UK - A kick in the teeth: How Labour destroyed NHS dentistry

A kick in the teeth: How Labour destroyed NHS dentistry
By EDWARD HEATHCOAT AMORY Britain's teeth are supposed to be improving. We have all become better at brushing and flossing, government spending on dentistry is soaring, and snaggle-toothed Tony Blair has been replaced by Gordon Brown, a gleaming advertisement for the dentist's art. But it turns out we aren't smiling after all, because according to a MORI survey for Citizen's Advice, 7.4million of us have tried and failed to find an NHS dentist to treat us since April 2006. A decaying industry: Dentists are quitting NHS treatment, much to the despair of patients1,000 dentists have quit since botched NHS shake-up...TWICE official estimates, latest figures reveal
This latest poll bears out all the other evidence over the last few years, that for many people, their so-called right to access NHS dental treatment is a myth. In many parts of Britain, there are no NHS dentists accepting new adult patients. Another survey before Christmas found a number of people who had resorted to pulling out their own teeth.
So what has gone so catastrophically wrong?
The problems began in the Seventies, when fluoride was added to toothpaste, and many experts concluded that dental decay would become a thing of the past. In fact, we have more money to spend on sweets and soft drinks, so we get just as many fillings. But meanwhile the number of places at dental schools had been drastically cut back. The result is that in 2004 we had only 3.7 dentists per 10,000 Britons; half the U.S. figure. The next problem is that more dentists do more private work. In 1990, 6 per cent of dentists' income came from the private sector. By 2000, it had risen to 42 per cent. Now it's 58 per cent. At this rate, there soon won't be any dentistry left on the NHS.
There's no question that Labour inherited problems. In 1992, the Tories drastically cut back on the rates the NHS paid to dentists, encouraging many to go private. But for years after coming to power, Labour did nothing, despite Tony Blair promising in 1999 that everyone would have access to NHS dental care. Then in 2006, they introduced a new dental contract, and the result - like the new contracts for GPs and hospital consultants - was a disaster.
Under the old system, dentists were paid for the work that they did.
Under the new one, they are paid a fixed fee of around £80,000 a year for achieving so many Units of Dental Activity.
This Stalinist approach has failed completely.
The energetic dentists run through all their NHS "units" early in the year and then can't treat any more public patients. The lazy ones haven't managed to complete all the units that they promised and have had to pay back nearly £100million to the primary care trusts.
None of them is happy. There's also a fundamental flaw in the way that these "units" are designed. There's no doubt the old system was too complicated; 400 different treatments and 400 different fees. But now it is over-simplified. Dentists receive the same amount of money for one filling on a patient as they do for six. So anyone with complex dental work needed gets turned away; it's not worth the dentist's while to do it on the NHS. At the same time, the costs of having NHS dental work have risen sharply.
Unless you are a child or on benefits, you have to pay 80 per cent of the cost of your treatment.
Before the reforms, a filling would cost £14; now it's £43. So the gap between NHS and private has narrowed for many patients. The new system has also introduced a new layer of bureaucracy. In the old days, the NHS contracted directly with dentists. Now the money goes to primary care trusts, who pass it on to dentists. This was meant to ensure the PCTs would find a dentist for everyone - but it hasn't worked like that. Instead, dentists suspect that much of the new money - spending up a third in three years and another 11 per cent this year - has been wasted on PCT bureaucracy. And from 2009, the dental budget will no longer be ring-fenced, so primary-care trusts can cut it back to fund more urgent priorities.
All this has persuaded many dentists - who pay for their premises and equipment themselves - that staying in the public sector is an unacceptable financial risk.
So what can the Government do about the mess that it has largely created?
It should redraw the dental contract, getting rid of the ridiculous units of activity.
It should pay dentists for the work they do. And it could find ways of preventing dentists - whose training costs the taxpayer £175,000 each - from immediately deserting the NHS.
Perhaps they could be banned from working privately for a number of years after graduating.
All these options are open to Labour, but because they continue to pretend that there is no problem at all, presumably they are doing nothing to solve it.