'Anger' and 'frustration' over time being taken to respond to Plymouth's dental 'crisis'
Councillors heard that millions of pounds went unspent due to dentists not being able to carry out enough treatments
Councillors have expressed anger and frustration at the time being taken by NHS England to respond to Plymouth’s dental ‘crisis’.
One senior Labour politician accused NHS England officials of “trying to paper over the cracks” in a system which had “let down” the city, after councillors heard millions of pounds went unspent due to dentists not being able to carry out enough treatments.
The city council produced a report in December 2019 highlighting the extent of what was described by councillors as an oral health crisis in the city.
It found thousands of adults and children were unable to access NHS care, with the most deprived areas worst affected. Children in Plymouth were four times more likely than anywhere else in the region to have teeth removed under general anaesthetic.
The study found a shortage of dentists meant that around a fifth of planned NHS work was not carried out.
In an update last week, the council’s health and wellbeing board heard that previous problems with accessing care had been made worse by the pandemic, and the number on a waiting list for NHS treatment has grown to 16,000 from 14,000 in October 2019.
Councillors were told the South West regional team of NHS England was now working on a dental reform programme, and a business case for a new commissioning plan was due to be produced in September.
Councillors told regional NHS officials they were frustrated about the delay in tackling the issues in Plymouth, and asked for an assurance that the city would be treated as a priority.
Cllr Mary Aspinall was chair of the council’s dental health select committee which carried out an investigation into the problems highlighted in the oral health needs assessment published at the end of 2019.
She said nothing had changed since then, apart from the NHS dental waiting list going up.
"That is not satisfactory for the people living in Plymouth, and we really need to ensure something is going to be done."
Cllr Aspinall claimed the NHS England officials were “trying to paper over the cracks” and she was “very angry because so many people are being let down.”
Health board chair Kate Taylor said the biggest issue faced in Plymouth was the difficulty accessing care, and it was “frustrating” that schemes set up to “bridge the gap” were not being funded by the NHS.
The Labour councillor highlighted a service for the homeless run and funded by Peninsula Dental Social Enterprise, a community interest company of the Peninsula Dental School, and plans backed by the city council for a new dental practice in the city centre to be staffed by final-year students as part of their training.
Conservative group deputy leader and shadow Cabinet member for health Patrick Nicholson said he hoped the proposals for a new city centre practice would be supported in the September NHS dental plans, and asked for an assurance that the problems in the city would be treated as top priority.
Cllr Nicholson said it was “inexcusable” that the current system allowed £15.7million of unspent dental funding in the region to be clawed back last year, after practices failed to provide the contracted level of treatments.
He said there was cross-party support to tackle the problems in the city, and unless they were addressed in a “timely manner”, local politicians would consider asking MPs and ministers to intervene.
Cllr Nicholson said: “We cannot continue with a generation of people suffering from inadequate dental health care facilities.”
Ian Biggs, NHS England’s South West director of primary care and public health commissioning, said it was working on a dental reform programme.
A regional oral health needs assessment had been completed and plans would be developed during the summer with a business case setting out commissioning plans due in September.
He said oral health and access to services were priorities for NHS England, but the challenges had been made worse by the Covid-19 pandemic which saw practices close, then reopen at lower capacity.
He said the dental reform programme would identify geographic and service priorities and produce a plan to commission “the right services in the right places”. Mr Biggs told councillors: “It’s absolutely vital that we maximise access to dental care.”
He said the homeless were a priority group, and councillors also heard that current contracts with dentists expected them to consider ways to reach vulnerable people. The committee heard the work in the city with the homeless could contribute to a new more flexible model of dental contracts.
Mr Biggs said a big problem was the department was unable to commit the underspent funding, which put it in a “tricky position”, but it was trying to increase the capacity of the practices which held contracts.
He said the underspend was a problem due to the way contracts were organised in negotiations between the NHS England national team and the British Dental Association, but the South West team tried to influence them to provide local flexibility.
He said the emergency dental centres would stay open and the NHS England team would continue to work with dental practices to increase capacity, so people should find better access to urgent care although it was “not as good as it should be.”
Mr Biggs said: “I don’t want to paint a rosy picture that we’re suddenly going to be able to solve this, because we had a challenge before Covid hit I think, and we’ve now got an even bigger challenge in trying to help dental practices get back up to what is a reasonable pace of activity.
“And that’s not their fault, it’s because they’re expected to follow the infection protection control guidelines that absolutely are the right things to follow, but the impact of that is on the ability for people to access care.”
Cllr Jemima Laing, the council’s Cabinet member for children, said the report said the number of more than 600 children a year in Plymouth having teeth removed under general anaesthetic was in line with the national average, which made it sound ‘acceptable’, which it was not.
The Labour councillor said: “In the past six years almost 21,000 teeth have been taken out of the mouths of Plymouth children, for almost entirely preventable reasons.
“We want to prevent it, we need you to support us to do it. I don’t want this to become an acceptable, normalised statistic.”
She said if a “largely preventable medical intervention” was happening thousands of times to young people in Plymouth on another part of their body, people would be horrified.
The councillor added: “We should all be horrified, and we mustn’t let this become seen as normal.”
Mr Biggs agreed it was not normal and should be avoided at all costs. “We don’t want anyone having teeth out, particularly young people,” he said.
Causes of children having teeth removed were multiple, including access to care, and it was an important area of work with partners.
The regional oral health needs assessment said Plymouth had the second highest level of deprivation in the region behind Torbay, with both seeing life expectancy below the national average.
The study found that in Plymouth in 2019, the proportion of five-year-olds with tooth decay was around one-in-five, slightly below the national average. Decay in 12-year-olds was above the average rate, and children’s access to dental care in the city was above the national average at just over half – 55.6per cent compared to 52.9per cent for England.
The study found mouth cancer in Plymouth was above the national average, it had one of the highest rates of homelessness, and adult access to dental care was below average at 45.1per cent compared to 47.9%.
The report identified a key priority to improve access to dental care for adults in areas of highest deprivation in Devon. In Plymouth, that was in the west and centre of the city, particularly St Budeaux, Devonport, and St Peter and the Waterfront.
Other priorities were improving access for the growing number of older people, supporting recruitment and retention of NHS dentists, and access for children, particularly in the west of Devon.
The study recommended targeted interventions with local authority partners to include:
- supervised tooth-brushing in schools and nurseries
- health visitors providing toothbrushes and toothpaste or sending them by post
- targeting oral health programmes at key vulnerable groups including the homeless, people misusing substances, gipsies and travellers, older people, and migrant communities
- developing the education, health and social workforce
- moving dental practices towards prevention
- developing healthy eating policies in nurseries and schools