The whole NHS system is under great strain because the politicians promise it will provide for all clinical needs for all the population, regardless of where one is in the UK, free at source, regardless of income. So, where does dentistry fit within the NHS?
The short answer is, although it is subject to similar pressures, dentistry (along perhaps with mental health) is the Cinderella of the wider NHS service.
For decades, the service has had to work very hard with fewer resources to satisfy demand whilst being generally unappreciated and downtrodden in the press and wider society.
For quite some time in England now, we have been working with a ‘limited’ UDA volume target system which is proving unsuitable to provide modern dental care and prevention to the population. Even the cross-party Health Select Committee agree it’s crazy. The ONLY reason it continues is because it provides a guaranteed annual limited budget for civil servants for a similar access volume count. However, this comes at a cost of quality and time to care, which is now known as ‘The Big Lie’ in the Dental Profession.
Wales has a similar UDA target system, Northern Ireland is moving to a more capitation-based system in an already high-needs population and Scotland still operates a fee-per-item approach under their NHS dental contract, but have started more preventive steps such as ChildSmile which has dramatically reduced the number of hospital admissions AND saved the NHS millions of pounds, though as always, much more can be done.
All four UK countries suffer from inadequate NHS dentistry resources to meet the increasing clinical needs of their whole populations, some worse than others and some about to get a lot worse in a ‘cuts’ and austerity environment. Thus, we need politicians to do something they have never done before for NHS dentistry – they need to be fully OPEN and TRANSPARENT with the public about the limitations of NHS dentistry and re-align the public’s expectations. They also need to shift the emphasis of NHS dentistry towards a widespread focus on prevention – across all sectors of society.
The only alternative is to double or treble NHS dentistry resources and budgets, and let’s be frank, that just isn’t going to happen in these austere times. I wish it were otherwise, but one has to have a strong dose of reality!
The only two options left are:
1) Keep perpetuating the LIE that the system is resourced to meet everyone’s clinical and dental needs in order to prop-up the unrealistic and short-term political promises – and accept the most vulnerable will suffer the most!
2) OR, publicly admit that the system is LIMITED now, but reduce disease/demand upon the system by channeling resources into an approach based on prevention – outside of dentistry too.
Dr Tony Kilcoyne “Given the number one medical reason any primary school child is admitted to a hospital bed in England is rotten teeth, with 45% of adults having gum disease at a level of BPE 3 (the max score is 4), then this rotten NHS dental system needs a totally different way of operating.
You see, dentistry has one big advantage over the rest of the NHS, which is massively under-played: almost 100% of dental disease problems are preventable or reducible relatively quickly and easily! Waiting until the public turns up at a dental practice before any real dental prevention is shown or taught is crazy… really crazy! Especially when said dental practice is run off its feet seeing high volumes of patients in an attempt to meet high volume, centrally set targets. Yet CRAZY is what we have now, and have had for years – if you want to disempower the public, which includes not just the often mentioned lower socio-economic groups, but also social workers, medical colleagues, teachers, parents, teenagers and even five-year-olds, keep prevention a secret!
Alternatively, if we want to make a GENUINE difference and do something that has never been done before, let’s run TV adverts, newspaper and social media campaigns and provide key information on prevention to every professional in every sector. It wouldn’t cost much for the Government to involve the BBC, after all we know their programmes during Smile Month in June made a huge impression upon the public.
Let’s empower everyone with the dental knowledge about the benefits of prevention, so they attend their dental practice already knowing the basics. Dental teams are then reinforcing and bespoking already existing knowledge, unlike now.
The third prong of this new approach has to be addressing the food industry. This industry is pumping sugar into almost all foodstuffs, not just the obvious things like sweet treats, but savoury snacks, crisps, bread, cereals, flavoured water – the list goes on. Sugar is addictive! It’s a cheap food filler and we are now in the sorry state where healthy snacks aimed at children and ‘approved by mums’ contain more sugar than a typical chocolate bar!
Given the number one medical reason any primary school child is admitted to a hospital bed in England is rotten teeth, with 45% of adults having gum disease at a level of BPE 3 (the max score is 4), then this rotten NHS dental system needs a totally different way of operating. This can be done, it should be done; it would be criminal if it weren’t done as a matter of urgency now in the public’s interest!
In summary, nothing can really improve unless we seriously address the following points:
1) Publicly admit that the current NHS dental system cannot meet all clinical needs of the population – this is the most important point!
2) Focus on dental prevention so every adult and child knows the basics to help themselves and others via national media campaigns.
3) Address the food industry pumping sugar into many foods and drink because it’s addictive and cheap; creating sweet-tooths early is hospitalising children and creating future diabetics and health problems that should be prevented early in life!
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Dr Tony Kilcoyne: Specialist in Prosthodontics. Haworth, Keighley, West Yorkshire UK
Please note: the above article is the personal opinion of Dr Tony Kilcoyne and is totally independent of any posts previously or currently held. Thank you.
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