Kevin Lewis on the dental recovery plan

Kevin Lewis – can we recover from the dental recovery plan?

It may well be true that the best things in life are worth waiting for… but this is not one of them. Kevin Lewis begins his recovery from the long-awaited dental recovery plan.

You could almost taste the embarrassment of ministers and other government spokespeople when they had to front up to the nation with the details of what they had been hatching deep in the DHSC bunker since at least April 2023.

With hindsight, it was probably a mistake to have raised expectations 10 months ago that something really exciting, massive in scale and transformative was about to be unveiled. A regional consultation on fluoridation in the north east (ironically, only 80 or so years after the benefits were first highlighted in North and South Tyneside), some supervised toothbrushing in nurseries and primary schools, a drizzle of fluoride varnish and some caravans.

With so many groundbreaking, brand-new ideas like this, it’s no wonder that it has taken so long to see the light of day. While the government was raiding the history books and buying time, the great British public was buying pliers.

‘It was probably not the Department of Health and Social Care’s (DHSC) intention that the recent announcement of the long-awaited ‘dental recovery plan’ would trigger so much talk of desperate members of the public extracting their own teeth (or those of their children) with pliers. But it has probably done wonders for the economy with sales on Amazon and other platforms booming for pliers of all shapes and sizes.’

Promises, promises

The headline pledge from DHSC could hardly have been more lavish (or more unachievable): ‘The plan aims to make sure everyone who needs to see a dentist, particularly those who have been unable to access care in the past two years, will be able to do so.’

Everyone? Really? If the current claimed spend of £3 billion a year on NHS dentistry has not been enough to avert this crisis, with not even half of the population being served, it doesn’t take a mathematical genius to work out that even an additional £200 million over three years (if it ever materialises) won’t cut it.

So not only was the DRP itself underwhelming, it was painfully obvious that the briefings and other preparations for the announcement were miles off the pace too. It was the very definition of an ‘own goal’ because most of the DRP was so obviously about ‘recovery’ (the clue is in the name) and crisis management which invited the legitimate question of how and why things had been allowed to slip to crisis point anyway.

Prevention or deflection?

The inclusion of the ‘long game’ preventive options like fluoridation or the stated intention of dramatically expanding the dental workforce over the next decade was presumably to deflect from that sense of acute crisis and to blunt the inevitable criticisms of short-termism. But quite apart from there being no flesh on the bare bones of several of the strands of the DRP, even the bones appeared to be fractured at birth and in need of a recovery plan of their own.

For example, much of the loudly-trumpeted ‘cash injection’ of ‘new money’ was not new money at all – it would be converted into the UDA equivalent and then deducted from the UDA target for the 2024/2025 year. So in striking contrast to all the public rhetoric, most of it wasn’t additional money paid as an incentive bonus on top of the existing failed contract, but would soon be part and parcel of it – and would cost nothing this side of an election.

Bung

This also appears (at first sight) to apply to the ‘new patient premium’, which is the somewhat insulting bung offered for seeing ‘new’ patients that haven’t attended for two years and need band 1 treatment (+£15) or band 2/3 treatment (+£50). But when is a ‘new’ patient not a new patient, we ask? And what if they don’t complete all the recommended treatment for which the bung is offered? History tells us that NHS-BSA will already be hard at work dreaming up reasons why all (or even some) of the bung won’t end up being payable after all.

The DRP prompted much head-scratching in trying to decipher the claimed ‘extra 2.5 million dental appointments’ and 1.5 million extra ‘treatments’ (whatever that means) that the plan would deliver in year one. These headline-grabbing numbers feel and sound like an output from the Truss-Kwarteng School of Economics and Statistics, but without all the sophisticated underlying mathematics and
careful thought.

The £20k ‘golden hello’ for 240 lucky (or unlucky?) dentists also turns out to be only £10k this next year, and £5k in each of the two following years – to work in the same broken system, treating patients with the greatest dental need. It is debatable whether an extra £36 a day next year, and £18 a day in the following two years, is enough to justify the adjective ‘golden’ at all, but at least no tax will be payable because these paltry sums will be more than gobbled up by extra operating costs. I concede that it’s better than nothing at all… but only just.

‘You could hardly see the smoke for the mirrors’

As big announcements go, you could hardly see the smoke for the mirrors. Nobody had answers to even the most obvious questions and nothing in the DRP generated excitement about the announcement itself, nor optimism about the future. The inescapable conclusion is that the government and NHSE just doesn’t ‘get it’.

They have not just carelessly ‘lost’ a generation of dentists from the NHS, they effectively guided and escorted them into the private sector like the proud winner of a sheepdog trial. Now that they have gone, they will not be rushing back to take the pain all over again.

Similarly, no matter how many new dentists you train, press-gang or import though the front door (or proposed back door), the outcome will be exactly the same unless you fundamentally change the demoralising system you are expecting them to work in. They seem not to realise that in UDA-land, dentists actually lose money when treating patients with very high dental needs and sometimes it is more cost-effective to have money clawed back than it is to deliver the treatment and lose even more money.

Where does the blame lie?

The government could blame the strikes of the junior doctors and others for the continuing problems regarding hospital waiting lists but there was no hiding place where NHS dentistry was concerned. Certainly not for Victoria Atkins, secretary of state for health, whose geographically huge constituency inconveniently spans much of rural and coastal north Lincolnshire – one of the worst dental deserts in the land.

Full credit to the BDA and its media team, who have played an absolute blinder; their briefings have ensured that even in the worst-affected areas, nobody has been blaming dentists for the current situation (not even the dentists who have left the NHS and gone wholly private, which illustrates just how good the messaging has been). I am old enough to remember the days when everything was blamed on dentists.

Misreading the mood music

Meanwhile the word is definitely out there that Labour had dreamed up and implemented the catastrophic UDA-based contract back in 2006 (and the current NHS patients charges structure to go with it, whereby some patients pay three times over). But successive governments – Labour, Lib Dem/Tory coalition and Conservative alike – had since presided over a contract that was well known to be unfit for purpose, clearly driving dentists out of the NHS and into the private sector… and they had all chosen to do nothing about it.

It is an open secret that this is because the current system gives the government and the treasury all the control levers, and that is also why we have seen several rounds of tinkering around the edges interspersed with masterful inactivity, but no genuine commitment and effort to bin the discredited UDA system and start again.

So no politician emerges with any credit, and not surprisingly in an election year they would prefer to talk about other things. Everyone except Wes Streeting, shadow health secretary, that is. Wes clearly misread the early mood music, bless him, and was desperate to claim most of the ideas in the DRP as his own. On which subject, I must say that some of that mood music was strangely short-sighted, naïve and ill-informed, even from a few organisations within the profession that could and should have known better than to welcome the DRP and most of its proposals so unreservedly.

Not so where the Nuffield Trust was concerned – they very quickly concluded that the DRP: ‘Is a much-needed scale and polish when what NHS dentistry needs is root canal treatment.’

How right they are – although on reflection, a clearance might be a better option?

Can we recover from the dental recovery plan?