The British Dental Association has condemned moves in the Autumn Statement that could withdraw free dental care from the long-term sick, while offering no additional resource to support the rebuild of NHS dentistry. Under the government’s new Back to Work Plan, announced in today’s Autumn Statement, welfare claimants who refuse to engage in job seeking activities will be lose access to NHS dental care, free prescriptions and other benefits.

The BDA believes the threat to withdraw access to free NHS dentistry from those not actively seeking work will inevitably hit vulnerable patients with higher needs the hardest and that the move will prove a repeat of the ‘ineffective approach’ taken to NHS fraud, which saw over £180 million in fines issued to innocent patients for ‘misclaiming’ free care that they were fully entitled to. Heavily briefed, dental care is thought to be among the “additional benefits” set to be lost alongside free prescriptions and legal aid. 

Chancellor Jeremy Hunt has made clear the reforms will not apply to claimants with children or disabilities.

A recovery plan for NHS dentistry was pledged by the Government in April but remains undelivered. The lack of any dedicated funding in the statement suggests that when this plan is finally published it will lack the material resources to make any meaningful headway on the current access crisis or halt of the exodus of dentists from the service. As part of its damning inquiry into dentistry, the Health and Social Care Committee stressed any plan must have “the scope and ambition required to immediately address the crisis of access people across the country are experiencing. This should be accompanied by the necessary funding and a plan for swift implementation.”

The service’s budget has remained effectively static since 2010 at around £3 billion, which has translated into savage real-terms cuts. Many practices now face the prospect of delivering some NHS treatments, particularly those that require laboratory work like dentures or bridges, at a financial loss. 

No commitment was made to increase funding to NHS dentistry, which is struggling with a lack of dentists, a declining number of practices and a backlog of appointments. 

Neil O’Brien MP, the recently departed minister with responsibility for NHS dentistry, said just days after his resignation, “if such fiscal headroom is opening up, I hope the Chancellor will devote some of it to health – GPs and dentists could rapidly do more with some extra funds.”

BDA Chair Eddie Crouch said: “The Chancellor offered no hope to the millions struggling to secure care. He failed to offer a penny to a service on the brink, just pulling away care from the patients who need us most. The Treasury will decide whether NHS dentistry has a future, but there’s no sign this government is willing to step up.”

Commenting on the announcement in the Chancellor’s Autumn Statement, Neil Carmichael, Executive Chair of the Association of Dental Groups (ADG), said: “The threat of removing access to NHS dentistry assumes that people can readily obtain these services in the first place – we know this isn’t the case. ADG’s work on Dental Deserts shows that deprived areas are more likely to have shortages in NHS dentists. The ‘carrot and stick’ approach to welfare reform will not work when most people are already failing to access NHS dental care. Further affront is caused by the government’s failure to announce any additional funding for NHS dental services in today’s Autumn Statement. As the government makes empty threats, NHS dentistry continues its fall into decay. “

NI reduction

The Autumn Statement also included news of a cut to National Insurance. Iain Stevenson, Head of Dental at Wesleyan Financial Services, said: “The cut in National Insurance will be welcomed by many dentists who are classified as self-employed, easing financial pressures at a time when the cost of living remains such a challenge. Dental practice owners will also be happy that the 100% capital allowances on qualifying expenditure has now been extended. This will allow them to plan their investments in equipment and premises with more certainty, enabling them to broaden their range of services and capitalise on the opportunities that offering private cosmetic work can bring, for example.”

The British Dental Association has said damning data secured by LBC underlines the case for radical and urgent action to restore NHS dentistry.

In Plymouth, data shared with the broadcaster shows that 600 children had a combined 4,000 teeth extracted. At one local primary school, teachers discovered that 50% of their pupils had never seen a dentist. This is resulting in children having to completely change their diets, moving off solid foods and relying solely on liquids such as soups and smoothies.

The BDA stresses Plymouth is far from an outlier, with access problems now gripping every corner of the country.

Tooth decay remains the number one reason for hospital admissions among young children, and ongoing access problems are set to see the oral health gap between rich and poor widen. Rates for extractions among children and young people living in England’s most deprived communities are nearly 3.5 times that of those living in the most affluent.

The discredited NHS contracts dentists work to has fuelled a recruitment and retention crisis across the service, with every vacancy translating into thousands of patients unable to access care. The BDA has been pressing government to deliver a recovery plan promised in April and expected before summer. In July the Health and Social Care Committee concluded a damning inquiry, describing the state of the service as “unacceptable in the 21st century”, and set out recommendations real, urgent reform. The Government’s response to the inquiry has been overdue since 14 September 2023.

The recent reshuffle and resignation of dental minister Neil O’Brien MP leaves the much-delayed recovery plan for NHS dentistry in limbo. However, O’Brien has since publicly stated that if ‘fiscal headroom’ exists in the coming Autumn Statement funds should be directed to NHS dentistry.

British Dental Association Chair Eddie Crouch: “We’re seeing children living off soup and smoothies thanks to government failure to get to grips with an access crisis. It’s as tragic as it is preventable. With the collapse in access many of these young kids have never had an NHS appointment. Dentists are trained to nip these problems in the bud, but until Ministers step up we’re going to keep seeing scenes that belong in the Victorian era.

The British Dental Association has said new evidence on the huge gains made in the fight against tooth decay secured by the sugar levy show how the Government must remain willing to force the hand of the food industry on reformulation.  

Using data on hospital admissions for tooth extractions caused by decay, new research published in BMJ Nutrition, Prevention & Health suggests that 22 months after it was implemented, the Soft Drinks Industry Levy was associated with a 12% reduction in admissions amongst children aged 0 to 18 years.

Tooth decay is the number one reason for hospital admissions among young children, with over 42,000 extractions taking place in NHS hospitals in England last year on patients aged 18 or under. 

The levy took out 47,000 tonnes of sugar from soft drinks in its first 4 years as it encouraged drinks manufacturers to reduce sugar levels to avoid the tax. The BDA stress its effectiveness is in sharp contrast to voluntary appeals to the food industry from the Government. 

Dentist leaders believe expansion of the levy into other product ranges – including milk-based drinks, biscuits, cakes, sweets, yoghurts and cereals – would drive widespread reformulation of high sugar foods and need not raise costs for consumers. 

British Dental Association Chair Eddie Crouch said: “The sugar levy is delivering the goods in the fight against decay, so it’s time to double down.

“This isn’t about adding to the cost of living. When voluntary action has clearly failed, this shows government must force industry’s hand on cutting sugar.”

With change at the top at the Department of Health and Social Care, the British Dental Association has stressed that real urgency and ambition are required to ensure NHS dentistry has a future.

The resignation of dental minister Neil O’Brien leaves the much-delayed recovery plan for NHS dentistry in limbo. While Andrea Leadsom MP has been handed the Parliamentary Under-Secretary of State for Primary Care and Public Health brief, it is unclear at this time if dentistry will remain part of the portfolio.

In an open letter to new Secretary of State Victoria Atkins MP, the BDA state that the new team must prioritise the publication of a plan, underpinned by appropriate resources. 

Dentist leaders also say the Department must show it shares the aspirations of the Health and Social Care Committee, who have offered a roadmap for rebuilding a patient-centred, prevention-focused service. The BDA have underlined that a break from the failed NHS contract the only way of realising stated ambitions from across government to ‘restore NHS dentistry’ and provide access to NHS care who all who need it.

The Government’s response to the inquiry has been overdue since September.

The British Dental Association has slammed plans by NHS England to raid future ‘underspends’ in NHS dentistry to pay for costs incurred by recent strikes across secondary care. 

According to reports in the HSJ, senior officials have now given license to Integrated Care Boards to use these funds to support their bottom line and to cover deficits as part of a deal to offset the costs of recent industrial action.

This ‘clawback’ – returned by practices struggling to meet their contractual commitments – is supposed to be ringfenced and kept for use providing NHS dental care. In April Dr Amanda Doyle, Director of Primary and Community Care at NHS England, told the Health and Social Care Committee “certainly now—for ’23–24—a ringfence has been applied by NHS England, so no ICB can spend a dental allocation on anything that is not NHS dentistry.” During the leadership election last year, the Prime Minister committed to a ring fence as part of his ‘5 Point plan’ for dentistry, to “strengthen the protections around the annual NHS dentistry budget” so funds would be “maintained exclusively for frontline dental services.”

The discredited NHS contracts dentists work to has fuelled a recruitment and retention crisis across the service, leaving many practices returning large slices of their budget when they are unable to hit their targets. The BDA believes taking away these funds is utterly perverse given the depth of the access crisis facing patients in England, and only reflects the fact officials are still banking on high levels of clawback from NHS contract holders this year.

Early this year the BDA anticipated record underspends of up to £400m for the 2022/23 financial year. So many practices were at risk that NHS England were forced to move the goalposts on required contractual delivery so fewer practices would face financial oblivion.

Since April the BDA has been pressing Government to deliver a promised recovery plan, making effective use of these underspends. In July the Health and Social Care Committee concluded its damning inquiry, describing the state of the service as “unacceptable in the 21st century”, and set out recommendations to government for permanent ring fencing, and for real, urgent reform, alongside a call for any recovery plan to be underpinned by necessary funding. The Government’s response to the inquiry has been overdue since 14 September 2023.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee, said: “Once again NHS dentistry is being treated as the Cinderella Service. When we desperately need ambition and investment, officials are raiding our budgets, robbing Peter to pay Paul. These ‘underspends’ are the result of practices struggling in a failed, underfunded system. If Government is banking on them to plug holes in their balance sheet millions of patients will lose out.”

The British Dental Association has stressed the Government must act to meaningfully restore access to NHS dentistry, as oral cancer rates and deaths continue to rise.

Dentists on the frontline in the battle with the condition, with the tell-tale signs often picked up at a routine check-up. New data shows there were 9,860 cases of mouth cancer in the UK in 2020/21 – up 12% on the previous comparable year. The disease killed more than 3,000 people in 2021 – up 46%, from 2,075 a decade ago.

Early detection results in a roughly 90% survival rate, compared to a 50% survival rate for delayed diagnosis. In this context the BDA stress ongoing access problems will make a difference between life and death for some patients.

While ‘high risk’ patients can be targeted – older smokers, heavy drinkers – there is a significant growth in cases from Human papillomavirus (HPV), who are generally younger, do not usually smoke and drink little or no alcohol.

Oral cancer now claims more lives than road collisions in each of the UK nations.

NHS dentistry in England is still waiting on a promised recovery plan from government, expected before summer. The government is also late in providing a response to the damning inquiry into the service from the Health and Social Care Committee.

British Dental Association Chair Eddie Crouch said: “Every dental check-up doubles as an oral cancer screening. When late detection can radically reduce your chances of survival, the access crisis millions face will inevitably cost lives. This condition causes more deaths than car accidents. With rates surging we need more than radio silence from Westminster.”

The British Dental Association has said figures from the Labour Party on the nearly 70,000 patients who sought dental care in emergency departments last year are just the tip of the iceberg, and that the access crisis in dentistry is being felt in all corners of the health service.

Dental charges and ongoing access problems have long pushed patients from high street dentistry to A&E services and General Practice, but access problems have escalated, with unmet need for dentistry now standing at 12 million, or 1 in 4 of England’s adult population. Medics and neither trained nor equipped to provide dental care, and these visits typically require a referral back to a dentist. While patients can receive pain relief, or antibiotics for infection, they usually require an operative intervention.

Tooth decay remains the number one reason for hospital admissions among young children. The first oral health survey of 5-year-olds published since lockdown showed no improvements in decay levels and a growing gap between rich and poor. Widening oral health inequality is set to pile more pressure across both primary and secondary care.

Ministers pledged a recovery plan for NHS dentistry in April 2023. Widely expected before summer recess, it remained unpublished as parliament broke for conference season. In July the Health and Social Care Committee concluded its damning inquiry, describing the state of the service as “unacceptable in the 21st century”, and set out recommendations to government for real, urgent reform, alongside a call for any recovery plan to be underpinned by necessary funding. The Government’s response to the inquiry has been overdue since 14 September 2023.

British Dental Association Chair Eddie Crouch said: “From GP surgeries to A&E, the crisis in NHS dentistry is piling pressure on every corner of our health service. Our medical colleagues can offer pain relief or antibiotics, but these won’t cure toothache. Patients in dental pain need a dentist, but any progress hinges on real reform and investment. Until then millions will have nowhere to go.”

The British Dental Association has said the success of reform in NHS dentistry will hinge on appropriate funding.  It follows comments by Shadow Health Secretary Wes Streeting that across the NHS “reform is more important than investment.”

The BDA welcomed recent Labour commitments on reform, but has stressed meaningful change to improve patient access and halt the exodus of dentists from the NHS will need to be underpinned by appropriate investment. 

While £111m has been pledged for 700,000 urgent care appointments, and supervised brushing there is no indications yet of what resources would be brought to bear to break with the discredited NHS contract dentists work to.  

The current system funds care for half the population, and with costs surging NHS treatments – particularly those that require laboratory work like dentures – can be delivered at a financial loss. 

Whitehall Dental Practice in Devon announced its intention to return its NHS contract this week.  The practice said the provision of “loss-making, underfunded NHS dental care” could no longer be sustained. In March Bupa Dental Care set out plans to close, sell or merge 85 dental practices in the UK, due to increased costs and workforce problems. 

In his speech to conference Labour Leader Keir Starmer noted “we must be the government that finally transforms our NHS. We can’t go on like this, with a sickness service. We need an NHS that prevents illness.” The BDA are calling on all parties to sign up to the recent recommendations of the Health and Social Care Committee, and provide the reform and resources necessary to make the service prevention-focused and patient-centred.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee said: “We cannot run a health service on goodwill alone, and dentists delivering NHS care at a loss are already walking away. Wes Streeting says reform is more important than investment. NHS dentistry will need both if it’s going to have a future.”