1 April means NHS dental charges in England go up again, by more than inflation.
Surely dentists should be delighted about a new source of investment for the service? Well no. Because dentists won’t get a penny of these hikes to improve services.
We can take no pleasure in a system that serves as a cover for huge cuts in spending, and punishes the patients who need us most. We are being treated as tax collectors.
1) Patient charges are no longer a ‘contribution’, but a substitute for state investment
It’s an irresistible logic for ministers. If patients put in more, they can pay less.
NHS dentistry in England has had a static budget for the best part of decade, and patients are paying an ever-greater share, up from just 21.8% to nearly 30% in 8 years.
So behind a static budget lurk deep cuts. A 30% increase in charges and a failure to even try and keep pace with inflation, mean that in real terms the government’s share of spending has fallen by over £500 million since 2010.
So that’s no extra cash to ease the recruitment crisis, or fix access problems that are becoming commonplace across England.
2) We’re reaching a tipping point
5% hikes have become an annual ritual. But unless ministers change course we’re now just a decade from the point where charges overtake taxation as the principal source of funding for the service.
This isn’t speculation, but a clear direction of travel. The term ‘NHS dentistry’ won’t have much meaning when patients are forced to put in more than government at the point of delivery.
3) England has chosen its own path
There’s nothing inevitable about the choices made by the Department of Health and Social Care.
Every other UK nation is putting more in to cover the dental health of their populations. England used to lead the field, but now per head, the government in Scotland puts in 50% extra in contributions from taxation, Northern Ireland nearly two thirds more.
And while the share of budget coming from charges in England is skyrocketing, everywhere else it is stable or in long-term decline.
4) These choices have consequences
In one respect charges remain a success story. They were designed in the 1950s to make patients think twice about treatment, and they keep on delivering.
Evidence shows that the cost of treatment is a barrier – and even for those who don’t have to pay. Official surveys show 1 in 5 patients say they have delayed treatment for reasons of cost.
Exemptions exist, but lack of clarity over entitlements and an aggressive approach to fines for ‘misclaiming’ care has seen take up for free treatment collapse by almost 2 million from 2013-14 to 2017-18.
It’s not just adults. Polling by YouGov shows 1 in 4 parents don’t know check-ups are free for their kids – 75% don’t know that every treatment is available gratis.
And when 5 million kids aren’t attending let’s not pretend children are insulated from the messages these hikes send out.
5) Another way is possible
“Increases are not automatic” said the most recent Minister for Dentistry Steve Brine MP. “They are carefully considered each year and take into account affordability for patients and any risk that patients would be deterred from seeking care."
We need to ensure these words aren’t rhetoric.
The NHS70 anniversary has seen billions in needed investment committed to almost every corner of the NHS. Both government and opposition have shown they are willing to put more into the pot, and dentistry cannot be left out.
We are health professionals, not tax collectors.
Choices on charges and cuts have real consequences. And we will keep spelling them out until we get change.