Access to NHS dentistry has been one of the most significant issues people have raised with Healthwatch teams across England over the last 18 months. Not only have we seen a large increase in the volume of feedback and a huge increase in the amount of negative sentiment in our evidence, but, more strikingly, we have noted a continuation of this trend over time.
These issues are not occurring in isolated pockets. People in every corner of England are struggling to get the dental treatment they need when they need it.
And that is why Healthwatch are again calling on the Government and NHS England to speed up dental contract reform and provide significant and sustained funding to tackle the underlying problems of dental access and affordability.
Concerns about dental care at a record high
Findings from Healthwatch England show that public feedback on NHS dental care has risen five-fold over the last 18 months, compared to pre-pandemic levels. It now accounts for nearly 25% of all the feedback we receive.
Pamela's story is not untypical.
Last Christmas, Pamela had an agonising toothache that required attention. She contacted every local dentist within 30 miles and could not find a practice to take her as an NHS patient. She has been living in pain since then. Pamela said:
"It's been a full year searching for a dentist, without any luck. I've basically been told that there's nothing they can do for me.
"I suffered a lot of pain due to the toothache over the festive period, agonising at times. I've managed to get an emergency private treatment, but this is not a long-term solution. If anything else goes wrong in the meantime, what am I to do? Surely, there must be a local practice that takes on new patients?
"I take good care of my teeth and have rarely needed to use the NHS dental services through the years. I pay taxes like everyone else and work hard to do so, yet I can't get NHS dental care."
Digging into the data
Analysis by Healthwatch England of 8,019 people’s experiences of NHS dentistry between April 2020 and September 2021 shows that:
Four in five people report struggling to access NHS dental care, including emergency treatment.
Positive sentiment, which was around 30% before the COVID-19 pandemic, is down to its lowest ever level – at just two per cent.
Some dental practices have either shut down or have gone fully private. Some dentists have used up their total NHS capacity and are asking people for private fees instead.
Many people find it hard to get up-to-date information about which practices are taking on new patients because NHS and dentists’ websites aren’t updated regularly. As a result, more people are contacting their local Healthwatch hoping that they’d provide them with accurate information.
It is often the most vulnerable people in our society, including children, disabled people and those living in care homes, who are suffering the most.
Children are missing out on dental treatment
As the effects of the COVID-19 pandemic on NHS dental services continue, data is starting to show that children and young people are increasingly the ones to suffer. An analysis of the experiences people have shared with Healthwatch highlights several issues:
Parents are struggling to find a practice that would take on children as NHS patients. As a result, children as young as five years old are putting up with painful symptoms and cannot eat as a result.
Parents are worried about their child’s oral health as they cannot get check-ups or preventative treatment.
Some parents reported that dentists are willing to take on a child as an NHS patient as long as the parent registers as a private patient (though NHS.UK says dentists shouldn’t do so). Due to the nature of our data, we cannot comment on the scale of this issue. However, people feel some dental providers are using unfair tactics to increase the number of private patients.
What do other national sources say?
It is not just Healthwatch witnessing these concerns. Reports from bodies across the health sector tell the same story.
In October, the Care Quality Commission, in the annual ‘State of health care and social care’ report, also highlighted problems that children and young people had in accessing routine dental care during the pandemic.
Findings from other data sources also mirror what people have been telling us about accessing NHS dental care:
- When the National GP Patient Survey asked if people if they had successfully got an NHS dental appointment in the last two years, in 2020, 6% of the respondents had said no. In contrast, in 2021, this figure was nearly four times higher at 23%.
- In 2020-21, the NHS delivered 69% fewer courses of treatment compared with the previous year, NHS Dental Statistics for England Annual Report,
- The difference in the number of appointments for children in 2021 is particularly stark. An analysis of NHS Digital Data for 2019 and 2021 found that the number of child patients seen has nearly halved, 44% down in 2021 compared to two years earlier.
- NHS Digital's figures also suggest that dental access issues are now acute in many areas. Our analysis of the latest data* found that seven of the NHS's 42 new sub-regions, known as Integrated Care Systems, report that they have no practices taking on new adult NHS patients. And less than one in five (17%) of practices say they are taking on new child NHS patients at the moment.
*Data supplied by NHS Digital on 7 December 2021.
Why dentistry needs fixing
Commenting on the findings Healthwatch England Chair, Sir Robert Francis QC, said:
“The big worry about the shortage of NHS appointments leading people to private care is that it further deepens the health inequalities that COVID-19 has starkly highlighted.
“We won’t build back a fairer service until access to NHS dentistry is equal and inclusive for everyone.
“Today, dentistry remains the only part of the NHS that receives a lower budget in cash terms than in 2010. The ongoing neglect of NHS dentistry will have repercussions for the life-long health of current and future generations. Lack of access to dental care, particularly for children, is a hugely worrying issue that the NHS must tackle immediately.
“Communities all over the country have made it clear that we need to fix NHS dentistry – we urgently need to make it accessible and affordable for everyone. And that is why we’re once again calling on the Government and NHSE to take people’s struggles seriously, speed up dental reform and provide meaningful, sustained funding."
We won’t build back a fairer service until access to NHS dentistry is equal and inclusive for everyone.
— Sir Robert Francis QC