Good morning.
In 2021 more than 2,000 dentists quit the NHS, and in 2022 a BBC survey found that nine out of 10 of the dental practices that still offer NHS services are not accepting new adult patients – eight in 10 are not taking on any more children. That has left millions without access to basic healthcare, resulting in “dental deserts” across England, and the problem is only set to get worse as more and more dentists leave the profession.
The impact is horrifying. Reports have emerged of people resorting to what can only be described as medieval methods like pulling their own teeth out with pliers because they cannot access or afford NHS dentists. Others are making five-hour trips to get treatment. A YouGov poll found that 10% of respondents resorted to “DIY dentistry”, including attempted at-home root canals and making their own dentures.
And for those still working in the profession, morale is at rock bottom. More and more young dentists are opting to go straight into private practice after their studies and many are quitting altogether. Even in London, which has never had a problem with recruitment before, there is an average of five vacancies for every applicant. The government’s response? Silence.
For today’s newsletter, I spoke to the chair of the British Dental Association executive committee, Eddie Crouch, who has been a dentist for over three decades, about what can be done with the dire state of dentistry in England. That’s right after the headlines.
Five big stories
Banks | Dame Alison Rose, the chief executive of NatWest Group, has stood down after a row over the closure of Nigel Farage’s bank account with the private bank Coutts, which NatWest owns.
Education | Smartphones should be banned from schools to tackle classroom disruption, improve learning and help protect children from cyberbullying, a landmark report by Unesco has recommended. The UN’s education, science and culture agency said there was evidence that excessive use reduced educational performance and emotional stability in children.
Italy | Five people have died in the past 24 hours as two extreme weather events split Italy between wildfires in the south and violent storms in the north. Fires in Sicily led to the temporary closure of Palermo airport after temperatures in the city climbed to 47C on Monday.
Transport | Railway workers who wear stickers supporting a campaign to stop the closure of almost 1,000 ticket offices are being threatened with disciplinary action, the National Union of Rail, Maritime and Transport Workers (RMT) has said.
Saudi Arabia | The kingdom has spent at least $6.3bn in sports deals since early 2021, more than quadruple the previous amount spent over a six-year period, in what critics have labelled an effort to distract from its human rights record.
In depth: ‘My dentist colleagues have given up hope that there ever will be a change’
The number of active NHS dentists in England is at its lowest level in a decade. This crisis has been years in the making – even before the pandemic, Britain had relatively low numbers of dentists in comparison to other G7 countries. The pandemic broke what was an already extremely fragile system. Now, almost six million adults have tried and failed to get an NHS dentist appointment in the past two years, according to a recent analysis by the British Dental Association. How did things get so bad?
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Why is the dental system in crisis
During the pandemic, the backlog of patients waiting for dentist appointments ballooned. Between 2020 and 2022, about 40 million fewer courses of treatment were delivered compared to pre-Covid levels. “We lost about a whole year’s worth of dental appointments throughout the pandemic, and that has exacerbated the problem but the cracks were developing years before Covid,” Crouch says.
The first real turning point was in 2006 when the Labour government changed the way dentists get paid. Prior to the new contract, they received a fee for every single treatment. Crouch compares it to going to the supermarket: “In a shop, you fill up your basket and pay for your goods. At the dentist you would fill this basket with all the treatments you got and the dentist would get a fee for each thing in the basket.” But from 2006, dentists were no longer remunerated per treatment. Instead they were paid in “units of dental activity” (UDAs), which have little to do with how much treatments actually cost. Instead, dentists were given three points for every patient they treated and had a set UDA target to reach each year. “But obviously if a dentist is being paid the same fee regardless if they performed one filling on a patient or 10, the system was never going to be popular with the profession,” Crouch says.
“The hope at the time back then was that the oral health of the population would improve and the amount of dentistry that would be needed would reduce, so dentists wouldn’t be worse off with the system,” Crouch says. But that has not happened because the new contract does not allow dentists to be remunerated for providing preventive care. “If we actually try to improve the oral health of our population, we’re having to do it for free.”
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Impact on patients
Dental deserts began appearing before the pandemic, particularly in areas where it has been historically difficult for practices to recruit dentists to go and work in the NHS, but this problem has grown exponentially worse. In 2019 around four million people were unable to access an NHS dentist – the latest figures found that 12 million people have been unable to get an appointment. And many patients can’t afford to pay for NHS care even if they can access it, as the government has increased NHS dental charges by 8.5%. “Not a single penny of that increase is being reinvested into improving the system. All it means is that the Treasury is paying less and patients are paying more,” Crouch says.
As a result, patients are making decisions about their oral health based on their ability to pay: “It costs far less for them to have a tooth removed, which costs about £50 to £60, than to have the complex treatment which will cost them over £300 to actually save the tooth.”
Oral health can be a life or death situation. Since people are not being screened in dental practices as frequently during checkups, the ability of dentists to find early signs of diseases like oral cancer, which is on the rise, is significantly hampered. It means that patients are being presented to the NHS much later and their prognosis as a result is much worse, which not only is a huge tragedy for the patient but also costs the NHS more in the long term. “It’s a bizarre system,” Crouch says.
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Political will
Crouch has been banging the drum about the issues with the dental system for 16 years, he says, but his warnings have largely been ignored by the government. Even though many leaders have said they plan to address the growing crisis, there has been a noted lack of political will. The reason, Crouch says, is that many politicians view the problems plaguing dentistry as too big to fix. “There has been no consistency with the approach. Even in the last two and a half years that I’ve been the chair of the BDA, we’ve had five ministers responsible for dentistry. No one stays in the job long enough to have an effect.”
The BDA has done all it can to raise the profile of this problem, Crouch says, and if even reports of patients in agonising pain fail to increase the urgency, he does not know what will. “I think my colleagues in the profession have given up hope that there ever will be a change significant enough on the contracts that will make the terms and conditions of working in the NHS much better.”
What else we’ve been reading
Sport
World Cup | Linda Caicedo scored on her World Cup debut as Colombia beat South Korea 2-0 on Tuesday. Switzerland clung on for a 0-0 draw with Norway. The Norwegians now face a do or die game against the Philippines, who surprised co-hosts New Zealand 1-0.
Football | The BBC has apologised after Morocco captain Ghizlane Chebbak was asked an “inappropriate” and “dangerous” question about LGBTQ+ players in a press conference on Monday. Chebbak was reportedly asked: “In Morocco it’s illegal to have a gay relationship. Do you have any gay players in your squad, and what’s life like for them in Morocco?”
Cycling | Lorena Wiebes, teammate to race leader Lotte Kopecky, won stage three of the Tour de France Femmes after a last-gasp chase reeled in the day’s solo breakaway, Julie Van de Velde, who at one point held a two-minute lead over the peloton.
The front pages
“UN calls for phone ban in schools to protect wellbeing of children” is our Guardian print splash this morning. Also on the front, “NatWest boss ‘sorry’ for Farage BBC story” – the Times has that as its splash, “No 10 wants NatWest boss to quit over Farage”. The Daily Express asks “How can bank chief in Farage row keep job?”. “Rose: I leaked Farage story to BBC - but I won’t resign” says the Daily Telegraph. “What planet are THEY on?” asks the Daily Mail, after the Bar Council criticised Rishi Sunak over the paper’s investigation of “bent migration lawyers”. “Sunak delays major recycle plan in Tories’ eco backlash” says the i this morning while the lead story in the Financial Times is “Sunak ready to overhaul green targets for landlords as election nears”. The Metro has wildfire coverage: “Ring of fire … Heatwave blazes encircle Med from Algeria to France”.
Today in Focus
Class of 2023: the UK’s unluckiest students
Many of the students who began their studies under Covid restrictions are now leaving university without knowing their grades. Anna Fazackerley reports
Cartoon of the day | Steve Bell
The Upside
A bit of good news to remind you that the world’s not all bad
When Edward Hain memorial hospital in St Ives was closed three years ago, it looked as if the century-old building was destined to be turned into flats for holidayers in the Cornish harbour town. But residents banded together to raise £1m and ensure the building will continue to provide health and wellbeing services to the local community. While it won’t be a hospital, the building will provide a home for charities and health groups to provide support for people with conditions such as Parkinson’s, dementia and offer wellbeing and preventive services like food quality awareness, yoga and exercise.
“The loss of our hospital was devastating,” said Lynne Isaacs, chair of the centre. “We’re thrilled that we can bring much-needed health services back to the town.” Among those to have contributed towards the fund was 92-year-old Enid Deeble, a nurse at the hospital in the 1950s, who took part in a sponsored walk to help save the building. The centre will celebrate its launch with an open weekend on 9-10 September.
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