public health

Dentists challenge Jeremy Hunt to prove his mettle by investing in prevention

The British Dental Association has challenged Jeremy Hunt to put prevention at the heart of government’s NHS ‘birthday funding’ pledge, as dentists warn that a rush to reduce political pressure on hospital targets will fail to tackle the pressures facing the wider service.

In an open letter to the Health Secretary the dentists’ union has demanded clarity on investment in primary care and public health services, which appear conspicuous by their absence, stating that any settlement geared purely around chasing targets for acute care stands entirely at odds with the preventive philosophy set out in the Five Year Forward View.

It has sought clarity on issues around the government’s successive manifesto commitments to reform dental primary care services, its increasing over-reliance on patient charges, threats to training budgets, and its unwillingness to engage meaningfully on public health programmes.

The BDA has stressed that a new prevention-focused NHS contract will only now be viable if ministerial contributions taken out of service since 2012 are restored, to boost quality, access and time spent with patients. Recent figures have shown spending per head has fallen £41 to £36 per person in just five years. Recent evaluation reports have demonstrated prototypes currently being tested are not financially sustainable.

Dentist leaders have also urged the government to engage with modelling from Public Health England on the huge returns of investment yielded by spending on prevention, and requested details on plans for public health budgets for cash strapped local authorities. £1 spent on early years prevention programmes of supervised brushing yield £3.06 in savings after just five years.

Tooth decay remains the number one reason for child hospital admissions in the UK, with a growing number of children facing more than six-month waiting lists. The BDA has documented the multi-million-pound costs hospitals are now facing for failure to tackle tooth decay, a wholly preventable disease, on GP services, emergency and secondary care.

BDA Chair, Mick Armstrong, said: “If Ministers fail to invest in prevention in primary care and public health services they will be on the wrong side of their own strategy for the health service.

“It is wrongheaded to focus on cure over prevention, treating the symptoms but not the causes of the pressure on our NHS. More and more children face six-month waits for tooth extractions in hospital, but the solution cannot be throwing cash at the surgical workforce.

“This is about targeted investment. Reform of the failed NHS contract has reached an impasse, and the government’s stated goals of improving both access and prevention simply cannot be delivered on a standstill budget. To make this work all we need is the cash Ministers have quietly siphoned out of the service since 2012.

“The government’s own figures show a pound spent on preventing decay can yield three back in savings. Reducing exposure on hospital and emergency targets is politically useful, but it isn’t a sustainable or cost-effective basis for a healthcare strategy.”

Dental neglect: Children falling through the cracks in “siloed health service”

The BDA has renewed its call for a joined-up strategy on children’s oral health, as new research reveals that GPs are not given the time or training to spot the tell-tale signs of dental neglect.1

The study, published in the British Dental Journal, surveyed all GPs in the Isle of Wight about their awareness and perceptions of dental health care in the identification of abuse. Among these family doctors, usually the first point of contact with the NHS, the majority had never liaised with a dentist. 96 per cent of respondents had never received any formal dental training and some did not perceive dental health to be important. Only five GPs mentioned a link between a lack of dental registration and childhood neglect and no GPs worked at clinics where child dental registration status was recorded.

Dental neglect is a marker of child neglect. It was defined in 2009 in the UK as “the persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development.” The research demonstrates that GPs lack time, training and confidence to identify dental neglect during routine examination of the oropharynx, and lack awareness of dental neglect as a potential marker of wider systemic neglect.

The study also notes that the sheer ubiquity of dental neglect within the general population may have desensitised many health practitioners to its wider social and health consequences, and blurred the lines between neglect and economic deprivation.

Official data shows that 41.8 per cent of children in England had not been to see a dentist for a check-up in the 12 months up to June 2017. Tooth decay remains the number one reason for hospital admissions among children across the UK. The BDA believes that progress can only be achieved by breaking down silos across the health service, along with co-ordinated and properly funded public health interventions.

The BDA’s Chair of General Dental Practice, Henrik Overgaard-Nielsen, said: “Tooth decay can be a tell-tale sign of abuse or neglect, and many children are falling through the cracks in a siloed health service. GPs bear an enormous burden and it cannot fall to them to ‘multitask’, when government is failing to deal with the problem.

“Tooth decay is the number one reason for child hospital admissions, but dentists are not seeing those at most risk early enough to make a difference. Poverty, neglect or ignorance can be huge barriers to good oral health, and we desperately need joined-up policymaking to tackle them.

“Oral health has such a low profile that it is not surprising that awareness of its importance is low in other parts of the NHS. When we face an epidemic of decay, dentistry can’t be left in a corner. Without meaningful engagement in education, in media and across the health service we simply cannot expect progress.”

  1. See: Colgan, S.M et al (2018). ‘Bridging the gap’ – A survey of medical GPs’ awareness of child dental neglect as a marker of potential systemic child neglect, The British Dental Journal, published 11 May 2018