One of the mysteries about the Conservatives over the past few years has been their devotion to the National Health Service, probably believing that this might help them prove that they are no longer the ‘nasty party’. Ever since the formation of the Coalition Government nearly six months ago, the talk has all been of cuts and October’s Comprehensive Spending Review showed large cuts in most departments, but with the NHS and all its works being exempt.
Fair enough. In their manifesto, the Conservatives said: ‘We will guarantee that health spending increases in real terms in each year of the Parliament’. They also said: ‘We are committed to an NHS that is free at the point of use and available to everyone based on need, not the ability to pay.’ However as we all know in NHS dentistry, whether a patient has a crown or an extraction depends in part on their ability to pay the Band 3 patients’ charge.
So in this world of cuts should the NHS have been exempt? Canada in the 1990s is seen as the example of how to cut Government spending. In 1995 their prime minister, unveiled what became known as the ‘bloodbath budget’, in which departmental spending was reduced by an average of 20 per cent. This had the desired effect because two years later the deficit had been eradicated. However, there were no exceptions and the health budget was slashed, the same as all other departments.
More recently and nearer home, last year the Irish Government made serious cuts in their spending on health and, in particular, on dentistry. But in the UK, NHS dentistry appears to have escaped unscathed. After over 60 years of under-funding of NHJS dentistry, there are few dentists who would willingly embrace cuts in our sector, but whenever the subject is raised the cry goes up: ‘what about a core service?’
The promise was that NHS spending would be protected from the cuts, but not individual parts of it. So it is not beyond the realms of possibility that dentistry will be chopped so that more can be spent on, say, cancer drugs. The Government has already signalled the end of primary care trusts and moved dental practice inspections to the Care Quality Commission where dentists will pay for these rather than the taxpayer.
So perhaps we ought to have a look at how spending on NHS dentistry could be cut, before some civil servant does it for us. Let’s look at the figures, of the ball-park variety, but nonetheless useful. Spending on dentistry is now more than £5bn a year we are told. Roughly half of this is private and half NHS. But of the £2.5bn that is the NHS share, 0.5bn comes from patients via NHS charges.
So in this NHS that is supposed to be ‘free at the point of use and available to everyone based on need, not the ability to pay’ the reality in dentistry is that a large number of patients already pay £3bn towards their treatment. The Government chips in a tenth of that amount. Governments of all shades like to pretend that there is comprehensive dental treatment for all. Isn’t it time someone told them that the reality is that most adults pay for most of their dentistry, either privately or through NHS charges?
There are advantages to the Government in removing patients’ charges from the NHS; less bureaucracy, no need to fret about whether patient charge revenue will hold up. Ministers have said recently that they want a system of registration and capitation. They are happy to talk about this change, but not the possibility that it could mean an annual patients’ charge just for being registered. The reality must be that you can only operate a capitation system for dentists, if it is free to patients as with doctors. It cannot be beyond the bounds of possibility that those who pay charges will be moved to the private sector. The Coalition had better do it quick, however, while they can still blame the ‘legacy left by Labour’.
Where would the taxpayers’ money be spent? The recent white paper said the Government wanted to ‘focus on the oral health of schoolchildren’. They could afford to do that and perhaps make sure that those who currently never step over our threshold receive proper care. There could be orthodontics for those whose clinical condition justifies it. Those who cannot pay charges could be offered capitation if they want to attend regularly or have urgent treatment as and when needed. There could be annual check-ups for groups of people such as the old living in residential care or those with a medical condition such as diabetes.
If only the politicians had the guts to accept that they cannot do everything for everybody. It would be a nice Christmas present for dentistry. I am not holding my breath though.