Written evidence submitted by Healthwatch Hertfordshire (DTY0030)
About Healthwatch Hertfordshire
Healthwatch Hertfordshire (HwH) represents the views of people in Hertfordshire for health and social care services. We provide an independent consumer voice for evidencing patient and public experiences and gathering local intelligence with the purpose of influencing service improvement across the county. We work with those who commission, deliver and regulate health and social care services to ensure the people’s voice is heard, and to address gaps in services quality and/or provision.
Overview – Patient Experiences
Percentage of all feedback received about services which related to NHS dentistry
October 2021 – March 2022
April – September 2022
We heard from large numbers of patients (more than 90) who are unable to access routine dental care on the NHS due to a lack of dental practices willing to see new patients with potentially unknown treatment required. The unfortunate side effects of this is that prevention of cavities or dental diseases is not taking place, and early warning signs of some cancers are likely being missed.
In the period mentioned above (Oct 2021 – Sept 2022), more people started to contact us with experiences where they were in pain and unable to find a dentist to treat them on the NHS. Some were also contacting us because they had in fact had an urgent dental appointment via NHS 111, but the dentist was unable fix the problem in one appointment and so suggested that they find a NHS dentist to give “proper” treatment.
Inequalities in accessing NHS dental services
Many of the people who contacted us stated that they are unable to afford to private dental treatment, but could not find any NHS practice to see them. Economic inequalities seemed to be the most common barrier to accessing dental care, with feedback about dentists pushing earlier private dental appointments over NHS being a common experience: “If you can pay for private dental treatment, we could see you tomorrow. We cannot see you as a NHS patient.”
Those that require root canal treatment find it particularly hard to find a dentist willing to treat them on the NHS and quite often are given a stark choice of paying thousands of pounds for treatment or having the tooth extracted.
Case study – November 2021
Sunny[*] contacted us via social media regarding the difficulty they faced trying to access NHS dental care; they explained that they are disabled and currently unable to work due to the condition and pain of their teeth. Although they had attended two emergency dental appointments at two different practices, neither one was willing/able to more permanently fix the problem on the NHS. Sunny was instead given antibiotics and told to find a “proper appointment”.
Sunny also described an upsetting experience when they were leaving one of the practices they visited for emergency treatment: “When I said I cannot afford private they said “that’s unfortunate”. Their reception staff [were] very rude about the fact that I said I didn’t pay for dental and in front of a room full of people; [they] kept asking for money and said the government will come after me if I am not entitled. Everyone was looking at me as if I am some dishonest person.”
Months later at the time they contacted us, the infection had reoccurred and Sunny had gone to their GP for help – they had a fever and “worryingly high” blood pressure, which the GP was especially concerned about considering they had a minor stroke less than a year ago. The doctor said they could not help because it is not their area of expertise and it’s not possible to tell what conditions are oral health-related and what aren’t.
HwH was able to locate a dental practice who said they could take Sunny as a NHS patient, but unfortunately this was not until early-January 2022. Sunny was grateful to have the appointment booked, but this did mean they would be managing on carefully temperature-controlled soup each day for the next month (including the Christmas/New Year period) until the day of the appointment arrived.
Feedback from the Local Dental Committee Secretary
We have also heard from our Hertfordshire Local Dental Committee that there is nowhere in Hertfordshire for anxious children to be referred to other than Hospitals for general anaesthetic. This means that the Local Dental Committee Secretary has felt it necessary to suggest that some patients are seen privately as they have few choices and need to consider the welfare of the child. NHS England Improvement (NHSEI) have set up a new approach to tackle health inequalities. One of NHSE’s five clinical areas of focus is for the oral health of children and young people. There is a local specialist dental service that may be able to take this on, but nothing is as yet agreed.
Healthwatch Hertfordshire Dental Engagement/Research Projects
Prior to the pandemic (2017-2019) we carried out visits to 28 dental practices across 5 districts in Hertfordshire focussing on the environment, physical access, information access, equality and diversity and complaints handling.
In February 2021, as requested by the Hertfordshire Local Dental Committee we then produced a self-audit checklist for dentists to start a conversation with their patients to improve services to meet their physical and communication access needs.
The report was shared by the Hertfordshire Local Dental Committee with the British Dental Association who highlighted it in their members’ newsletter.
In September 2021, we published our report Improving Dental Information Online as patients found it very difficult to find up-to-date information about NHS dental practices. We audited the 157 dental entries for Hertfordshire NHS dentists and conducted a telephone mystery shop of 32 dental practices. (Note: at this time updating the NHS Website was not mandated and completed by dentists on a voluntary basis). We found that:
It is important to ensure patients have the most recent information available so that they access services more easily. We welcome the announcement that the updating of the NHS website and Directory of Services will be a requirement in legislation for dental practices. However, NHSEI needs to work closely with dental practices to ensure that they have systems in place to do this on a regular basis (not just every 90 days) and that any feedback they have on the process is considered and explored.
Working with Commissioners and Providers
During 2020/21 we provided up to date information on our website for Hertfordshire residents using guidance from the Hertfordshire Local Dental Committee on what patients could expect. This meant that the public had clear information about what to do when they needed dental treatment, who to contact and what to expect when they went to the dentist. We then shared this information with other organisations and local networks to increase awareness.
This trend has continued in 2022 and we still receive a large volume of contacts from patients who can’t get to see a dentist - whether they are in pain or not. In November 2022 we published another article to help with this and update the public on the current position.
Importantly, we also raised the issues shared by patients with NHS England locally. During the pandemic, NHSEI acknowledged these concerns and established a supplementary route for patients who contacted us needing urgent dental care. One such patient was recovering from cancer and had been given several successive courses of antibiotics for an abscess, in preparation for the practice’s earliest “urgent” appointment in 5 weeks’ time. With this new treatment route, we were able to get that patient’s appointment moved up to the next day.
Additionally, as a result of providing NHS England Improvement with this intelligence, an enhanced pathway to urgent dental treatment via NHS 111 was created with the aim of ensuring that no dental patient in pain is left alone.
Fortnightly meetings with NHSEI East of England, the local dental network chairs and all local Healthwatch in the region were created during the pandemic to share information and feedback on the current situation to improve services as quickly as possible.
These meeting are now monthly but remain an important forum to share patient experience and information and will need to continue with the Herts and West Essex ICS and include the Hertfordshire Local Dental Committee to improve services for the long term for patients in Hertfordshire.
[*] We have used a pseudonym to protect the caller’s anonymity.