Disadvantaged primary school pupils at the government’s first wave of new breakfast clubs can expect to be trained in toothbrushing, as well as fed. Data showing that a fifth of all five-year-olds in England have experienced tooth decay persuaded ministers to make improved oral health part of the early years and reception class curriculum. But the prevalence of decay is not evenly spread across the country. And research showing how much worse the situation is for children in deprived areas is in line with other findings about widening health inequalities.
New analysis from the Local Government Association highlights the differing availability of dental care across council areas – a situation sometimes described as a dental divide. It found no specific correlation between the numbers of NHS dentists and young children with tooth decay. But it adds to a body of research showing that people in poorer areas are generally less well provided for. In Middlesbrough, for example, there are just 10 NHS dental practices per 100,000 people, while in wealthy Richmond upon Thames there are 28.
Health inequalities are, of course, nothing new. Ensuring a more equitable distribution of healthcare – one of the greatest of all social goods – was Labour’s aim when setting up the National Health Service in the first place. But as the number of people living in deep poverty has increased, while healthcare costs and expectations have risen, disparities in health experiences and outcomes between people from different socioeconomic backgrounds have become more starkly apparent. This includes a widening gap in life expectancies.
Deprivation is not clearly related to the provision of all NHS services. Data on diagnostic waits suggests a fairly even picture across England (since health is devolved, data in Scotland, Wales and Northern Ireland is captured separately). But along with A&E admissions, which are nearly twice as high in the poorest communities, dentistry is an area in which geographical differences are troubling – and all the more so given well‑established links between poverty and other diet-related health problems, including obesity.
The health secretary, Wes Streeting, has pledged to reform the dental contract within this parliament, and introduce a “tie-in” obliging dentists trained in the UK to work in the NHS for three years after qualifying. But it is hard to see how services in deprived areas will be improved unless funding for NHS dentistry is increased to the point where practices are viable without the cross‑subsidy provided by private patients. Currently, dentists’ reliance on fees is a strong incentive to work in areas with plenty of such patients.
The shift of £2.2bn of NHS spending to poorer parts of the country, announced by the government in June, should make a difference to dentistry as well as health overall. But if gaps both in access and outcomes are to be narrowed, then funding for dentistry will need to be prioritised. Evidence so far suggests only modest take-up of a “golden hello” scheme of one‑off payments to reward dentists setting up practices in underserved areas. A parallel scheme to address localised GP shortages is at risk of being cut.
A far higher proportion of dentistry than healthcare overall is delivered in the private sector. Another lesson to be drawn from “dental deserts” is about what happens when market forces, and not democratically accountable policymakers, are in charge.
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