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.
Having only just got over the shock of the Brexit result (just about) and Theresa May’s decision to hold a snap election, the country is once again plunged into uncertainty as the Election Results for 2017 reveal a shocking outcome for the Conservative party. What was meant to be a straightforward win for the current Prime Minister – or so she thought – has instead ended in the humiliation of a hung parliament. As a result of this, Mrs May and the rest of her party face the prospect of having to form a minority government – a far cry from the majority vote and ‘stronger mandate’ she was hoping for.
In comparison, the election has been somewhat of a victory for Jeremy Corbyn and the labour party, who have gained a considerable number of seats across the UK, including Sheffield Hallam which was previously held by the former leader of the Liberal Democrats, Nick Clegg.
To form a minority government, Theresa May will require the assistance of the Democratic Unionist Party, who she says will work together having “enjoyed a strong relationship over many years”. Were anything to happen, however, the Tories will not have the 326 seats required for a majority to pass a legislative programme.
Labour, in the meantime, will likely turn their efforts to forming their own minority government. After all, if the Conservative’s plan doesn’t pan out the way they want it to, Jeremy Corbyn could yet become Prime Minister. The question is where does this leave the dental profession?
Before the results were even properly announced we saw a fall in the value of the sterling compared to the dollar and the Euro. Between the uncertainty of a hung parliament and speculation about how the final result will impact Brexit negotiations moving forward, we are once again faced with the prospect of higher imported goods’ prices and an increase in overheads.
As for how dental practices, along with other small businesses will be affected by the whole thing, it is not yet clear what the future holds. What we do know, however, is that if May is successful in forming an alliance with DUP, there will be a number of changes made to taxation throughout 2017 into 2020. Personal Allowance, for instance, would rise to £12,500 as planned, as would the Higher Rate Threshold, which Mrs May has promised would increase to £50,000 by 2020. With scheduled reductions also due to take place to Corporation Tax (CT) if the Tories stay in, it is clear that dentists would have much to gain from a Conservative government. In regards to pensions, dentists must consider how proposed changes would affect their financial planning moving forward.
In the event that Jeremy Corbyn steps in and tries to run a minority government or form a coalition, it could be somewhat of a mixed bag. Indeed, while Labour’s promise to review business rates and bring in a small profits rate of CT for SMEs would no doubt be welcomed by many in the profession, increases in Income Tax for those earning over £80,000 certainly wouldn't be, nor would an increase in CT for larger businesses.
Brexit, in the meantime, is scheduled to go ahead as planned, so the best any of us can do is wait and see what happens!
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With days to go before the UK once again goes to the polls and a large number of voters still undecided on how to cast their vote, there is still a huge amount to play for in the General Election 2017. The handling of the NHS is critical to any party’s success, so we have scrutinised the Conservative, Labour and Liberal Democrat’s offerings in the lead up to June 8th. If you don’t have the time or energy to trawl through hundreds of pages of manifesto pledges, read below for a helpful summary of NHS commitments.
The Commitments
1. A commitment to the founding principles of the NHS; a service that meets the needs of everyone, based on clinical need not ability to pay and care should be free at the point of use.
2. Spending will be increased by £8 billion in real terms over the next 5 years.
3. Create a “truly seven-day healthcare service”, with GP weekend and evening appointments for all by 2019. Hospital consultants will be supervising patients every day, with weekend access to key diagnostic tests.
4. Current 95% A&E target and 18 week elective care standard will be maintained.
5. Prioritise during the EU negotiations that the 140,000 staff from EU countries “can carry on making their vital contribution to our health care system”, whilst continuing to invest in training medical students. Will encourage and develop new roles and create a diverse set of potential career paths for the NHS workforce.
6. The most ambitious investment in building and technology that the NHS has ever seen, to ensure that care is delivered properly and efficiently.
7. The NHS will become a “better employer”, strengthening the entitlement for flexible working and introducing better support services for employees.
8. To implement the recommendations of the Accelerated Access Review to make sure that patients get drunk treatments faster, whilst ensuring value for money for the NHS.
9. GPs will be expected to provide greater access, more innovative services and offer better facilities. A new GP Contract will be introduced.
10. The role of the CQC will be extended to cover health related services commissioned by local authorities.
11. 10,000 mental health care professionals will be recruited. The co-ordination of mental health services with other local services will be improved.
12. Radical changes to social care for the elderly. Aligning the current means-testing for domiciliary care with that for residential care. The value of the family home will be taken into account, along with other assets and income when assessing the amount of funding that an individual will receive from the state. The current cap of £23,250 will be increased to £100,000. Individuals will be able to defer payments if receiving care at home in order to avoid selling their home during their lifetime.
13. End of life care will be improved. Families who lose a baby will be offered additional bereavement support.
None of the above pledges have been costed in the published manifesto.
1. A commitment of over £30 billion in extra funding over the next Parliament. Paid for through increased income tax for the highest 5% of earners and an increased tax on private medical insurance. Money will be freed up by halving the fees currently paid to management consultants.
2. A new office for budgetary responsibility will be introduced to oversee health spending and scrutinise how it is spent. “Sustainability and transformation plans” will be halted, and a review undertaken, asking local people to contribute, considering patient need rather than available finance. A new regulator “NHS Excellence” will be introduced.
3. Privatisation of the health service will be reversed. A legal duty will be introduced on the Secretary of State to ensure that excessive private profits are not made out of the NHS at the expense of the patient.
4. Promise investment to give patients a modern, well-resourced service. Guaranteeing access to treatment within 18 weeks, taking a million people off the NHS waiting lists by the end of the next Parliament. Patients will be seen in A&E within 4 hours. Mixed sex wards will end.
5. The Cancer Strategy for England will be fulfilled by 2020.
6. Funding will be increased to GP services and cuts to pharmacies halted, and the current position reviewed.
7. Patients will be given fast access to the most effective new drugs and treatments, and “value for money” agreements will be negotiated with pharma companies.
8. To make the country “autism friendly”; with specialised care plans in place and access to condition management education.
9. High quality and personalised end of life care.
10. A commitment to completing the trial programme for PrEP, and rolling the treatment out to high risk groups to reduce HIV infection.
11. Free parking for patients, staff and visitors at hospitals by increasing tax on private medical care premiums.
12. For the work force the pay cap will be scrapped, with an independent review body making the decision. Bursaries and funding for health related degrees will be scrapped (University tuition fees will be scrapped).
13. The rights of EU nationals working in the NHS will be immediately guaranteed.
14. The foundations for a “National Care Service for England” will be laid. Social care budgets will be increased by £8 billion. Place a maximum limit on lifetime personal contributions to care costs, raise the asset threshold below which people are entitled to state support, and provide free end of life care.
15. Funding for mental health services will be ring fenced. Out of area placements for young people will be ended by 2019. Early intervention for children and young people’s mental health services will be prioritised. Counselling services will be available in all secondary schools.
1. Pledge to put a penny on the pound on Income Tax to raise £6 billion in extra revenue for NHS and Social care funding. This money would be directed to key areas, including social care, primary care, mental health and public health.
2. Commission a dedicated health and care tax following consultation.
3. Guarantee the rights of all EU NHS and social care staff to remain in the UK.
4. End the public sector pay freeze for NHS workers and reinstate nurse bursaries.
5. Transforming mental health care and reducing associated waiting times to no more than 6 weeks for a therapy appointment for depression or anxiety. No young person will wait for more than two weeks for treatment when they first experience psychosis. The focus will be on young people and pregnant women/ new mothers.
6. An end to out of area placements and improving front line services in schools and universities. Ensure LGBT and inclusive mental health services receive funding and support.
7. Establish a cross party health and social care convention to carry out a review of the long term sustainability of the health and social care finances and workforce. Introduce a statutory independent budget monitoring agency for health and care, similar to the Office for Budget Responsibility.
8. Improving the integration of health and social care; ultimately creating one service with pooled budgets.
9. Implement a cap on the cost of social care and increase the earnings limited from £100 to £150 per week for eligibility for carers’ allowance, and reduce number of care hours a week for qualification.
10. Provide more choice of end of life care and move towards free end of life social care. Expanding the work of hospices.
11. Promote easier access to GPs, expanding evening and weekend opening, encouraging the use of on line appointments, whilst supporting GPs to prevent practice closures.
12. Using innovative funding to promote GP led multidisciplinary health and care hubs and ensure access to local pharmacies.
13. Helping people stay healthy in the first place through a National Well Being strategy, including public awareness campaigns on cancer and by developing a strategy to tackle childhood obesity and a sugar tax.
14. Introduce a minimum unit pricing for alcohol.
15. Make PrEP for HIV prevention available on the NHS.
What will these pledges cost?
The Institute of Fiscal Studies has undertaken its own review of the funding behind each of the above pledges and state as follows;
The Conservative manifesto: Would suggest an increase in Department of Health (DH) spending to £132 billion (in today’s prices) in 2022–23, if the other (non-NHS) aspects of DH spending were frozen in real terms over this period. This would be an average growth in real spending of 1.2% per year between 2016–17 and 2022–23.
The Labour manifesto: promised a larger increase in health funding. Labour would increase spending relative to current government plans by £7.7 billion in 2017–18, rising to £8.4 billion (in nominal terms) by 2021-22. This could take DH spending to around £135 billion (in today’s prices) in 2021–22. This would be an average 2.0% per year real increase in spending between 2016–17 and 2021–22.
The Liberal Democrats: have pledged to increase spending on health and social care in England, Wales and Northern Ireland by approximately £6 billion each year, with £2 billion ring-fenced specifically for social care. This could imply DH spending of £131 billion (in today’s prices) in 2021-22, and average growth in spending of 1.4% per year in real terms between 2016–17 and 2021–22.
However they also conclude that the planned spending of all three parties is well below the historical 4% per year growth in health care spending per year that has been seen since 2009/10. The difference between the parties spending plans is in fact reasonably modest and as such the NHS will continue to suffer financially whoever will win the general election.
Julia Furley, Barrister, JFH Law LLP
These are politically exciting times in which we live. The earth shaking events in Nepal are unrelated of course and to those of you connected in any way, I hope that our thoughts and prayers provide comfort.
The French have had their revolutions. So have the Russians. The North American history is littered with conflict. Closer to home the Scots were victim of some brutal clearances. The Irish found themselves on a similar receiving end of some English-driven realpolitik. The English have had their civil wars be they flower based or parliamentary in origin.
The definition of the word revolution includes this:
The 8th May - the day things changed
And now we are about to witness a UK wide political revolution. A conflict of ideas and ideals as dramatic as any more military revolution.
On Friday the 8th May, the manifestos of the various parties will be torn into small bargaining chips. All political discussion will become secret and behind many sets of closed doors as the hidden powerhouses of advisers thrash out a deal which allows either Mr Miliband or Mr Cameron to pay a visit to Her Majesty and request that they be allowed to form a Government.
Your conversation with your patients on Friday 8th will at least be a bit different from the usual weather and holidays. But what will you think? If we have no clear large party, by definition we have a coalition at best and minority Government at worst. First past the post only work if you have a winner. Imagine you are overseeing a race and because you forgot your stopwatch and glasses, the result looks like a sort of fuzzy dead heat where does that leave the voting system? In dentistry of course we used to have transferrable votes for electing the GDC - heady days, eh? We were ahead of the game I suggest.
Where does this leave dentistry in the minds of our politicians?
I for one find it quite extraordinary that less than a year ago we as a profession were making headlines with child dental health and child hospital admissions being the headline concern, but allied to issues of obesity, diet and refined carbohydrate. You all know what it takes to be dentally healthy.
The drive for caries-free children is not a mystery. You all know that.
Dentistry... why, is there a problem?
So has dentistry been, if not a headline element, perhaps a second string part of any debate?
Nah. Non. Nyet. Not a dicky bird. It’s as though the 45% of the population who never visit a dentist are happy to take their own teeth out, [and for those of you so inclined to listen again, our colleague Dr Tony Kilcoyne had to endure a strange slot on Jezza Vine on BBC R2 recently].[1]
Meanwhile the 55% of the population who do visit a dentist are commendably happy with their service and experience, and are no doubt filling out the FFT as we speak.
Well they will be, until told by dentist A that their crown and root canal must be privately funded, and yet dentist B can provide the same treatment for a friend under the NHS and everyone is correct!
Clarity of NHS provision in dentistry is a ticking political time bomb with a shortening fuse. The lawyers are the ones who keep relighting the fuse and at some point it will be a major problem.
And yet sadly, dentistry has as a profession and an NHS Primary Care service been parked in the sidings of political irrelevance. We have in political terms, been marked with a large tick.
Have the politicians taken their eyes off the dental ball? You might think so. If you read the NHS Confidence Survey by Practice Plan, [2] the mood of dentists is darkening from so many angles it is hard to find true optimism anywhere for Government funded activity. [3]
Well come the 8th May we are going to witness the start of a Revolution whoever polls the most votes. Indeed those who poll the least may feature the most.
Perhaps dentistry will feature during the post-election negotiations?
And of course for those of you in Manchester for the BDA Conference… [4] Well maybe that will be the long-needed start of a dental revolution.
It’s not too late to check in and go have an excellent three days of networking and updating across a huge range of dentistry
A chance perhaps for at the very least a bit of private revolution.
Enjoy the long weekends coming up. That grass is still growing...
[1] Dr Tony Kilcoyne on BBC R2 http://www.bbc.co.uk/programmes/b05qsjpl
[2] Practice Plan NHS Confidence Monitor http://www.NHSDentistryInsights.co.uk
[3] Dr Claire Roberts at Dentistry portal http://www.dentistry.co.uk/2015/04/22/reflecting-future-nhs/
[4] BDA Conference agenda
https://bdaconnect.bda.org/wp-content/uploads/2015/04/Conference-Preview-Brochure-2015-WEB.pdf
Dental Profession, 2015 Electi...
