7.8m claims were made for free dental care by adults in England in 2015/16, falling to 5.4m in 2023/24. We examined all the benefit groups transitioning to UC and found no corresponding growth in paying adult NHS patients, leaving a net loss of over 2.3m appointments in this group – which is characterised by lower incomes and higher needs. Over 500,000 free appointments were claimed by Tax Credit Certificate recipients last year, down from nearly 2.5m in 2015/16 as a result of the UC transition.
Factoring in COVID disruption, these vulnerable patients have been left as a much smaller share of overall appointments, 16% in 2023/24 compared to 20% in 2015/16. While the ongoing crisis in access to NHS dentistry has led to a drop in the number of paying adults seen too, the fall in the exempt group has been by far the most dramatic, fuelling health inequalities.
While we have only assessed English data, this change will hit recipients across all four UK nations.
Fuelling this fall is huge confusion over entitlements for UC recipients. To be eligible for free NHS dental treatment when receiving UC, a household's total take-home pay in the last assessment period must be £435 or less, or £935 or less if the UC includes a child element or the adult (or partner) have limited capability for work. Exemptions based on previous benefits like income support and tax credits did not include such complex conditions and have instead operated on a simple yes/no basis for access to free dental care.
We’ve told the Department of Health and Department of Work and Pensions that a transition period must be introduced, that ensures these tax credit recipients do not end up exposed to the £100 fines routinely issued to confused patients for ‘misclaiming’ free care. A transition must be used to roll out Real Time Exemption Checking to NHS dentists, a service that already exists in pharmacy that could help eliminate this confusion.
“The architects of welfare reform in the last government threw millions of our patients under a bus. A new government must change tack, says BDA Chair Eddie Crouch.
“The people who lost their entitlement to free dentistry haven’t suddenly started paying for NHS care. They’ve just stopped attending.
“Further changes are set to cast more patients adrift or expose them to the risk of fines because no one is spelling out what these changes mean.”
This drop illustrates the huge impact charges have on patients. On Tuesday charges in England increased by around 2.3%. The increase is unlikely to put a penny into the struggling service – in the past hikes in patient charges have simply allowed government to reduce its share of spend into a budget that has remained effectively static for a generation.
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