NHS dentistry is nearly 70 years old, and everyone is talking birthday presents. And every corner of the health service is pondering what the PM's pledged £20 billion investment could mean for patients and services.
We've seen that underfunding has placed all service areas where our members operate in some degree of jeopardy. And because we represent members operating across all UK health services, in primary and secondary care, general practice, community and public health settings, academia and training we can take a unique view on proposed spending pledges.
So what we're seeking now is clarity – on whether this much-needed funding boost will be shared across primary and secondary care. That it will be used in areas where it can achieve the most benefit for our patients, and offer the clearest return on investment for taxpayers.
Ministers have a choice. Today we see an increasing number of children facing 6 month waits for tooth extractions in hospital. Do we throw cash at expanding the surgical workforce: more forceps and faster turnaround times? Or do we balance money spent alleviating embarrassing targets for acute care by looking upstream, at primary care and prevention, so we treat the causes, not merely the symptoms of the pressure on our NHS?
For us it's a simple choice. And we need assurances that new funding will better enable prevention, and not just cure.
So we're asking Jeremy Hunt for answers on 5 key fronts:
1. Will funding be used to break the deadlock on NHS dental contract reform?
Government is now putting in less to NHS dentistry in England each year, as our patients are asked to put in more. Spending per head has fallen £41 to £36 per person in just 5 years.
Meanwhile official evaluation reports show that the preventive contracts being prototyped are not financially sustainable. Needed reform faces an impasse, and the government's stated goals of improving both access and prevention simply cannot be delivered on a standstill budget.
This answer requires targeted investment, to reduce the burden to targets, and give GDPs the time to focus on prevention and quality. To make this work – and for the government to deliver on successive manifesto pledges - we need to know if Ministers are prepared to put back the funds they've quietly siphoned out of the service since 2012.
2. Can we secure a sustainable approach to NHS charges and funding?
As money from ministers declines, charge revenue is surging to nearly 1/3 of the whole NHS budget.
We know these charges do impact on low income patients. And it's obvious they are being treated as a substitute for direct investment from government.
As part of any new settlement we need to know if sustainable funding will be found to keep pace with growing demand, and that patients won't be asked to plug the funding gap.
3. Can we finally keep the money set aside for NHS dentistry, in NHS dentistry?
A growing number of areas are facing access issues, and when GDPs can't hit their targets official language of 'underspends' does not correspond to a lack of patient demand.
It is no longer defensible that £85m of clawback a year is being returned to the treasury while some communities are unable to access basic services.
So we need clarity on whether new investment means dental budgets are no longer used to balance the books in other parts of the service as a matter of routine.
4. Will government put its money where its mouth is on public health?
Any investment should yield a return. And Public Health England's own figures show a pound spent on preventing decay can yield three back in savings.
The battle for good oral health is won – or lost – in early years, but efforts in England are a pale imitation of the properly resourced national strategies in evidence in both Scotland and Wales.
Public health is another missing piece in this pledge. So we are seeking answers on what national spend is earmarked for dental public health, both at national and local levels.
5. Will Ministers secure the pipeline of NHS dentists?
Funding for Dental Foundation Training (DFT) – the bedrock and requirement for careers in NHS practice – remains under threat.
You can't have an effective service without a reliable pipeline of talented people willing to work in it. Quite simply we need an end to raids on the dental training budget. DFT places for all dental graduates who wish to do it must be guaranteed.
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Dentistry remains the 'Cinderella Service', and we've seen how inaction has placed huge pressures across wider NHS services. We're pointing to forces that are pushing dental patients to A&E and GPs that are already under pressure. That tooth decay shouldn't go unchallenged as the number one reason for child hospital admissions.
The PM has stated her desire to achieve value for money, and see real return on this new financial commitment. Decay is a wholly preventable disease, and effective, targeted investment in prevention, in primary care and public health services, is the philosophy that underpins the Five Year Forward View.
Failure to act will leave Ministers on the wrong side of their own strategy for the health service.
Mick Armstrong
Chair, British Dental Association
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