HISTORY

Two historic events can be found since 1948 as being highly significant in the national calendar of health and wellbeing statistics in the UK .In July 1954 Food Rationing ended an environment in which prudence, healthy eating habits and a shortage of sugar were a feature. The existence of National Military Service added another ingredient of health and fitness that continued after the War until 1960 with the last National Service personnel being discharged finally in 1963. The relative absence of obesity came during an economic recession that helped to reduce the incidence of potentially fatal medical conditions such as Diabetes. And so,after 14 years of dietary control combined with a 21 year perid of national physical fitness routines, Britain’s younger generations were endowed with important ingredients for their future wellbeing and longevity. The lessons in preventive care and good housekeeping were reinforced by the educational curriculum in schools where PT and Games were important features. It is unsurprising therefore that this cohort of babies born between 1938 and 1948 enjoy long lifespans.

We ignore history at our peril and the political decision to contract dental care from private dental practices in the beginning proved an expensive mistake in the detail. The early-warning signs of the wasteful cost of free prescriptions, dentistry and spectacles, appeared within months of introduction,with the insatiable demand for free dental services in particular blowing a massive hole in the Exchequer Budget. The comprehensive provision of free dentistry under NHS Dental Contracts was brought to a swift conclusion within two years following emergency debates in Parliament. Swift remedial action was taken with the imposition of NHS dental charges in 1950 and charges for Spectacles and Prescriptions followed soon afterwards in 1952 beginning a slippery financial slope.

Those with no teeth and poor eyesight were made the target of financial discrimination as the demand for free false teeth and spectacles went viral. Two or more pairs of spectacles proved to be irresistible for theatre viewing whilst free sets of false teeth could be taken on holiday as spares. Free medicines were treated as something to be obtained from a sweet shop.

Providing free dentistry proved too much of a luxury for the politicians to continue within the comprehensive nationalization of healthcare. And so the precious principle of free healthcare for all was sullied upon the altar of a burgeoning political religion. Instead, NHS Contract Dentistry continued to be purchased from private dental practices by the NHS but made the subject of strict NHS Terms and Conditions accompanied by a universal fixed item of service fees schedule. A new set of dentures supplied in a smart London Dental Practice attracted the same NHS Contract fee as in less expensive Lincoln or Littlehampton.  Unsurprisingly, the quality of the end products proved to be very different and so it remains today with the term “NHS Dentistry” acquiring pejorative status.

The NHS patient charges for spectacles, have led a competitive commercial market place, with a number of well established High Street Brands. Competition introduces excellent consumer choice and an efficient market place, unlike dental services with the evolution of corporate models extracting a third party profit share that only increases prices and reduces demand.

Ever since the NHS Dental Contract was introduced in 1948, dentists have retained the freedom to choose whether or not to accept a patient under an NHS Contract. Inevitably, the huge initial NHS overspend on dentistry has been followed by progressive fee cuts for treatment and an under funded NHS Contract is extremely unattractive for dentists who pick and choose patients according to potential profit and loss calculations. Sadly,preventive dental care has never been on the NHS menu and the NHS funding formula imposes a fixed budget to fund unlimited courses of treatment with no quality audit of outcomes ever being recorded as a measure of value. Dental disease is very largely preventable which is why dentists’ children have little or no need for restorative treatment in childhood or later in life.

The availability of private practice services provided by Dentists and Opticians during the Covid-19 Pandemic has illustrated more than ever how important it is to respond to emergency patient demands with face-to-face appointments provided in general practice. No Health Minister can ever dictate the terms of what is good or bad for patients in private practice where the customer is king and competition in quality and price can be found. The NHS should encourage competition.

In my time working with Patrick Jenkin (Secretary of State for Health and Social Services) and Sir Gerard Vaughan (Health Secretary) in the early days of the Thatcher Government, their focus was upon the importance of the NHS providing competition, patient freedom of choice, cost control and value for money.

Since 1948, countless Reports on improving the delivery of NH Services include a Royal Commission taking four years to Report in 1979, have usually been accompanied by disruptive reorganisations that seem to have made little or no difference to the cost, quality or availability of patient care. Noticeable however, is the political disruption that occurs with every change of Health Minister at the time of General Elections and within periods of governments of diffrent political persuasion.