There are very few countries in the world where one would get reliable and standardised dental treatment at a low cost or even free like NHS dentistry. From the point of view of affordability, it cannot get better for the patient seeking care from a dental professional. By default, everyone has access albeit not advanced. Scotland is in such a unique position and it is time we start appreciating this great health benefit around us. Most economic indicators across the globe show a widening gap between rich and poor and this service provision goes a long way.
Of course, when such a niche service is provided by the State it is argued that State cannot cater to the ever increasing demand for advancement of science and technology in dentistry but risks being a very basic service. Is that fair? Many a times I wonder why do such discussions not happen when a NHS Trust invests on a ultra-modern MRI scanner costing millions? Business case is always there. Is successful dentistry not important for health and well-being of the society? Dentistry isn’t just a cosmetic tooth replacement program, it is an essential commodity to provide a decent quality of life in the society and pays for itself. As simple as it sounds, I wish policy makers were thinking on these lines.
It is important we remind ourselves of the law of diminishing value in economics. The law states that once you become used to a value or benefit, if not reminded of the value on a regular basis, the original high-perceived value diminishes. You can see this law at work all the time in the world around you. It seems perfectly plausible that when something is given free or at a price next to nothing, it is not perceived as being good. Patients rightly think it is their right. Imagine the sweat and hard work for that difficult surgical extraction of a root treated lower molar. Neither the State nor the patient in general appreciate it. The same procedure carried out privately at a much higher price is seen as excellent, outstanding, great value for money and so on.
Corona virus pandemic has opened up new challenges and we have all heard from time to time ….there is no more money in the pot….. Of course, priorities of health care providers has changed dramatically.
Speaking on the basis of social welfare, NHS dentistry is indeed a great service that State delivers, as long as it is robust and comprehensive. However, we need to ask the question why despite pumping in millions, Oral Health in Scotland is one of the worst in Western Europe? Is it worth spending that money on preventative dentistry and let the individual take responsibility for oral health? Many of us think NHS dentistry must provide basic pain management and emergency treatment to the needy. Rest of the services must occur in an independent patient funded manner.
What is the need of the hour? Should we as professionals start advising patient to move away from NHS dentistry as it isn’t possible to deliver the service at the costs agreed by the State? (considering the massive upward increase in costs of delivering dental services and ever increasing regulatory scrutiny) Or should we appraise Scottish Government and policy makers that pumping in additional funding will drive the oral health and quality of life upwards? The ultimate issue here is how we can adequately fund the service and expect good outcomes?
What will happen to a patient who cannot afford and need additional treatment? Imagine the letter you received from a Hospital Consultant asking you to provide 6 posterior composite build ups to be changed to full coverage crowns down the line to manage tooth surface loss or even a chrome denture where practitioners have to pay the cost out of their pocket? Worst when the denture needs remade within a short span of time!
It makes complete sense not to waste money and time on expensive treatment that would have poor outcomes and therefore within NHS dentistry a scaling down of disease centred approach and bringing it in line with a preventative model sounds attractive. Any high value treatment can be an opt in by patient rather than provided by default could be one perspective, while retaining access to dentistry for essential treatment and maintenance of oral health?
This reminds me of my mentor and a trusted surgeon who used to say…….. you don’t need teeth to survive, so no major emphasis is needed on saving them……but then I would say ……would anyone imagine stepping out without their full compliment of teeth in this day and age? Let the patient decide what is needed.