Written evidence submitted by Healthwatch Sheffield (DTY0053)

 

Introduction

Since the first lockdown in March 2020, access to NHS dentistry has been a key issue for people in Sheffield and beyond.

Over the past 12 months, approximately 1 in 4 enquiries we received were from members of the public struggling to access NHS routine and urgent dental care.

Just under half of the people we heard from were seeking urgent dental treatment. They were experiencing significant pain and did not know what to do. Some told us they had already contacted NHS 111 but couldn’t get the care or help they needed. 

Other people were trying to access NHS routine care and treatment, and were finding this impossible. A large proportion of people told us they or their families had not seen a dentist since before the Covid-19 pandemic or even longer.

Currently in Sheffield, many dentists have long waiting lists in place, which can be up to a period of 2 years. The demand at some practices is so high they have had to close their waiting lists for new patients.

Approximately 1 in 4
calls and emails to Healthwatch Sheffield
are about accessing NHS dentistry*                             

*Jan 2022 – Dec 2022


 

Accessing an NHS dentist in Sheffield

New reforms implemented to the dental contract last year included ensuring practices regularly update their information on the NHS website and directory of services, so patients can easily find the availability of dentists in their local area.

We conducted research in January 2023, looking at the NHS listings and phoning local dental practices, to find out the local picture. We discovered that availability of NHS dentists is low, and that a large proportion of information on the NHS website is still out of date:

 

Key Themes

Based on our conversations with local people, clear themes have emerged when trying to access NHS dental care in Sheffield.

We have detailed the themes below which we believe are the most prominent, and most concerning. It is important to note that many of these issues impact even more severely on those who were already finding it difficult to access care – whether that’s due to lack of stable housing, low income, existing physical or mental health challenges, or communication barriers - and will further widen health inequalities.

 

People have reported information on the NHS website has not been inaccurate

When people have tried to access an NHS dentist, often their first point of call has been the NHS website. However, many people have found the information on there to be inaccurate or out of date. Some reported the site stated some dentists were accepting new patients, but to people’s frustration when calling the practice this wasn’t the case. Following a research exercise carried out in January 2023 we found a third of practices had still not updated their information despite new DHSC guidelines stating this must be up to date.

Some people were unable to access urgent care

NHS policy states that dentists should prioritise those with the most urgent needs. However, when calling local dental practices, many people reported not being triaged and being unable to access treatment despite experiencing severe pain. We found that many people were not aware of the NHS triaging policy, so were unaware of their rights. We suspect this is partly due to the difficulty in finding clear information and guidance for patients.

Patients can also call NHS 111 to access urgent medical care. When we spoke to people who had tried calling NHS 111, many felt that they weren’t being taken seriously, leading to them not getting the urgent treatment and care they needed.

People who have a regular dentist have had a different experience to people who don’t

Triaging policy means urgent care should be available to anyone who needs it, regardless of whether they are a regular patient of a practice or not. Many of the people who were unable to access urgent care told us they did not have a regular dentist. In contrast, people who did have a regular dentist were able to obtain urgent treatment alongside booking routine check-ups.

A growing rift: NHS vs private care

One of the most significant concerns we have is the increasing inequity of dental provision, between those who can afford private treatment, and those who cannot.

When conducting recent research several practices made it clear that we could access private dental treatment long before we would be able to access equivalent NHS care. This is further evidenced by the many people who have been telling us the only timely treatment they were offered (or in some cases, the only treatment at all) would mean paying private fees.

When even NHS dental treatment is prohibitive in cost for some people, this lack of availability will further compound health inequalities for many families.

Waiting lists for NHS appointments are extremely long, and the demand at some practices is so high that they have closed their waiting lists. This leaves people with few or no options for affordable care. Some families told us out of desperation they had resorted to applying for finance such as credit cards to cover the cost of private treatment.

The impact of delayed treatment

We are increasingly hearing from people who tell us they’re concerned about their future health due to delays in getting treatment.

Some people have been left in dental pain, which is having a knock-on effect on their wider physical health, as well as their mental health. We heard from many people who were seeking routine treatment or check-ups, but were worried that going for several years without this would lead to future health problems that could have been avoided.

We have also heard from those who were pregnant or had recently given birth but hadn’t been able to access the free dental care they were entitled to, as well as people with young children who wanted to ensure they would get a healthy start.

Others informed us they knew they needed fillings or other ‘non-urgent’ treatment, but couldn’t access it at this time, and worried it would lead to further complications if left for a long while.

 

 

Children’s access to NHS dentistry

During the research activity we discovered only 1 in 5 practices were taking new patients under the age of 18yrs.  Children’s access to NHS dentistry is becoming a key concern for the parents we’ve spoken to. For children born during or shortly before the pandemic, some parents have struggled to find them an NHS dentist, so at this stage they have never been. There is concern that the only young children who are currently getting early access to dental care are those with families who can pay for private appointments. Some parents have informed us their children had been in significant pain but had still not been able to obtain urgent dental care.

This has an impact on their early dental health, but also sets up challenges for the future. We know that going to the dentist at a young age helps children get used to dentists – some children just aren’t getting this chance.

 

Case Studies

Keira had an emergency dental extraction carried out by her regular dentist. A few days later Keira developed a bad infection, describing symptoms of an abscess the size of a golf ball. It was the weekend, Keira called her local dentist but was unable to access an appointment, she then rang NHS 111 but at the time of the call, Keira was told there were no dentists currently offering emergency appointments throughout the South Yorkshire region. Keira was in a lot of pain and was worried her condition was getting worse. On Monday, Keira luckily managed to get an appointment at her regular dentist and was prescribed antibiotics and pain relief.  After making some initial inquiries we discovered some urgent care appointments were only available at the weekend between the hours of 9am and 1pm in one Sheffield location and at Doncaster, but no urgent care service was offered at that time for people living in the Rotherham area.

Imran called us to say he was struggling to access NHS dentistry. He is a student and can’t afford private treatment. He had previously had emergency treatment – a root canal - but this was only a temporary fix so he was needing further treatment. He had contacted over 100 practices in Sheffield and the surrounding areas but nobody would see him. Imran told us if he didn’t get the treatment he needed he would lose his tooth. He contacted 111 but was told he could not access any help due to the situation not being classed as an emergency

Jennifer hadn’t seen a dentist for 7 years. Recently she had been trying to make an appointment with a dentist but out of the 30 practices she spoke to they all stated they had waiting lists of 2-3 years. One practice told her they had a list of over 3000 people and within a 2-year period the list had not gone down. Out of desperation, although she really could not afford it, Jennifer went for a private assessment which cost over £1000. Jennifer was told she needed 5 fillings which would cost a further £1000 for all the work to be undertaken. Jennifer told us there was no way that she could afford this so was unable to get the treatment she urgently needed.

 

 

Anika had been trying to find a dentist for the last 3 years, she just kept being added to different practices’ waiting lists.  Anika checked the NHS website regularly and discovered most practices said they were accepting NHS patients but when she called they never were. She didn’t even know if she was actually added to some of the waiting lists as when she called to find out the wait times she was surprised to be re-added to the list again. Anika had a lot of dental issues which were causing significant pain, and impacting her daily activities, Anika stated she was getting desperate, as she couldn’t afford to pay for private treatment she applied for a credit card but was unsuccessful. Anika also had 3 children who hadn’t seen a dentist for a long time and needed a routine check-up.

Julie informed us her autistic child had been in pain for a number of days due to urgently needing a tooth removing but was unable to get an urgent appointment anywhere.  Julie contacted their own dentist but was told they could not perform the extraction due to the child needing sedation as they were afraid of needles. Their regular dentist referred them to the dental hospital but the nearest available appointment was six weeks away and that was for an initial assessment only. Julie was extremely concerned as their child has been in pain for a number of days, but they had been told to just continue administering painkillers.

Margaret was trying to assist her friend Annie in trying to obtain urgent dental treatment but stated it was proving impossible as Annie wasn’t registered with a regular dentist. Annie’s denture had broken and she had severe decay in her remaining teeth causing discomfort and the inability to eat. Margaret told us Annie was on a waiting list for a regular dentist but was told this could be up to a two-year wait. Margaret called NHS 111 but was told they couldn’t help either, she didn’t know what to do and felt like she was going round in circles.

Jan 2023