Healthwatch England submission to the Health and Social Care Committee’s Inquiry on NHS dentistry.
• A review of 31 local Healthwatch reports and a YouGov poll of 2,048 adults in 2016
• Evidence from 1,313 people shared with local Healthwatch and a YouGov poll of 1,900 adults in 2020
• A briefing on 1,375 people’s experiences shared with local Healthwatch and results of a poll by Yonder Data Solutions of 2,019 adults in 2021.
Key themes of public feedback
Stories of NHS ‘dental deserts’ have consistently been shared with Healthwatch as these patient stories, seven years apart, show:
• “I have been looking for a dentist for over three months and have still not found one…I am now in extreme pain. They are all saying that they will only take on private patients, not NHS.”
As told to Healthwatch Kirklees, 2014
• “My dentist went back to Bulgaria in 2016 and ever since no dentist has been willing to take me as a new patient on the Isle of Wight. The results are three teeth almost missing, two other chipped and constant pain with several abscesses…. I don't have the means to go private which is the only option offered to me! It's scandalous.”
As told to Healthwatch England, 2021
Our national polling confirms these experiences, with eight in 10 people finding it difficult to access timely care in 2021, up from 73% in 2020 and 20% in 2016.
At the start of the pandemic, NHSE set up urgent dental centres for people with new, serious problems or who needed ongoing care, accessible by referrals from their usual dentists or NHS 111. But many people described ‘a merry-go-round' via dentists, 111 or complaints departments, and still not getting help:
“Last week I ended up in hospital for three days because I had severe pain and could not find a dentist for emergencies or otherwise to fix my teeth. I ended up taking too many paracetamols and had to go to A&E on the advice of NHS 111. I ended up on a drip for 36 hours and…I still do not have a dentist.”
As told to Healthwatch Suffolk, March 2021
In extreme cases, some people resorted to DIY dentistry, like a man in Portsmouth who used pliers (and pints of beer as anaesthetic) to remove teeth.
Post-pandemic we still hear from people about how urgent dental care isn’t working. The current contract only really supports people to get a short-term fix in, and then because routine treatment is even harder to access, the underlying problems are not fixed.
A national poll we commissioned just before the Covid lockdown in March 2020, found that 73% of adults believed that NHS dental treatment charges were expensive and 42% said they struggled to pay or avoided treatment because they couldn’t afford the costs. This was up from 2016, when 17% of people told us they avoided dental care because of cost.
Our 2020 poll also found that 72% believed it wasn’t easy to find information about NHS dental treatment charges. In some cases, people said their dental practice had given them wrong information about help with costs if they were on benefits.
In our 2021 poll, 39% people felt they had been charged extra for NHS treatments, despite this going against NHS guidance, like covering the costs of PPE for dentists:
“My husband uses an NHS dentist. He has been advised he will be charged an additional £7 for a check-up and £35 for a filling - to cover PPE costs!”
As told to Healthwatch Gloucestershire, 2020
Our 2021 poll showed that 30% felt pressured into going private by their usual NHS dentist, even for serious problems like being unable to eat. Local Heathwatch also have many examples of this:
“[They] had been advised by her dentist that a root canal and a crown is needed but that ‘due to Coronavirus this is not available on the NHS and only available to you privately’, at a cost of over £1,000.”
Healthwatch Central Bedfordshire, 2020
This persists as an issue, due to lack of local NHS provision:
'My NHS dentist quit so now I am forced to pay exorbitant fees to private dentists.'
Respondent to Cost of Living survey, 2022.
We have found that some parts of society are affected more than others, including:
Practice closures at the start of the pandemic and ongoing problem ‘dental deserts’, mean that pregnant women or new mothers have been unable to benefit of from their maternity exemption certificate, entitling them to free NHS dental care. If their pay has been reduced while on maternity leave, they also haven’t been able to afford to pay privately. Our calls for the exemption duration to be extended until NHS provision becomes available, hasn’t been taken up by government.
Our 2021 poll also showed that more women (10%) than men (7%) have avoided dental treatments because of cost, especially those on lower incomes.
• Children and young people
Although under 18s (or under 19s in full-time education) are entitled to free NHS dental care, some parents say dentists have told them they won’t see their offspring unless the parents sign up as private patients:
“I have been trying to obtain an NHS dentist for my 10-year-old daughter, myself and my husband…. One dentist said they could add us to a list that had a 3-year wait for an appointment. Another told me that the only way that my daughter could be seen would be if myself and my husband took a private place at a cost of £75 for an initial consultation! This is disgraceful and holding people to ransom for their children to be able to access basic dental treatment.”
As told to Healthwatch North Yorkshire, 2021
We have also heard of some children who have never seen a dentist due to the poor access to NHS dentistry, thereby missing out on vital prevention advice. Government figures show removal of decayed teeth under general anaesthetic remains the most common reason for hospital admissions in 6-10-year-olds – with children from the most deprived communities nearly four times more likely to be admitted than those in the most affluent areas.
Closures of some orthodontic services, have also left some children stranded midway through braces treatment.
People from a minority ethnic background
Minority ethnic people from lower socio-economic grades, were twice as likely to avoid dental treatment because of costs, compared to similar White people, our 2021 poll found. Fewer ethnic minority people (26%) than White people (41%) also said they were planning to go to a dentist for regular check-ups, post-pandemic.
Statistics from the national 2021 Oral Health Survey also highlight that more people in deprived neighbourhoods (where ethnic minority people are more likely to live than White people) have pain (41%) or broken (36%) or decayed teeth (40%) compared with those living in the least deprived neighbourhoods.
• care home residents (which led to an NHS Long Term Plan commitment that they would receive greater support for oral health but we have not seen an evaluation of progress)
• people with learning disabilities (who need extra time and specialist staff), and
• asylum seekers (who are entitled to free NHS dental care but often can’t find practices willing to see them or get interpreters provided at appointments).
People’s concerns have been compounded by out-of-date information on the NHS website or from NHS 111 about where people can find an NHS dentist. Many local Healthwatch have plugged the gaps by doing time consuming ring arounds of all practices in their area to get correct information.
24. Dental practices should operate more like GPs
Although people may have a usual practice they go to, they don’t have the same right to treatment as with their GP, which is confusing and leads to a whole host of problems when NHS appointments are scare. The new contract should ensure dentists run the same way as GPs, so people have more certainty about where to get care when they need it. Rebuilding the link between dentist and patient, does have significant implications relating to capacity, which would need to be resolved before this can be universal.
The current contract makes it more likely for dentists to see people who only need a check-up or simple treatment, rather than people who require more complex treatment, such as root canal. We need changes which provide timely treatment to people with complex needs, otherwise we leave them in pain and they end up elsewhere, like A&E.
In considering oral health in terms of equity, we require a clear view of both the need. and the services required to meet that need. This should take into account that many people who want to use NHS dentist are currently using private services because they see no other option. Local oral health needs assessments should identify the overall need (including responding to shorter-term issues) as well as how these will be met. This should give local people a realistic view of what they can expect from NHS dentistry.
Having decisions made locally by ICBs, and the involvement of local authorities in ICSs, may mean that commissioners can respond more clearly to local circumstances and health inequalities. Partnerships with local Public Health teams and links with schools also offer opportunities to prevent tooth decay and instil oral health hygiene habits in children.
We urge ICBs to engage with local Healthwatch, who can provide a wealth of qualitative evidence and can reach those experiencing the greatest health inequalities.
ICSs will also need good quantitative data on oral health inequalities and this requires national efforts to overcome the ‘paucity’ of evidence as described in a national review.
It is also to be seen whether NHSE dentistry commissioning expertise will be lost in the transfer of responsibility to ICBs.
Overall, ICSs will still rely on national policy for issues such as training numbers and contract negotiation.
The other fundamental change needed is to NHS dental charges, which our research shows disproportionately deter certain groups.
Today, dentistry remains the only part of the NHS that receives a lower budget in cash terms than in 2010. The amount we spend is only enough to treat half the population anyway. A fully overhauled contract cannot come quick enough and must secure meaningful funding based on the level of the country's dental needs.
 Access to NHS Dental Services: What people told local Healthwatch, Healthwatch, 2016
 What people are telling us: A summary July-September 2020, Healthwatch, 2020
 What people have told us about NHS dentistry: A review of our evidence - January to March 2021, Healthwatch, 2021
 Health and the Cost of Living, Healthwatch, 2023
 ‘DIY dentistry on the rise…’, The Guardian, 8 August, 2022
 Oral Health and Dentistry Westminster Hall Debate, Hansard, 25 May 2021
 Open letter to then Chancellor, Healthwatch England and British Dental Association, October 2021
 NHSE announcement, NHSE, January 2022
 NHSBSA FOI disclosure, NHSBSA, August 2022
 NHSE announcement, NHSE, July 2022
 News article, Portsmouth News, 14 October 2020
 Hospital tooth extractions of 0 to 19-year olds, Public Health England, August 2021
 The impact of COVID-19 on access to dental care: a report from the 2021 Adult Oral Health Survey, Office for Health Improvement and Disparities, December 2022
 Ethnicity Facts and Figures, www.gov.uk, September 2020
 Paragraph 1.15, page 16, NHS Long Term Plan, 2019
 Inequalities in oral health in England, Public Health England, 2021