No, it’s not a misprint – “whither” might be more grammatically correct, but in fact I’m still surprised by the number of colleagues who continue to believe in the ‘wither on the vine’ theory. This holds that, whatever the current stated aims of government, be it Labour, Conservative or Coalition, the deeply underlying approach taken is that NHS dentistry is a lost cause and in time will simply fade away, leaving more cash to be spent on the acute, life-threatening and generally sexier parts of the healthcare system.
As conspiracy theories go, this isn’t a bad one, really. Witness the lack of investment in dentistry during the nineties and early noughties (Con and Lab), Tony Blair’s empty promise of “everyone” having access to NHS dentistry in two years, the subsequent disastrous introduction of the 2006 contract and the current pay freeze/cut. Not to mention the long drawn-out piloting process for further change.
However, this theory omits a few important facts. Not least is the fact that substantial funding was pumped into NHS dentistry between 2007 and 2010, at a time when austerity was becoming the name of the game and similar cash injections were not seen on that scale in the wider NHS.
Very significantly, with some 30m adults visiting NHS dentists each year, or well over half a million patients a week, dentistry is one of the most publically apparent and accessed parts of the system. That’s 30m votes, and what’s more, in general it is a demographic that is more likely to actually exercise its mandate come the next election.
So, in short, I see no signs of withering. However, that does leave the big question un-answered. Where does NHS England and the various Departments of Health see dentistry in the future? And where is the funding to come from which will secure the high quality service that is extolled?
The answer to the first question remains – at least to me – a mystery. The report issued following two years of piloting in England suggests, in explaining the fall in access in most pilot practices, that if the cost and effort of preventing disease is actually greater than simply allowing disease to develop and treating it anyway, then the ‘profound long-term benefits’ will not be realised. The latest pilot software suggests significant reduction in detail, but it will take further, and long-term, study to establish the balance. We are potentially five years away from a
‘considered’ introduction of any new system.
Sources of funding are equally a problem. The recent statements at political party conferences by all leading proponents are little more than vague window-dressing, as is typical at this pre-election stage.
We are still some major distance away from beginning to fill the projected £30-50bn gap in NHS funding expected by 2020, and at a current annual rate of growth in funding of less than 0.1 per cent in real terms, further drastic action will be required. Dentistry is well down the food-chain when it comes to further hand-outs.
A recent influential report commissioned by the King’s Fund – the Barker report - suggests some radical ways to bridge the gap and to further integrate health and social care. Increased dental charges are dismissed as they are considered already to recover 80 per cent of treatment costs, with exemptions tightly drawn. Instead, the commission makes some controversial proposals to reduce exemptions from prescription charges and increases in National Insurance. Predictably, these have been ignored by all the parties, but will no doubt be dusted off after next May’s election for more serious consideration, whoever wins...
By the time you read this, we will have had the first pay strike by health service workers in 32 years, with further action promised. There are predictions that with the loss of the Minimum Practice Income Guarantee over the next six years, more GP practices will close. And I noticed recently that the average tenure of a hospital chief executive is less than 2.5 years, which even challenges the statistics for Premiership football managers.
All this suggests to me that further radical change within the healthcare sector is likely within months of next year’s election, and that whilst no party can afford to let dentistry wither, its place in the league rankings of an under funded system is not likely to rise anytime soon.
References available on request.