The people who could actually save NHS dentistry were nowhere to be seen, but their Treasury talking points were there for all to hear.
Because as we’ve spelled out to both MPs and the press the biggest barrier we now face is at HM Treasury. This is the argument we need to win, and on the basis of today we’re off to a strong start.
Delivering NHS care at a loss
We’ve made our case to the new inquiry into ‘Fixing NHS dentistry’.
The Public Accounts Committee is Westminster’s public spending watchdog. This isn’t about revisiting the excellent work of the Health Committee, who set out an instruction manual to save this service: this is about how a new Government should actually pay for it.
We’re very clear that ‘Fixing NHS dentistry’ is impossible without sustainable funding.
And the numbers we’ve collated have set the debate in the press and at the Committee.
Last year we completed the largest study into the timings and costs of NHS treatment in a generation.
The numbers won’t shock any of our members, but MPs and the media are now alert to the fact practices are losing at least £332m a year delivering loss-making treatment.
This is a figure set to rise as high as £425m next year as a result of Treasury hikes in National Insurance and the National Minimum Wage. Clearly with practices being kept afloat by private care, this is only ramping up the long term drift from the NHS.
What this means at practice level is eye watering. A simple new NHS patient exam loses a typical practice £7.69; a denture £42.60.
The biggest roadblock
While there is rightly focus on the obstacles to reform at both the Department of Health and Social Care (DHSC) and NHS England, the principle block lies at the Treasury.
The reality is there’s a long-term HM Treasury view that NHS dentistry is unworthy of investment. And this unwillingness to help NHS dentistry stand on its own two feet is now accelerating the exodus to the private sector.
We’ve seen several years of record-breaking underspends – with hundreds of millions perversely lost from the front line during an access crisis. And the Treasury want to see existing budgets spent before new funds are put on the table.
Officials have singularly failed to grasp that unsustainable funding levels is exactly what fuels these underspends.
Practices that cannot fill vacancies because they cannot offer competitive pay – and often do not even break even on some NHS treatments – will find it impossible to deliver their allocated activity.
Under scrutiny
NHS England CEO Amanda Pritchard agreed to the proposition that we need to ‘rip up’ the UDA contract.
Likewise Acting DHSC Permanent Secretary Prof Chris Whitty agreed on the need for fundamental change.
Sadly, when pressed on funding, assembled officials had little option but to echo Treasury standard lines.
That the recipe requires making use of underspend, recycling already inadequate budgets. The reality is the financial envelope is now limiting the headroom of both Ministers and their civil servants to keep the government’s promises.
Ali Sparke, Director for Pharmacy, Optometry and Dentistry at NHS England acknowledged that “there just isn’t enough dentistry commissioned full stop… we know there is only enough funding for 50% of the population.”
Officials fudged answers to calls from the Committee for an official assessment of the real costs of providing care, to underpin a new contract.
This is a really important point. The Committee rightly ripped to shreds historic modelling that was used to underpin the PR claims of the last recovery plan. We need a serious – and collaborative – effort here, because no dentist should be expected to deliver NHS care at a loss.
Our lowest ebb
Government says it's 'going for growth', but Treasury policy is doing the exact opposite for dental care.
For us the coming Spending Review – and the NHS 10-year plan that’s tied into it - will either sink or save NHS dentistry.
I’m sure Rachel Reeves doesn't want to be remembered as the Chancellor who killed a service millions depend on. But her recent budget has brought this service to its lowest ebb.
Demoralised dentists are walking away from a system that is forcing practices to operate like charities.
We greeted the tone from the new government, but as we have said deeds need to match words – and that must include the Treasury.
This service is running on empty. Kept afloat by private work and goodwill which is in increasingly short supply.
It has been a rollercoaster first week for me as the newly elected Chair of the General Dental Practice Committee.
This is a hard fight, but we are winning the argument. And we are not losing sight of the fact we need to see real urgency and ambition here.