A double whammy of good news? Hopefully
NewsPosted by: Dental Design 13th August 2021
Health Bill brings hope on two fronts
Unsurprisingly, there has been a lot of doom and gloom in the dental world over the last couple of years, just like there has been in society generally. Although we are clearly not out of the woods yet on the Covid front, things look a little better. There will still clearly be bumps in the road along the way and, in relation to dentistry, my optimism is based on the recently published Health Bill and the comments made by MPs during the second reading in the House of Commons before the Bill goes into the committee stage.
As Chair of the British Fluoridation Society, I have already written about my delight at the stated intention to remove some of the blockages that need to be overcome when trying to establish new schemes, and I was pleased to see Steve Brine MP, a former health minister, welcome the proposal in The House.
The letters NHS stand for National Health Service but, over time, it has really started to become a national treatment service, which, in many ways because of its own success, is becoming close to unaffordable. People are living longer with higher expectations and the service can often (or should that be sometimes?) meet those expectations. In dentistry, how many people can now remember the 50s, 60s or indeed early 70s in some cases when the only option for people with high levels of disease was a full clearance and the provision of dentures? Change happens quickly. When I graduated, over 40% of the adult population was edentulous but now that figure is below 5%. The older generation are now largely dentate with a not unreasonable expectation of remaining that way without discomfort. Prevention is the way forward, in both oral and general health, and the penny seems to have finally dropped at a high level. Money can be a key factor; we know that one of the main drivers of the reduction in cigarette smoking has been the rising cost – similarly, making unhealthy foods more expensive through the application of a health focused tax, such as the sugar tax, can have a rapid impact on oral and general health.
Fluoridation is a key weapon in tackling inequalities but access to NHS services is again becoming a major issue and some of the proposals in the Bill offer up the possibility of positive progress. Contract reform is often quoted as being necessary to solve access issues, but the patchy nature of new access issues suggests that the real problems lie elsewhere.
The 2005 Health and Social Care Bill gave the NHS a responsibility to provide or commission NHS primary care dental services and that is not currently affected by the bill. However, without adequate funding and sufficient workforce, neither commissioners nor providers can deliver on that obligation. There are many players in the workforce discussion but until someone takes the lead, be it in Health Education England, NHS England or the DHSC, and recognises that something needs to be done urgently, solving the growing NHS access issues will be either impossible or prohibitively expensive.
Until 2006 the NHS had no ability to control access or fund significant expansion in NHS general practice where there were huge problems that had been growing since 1992. The proposals in The Bill around Integrated Care Systems, which reposition dental commissioning into the mainstream, alongside pharmaceutical and optical services, open some real opportunities. The level of complaint about access seen in the second reading debate would now need to be responded to by the local Integrated Care Systems who, conveniently, hold both the overall budget for their area and would be responsible in law. It also brings the commissioning of primary and secondary care dental services within the remit of the same organisation. This could open opportunities for significant cost savings in the secondary care sector budget while at the same time delivering care closer to home for many patients and developing more diverse career opportunities in primary care.
When I was CDO, the secondary care sector delivered about 4% of dental care but accounted for about 20% of the budget. Clearly some of the work provided in the secondary care environment is appropriately placed there either because of complexity, comorbidities or for educational purposes but a significant proportion could be commissioned in primary care without the overheads associated with delivering services in the secondary care environment – orthodontics comes immediately to mind!
So, watch the progress of The Bill and see if we can prevent dentistry returning to what the BDA refer to as a ‘Cinderella service’. I often think that those in power have never seen real dental inequality, but what is clear is that access to dental care is a high priority for patients.
Dr Barry Cockcroft CBE is the former Chief Dental Officer for England and current chair of the British Fluoridation Society.
