The coming Spending Review will either save or sink NHS dentistry, as new analysis by the British Dental Association put to the Public Accounts Committee (PAC) reveals the struggling service is now being kept afloat by a cross-subsidy from private work worth at least £332m a year.
The most exhaustive assessment of NHS treatment costs and timings in over 20 years shows a decade of austerity funding means thousands of NHS dentists are now delivering some NHS treatment at a loss. The BDA stress that the Treasury’s unwillingness to help NHS dentistry stand on its own two feet is accelerating the exodus to the private sector.
A simple new NHS patient exam loses a typical practice £7.69 – a denture £42.60.
The PAC will hear this morning from acting Permanent Secretary Prof Chris Whitty and NHS England CEO Amanda Pritchard in their first hearing in their ‘Fixing NHS dentistry’ inquiry. The professional body have warned the Committee that time and again the Treasury has stifled reform, and limited change to modest recycling of unsustainable budgets. The BDA say this toxic culture remains in place despite the change in government.
Analysis of a decade of accounts shows NHS dentistry has experienced a level of cuts with no precedent anywhere in the NHS.
The BDA attacked the last government for operating a long-term strategy to substitute government investment for patient charge revenue, with ministers putting in less, while patients paid more into a static budget. Dentists leaders are now wary that the new leadership at Treasury will continue to pursue this strategy, and is asking Chancellor Reeves to categorically rule out further hikes that will discourage millions on modest incomes.
NHS dentistry has experienced several years of record-breaking underspends – with hundreds of millions perversely lost from the front line during an access crisis. The BDA say the Treasury want to see existing budgets spent before new funds are put on the table. The BDA has told the PAC that officials have singularly failed to grasp that unsustainable funding levels fuel these underspends. Practices that cannot fill vacancies because they cannot offer competitive pay and often do not even break even on some NHS treatments find it impossible to deliver their allocated activity.
The recent budget has brought service to lowest ebb. This modelling was undertaken before the autumn budget added millions in new costs – via both National Insurance and National Minium Wage increases – which will hit on 1 April with no mitigations in place. Dentists have just been offered a real cut in pay after given failure to cover the soaring costs of delivering NHS care.
The BDA estimate that failure to cover cost of NIC, NMW and keep pace with dental inflation will bring the total size of the cross subsidy from private care up to £425m.
The BDA say the PAC inquiry has come at a crucial moment ahead of the Spending Review. Despite welcome Government pledges to reform the discredited contract fuelling the crisis, to deliver 700,000 additional urgent appointments, and roll out of supervised brushing programmes, there been no progress towards delivery. Promises of new money set out in the Labour Manifesto – from the non dom squeeze – have already been dropped.
The professional body says the 2023 Health and Social Care Committee has already laid out the blueprint for reform. It warns the Public Accounts Committee is a last chance to secure sustainable investment to realise it.
Shiv Pabary, Chair of the British Dental Association’s General Dental Practice Committee, said: “Government says it’s ‘going for growth’, but Treasury policy is doing the exact opposite for dental care. The coming spending review will either sink or save NHS dentistry. Rachel Reeves doesn’t want to see her signature on the death warrant of a service millions depend on.”
