Photo: Elena Mozhvilo from Unsplash

Whilst it may be some way from being the most glamorous debate in political economy, the issue of tooth decay is instructive of a larger systemic problem in the relationship between pre-general election party policy and the future of the NHS. This is because tooth decay is now the biggest primary cause of NHS hospital admissions for children in England aged between five and 17, with 40% of children no longer having access to regular dental appointments. Between April 2022 and May 2023, 30,000 children and more than 70,000 adults in England were admitted to A&E with tooth decay. As Matthew Taylor, chief executive of the NHS Confederation, said last year: “Accident and emergency departments are overflowing with people in severe dental distress.”

The latest data shows 40% of children don’t have regular NHS check-ups and 104,133 children went to hospital with rotten teeth over the past five years. 90% of dentists across the UK are not taking on new NHS adult patients – according to the British Dental Association (BDA) – and many are refusing to see a child unless a parent is signed up as a private patient. As a result, people are now turning up to A&E in their tens of thousands.

Moreover, large parts of the UK are now “dental deserts”, where 100% of dentists are not taking on new patients, with more deprived or rural local authority areas having fewer NHS dentists than those in more affluent urban areas. All dentists in the UK are private contractors. About three-quarters of these have a contract with the NHS to deliver a certain number of services, quantified in units of dental activity. The data makes it clear that the current government has wholly abdicated its responsibility for effective dentistry and has instituted a systemic betrayal of many residents who need, but cannot access or afford, dental care.  So, an important question at this juncture is to turn to the incoming Labour government to understand the solutions that they propose for this health scandal.

There is an argument that for this crisis to be addressed, the Labour leadership will require a bold political vision and progressive taxation and health policy if the incoming Labour Government is to improve on the record of the imploding Conservative Party and their years of sustained failure in health delivery. However the combination of the first past the post voting system, and a very substantial polling lead, means that the Labour Party have the seeming luxury of counting on their core progressive voting base while fashioning a political prospectus that largely follows that of their predecessors.

The Parliamentary Labour Party has been accused of being vague on policy but I would suggest to the contrary that there is nothing particularly vague about Keir Starmer’s political programme. Over the last four years, voters have seen a substantive shift of his policy programme away from progressive economic and social policy to the fiscal discipline and political timidity that are now the hallmarks of his politics.

The first past the post voting system compels those seeking progressive policy to supplant four decades of dominant neoliberal consensus to seek solace in the Labour leadership being the lesser of two evils. However, such a narrative has facilitated the Labour leadership to move away from progressive policy and rewards a politics that maintains economic and social inequality and the attendant underinvestment in key public services. Every Labour policy that might have given the proponents of ‘lesser evilism’ something to work with has been subverted or junked- the Green New Deal, the commitment to maintaining the two child benefit cap, a failure to reinstate the cap on bankers bonuses, following the fiscal discipline of Conservative austerity, maintaining tuition fees, and continuing the outsourcing to private companies in the NHS, which Labour now proudly announces it will increase.

This may be part of the reason why a recent poll showed that 61% of voters think they will be either the same or worse off under a Labour government. A majority of voters appreciate that if the Labour Party does not commit to a progressive policy platform and adequate investment in local government and public services, they will simply be consigning the country to another 5 years of economic austerity and sustained health inequalities.

What does this mean for the crisis in dentistry? Until now the Labour Party have promised an extra 700,000 urgent dental appointments, reform of the NHS dental contract and the introduction of supervised toothbrushing in schools for 3-5 year olds, targeted at the areas with highest childhood tooth decay. While on the surface this may look positive, it has been criticised for being largely insubstantial. Supervised tooth cleaning (currently happening in some schools) and a meagre 700,000 more appointments each year is nowhere near enough to address the scale of the crisis in dentistry. What is needed to stem the multiple crises that the NHS is facing (of which dentistry is only the tip of the iceberg) is the same radical progressive vision and courage to invest in our future as was shown in 1948. This happened against the backdrop of a war-ravaged economy and much higher levels of government debt.

We spend less on healthcare than comparable major economies and our spending since 2009 has not kept pace with the combination of inflation and population growth. Anita Charlesworth, Director of Research for the Health Foundation observed: ‘Either we are going to have lower quality healthcare relative to other countries or we spend more’.

First past the post has allowed the Labour Party leadership to privilege fiscal discipline and the wooing of the markets, the right-wing press and disaffected Tory voters over the 30,000 children and more than 70,000 adults in England who are admitted to A&E with tooth decay. With every month that passes it’s becoming more difficult to position the Labour Party as the lesser of two evils.