November 2025 blog

Why NHS dentistry died...

Thatcher and Regan developed the "sod the poor, lower taxes strategy...

In NHS dentistry-the DHSS took target income (knobbled by DDRB!),
plus target averaged expenses to calculate the global sum.

The spreadsheet (covered by the Official Secrets Act!) took as fixed the global sum, and divided each fee into this…

If dentists worked hard, did more exams, fillings etc-the fee went down…

If a dentist spent more on equipment, because the average stayed constant-his income went down…

In theory-if we all did fewer fillings etc-the fee would go up, but nobody could afford to do fewer…

DHSS really wanted dentists to do cheaper, basics: say extractions only, no dentures if possible

but dentists wanted to try to do good dentistry-root treatments, crowns, chrome dentures, bridges.

A crown was £39, profit after expenses £4 before tax, £2 after tax…

Blair was urged to remove crowns, chrome dentures, bridges etc from the menu-but wanted the illusion that NHS dentistry was comprehensive, and just as good as private treatment...

The government used "we need more time with the patient" to introduce capitation

children got 29p a month-so received no treatment, and hospital referral for extractions under GA soared.!

adults got the same fee for three fillings as one..., same for difficult etched white fillings as cheaper, quicker (?better?) amalgam

this deterred dentists

the unit of dental activity UDAs (yoodahs) were rationed to each dentist in a year, dispersed late by Crapita, so dentists were stopped from working hard-the exact result DHSS wanted-it kept the cost of dentistry down!!!

The BDA urged any dentist who was in a wealthy area togo private-and many brave souls did, in droves...

Rationing treatments

Accountable Care Organisations, ICBs, use rationing to deny
treatment-as do Private Health Insurers....

The government, Treasury and DHSS really want inexpensive basic NHS treatment.

Surgeons, medics, eg, want to develop best techniques and operations for their patients…
and advocate for their patients…

Say an eminent experienced surgeon is good at leg lengthening… is this really essential for a comprehensive NHS?

Equally-breast reduction, breast augmentation (except after removal)
facelifts, hair transplant...
-
some wise caring Solomon may need to ration treatment.