Plymouth councillors have expressed anger and frustration at the time being taken by NHS England to respond to the city'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 have gone unspent due to dentists not being able to carry out treatment.
In response, NHS England South West said it was working on a dental reform programme, with plans being drawn up during the summer.
It follows a council report in December 2019 highlighting the extent of what was described 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. It also found that children in Plymouth were four times more likely than anywhere else in the region to have teeth removed under general anaesthetic.
The study also 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 of people on a waiting list for NHS treatment has grown to 16,000 from 14,000 in October 2019.
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,” she said.
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.
Recommended targeted interventions by the study 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, gypsies 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.
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.
Ian Biggs, NHS England’s South West director of primary care and public health commissioning, said it was working on a dental reform programme.
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 added 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 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 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.”
The study found mouth cancer in Plymouth was above the national average. The city also has one of the highest rates of homelessness, and adult access to dental care was below average at 45.1 per cent compared to 47.9 per cent.
The report identified a key priority was 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.
Credit: Ed Oldfield, Local Democracy Reporting Service