Healthwatch England’s latest findings show many people continue to struggle to access or afford NHS dental treatment.
Since the start of the COVID-19 pandemic in 2020, Healthwatch have seen an increase in the number of people sharing their experience of trying to access NHS dental care. We have also seen the proportion of positive feedback about dentistry fall sharply.
In December 2020, we published a report outlining the impact COVID-19 has had on people’s dental care. This update:
- Highlights that many of the issues we have previously reported have continued;
- Explores in more depth people’s attitudes towards accessing and affording NHS dental treatment; and
- Recommends action to create equal and affordable access to NHS dentistry.
January- March 2021: Feedback to us on NHS dental care
• 80% of people found it difficult to access timely care.
• 59% reported a negative experience of care.
• 3% of people told us about a positive experience.
Consistent problems that people report
Delayed and unequal access
Access to NHS dentistry continues to be the biggest issue for most people who spoke to us. Common challenges people face include finding an NHS dentist to register with and a long waiting time for treatment.
Caller is 24 weeks pregnant and have a broken and infected tooth. They have tried to register with many dentists in Watford but have been rejected by all of them.
— Healthwatch Hertfordshire.
People have also told Healthwatch about the different ways that access issues during the pandemic can affect them:
- Black, Asian, and minority ethnic communities have told local Healthwatch that they are less likely to be registered with an NHS dentist and more likely to struggle to access one when they needed to.
- Pregnant women and new mothers have reported being unable to take advantage of free dental care because of a lack of appointments. As they were on maternity leave, they couldn’t afford to pay privately, leaving them unable to see a dentist.
- Some housebound disabled people have been left unable to access care after dentists stopped home visits because of COVID-19.
Disrupted care has been an issue throughout the pandemic. People have been asked to wait from anywhere between a few months to a few years for NHS dental appointments.
Many people have reported that even though they booked appointments, they were cancelled, meaning people cannot complete their treatment, such as root canal surgery. Others have found that when they have tried to book a dentist appointment, they have been removed from their practice list.
Pressure to go private
People have felt pressured to go private, as dentists have said they couldn’t provide NHS treatment but could if people were willing to pay private fees. This was especially difficult for those on low incomes, those who lost their jobs during the pandemic, and people who faced having to afford private care for their whole family.
I have had a problem as I lost a filling and now the tooth has completely broken off. Although no in pain, it’s making it difficult for me to eat. My dental practice has told me that they only have appointments for serious cases. However, the same practice is sending me emails encouraging me to pay for private treatments.
— Story shared with Healthwatch Bristol
Being left in pain
Being unable to access care or having it delayed has left people with pain, swellings, and broken teeth, fillings and dentures. People have also reported being unable to get preventive care, leading to worsening dental problems and sometimes tooth loss.
Some people said they were given antibiotics to help manage their pain which provided temporary relief but could later lead to reinfections. Other individuals have told us that they have had to self-medicate.
I have been trying to get a dentist for three years, last week I ended up in hospital for three days because I had severe pain and could not find a dentist for emergencies or otherwise to fix my teeth. I ended up taking too many paracetamols and had to go to A&E on the advice of NHS 111. I end up being on a drip for 36 hours and have finally come home. I still do not have a dentist and I am still in pain.
— Story shared with Healthwatch Suffolk.
The access and affordability issues people have told us about are often made worse by incorrect information:
- Out of date information on practice websites left people unsure if dentists are taking on new patients or offering routine care.
- Inaccurate information about treatment costs has led to individuals paying more than they can afford or being penalised for claiming free treatment in error.
Exploring public attitudes to access and affordability
As well as looking at the stories shared with Healthwatch, we also commissioned a separate poll of 2,019 adults, looking at people’s experiences of NHS dentistry during the pandemic and how it has impacted their future habits1.
The poll found that most people (61%) feel that NHS dental treatment charges are expensive.
However, over a quarter (27%) of respondents said they either struggled to pay or avoid dental treatments altogether because they cannot afford the costs.
People who took part in the polling from lower socio-economic backgrounds were most likely to agree that they avoided dental treatment due to affordability issues.
About one in three people (30%) reported they felt pressured into paying private fees to get all the dental treatment they needed. And nearly two in five (39%) said that they had been charged extra for NHS treatments.
Access during the pandemic
Most people (61%) reported not having had a dentist’s appointment since March 2020. However, respondents were more likely to say this if they had a lower income.
While half of the people (51%) from the highest socio-economic grade reported having an appointment, only 31% from the lowest said they have been to the dentist.
The polling also highlighted many of the issues that people have reported directly to Healthwatch:
- 51% of people found it difficult to book an appointment;
- 31% had to pay private fees to get all the treatment they needed; and
- 29% found it difficult to find information about NHS dental treatment charges.
Future dental care
Our polling indicates that the pandemic may also have affected people’s habits of seeing a dentist. Nearly a quarter (23%) feel they will now visit the dentist only when they need treatment, despite clinical guidelines recommending regular dental check-ups to keep people’s mouths healthy.
Respondents from ethnic minority backgrounds were less likely (26%) to say they will continue to see their dentist for regular check-ups when compared to white respondents (41%).
A similar pattern was also seen in responses from younger people and those from lower income households.
1 – An online poll carried out by Yonder Data Solutions for HWE from February 19-25, 2021, received responses from 2,019 adults (aged 18+) based in England.
What needs to happen?
We believe that action in four areas needs to be taken to address the issues that people have shared with Healthwatch.
- A more rapid and radical reform of the way dentistry is commissioned and provided – recognising that the current arrangements do not meet the needs of many people who cannot access NHS dental care in a timely way and acknowledge issues faced by the dental profession.
- Using the reform of commissioning to tackle the twin crises of access and affordability – ensuring that people are not excluded from dental services because of lack of provision locally or difficultly in meeting charges. Currently, there are significant inequalities that must be removed. New arrangements should be based on maximising access to NHS dental services, with particular emphasis on reducing inequalities.
- Greater clarity in the information about NHS dentistry – improving information, including online, so that people have a clear picture of where and how they can access services, and the charges they will need to pay. Particularly, the reform must address dentistry ‘registration’ which causes significant confusion for both services and patients.
- Look at using dental practices to support people’s general health – harnessing opportunities, such as the development of Primary Care Networks, to link oral health to other key issues such as weight management and smoking cessation.