistry could become part of something much greater. 

One thing is for certain, the time for tinkering is over. We need a fundamental rethink of dental care in England. 

*Jacob Lant is the Chief Executive of National Voices.

The Nuffield Trust has today published a new report on the state of NHS dentistry and future policy actions.