Written evidence submitted by Healthwatch Leeds (DTY0085)
“I just want to be able to smile again” – Dental Crisis in Leeds
Healthwatch across the West Yorkshire and Harrogate area receive frequent enquiries/feedback relating to finding a dentist that is taking NHS patients. (The link on the NHS website suggests that Healthwatch might be able to help: https://www.nhs.uk/nhs-services/dentists/how-to-find-an-nhs-dentist/).
“I am really struggling to find an NHS dentist that is accepting new patients at the moment. I am an apprentice and get paid minimum wage and cannot afford a private dentist. I read online that if you cannot find a dentist to email your local Healthwatch”.
Dentistry calls to Healthwatch Leeds has significantly increased since the pandemic from 66 (1st April 19 – 31st April 20) to 265 (1st April 20 – 31st March 21 with 253 this year up until January 2022) and we are not able to help as much as we could before as there are far fewer dentists taking on NHS patients.
People have felt unable to access clear information about the changes to dentistry services over the course of the pandemic. Now that many dentists are beginning to offer more treatment, we are still hearing from people who can’t access care.
We know that dentists have been trying to operate with limited capacity and strict safety procedures. We also acknowledge that local action is constrained by complex national challenges around the commissioning and contracting of dental services. However, the impact on people trying to access dental care during Covid-19 has been significant, and we know that many people have been left distressed and confused by the situation.
What are the issues we are hearing about?
People who are not already connected to a dentist are having significant problems in finding one that will treat them. This includes families struggling to get appointments for children and people new to the area. They spend a long time calling individual practices and being told that waiting lists are between 12 months and 5 years. Local Healthwatch are not able to help them anymore as the provision isn’t there. This is causing a great deal of stress and could potentially increase oral and other health conditions.
“I am feeling defeated… I am 6 years on waiting lists, using the means and tools mentioned online I have effectively contacted every dentist in York, Selby & Leeds/Bradford. I have attended Leeds emergency dental care for antibiotics more than I can count. After 6 years I have only been given antibiotics by the dental system in this region (North & West Yorkshire). I am 24 years old and am due to lose all my teeth by the failings on the NHS to provide access to these services… I need to be referred to the dental hospital but I can't be referred unless I have a dentist, which is quite ironic. I have broken teeth below the gum line which is potentially very dangerous and I'm at risk of septicemia due to having to take antibiotics constantly, as I have open pockets in my gums.
I'm really hoping someone can help me as I'm at my wits end with this. If I could afford private care it would have been sorted by now.”
We are hearing that people are left in considerable pain, with the medication prescribed not being of much use.
“Her 19yr old son had multiple emergency appointments (via NHS 111) for an abscess. He’s been sent away with antibiotics, which again haven’t worked. He’s also recently tried popping the abscess himself, which has only made things worse. Her son has not been able to eat for over a week and was already underweight. She has severe breathing difficulties as well as other health problems, so her son is her carer. The pain and malnutrition are affecting his ability to look after her. He was told by 111 that they couldn't extract his tooth because they are twisted around each other, and this was too much work. After calling many dentists around Leeds for an urgent appointment, most didn’t have any appointments, some were understaffed and lacked capacity to provide additional appointments and only 1 called back to explain that they could not treat him as an emergency appointment as it would take multiple appointments and it’s unfair to give him priority over the other people on their 3yr long waiting list. The only thing that they could provide was a single appointment to prescribe more antibiotics”.
People are also telling us how having no access to treatment is impacting on their general well-being and mental health.
“My niece is 32 and lives with me. She had a pretty tough upbringing and for years used substances. Owing to this and from a history of violent relationships she only currently has five teeth. Since living with me she has been 7 months clean from substances and is working on her mental health but is struggling because of her teeth, not least because eating is hard and the teeth that she does have are becoming wobbly. She would really like to start thinking about college but she is so embarrassed about her teeth that it is affecting all areas of her life. We have tried ringing so many dentists in Leeds but none are accepting NHS patients and we don't know what to do anymore.”
"I contacted you a few months ago asking if there was any way of finding help to get into a dentist (it would need to be wheelchair accessible) I’ve tried every avenue I possibly can including asking my doctor to make a referral which she did and it was rejected, I’m in constant pain and getting abscesses continuously plus my teeth are literally falling out, I’ve lost 4 in the last couple months which included a big molar which I woke up choking having nearly swallowed it, I’m disabled with severe osteoarthritis and other ailments which makes me literally housebound but my daughter helps me lots with daily tasks and getting to and from hospital appointments, I’m on quite a lot of medications which includes numerous strong pain killers… I have at present 3-4 very loose teeth and obviously this also affects what I can eat.. its also making my mental health suffer as it can make me extremely distressed... I’ve tried the nhs helplines and rang every dentist listed in Leeds and surrounding areas and can’t find any willing to help.”
“I have applied over and over again for dentists and just always seem to get the same problem “we are not taking on NHS patients”
I’ve called, emailed and begged for someone to take me. I’ve even had to have antibiotics prescribed by my GP for abscesses.
I suffer with anxiety and depression, was in a violent and abusive relationship from 2013-2017 and suffer a neurological condition called Chiari Malformation. I have asked my GP to refer me to the dental hospital however it’s been rejected because I am not an asylum seeker, gypsy, homeless, etc It was noted by my GP in 2018/2019 that I had oral problems, and that if I wasn’t to be seen by a dentist I will lose my teeth. That is already starting to happen, and the front are starting to go as well. I’m truly embarrassed and don’t want to go out, speak to people, laugh or smile because of the issue and just want help. But no amount of begging is helping, I’m terrified it keeps me up at night thinking my teeth are gonna go and it disgusts me. There’s nothing I can do about it. I can’t afford private treatment especially the amount that needs to be done. It makes me feel sick to even look in the mirror I won’t even smile at my partner no more, and my children are picking up on it asking why my teeth are broken. It’s becoming difficult to eat certain food because of breakages and missing teeth at the back.
I’m not a dirty person, I don’t drink alcohol and I don’t take drugs (reason I say that is because I know a lot of dental problems can be brought on by that.) I just don’t know what to do, who to turn to, how to get help. I just want to be able to smile again”
There has been an increase in people telling us that Practices have been unable to see them as a NHS patient but they could pay for private care and be seen more quickly. This is very concerning from a health inequalities perspective.
“This morning I received a letter from my dentist informing me that they are not going to see NHS patients anymore as of 1st June 2021 – they are becoming a fully private dental practice.
Since finding this out, I have spent the best part of the day (when I should have been working, might I add) searching for a dentist that is taking on NHS patients, and have been completely and utterly unsuccessful… No-one is taking on NHS patients – even though many of their entries on the Find a dentist - NHS (www.nhs.uk)website imply that they do! One practice even told me that they have a waiting list of 3 years!
I am struggling/failing to find a replacement NHS dentist, and I hear that I am not alone – all of the NHS patients at this Practice are in the same boat as me, and from what I hear, the COVID-19 pandemic has made the task of finding an NHS dentist even more difficult/impossible than it was before countrywide. I, like many others, may be forced into trying (and “trying” is the operative word, here) to afford the payments for a private dentist, which could be crippling. I have been quoted many prices for private dental plans today ranging from £12 a month upwards – and that is before they even see you, and if you need work doing, the prices for work that needs to be undertaken is, in some cases, prohibitively expensive.”
“We had to go private in order for our two children to be seen by a dentist… The reason why we had to do this is because our current dentist says that government restrictions mean that they can’t see children. However, they were happy to see:
• my husband and I for hygienist appointments
• my husband to have a new bridge made and fitted
• my daughter (a child!) for a hygienist appointment
So it seems free NHS treatments, e.g. regular dental checks are unavailable, but where we have to pay, there is less of an issue… people don’t have this money available. I am angry about it though because dental health of children in West Yorkshire is one of the worst in England and we need decent teeth in order to eat well and feel good about ourselves - it is a health and mental health issue as far as I’m concerned.”
“… My nearest dentist has a 2 year waiting list. Sadly they won’t even take my name to add to the list. Is there anything else I can do please or can you help me to at least get to see an NHS dentist as a one off to try help me with the teeth, gum problem I am having.
I used to pay privately but sadly can’t afford it anymore and due to ill health with a brain tumour, autoimmune condition and recent diagnosis of thyroid disease. I am really struggling as cannot work either due to being in the Extremely Vulnerable category.”
NHS England guidance states that patients can phone a local dentist for urgent care even if they have not been treated there before. However, we have heard confusion about this – whilst dental practices don’t have a patient list in the same way that GP practices do, people tell us that their local dental practice has cited ‘not being registered’ as a reason they cannot access an appointment. Nor have some been following the Standard Operating Procedure of offering a triage service to anyone that calls, so 111 has been the preferred route for people when trying to access emergency or urgent dental care. Even then people are unsure what is classed as emergency or urgent.
“For the past year I’ve been trying to find a new dentist. I ended up calling 111 to get emergency dentistry. I have multiple cracked teeth, broken teeth, need for fillings and gum disease. 111 only look at one issue at a time and because I have multiple tooth issues it would be too much to call 111 for each issue and get one sorted at a time. It would be better to go to a dentist who will look at and treat everything in one go and have a holistic approach.”
“They went to the GP with a lump in their mouth which is uncomfortable. The GP told them to go to a dentist about the lump as dentists are specialists of the mouth. They told their GP that they are not registered with a dentist so they told them to call NHS 111 as it is very important that the lump is checked and not left unseen. When they called NHS 111 they said that the lump isn't deemed as an emergency because they weren't in extreme pain or have broken teeth etc. and was dismissed.”
Many of the people who contact Healthwatch have commented on the NHS website containing out of date information or that there is often out of date answerphone information or that dentists’ websites can be confusing about what they offer (e.g., Saying treatment is available but when contact is made this is only for private patients.)
“Late 2019 I tried to book an appointment with my dentist to discover he had gone entirely private, so I had no dentist for myself, or my three kids (two of whom now adults). I tried phoning a few, couldn't get a response. After the first wave of Covid, I tried some more dentist numbers - none would answer. At least before Covid they answered, but despite what the website said, wouldn't take new NHS patients. In November last year, 2020, I developed an abscess in a tooth. It was seriously painful. I tried phoning a couple of dentists - no one answered. Eventually the abscess went away. In January 2021 the tooth broke in half. I got some dentist recommendations from friends - checked the websites - they said they were taking NHS patients. But no one answered the call. I left a message, several. No one called back.
It now feels as if an abscess could be in my jaw, underneath the jawline where I have a half tooth - and I still can't get a dentist.”
What have we done?
Local Healthwatch have regularly shared information and feedback with the Dental Commissioning Executive and have been in regular contact with the local NHS dental commissioners, often seeking advice on enquiries.
Local Healthwatch have met with local commissioners as we have felt that access to dentistry in the region is at crisis point.
Feedback has also been shared with Healthwatch England, local CCG’s, the NHSE Chief Dental Officer, local and regional dental committees, British Dental Association, Public Health locally and nationally, NHS Business Services Authority and NHS 111/YAS.
The above quotes are a small handful of examples that we receive on a daily basis and there are many more people who we don’t know about and are continuing to struggle to find a dentist and suffer without treatment. There is a clear dental crisis and we need your help.
Jan 2023