Media interest in NHS provision tends to focus on the dramatic: the pensioner on a trolley for 12 hours; the heart patient turned away four times in a row. I've dealt with cases like these as an MP, but there's no doubt which aspect of NHS treatment produces the most constant stream of complaints and emergencies in my office: dentistry.
I had an idea of the problem before I became an MP: my wife and I have been unable to register with an NHS dentist in Aberystwyth for over five years now, but the sheer misery engendered by poor NHS dental provision in Ceredigion has been a real eye-opener. What I have seen is symptomatic of a deeper decline in our NHS dental provision which is going almost unreported. The Prime Minister's commitment to make NHS dentistry available to all has been forgotten.
NHS dentistry in Ceredigion is already the preserve of the few, not the many: just 31 per cent of the population are registered with an NHS dentist. My constituency workload reflects a high demand from patients seeking to register with the NHS or in need of emergency treatment as an unregistered patient.
The prime responsibility for NHS dentistry in Wales rests with the National Assembly. Health Minister Jane Hutt has just been re-appointed to her post after failing to meet every target she set herself in her first four year term. To be fair, however, NHS remuneration for dentists remains a Westminster issue. The National Assembly government's main response has been to provide grants to dentists to set up in under-provided for areas. However there is nothing to stop these dentists slowly "privatising" and treating less and less NHS patients.
Whatever the reason for the inaction, patients are suffering. Ceredigion has higher than average dental decay amongst children and adults and startlingly high levels of mouth and lip cancer that place the county at the top of the European league for these cancers.
In response to this crisis, I undertook a street survey in Aberystwyth and Cardigan in summer 2002. Hundreds of responses were received, demonstrating a common theme: the impossibility of registering as a NHS patient as an adult, and the incredible distances involved in travelling to the nearest NHS dental service.
Some constituents' comments may illustrate the situation:
Mr E, Aberystwyth
As a local doctor I am conscious that many of my patients"cannot register with a dentist"Therefore they go to their doctor with dental problems which I am not qualified to treat.
Mr and Mrs J, Cardigan
Having phoned at least 20 dentists, they will only take patients if they agree to be private"NHS Direct could only recommend one dentist in west Wales, ie Ammanford"I have been left with unfinished treatment"
Mr and Mrs J, Llanrhystud
NHS Direct suggested Barmouth, but the distance was unacceptable.
Mr E, New Quay
Been unable to register with a dentist and contacted NHS Direct and was offered Tenby or Llanelli. In need of urgent treatment but failed to be seen even by a private dentist.
These stories - and scores of other letters, e-mails and phone calls I have dealt with - only partly convey the nagging agony of living with decaying teeth. Most constituents are told to contact NHS Direct, who seem to have no sense of transport or distances in rural Wales.
Solutions are painfully slow to emerge. A National Assembly consultation document last year acknowledged the problem, but offered few answers. A Community Dental Service exists in Wales, but is limited to treating children. The paper accepted the conclusion of the Health Select Committee report of March 2001 Access to NHS Dentistry that: "the current remuneration system in the General Dental Service (GDS) was at the heart of the access problem". But it makes no concrete recommendations. The fact that dentists who treat NHS patients can be paid less for their work through the GDS than the actual cost of that work is a huge motive in the move of many dentists towards private practice and limiting their NHS patients.
It is the difficulty of achieving this reform that has allowed compulsory fluoridation to raise its head again. I am opposed to compulsory medication, particularly when you can't control the dose. The beneficial effects of fluoridation can be achieved by using tablets or toothpaste. Its side-effects in excess - as shown by the events in the Indian district of Nalgonda, where 10,000 people are suffering from bone disease - are crippling. The National Assembly government has just promised free school breakfasts to all schoolchildren. Ensuring they clean their teeth afterwards with a fluoride toothpaste would be just as efficacious.
I believe that only a system of salaried NHS dentists, perhaps as part of an expanded Community Dental Service, can plug the gap. This needs to be allied with the introduction of a "bulk payment" system and looking at remunerating dentists for their preventative work, as well as treatment. Fluoridation is a cop-out and a tacit acknowledgement that our NHS dental provision is failing those who need it most.
