The NHS is one month older than I am. It has been a constant companion, there at my birth, at the birth of of my children and grandchildren and at the side of my parents and parents-in-law at the end of life. The NHS offer of universal healthcare, based on need rather than capacity to pay, was one of the outstanding achievements of the 20th century. Yet having almost been present at its birth, I fear I may also witness its death.
Fears about the future of the health service in the UK are well-founded. Successive Conservative administrations have privatised large swathes of the public realm. Perhaps they naively believe in the superiority of the private sector. Perhaps the aim is to provide lucrative opportunities for their chums. Whatever the reason, the result has been the same across sectors as varied as water, railways, or the probation service. Poorer value for citizens. Poorer services for users. Soaring profits for shareholders.
Conservative politicians respond to fears about privatised health by insisting “the NHS is not for sale”. It’s a pretty meaningless phrase. No-one imagines that the entire health service would be put up for auction. The threat is that bit by bit the driver of services would not be patient need, but private profit. Look at what is happening to NHS dentistry.
At the start NHS dental services were, like other services, universal and free. In 1951 charges were introduced for dentures and gradually for other work as well, though they remained well below the sums charged by private practice. Today the problem is not just the rising cost of charges, but the availability of any NHS care at all.
I had paid little attention to the state of dental services until recently. When my practice stopped treating NHS patients I was able to pay, so reluctantly opted to carry on with the same team. I noticed the increasing charges, however, and wondered how those in poorer circumstances might cope.
I took a bit more interest when in January I broke a tooth and found the earliest date I could get treatment was April. I was recounting this to a friend the other day and she told me her story. She broke a tooth in April 2020 and was not treated until the following January. Since she was not in pain, and honest, her appointment kept being put back. Pretending to be in pain might have accelerated her appointment, but, as she says, “That might have taken a place from someone really suffering.”
By co-incidence that same day I came home and read a letter in my local paper, the Wells Journal. The writer had been registered with a practice in Cheddar for 70 years and had just been told that their dentist would no longer be treating NHS patients. On asking where NHS treatment was available the answer was that there were no dental practices in Somerset taking on new NHS patients. There were however places for private patients in Cheddar, and a handy insurance scheme that, for £18 per month, would cover “some of the costs”.
It reminded me of another local story, also concerning Cheddar. A young man had been the subject of a brutal attack while on a night out in Exeter, had suffered damage to his teeth and was in pain. He called his dentist, only to find that he had been taken off their list because he had not attended recently. They had not told him. They would not reinstate him. They could, however, treat him as a private patient.
Once I started looking, I found similar stories everywhere. We wrote about the dire shortages of dentists in Devon and Cornwall back in June last year. People being asked to wait years for an appointment. People unable to find an NHS dentist and simply living with pain or resorting to treating themselves with ‘DIY filling kits’. A BBC story from December 2021 reported that in Devon “there are currently no practices showing as taking on adult or child patients.” In the words of Healthwatch UK
“People in every corner of England are struggling to get the dental treatment they need when they need it.”
Why is the state of dental services so bad? No doubt policy makers will blame the pandemic, which has certainly disrupted treatment, but the crisis clearly predated Covid. Brexit, as in so many cases, has helped make a bad situation worse, but is not the primary cause. The simple fact is that dentistry is being allowed to move from being a universal public service to a private, profit driven business. If there are places for private patients there is clearly capacity to treat more on the NHS.
This then is the future of dental services. Those who can afford to pay get good and prompt treatment, though at an increasing cost. Those who can’t, have a long wait for treatment, if they get any at all. Insurance companies have a profitable business helping people pay “some of the costs” and the system focuses on cosmetic treatment for the affluent rather than urgent care for the needy.
What might be next in a programme of stealth privatisation? An obvious candidate might be hip and knee replacements, increasingly carried out in private treatment centres like this one in Shepton Mallet. It’s not hard to imagine that step by step such centres could stop admitting new NHS patients and grow their private practice.
After that it might be audiology services or routine heart surgery. The NHS will not be sold off all at once in an ‘everything must go’ closing down sale. If we are not careful it will be lost practice by practice, specialism by specialism.
When politicians say that the NHS “is safe in our hands” there is a simple answer. “Look what you have done to our dental services? How can we trust you with the rest?”
