Government ‘asleep at the wheel’ on the crisis in NHS dentistry   

23 February, 2022 / infocus
 Will Peakin  

The Scottish Government today defeated an opposition motion that was calling for the prevention of the “collapse of NHS dentistry in Scotland”.

The motion tabled by the Scottish Conservative Party noted “with concern” that almost half of people in Scotland have been unable to see an NHS dentist for the last two years, and that from 1 April the Government was proposing to withdraw emergency funding provided to dental practices.

It said that the funding should be maintained for the upcoming financial year “in recognition of the considerable efforts still required to restore services and reduce the significant backlog of patients seeking dental treatment, particularly while maintaining enhanced infection control measures.”

The motion highlighted the importance of regular dental check-ups for people of all ages “both for good dental hygiene and in the detection of some forms of oral cancer”.

It said that many in the profession had expressed concern that the current settlement “risks making NHS dentistry financially unviable” and called on the Government to “come forward with a plan for ensuring the long-term sustainability of NHS dentistry, including a complete overhaul of the current fee structure to more accurately reflect modern dentistry”.

The motion also called for the development of a “more holistic service that NHS patients deserve, in place of the current conveyor belt system”. After the vote, the British Dental Association issued a statement accusing the Government of being “asleep at the wheel”.

Morale in the profession was at an all-time low, it said, with more than a third of dentists saying they intend to leave the profession in the next 12 months, and 80 per cent planning to reduce their NHS commitment if the Government reverts to pre-pandemic arrangements.

“Failure to act risks sparking an exodus from the workforce which would mean families across Scotland losing access to NHS dentistry for good,” the statement added.   

 More than 3.5 million NHS dental appointments have been lost in Scotland as a result of the pandemic. As infection prevention and control measures continue to limit the number of patients dentists can see, this unprecedented backlog continues to grow and will likely take years to clear, said the BDA. 

The BDA has warned that the SNP’s 2021 election pledge of free NHS dentistry for all will be “unrealisable without meaningful support and real reform”. It is pressing for a “workable interim funding model, and long-term change to a system that prioritises prevention, is patient-centred and reflects modern dentistry”.   

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “NHS dentistry in Scotland is facing crisis, but sadly Ministers seem asleep at the wheel.

“Opposition parties are all seeing the plain facts that Scottish Government plans could devastate services millions depend on and widen already unacceptable health inequalities. Promises have been made to the voting public that simply can’t be kept unless we see meaningful support and real reform as we head out of the pandemic.”

In response to the Conservative Party motion, Maree Todd, the Minister for Public Health, Women’s Health and Sport, said: “The dental sector has been disproportionately impacted by the nature of the pandemic. In order to protect patients and staff, dental practices are required to operate with specific infection, prevention and control measures including a fallow time between patients and full PPE protection.

“During the initial lockdown in March 2020 dental practices were closed to face-to-face patient care and NHS Board centres largely focused on emergency and urgent dental care.  Since that initial phase of lockdown, dental practices have slowly remobilised offering increasing levels of care to their patients.

“While registration levels remain comparable with before the pandemic those patients attending a dentist in the last two years has fallen from around 70 to 53 per cent.  This is entirely due to the impact of the pandemic. Which is why the Scottish Government has supported the NHS dental sector throughout the pandemic, with an additional £50m of financial support payments.

“We have also provided specific funding to mitigate the impact of the pandemic on dental activity.  This includes £7.5 million funding for new dental drills, £5 million for ventilation improvements and £35m of NHS PPE to date. The Scottish Government is determined to ensure NHS dental services emerge well-placed to care for the oral health of the whole population. 

“We have also committed to tackling the pandemic-related backlog in routine dental care. We have announced an additional £20 million of increased fees this month to help them see more patients face-to-face, including those from our most deprived communities. This funding announcement is part of a nine percent increase in the overall budget for NHS dental services in 2022/23 to support a return to more normal levels of activity.

“The additional money will deliver enhanced examinations for all patients, both children and adults. Children are a key focus as we recover NHS dental care. We have also taken steps to expand the funding for the Childsmile Programme in dental practices, increasing it up to 17 years of age. The Scottish Government absolutely recognises the need to address oral health inequalities arising from the pandemic. 

“So, we are making additional Childsmile interventions of £2m over two years from April 2022 to support the distribution of additional toothbrushing packs and recruitment of Dental Health Support Workers. These initiatives will focus on families and children living in areas of disadvantage, especially those from minority ethnic backgrounds.  

“The National Institute for Health and Care Excellence (NICE) guidelines state: ‘Recall intervals for patients who have repeatedly demonstrated that they can maintain oral health and who are not considered to be at risk of or from oral disease may be extended over time up to an interval of 24 months.’

“Looking forward our vision for NHS dental services is to ensure that all persons with the same clinical needs should be treated in the same way, and that special attention is paid to actions that might further disadvantage the already disadvantaged or vulnerable.

“As part of this we will engage the sector in suitable reforms that will allow dentists to practice modern dentistry, including the introduction of an Oral Health Risk Assessment and patient-focused care. 

“There are a number of vitally important processes that we are putting in place. What we must do, is to link financial support to dentistry, to seeing patients. We must reward NHS dental teams for improving patient access. The focus must be on recovery of the sector.” 

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