NHS dentistry in England is at its most perilous point in its 75-year history.
Worsening problems in accessing a dentist, a funding squeeze, the Covid-19 pandemic, and growing inequalities in oral health have created a widespread crisis. The Health and Social Care Select Committee has called for fundamental reform to end the crisis of access, and the government has promised a dental recovery plan.
The wholesale closure of routine dentistry for several weeks during the pandemic exacerbated many problems in NHS dentistry. But these problems have deep roots in a series of poor policy choices, and a general approach which may be charitably described as ‘muddling through’ over several decades.
This report seeks to understand how we got here and what choices we face if we want a sustainable future for a publicly funded dental service that meets the needs of the population.
Using the latest publicly available data, plus interviews and consultations with a range of key stakeholders, we focus on general primary care dentistry for adults and children in England, in particular NHS-funded dental work. Sadly, there is a clear trajectory of decline: nearly six million fewer courses of NHS dental treatment were provided last year than in the pre-pandemic year; funding in 2021/22 was £525m lower in real terms than in 2014/15; and there are widespread problems in accessing a dentist – something that is particularly marked for people from Black and Asian ethnic groups.
Full, universal access to NHS dentistry has probably gone for good, and a drift to the private sector has been taking place for years. But with bold policy-making it may be possible to prevent further decline. We propose a series of short-term actions relating to commissioning, the workforce and recall intervals. We also set out two options for longer-term action, which involve improving the current model or adjusting the NHS offer – both of which have strengths and weaknesses.
Williams W, Fisher E and Edwards N (2023) Bold action or slow decay? The state of NHS dentistry and future policy actions. Policy briefing, Nuffield Trust.