Written evidence submitted by Healthwatch Bolton (DTY0072)

Healthwatch Bolton is part of a national network of 152 local Healthwatch. Our remit is to listen to the public about their experiences of accessing local health and care services. We then feed this evidence back to health and care commissioners and providers to recommend changes and help shape services. Our umbrella organisation – Healthwatch England has been gathering evidence over the past couple of years from the information that Local Healthwatch have been submitting about the issues people face accessing NHS dentistry.

We are submitting this evidence because we do not feel that accessibility to NHS dentistry has improved despite more money being allocated to NHS dentistry. This is causing real suffering for people in our community, not only for their dental health, but the wider impact it is having on both physical and mental health. In November 2022 we decided to run another survey to find out the experiences of people in Bolton of accessing NHS dentistry and how this is impacting them.

Over the past 12 months (Jan 2022 – Jan 2023), Healthwatch Bolton received 112 enquiries from the public asking for help accessing an NHS dentist, because they are unable to find any taking on new NHS patients. We believe this figure in real term is much higher because often people who contact us are also looking to secure access to an NHS dentist for more than one family member.

What follows is a summary of the evidence collected by Healthwatch Bolton from the survey we launched in November 2022. From 1/11/22 to 24/1/23.

134 people gave their feedback on the following:

Do you have access to an NHS dentist?             

Yes                                          43

No                                           65

Private dentist              23

Not sure                            4

      59 people had difficulty getting a routine appointment

      57 had difficulties getting the treatment they needed

      32 had difficulties getting an urgent appointment

      42 had no difficulties

 

 

If you do not have access to a dentist, tell us who needs access?

Self-care – have you done any of the following to alleviate dental issues, such as dental pain?

Out of 115 responses:

      91 had used painkillers

      106 looking after teeth, regular brushing etc.

      25 used temporary dental repair packs

Comments:

“Self-bought anti-biotics at £45”

“Pulled teeth out myself”

“Oil pulling”

“Extracted many teeth myself”

“Had to remove many of my own teeth and used resin bought online”

“Attempted meditation to block out pain and self-removal of some loose teeth”

How has not being able to access dental care (NHS or private), impacted on your physical/mental health?

16 people said it had impacted on their physical health

26 people said it had impacted on their mental health

47 people said it had impacted on both their physical and mental      

health

36 people said no impact

Comments from the public feedback on impact on health:

Other comments:  Is there anything else you would like to tell us?

 

 

 

Case Study 1 as at 20th January 2023

“I have now been trying to join a dentist as an NHS patient for 3 years. 

I am constantly told they aren't taking on new patients, but I can be taken on if I choose to go private. I was even told when I was pregnant with my certificate of entitlement to free healthcare to "book in private as no dentist in their right mind will take on a non-paying patient, even if it is temporary".

As a single parent paying full time childcare and working full time, private health care pricing is simply not an option for me. I have called all the local dentists (upwards of 10 practices) every month for the last 12 months to check if they are taking on NHS patients  (I even have a reminder in my phone so I don't forget!), the answer is always the same, no.”

 

Case Study 2 as at 19th January 2023

I have toothache and jaw pain that is constant and impacts my daily life. It is not severe enough to see the emergency dentist as I have no swelling. Sometimes I worry because I get a stabbing pain in the affected tooth and lose a lot of blood, almost like a small haemorrhage. I have a genetic condition that causes uncontrollable bleeding, and this is a red flag for me.

I've also read that tooth decay is a cause of heart problems and I'm worried about the effects of leaving this bad tooth. My jaw dislocated while I'm eating and I'm also under ENT [Ear, Nose and Throat] for swallowing difficulties. Only being able to chew on one side is massively affecting my ability to swallow safely.”

 

Case Study 3 as at 19th January 2023

It’s horrible my eldest child has not been to a dentist in years as we got booted off the list as we didn’t attend for a few years; Covid. Trying to find a dentist. I could not get one whilst pregnant and still cannot find one now for myself or my eldest child. I was seen by the emergency dentist shortly after giving birth as I had abscesses and needed to have teeth removed. No follow up to have restorative treatment even though the dentist I saw said the surgery would help me.”

 

 

 

 

 

Case Study 4 as at 19th January 2023

“I cannot find a single NHS dentist.  I’m in pain I have broken tooth, I can’t bite down.  I have a HC2 and I can’t find any dentist to take me on.  Please help.”

This gentleman is in desperate need of a dentist.  He has broken teeth and is only left with 11 teeth in his mouth.  He also has loose teeth and is in a lot of pain. He finds himself drooling and is struggling to chew food.

He is also a registered carer for his dad who has vascular dementia.  He is also disabled himself through an industrial accident.  He said, “I want to 'smile, chew, and get my life back”.

“I’ve had enough I feel suicidal.”

He is going to speak with his GP.  He has no current thoughts of actioning his feelings and we discussed how to approach his GP for the help he needs.  He lives with his dad and his dads’ condition is deteriorating. He has no input from services. 

 

Case Study 5 as at 23rd January 2023

My long term mental and physical health condition has an impact on the calcium and vitamin d levels in my body I need dental treatment and cannot access it. My older child has a learning disability and has teeth affected by poor oral hygiene and long-term antibiotics as a baby toddler they also cannot get dental care or treatment as unable to register.”

 

Case Study 6 as at 19th January 2023

“The children need braces and were promised a referral before they were refused a follow up appointment. Their mental health is suffering as they worry they will never see an orthodontist and will have to live with protruding/uneven teeth forever.”

 

Case Study 7 as at 20th January 2023

“I had unbearable tooth pain in 2021 and was unable to get into a dentist anywhere. After researching online, I managed to find a private one in Harrogate. I had to drive there from Bolton and pay nearly £1000 for a root canal - I am a student studying Social Work at Uni, a carer for my Grandad and I work part time at the Samaritans so this wasn’t something I could afford and had to take out a credit card.”

 

How should inequalities in accessing NHS dental services be addressed?

Many people are still unable to access NHS dentistry.  People can access NHS urgent dental treatment if they meet certain criteria. But this is also problematic from there being enough appointments made available, and the locations of the surgeries. In many cases people are forced to travel long distances, and for some that is not physically possible and it some cases it is unaffordable.

There is also an issue with ongoing dental work that is sometimes needed when someone has had urgent dental care. The urgent dental appointment may solve the immediate problem, but if there is further ongoing treatment needed, some patients are told they will have to go and find a dentist who can do this. So, if they are unable to find an NHS dentist, then they are back to their teeth at risk of deteriorating and then they may have to go back to urgent care.

From past evidence, and the evidence we have very recently collected, certain groups of people are being affected which are:

      Children

      Older people

      People with disabilities and their carers

      People who are pregnant or recently given birth

      People without the means to pay privately

Change is therefore needed to ensure that all cohorts of the general population do not face barriers accessing dental care[i]. People should not be unable to access dental treatment because they are unable to afford it. Improved accessibility should be given to people with disabilities who are struggling to access dental care. For example, if someone is housebound, there should be dental provision that will visit the person in their own home, to ensure they get the same level of treatment as someone able to attend a dental surgery.

People should not be discriminated against because of their age. Ageing is normal and with that there is usually a need for more health and care interventions. People cannot live well into their later years without adequate and affordable health and care services.

People with maternity exemption certificates are finding they cannot access NHS dentistry. These certificates are issued because pregnancy affects oral health, yet the certificates are rendered useless if people cannot use them. 

It needs to be recognised that not having adequate access to affordable NHS dentistry has wider impacts on people’s physical and mental health.

Dentists also check for signs of oral cancer and gum disease which can be associated with developing heart disease (British Heart Foundation have information about this on their website). Dentists also play an important role in looking for signs of abuse and neglect.  It also contributes to impacting other family members for example if a person is a carer for someone.

Children are also struggling to access NHS dentistry which will lead to further dental issues as they get older. There is also the physical and mental impact this is having on children.

In summary – Inequalities should be addressed by ensuring there is adequate, accessible, and affordable dental provision for the whole of the population. This dental provision should address the different needs that people have. This will also go some way to ensure that oral health does not become or aggravates a physical or mental health problem which will result in more pressure being placed on the health and care system. A focus on prevention and good oral health also needs to be embedded in schools to tackle any potential problems early.

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[i]In 2022, Healthwatch Bolton dealt with a dental enquiry whereby the caller blames the lack of access to NHS dentistry on immigration.  In our experience, many cohorts within our jurisdiction are unable to find an NHS dentist that is accepting NHS patients.

 

Jan 2023