Trump, Korea and NHS Charges. Not usually words you expect to see in the same sentence.
But with the 68-year-old Korean War now inching closer towards a formal peace settlement, it is worth considering the status of NHS charges - which were first levied to help finance the conflict.
And for those of you interested in dentistry's past – and its future – it's worth a closer look.
NHS Dentistry was – briefly – free at the point of delivery. And 33 million dentures were produced in the first 9 months of the service.
Charges began for false teeth in 1951, along with parallel action on spectacles, to help stem that demand, amid pressure to achieve economies across the health budget and fund a crash rearmament programme.
The Korean War put a square focus on defence spending, and then Chancellor Hugh Gaitskell agreed sweeping savings from the health budget – with a £7 million target from charging for dentures.
In a briefing Cabinet Secretary, Norman Brook, advised the cabinet that "there is likely to be wide public support for charges, partly because many of the people who needed these benefits have already secured them." But that logic didn't stop once the public appetite for dentures was sated, and very shortly charges covered all NHS treatments for adult patients.
Both NHS architect Nye Bevan and future PM Harold Wilson resigned from Cabinet in protest at the reforms. And prescription charges duly followed in 1952.
Why wander back into history? Well the logic behind these charges continues to impact negatively both our patients and this service.
New data requested by Bootle MP Peter Dowd shows what we're facing: declining budgets, propped up by ever-increasing charge revenue.
|Gross expenditure (millions)||2,844||2,740||2,746||2,804||2,768|
|Patient Charge Revenue (millions)||653||684||716||744||777|
|Net Expenditure (millions)||2,191||2,056||2,030||2,060||1,991|
|Mid-year population estimate (millions)||53.5||53.9||54.3||54.8||55.3|
|Net expenditure per capita||£40.95||£38.14||£37.38||£37.59||£36.00|
|Patient charge revenue as a percentage of expenditure on total NHS dental services||23.0%||25.0%||26.1%||26.5%||28.1%|
These charges began as a tax on dentures to fund tanks and trucks for Korea. And now that a peace treaty is on the horizon perhaps we can have an honest conversation about their place in the NHS.
And the facts are these charges are increasingly a stealth tax, and a substitute for needed investment in NHS services.
Ministers say patients should make a 'contribution' towards their care costs. But that shouldn't be a license to deliver inflation-busting annual increases as cover for cuts.
Remember these 5% inflation busting increases don't go towards improving care, or expanding access. England really should follow the leads of other UK nations where charges form a stable or declining portion of total budget, and they should ensure any increases are capped to inflation.
Let us remember these charges were designed to make people avoid treatment, and among low income working families who are not eligible for exemptions little has changed.
1 in 5 patients delaying treatment for reason of cost according to official statistics. This is putting pressure on other parts of the health system, with toothache costing GP and A&E services millions. We've even seen that government is now profiting from charges at hundreds of NHS practices in England where providers are paid less than the £21.60 band 1 charge rate.
For nearly 70 years discouraging patients from seeking treatment has been official policy. We've been promised a debate on NHS funding, and these charges must be part of it. Our patients shouldn't keep having to pick up the cheque for an underfunded dental service.
Chair, General Dental Practice Committee
NHS dental charges
We have highlighted how charge increases are providing cover for NHS cuts and how the Government is now profiting from NHS charges at hundreds of dental practices.
In a recent comment piece CDS Chair Charlotte Waite asks Is it acceptable that vulnerable dental patients are being excluded through fear of fines?