Speaking Truth To Power - Eddie Meets MPs
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- Published: Wednesday, 31 July 2024 09:06
- Written by Guy Tuggle
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As the new government sets to work, NHS dental reform is high on its agenda. GDPUK‘s Guy Tuggle catches up with BDA Chair Eddie Crouch to examine the currents beneath the surface at Westminster
Eddie Crouch is a busy man. Never more so it seems, than since the general election of 4th July which ushered in the first Labour government for fourteen years.
A quick glance at Mr Crouch’s ‘X’ (formerly Twitter) feed reveals a string of MP’s, many newly elected, eager to be photographed on the Commons terrace with the media’s favourite dentist. Images that will doubtless be beamed back to their constituents via social media by MPs seeking to demonstrate that they’re already on the case, fighting as they promised to for NHS dentistry
“There’s a hell of a lot of new MPs, and a lot of interest in dentistry” says Crouch. “They clearly had it thrown at them on the doorsteps when they were out canvassing during the campaign, and especially in the areas with the access problems, you know, the deserts. In my part of the world, Birmingham, where contract delivery is usually above 90%, it hardly got a mention.”
Not since 1945 has the state of healthcare, and access to it, occupied such a prominent role in an election campaign. Back then, there was no NHS, and access to the comparatively rudimentary dentistry that existed was the preserve of a fortunate segment of the middle class.
The 1945 Attlee Labour Government, like Sir Keir Starmer’s of 2024, was also elected on a landslide by a population hungry for ‘change’. It responded by ushering in the NHS (1948) with, at least in its early days, ‘free’ dentistry for all.
Not surprisingly, long queues formed outside dental practices as people with rotting teeth queued for a ‘clearance’ followed by the fitting of dentures that had thus far eluded them. A million, yes one million, were distributed in the first nine months of the service.
When similar queues formed outside a new NHS practice in Bristol in 2023, it made the national news. For those with a sense of history, it was back to square one, back to the 1940s.
The pressure in Parliament scaled new heights. Week in, week out, questions were being asked by MPs from all sides. Dentistry even became an issue in the Conservative leadership debates, with Sunak promising to address it on day one.
He didn’t, and more prescient Conservative MPs knew that as their rural seats became ‘dental deserts’, dentistry was poised to become a highly toxic doorstep issue at the election.
Many of the dental deserts in the South of England and in the West Country are now represented by 72 Lib-Dem MPs. The imperative of fixing dentistry is particularly acute amongst their number, and in addition to forging their own channel of communication with the BDA they’ve vowed to maintain a beady eye on Mr Streeting’s progress.
The so-called minority parties too have become excitable about dentistry, and Mr Crouch says the Green Party are highly engaged.
“When I read their manifesto, I liked what they were saying, especially with regard to a requirement for increased funding” says Mr Crouch “so I started tweeting my approval and next thing I know is all their top brass started following me. Their co-leaders Carla Denyer in Bristol and Adrian Ramsey in Norwich both won seats in areas where dental access played a big part.”
Crouch is keen to stress that whilst dentistry is very much a political issue, he and the BDA are not. Mr Ramsay contacted Eddie Crouch to request a meeting following which Mr Crouch tweeted “the Greens showed leadership on NHS dentistry during the recent election. We’re ready to work with all parties to secure a better deal for our patients”.
Step Change At Westminster
Accompanied by his BDA colleagues, Mr Crouch famously met Wes Streeting on the Secretary of State’s first day in office. What was it like meeting a new Labour Secretary of State on his first day?
“The first thing we felt was their sense of urgency and importance. The attitude of the civil service was completely different from that under the previous administration” says Crouch.
“You could feel it in the room. I can only compare it to the first day at a new school. Everyone was eager and wanting to get going. But what was also noticeable was we were talking with far more senior people than was the case before.”
Mr Streeting had invited Julian Kelly, Deputy Chief Executive and Chief Financial Officer of NHS England to attend along with Dr Amanda Doyle, National Director for Primary Care and Community Services. This was the first time the BDA met them.
“I must say we were impressed, it felt like the government was really serious about what we had to say.”
Mr Crouch was also clearly impressed by Wes Streeting’s appearance at the Despatch Box on 23rd July when the Secretary of State, flanked by his ministerial team, fielded his first session of Health & Social Care questions.
Like fast balls to a batsman, the questions came thick and fast with dentistry dominating the first twenty minutes of an hour-long grilling. “Wes Streeting was visibly angry” said Mr Crouch “One MP asked him about dental vans and he really let rip. His body language...try and view it on iPlayer.”
The question Mr Crouch was referring to came from Saqib Bhatti MP for Meriden and Solihull East (Con). Harking back to the previous administration’s so-called ‘Dental Recovery Plan’ Mr Bhatti asked “The dental recovery plan … announced new dental vans to provide access to care to our most rural communities and coastal communities in England. We had agreed with NHS England that the first vans would be on the road by this autumn, and I know that that timescale was welcomed by colleagues across the House. Will he confirm that dental vans will be on the road by this autumn?”
Mr Streeting thundered “I could not have picked a better example of the previous Government’s desperately low ceiling of ambition than the fact that, after 14 years, they laud their triumph of dental vans roaming the country in the absence of actual dentists and dental surgeries. What an absolute disgrace.”
Would Mr Crouch say how he believes the dental contract needs to be reformed, because the elephant in the room is that whilst the BDA may win the battle to end targets and UDAs, there will still only be ‘X’ number of dentists to look after a population of seventy million, many of whom can’t get access and especially when in pain.
Nobody knows whether dentists who have left the NHS can ever be enticed back, and surely what MPs need to be able to say to their voters by the next election is that they are able, easily, to obtain emergency dental appointments when they need them without resorting to DIY dentistry. This will require a fundamental rethink on what NHS dentists are for.
“Oh it’s all there in the Nuffield Trust’s report which came out last year, and yes there will have to be a rethink” said Mr Crouch.
“Where it’s been tried, ‘flexible commissioning’ has been shown to work. Pay dentists a sessional fee, no UDAs, they work the morning, see six or seven emergencies, and if the patient doesn’t turn up, they still get paid.
That will work, and that’s how the government might get its 700,000 appointments. And Associates like it too, because it’s not five UDAs!”
Were there any other nuggets Mr Crouch might be willing to share from his early meetings with our elected representatives? For example, do MPs actually understand how dentistry works, that clinicians are not employed by the NHS but are self-employed contractors?
“Many do have a good understanding,” said Crouch. “Because they’ve received so many complaints from their constituents a lot of MPs and would be candidates have got close to dentists in their areas in order to try and gain an understanding of the issues.”
Of course it’s early days. Government and taxpayers are confronting a bleak economic outlook and millions of pounds are unlikely to be forthcoming any time soon. But what’s clear from Mr Crouch’s work to date is that in the form of the BDA, the profession’s representatives are being heard at the top table and are talking to the highest pay grades of the Health Department’s civil servants.
And there’s a glimmer of hope already: Mr Streeting listened carefully and took notes when Eddie Crouch and Shawn Charlwood dissed the previous administration’s proposal for a five year ‘lock-in’ as the way forward.
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