The Welsh Government is in denial about Wales’ emerging dentistry crisis

Llyr Gruffydd, Plaid Cymru MS for North Wales

With the chaos engulfing Betsi Cadwaladr University Health Board dominating the headlines over recent months, another emerging crisis has gone under the radar.

Industry leaders have warned that dental services on the NHS in Wales could to all intents and purposes come to an end. This is because there are so many dentists who have either given up, or are about to give up, their NHS contracts. The consequences for people who rely on those services are disastrous.

Given the dire warnings, one might think that this would prompt the Welsh Government to take action to get to grips with the issue. But to the dismay of dentists across Wales, and those who rely on their services, they tell us responses to their concerns from government ministers have ranged from arrogantly dismissive to downright hostile.

No one denies that the way NHS dentistry services are commissioned in this country needs to be improved. However, the programme of reform that the Welsh Government is pressing ahead with risks creating far more problems than it solves, and this has not gone unnoticed.

Dental practices complain of being bounced into signing up to contract reform. They say they face being whacked with huge financial penalties if they don’t meet targets that rely on unevidenced, untried and untested metrics.

Privatisation

My office has been contacting dentistry practices across North Wales to get a detailed understanding of the situation. Of those contacted only 14% were taking on NHS patients. What we’re seeing is the effective privatisation of a key element of the NHS with tens of thousands of people across north Wales struggling to access a dentist. This includes children, pregnant women and has long-term implications for people’s health and wellbeing.

That’s why I’m launching a survey to assess the state of NHS dentistry across the north Wales region I represent. We want to know what kind of dental services constituents are receiving, or not receiving in an increasing number of cases.

A survey by the North Wales Local Dental Committee paints an equally bleak picture. When asked how many practices were on target to achieve the metrics only 8% answered positively, which means over 92% of practices may face financial penalties.

When asked whether the current contract had affected recruitment and retention of staff 81.5% of respondents said yes. When asked if they intended to remain in contract reform for 2023/2024 only 40% answered yes with 28% no and 32% unsure. Of those that answered no. 75% plan to reduce their NHS contracts and commitment with the other 25% reverting to the original General Dental Services contract of UDA’s (Units of Dental Activity).

Worryingly, over 88% of respondents felt they did not have the necessary capacity for the new patients they will be expected to see in 2023/24 with 96% reporting that they have received negative feedback from historic patients of the practice who cannot access care.

Dentistry deserts

The proverbial canary in the coalmine is starting to get agitated and it’s getting noisier too. We’re seeing an increasing number of NHS dentistry deserts emerging across the country and the problem is set to get even worse.

Dental practices are handing back their NHS contracts, opting to only provide their services on a private basis. In North Wales, the region I represent, evidence of a serious systemic issue is beginning to mount. Out of the 10 dentist surgeries around Ruthin – in places like Wrexham, Mold and Llangollen, only one is receiving NHS patients at the moment, and there’s a waiting list of two years to be able to access those NHS services. This is a snapshot of what’s happening across the country.

This has been put down to the heavy handed and downright incompetent way that the Welsh Government has gone about trying to impose new NHS dentistry contracts.

It’s abundantly clear that there is no understanding from the Government that there are three tiers of people using the service. The first is those who can afford private treatment; second, those who can’t afford it but are succeeding in accessing NHS services. But there’s a third tier, and that’s growing on a weekly basis, where there are people who can’t afford to go private and also can’t access NHS services.

Fundamental right

Access to dental care should be a fundamental right. But this is a right that effectively does not exist for many people in Wales, and if things continue on their present course it will exist for even fewer people in the future. Instead it will be a privilege. Something that exists only for those who have the money to pay for it. Those who don’t have the necessary financial resources will have to go without, whatever their level of need.

Welsh Government ministers failed to get a handle on the problems at Betsi Cadwaladr University Health Board for well over a decade. They blithely ignored warning after warning and we all know how that ended up.

We are now seeing a similar pattern play out when it comes to dentistry services and as is always the case, it is the poorest and most vulnerable who will end up paying the price. The Welsh Government is giving them a kick in the teeth, and they don’t even have a dentist to go to.

Please click Dentist survey – Arolwg deintyddion (llyrgruffydd.wales) to complete a two-minute survey on dentistry in North Wales.