What the next Welsh Government must do to bridge the gap in oral health inequalities and rebuild dentistry in Wales.
Oral health inequalities were rife in Wales before COVID-19 hit and have only worsened since. That’s why,
our recently-launched manifesto presents a clear roadmap for building back better and improving access to care.
Sharing this manifesto with all the major parties ahead of the elections has already made a difference.
Plaid Cymru have now devoted an entire section of their manifesto to their plans for improving dentistry in Wales. Improving access to dental services has also been included in the Welsh Labour manifesto. We look forward to similar commitments from the other major parties in the days to come.
If the next Welsh Government adopt this vision for change, it will have a real impact on dentistry and the health of our patients. Here’s what you need to know and how you can make your voice heard.
Improving access to care
Dentists don’t need to be told about the real-life impact of lockdown on access to dental care, we see it every day. There are 10,000 patients on my practice’s list, but in 2020, we saw only around 30% of them.
“The key to tackling this is improving ventilation and reducing fallow time.”
One of my patients embodies the heartbreak of these missed care opportunities to me. She is six years old and before the pandemic we worked hard with her to save 11 teeth from GA extraction and get her used to the dental environment. We were making great progress in difficult circumstances. But now all that hard work may have been for nothing. Disease simply does not wait.
We’re far from business as usual and access continues to be limited, making it impossible to catch up with the backlog. The key to tackling this is improving ventilation and reducing fallow time. While the Welsh Government led the way in the UK last year by setting aside £450,000 in grant funding for ventilation, more is needed to boost patient throughput and future-proof practices. The virus is here to stay – but the sooner we can get closer to our normal treatment procedures the more chance we have of taking care of the patients who rely on us.
In the longer term, we also need an end to the chronic underfunding of NHS Dentistry in Wales and support for the expansion of the Community Dental Service. Access to care should not be a postcode lottery.
Taking action on inequalities
The Designed to Smile programme was making good progress in bridging the inequality gap before it was suspended by lockdown. Getting Designed to Smile back up and running is essential to combat this ticking time bomb of dental decay. Indeed, to help further tackle oral health inequalities, an extra £2m must be invested to expand the scheme to 6-10 year olds.
“The Designed to Smile programme was making good progress in bridging the inequality gap before lockdown.”
Compounding this, the impact of lockdown lifestyles is now a big challenge. This is a particular risk among children, who will likely have had increased access to sugary snacks while being home-schooled. Mine certainly did! The simple reality is that balancing the demands of work, home-schooling and entertaining children is an enormous challenge for parents, even for those who are motivated and educated on the importance of sugar reduction for oral health.
Also, at the moment I don’t see when we are going to start seeing low risk patients, as there will always be high risk patients that will be prioritised first: managing the expectations of these motivated low-risk patients within the NHS is a real challenge. Some of these patients have already opted to see private practitioners – but that access is not open to everyone. If this trend continues, we risk accidentally creating a two-tiered dental health service which penalises diligent, low-risk patients.
A fresh start for dental services post COVID-19
It’s essential that we use this opportunity to reform NHS dentistry. There can be no return to Units of Dental Activity and dentists must be allowed to continue to prioritise patients based on their clinical judgement without arbitrary targets for clinical interventions. But whatever system we move to must be better than the old system. There needs to be meaningful engagement with the profession and testing of any system before it is rolled out.
“The wellbeing of practitioners also needs to be prioritised.”
The wellbeing of practitioners also needs to be prioritised. Long days spent in PPE are taxing and stressful and, with hotter weather on the way, we’ve got fatigue, dehydration and discomfort to look forward to. Dentistry was not a low stress profession before the pandemic, and many practitioners are really feeling the strain.
Even before COVID-19 hit, we already had difficulties in NHS dentist retention and recruitment. Contracts are unfilled, and it gets harder to recruit the further away from Cardiff your practice is. We need incentives to be put in place, more contract security and a better work/life balance to make a fresh start after COVID-19 and ensure a sustainable future for the profession.
Making your voice heard
With the elections coming up, candidates will be out on the streets, on your doorstep, and at hustings events. Nothing makes the case more powerfully to prospective MSs than hearing directly from you. I urge you to show your support for dentistry by speaking to your local candidate. So if you can, please explain to them the problems facing NHS dentistry and ask them – if elected – to speak up for dentists and the nation’s oral health in the Senedd.
You can also share the manifesto with local candidates on social media and ask them to pledge to #BridgeTheGap on oral health inequality in Wales. Please tag @theBDA when you do, so we can follow up any conversations with newly-elected MSs and ensure our issues are not forgotten. With candidates from five different parties already having pledged to support dentistry, it’s clear we’re already seeing the impact of our campaign. Please help amplify it.
Russell Mark Gidney
Chair of Welsh General Dental Practice Committee