New Government, New NHS?

NHS Dentistry has been the sick service of the NHS for a long time. Not given importance by successive governments and treated like an optional extra, a nice to have but not necessary service. Their neglect over the years and decades has finally come home to roost and we are now in a position where NHS Dentistry will be one of the top 5 concerns for voters at the next General Election due at some time this year.

Speculation is rife that the Prime Minister, Rishi Sunak may choose to hold it on 14^th November 2024, thus giving him a full 2 years in office and one last chance to celebrate Diwali at Number 10, Downing Street. He may even hope for a post-Diwali and pre-Christmas boost to his party’ s electoral prospects, but I suspect that Halloween may win the day, or night. There are no tricks left in his bag and our treats will be reserved for the next government.

The British electorate is known at times to be fickle and unpredictable, but to its own detriment has continued to rely on two parties for much of its history and has given each such party multiple terms in office for several decades now. Such behaviour, far from rewarding good work and encouraging better work has often had the effect of encouraging complacency and destructive behaviour by the relevant parties that then became entrenched in government.

We may not have to change our politicians as often as we change our underwear, but it may make sense to change them far more frequently than we currently do. Examples of this can be found ranging from council wards and devolved governments to the UK government.

The Conservatives have under-invested in real terms in the NHS in their 14 long years in government. There wasn’t a moderating influence on the matter even in the coalition years as they enjoyed their position as the dominant partner and the Lib Dems failed to take cues from other democracies where tails often wagged the dogs in times when they depended on them for survival. As an active Lib Dem at that time, I was left disappointed by the party’s almost subservient role in government. There were some victories, but there were also too many failures. The 2010-2015 parliament only helped to make the Tories more electorally palatable from their previously well-known nasty/toxic party status and then elevated them to single party government from where they could run amok with their core beliefs. They have never been comfortable with an NHS ever since it was conceived and since its inception in 1948. We hear helpful noises from them but their actions almost never match their words, and every time that they’ve held power for a significant period, the NHS has come close to collapse.

We are at such a moment again.

NHS Dentistry is no exception and it often is the test case for what governments could then do to the rest of the NHS.

We cannot blame the Conservatives for the much-hated UDA contract as that was the last Labour government’s baby, but that child went to school and became an adult under the neglectful eyes of the Conservatives. Now that child ill-equipped to deal with the big bad world must find its own way. It has few friends, if any. Its parents and guardians blame each other for both its existence and its current state. The conservatives are trying to make marginal changes to it, but no one is willing to transform this young adult.

The Labour party which started this process must be the one to end it after the next election if indeed as is widely expected, it gains power and forms the next government. The work to fix things must begin now and proceed at pace in the first few months of a new government. Significant change must be in place by April 2025 and radical reform must be in place by April 2026 if there is to be any hope of an NHS Dentistry service beyond that time.

Too many committed NHS Dentists that I know have left the service in the past few years and one tearily explained the reasons for his decision to leave at a recent Local Dental Committee meeting that I attended. These people have been driven to desperate depths and they still held on in hope until they could no longer afford to do so.

Unlike a lot of other NHS dentists, I will not pretend that the marginal changes to the NHS contract haven’t helped. I have benefitted tremendously as I work in an area of high need and the Band 2(B) and Band 2(C) iterations have made an impact over the past year. The new “little bit extra” for seeing new patients or patients returning after a significant absence will in time make a difference too, but not if more dentists continue leaving the NHS and there are too few remaining to do the much-needed work, and definitely not without significant additional funding. A concept that the government appears to struggle with, as they did during the 2019 election campaign when they couldn’t clearly state if X more nurses and X more hospitals meant additional nurses and hospitals or replacements! Recently they’ve had to accept that their fibs about new money for NHS dentistry were indeed fibs and that they were actually robbing clawed-back Paul to pay the very rare excess-capacity Peter.  

That now brings me back to what the next government should do:

1. Commit to and provide increased real-terms funding for NHS Dentistry. This could include both a one-off investment and a sustained increase in annual funding that is both index-linked and proportional to needs as they may arise and develop over time.
2. Reform the contract to one that rewards dentists fairly for their efforts and enables them to stay in the NHS and offer care to more people. This would also help attract and retain new dentists.

It really is that simple. Anything short of that, and there will be little to no NHS Dentistry remaining when the time comes for the election after.