'Prevention' was meant to be at the heart of the new NHS 10 Year plan.
Since taking office Health Secretary Matt Hancock has used the 'P' word time and again – but we have been waiting for a tangible commitment to dentistry. We've had warm words over the years, but seen the Westminster Government's actual spend per head on NHS dentistry tumble from £40.95 to £36 in the last five years.
So, now we have the plan here's what made the final cut:
1. Prevention
You don't need me to tell you tooth decay remains the number one reason for hospital admissions among young children.
England has deep-seated oral health inequalities, so it's hard to disagree with the stated intentions behind government's Starting Well programme. Yet it's impossible to square a limited number of schemes in a handful of local authorities with a claim to be "supporting 24,000 dentists across England to see more children from a young age to form good oral health".
This programme has not received a penny of new investment. Ultimately it still feels like the poor relation of efforts in both Scotland and Wales. Where children's oral health in devolved nations has seen huge gains through dedicated strategies and real outreach in nurseries and schools, England risks being left with a second-class service.
It's not a good look. Particularly when councils at the coal face have just been handed swingeing cuts to public health budgets – and oral health initiatives have been one of the top casualties.
2. Primary Care
The Plan reads as a love letter to primary care. An unprecedented funding boost was trailed. Surely then general dental practice (reformed contract and all) is part of the picture? Well no…
Oral health gets a mention in the context of some other key priorities, which is progress. But despite a realistic chance of what may be a voluntary opt in to a 'prevention focused' GDS contract as early as next year, we saw no effort to applying the Plan's rhetoric directly to primary care dentistry.
We're clear contract reform needs to offer a break from the past. But if we are going to preserve quality, access and give colleagues the time to care, GDPs cannot be given second class status when it comes to funding or priority.
3. Oral Cancer
The Plan confirms what we already knew. After years of campaigning on the human papilloma virus (HPV) vaccine we've helped secure a welcome roll out to boys aged 12-13 that will start this year.
HPV is a leading cause of oropharyngeal cancers, which have seen a sharp rise in incidence in recent years. So this is welcome progress, but it's our duty to highlight the limitations.
The government has said it's passing on the opportunity to extend a one-off catch up programme to older school aged boys. This was the approach adopted when girls were first offered the jab, and adopting any other model smacks of penny pinching. The result is 2 million boys who could have been protected will miss out.
The document also commits to increase screening for major cancers. This is also good news, and we will seek to ensure this logic applies consistently to oral cancers. Any further talk of extending recall intervals just to stretch budgets further is at odds with our patients' best interests, and this Plan.
4. Vulnerable Patients
Reasons to be cheerful. We have commitments to ensure children in special residential schools with learning difficulties or autism get dental checks, alongside sight and hearing tests. Likewise, there is finally recognition that care home residents must be supported to have good oral health as part of the funded rollout of the Enhanced Health in Care Homes plan.
These are the passages in which it feels like there are attempts to join up oral health with the wider health system. While the overall lack of integration feels careless, we will make the most of any opportunity to show the benefits of this approach.
5. Workforce
So we have a plan, but exactly who's going to deliver it?
The document demonstrably failed to address workforce issues, including the mounting recruitment and retention problems in dentistry. Our own surveys have shown that 65% of practices who tried recruiting in 2017 experienced difficulties filling vacancies. But no solutions have been offered to what's seemed like open season on practice closures.
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The PM launched the Plan at the Alder Hey Children's Hospital, where dedicated professionals have made fine art of extracting rotten teeth from kids. They are doing their jobs to the very best of their abilities, but there is no reason why the NHS in Liverpool should be spending £1 million a year on these procedures.
This Plan as it stands doesn't really begin to put prevention into action. It risks offering more of the same: casual indifference, year on year cuts, a recruitment and retention crisis, which has left patients travelling over 50 miles to secure access to basic services.
If government intends to put the mouth back in the body they need to work with us on these issues and more. Dentists need resources and a coherent plan. The alternative is to keep treating dentistry as an afterthought, and let the NHS pay the price.
Mick Armstrong
BDA Chair
Prevention first for oral health
When it comes to oral health, we believe in prevention first: tooth decay is an avoidable disease and we are campaigning for Government's to take this problem seriously, to act now and invest in real prevention. Read our latest blogs on the topic of public health in dentistry.
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