The Long-term Sustainability of the NHS and Adult Social Care

Lord Colwyn Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Colwyn (Con)]

My Lords, I declare an interest as a retired dental surgeon and a fellow of the British Dental Association. I am sorry I was not on this committee. It was well organised and the noble Lord, Lord Patel, deserves our congratulations. He assured me that it was his hope that the debate would provide an opportunity for Members to speak about the broader issues facing the health and social care systems in our country today. With this in mind, my noble colleagues will not be surprised to hear that I am keen to turn the attention of the House towards the question of where oral health and dentistry sit in the wider context of the NHS being able to meet its future demands.

More and more studies now confirm what dentists have always suspected—that a healthy mouth is a gateway to a healthy body, and that neglecting oral health can sabotage our long-term overall health. Tooth decay and gum disease are increasingly linked to heightened risk of serious health problems such as stroke, heart disease and diabetes, yet funding for NHS dentistry has fallen by 15% in real terms since 2010, while patient charges have gone up by an inflation-busting 5% in each of the past three years.

Underfunding NHS dentistry might seem tempting in a time of austerity, but such thinking is short-termist and wholly counterproductive. Patients who cannot find an NHS dentist or delay treatment due to its cost end up piling huge pressures on other parts of the NHS. Every year, hundreds of thousands of patients seek free help for dental pain from their GPs or at their local A&E, which is not equipped to cope with and help them. Add to that the cost to the economy of sleepless nights and lost working days caused by tooth pain, and it becomes even clearer that cutting dental services is not only bad for the patients but a false economy.

The number of children going to hospitals to have decayed teeth extracted under general anaesthetic is rising fast, with the latest figures released earlier this month showing that a child in England is admitted to hospital every 10 minutes for this almost entirely preventable condition. Public Health England estimates that around 60,000 school days a year are missed as a result, not to mention the wasted £36 million that these preventable procedures cost. All things considered, it is appalling that more than four in 10 children in England have not seen a dentist for over a year, even though they should ideally have a check-up every six months. We must make sure that we improve access to NHS dental services so that both children and adults can attend regular check-ups, get a timely diagnosis and get appropriate treatment for any problems early on.

The past few months have seen one local newspaper after another announce acute shortages of NHS dentists in their area, as practices struggling to make ends meet under the current dental contract have been quitting the NHS in large numbers. This brings into sharp focus the urgent need to deliver a reform of the dental contract. It is crucial that we introduce a new, more preventive contractual basis for NHS dentistry. This April sees the 12th anniversary of the introduction of the current dental contract, which is not only widely detested by dentists and discredited by health policy experts but, more importantly, is bad for patients because it rewards dentists for carrying out interventions rather than for keeping their patients healthy to avoid them. Shifting the focus to preventive treatment would not only yield long-term savings but improve the quality of life across the country. Dentists were promised a new, improved contract back in 2010 but, with Ministers recently announcing that pilots of the new arrangements will run for at least another two years, it looks like this badly needed reform is being kicked into the long grass.

With tooth and gum disease linked to many other costly health conditions, such as diabetes and heart disease, our health system cannot afford to wait much longer for NHS dentistry to be commissioned in a way that makes a decisive break from activity targets and puts prevention squarely in the centre. The British Dental Association tells me that dentists want to be paid for keeping their communities healthy, not for the number of treatments performed. That is what makes most sense for the long-term sustainability of our NHS too. We cannot achieve improvements in oral health with a system that continues to offer perverse incentives to treat instead of rewarding dentists for preventing disease.

Finally, much progress has been made in the field of oral health and dentistry over the past few decades, and that momentum cannot be allowed to falter. A new, improved contract, a focus on prevention rather than cure and making sure that dental services are properly integrated with the rest of the NHS are essential components not only in delivering cost-effective dentistry but in improving general health outcomes for the British people.