Healthy living
Body matters
How the NHS left me up a gum tree
When Ian Cotton was told he had gum disease, the last thing he expected was an eight-month battle with the health service. Here he gives a blow-by-blow account of his epic struggle to get treatment
Not every dentist is beautiful, but mine is. Black-haired, bright-eyed and full of a fiery, fine high-seriousness, she's made going to the dentist something unprecedented in my life: a day to look forward to.
Imagine my distress, then, when I went to her last autumn for what felt like a small cavity somewhere upper left and she declared it was "gum disease" - and then added that she could not treat it herself but would have to hand me over to a colleague in the private sector. So would it cost? Well, yes it would. Maybe hundreds? Er, yes, quite possibly hundreds.
She'd been warning me about the possibility of gum disease for months. This time, a swift check round my mouth with a long, spindly, probe showed that there were other, comparable recessions all around, all of which needed treatment.
But what about the NHS? I am, after all, an example of that endangered species, an NHS dental patient. Well, for gum disease treatment, she said, this could be tricky - but she would try. To be absolutely honest, she said, the sole realistic hope would be a teaching hospital such as Guy's in London. She'd write.
The letter sped off the very same day, and there started a true tale for the over-fifties (I am 61) because it is we who are the age-band - or "cohort" in the jargon - who most need dental help. The dental health of the young has been improving for years - fluoridation, diet, flossing - but we oldsters need, if anything, rather more (itals) help these days than we did; not least because ever more of us are keeping our teeth.
The weeks passed. I rang the dentist's surgery; they'd heard nothing. I rang Guy's, and got a machine.
"If you require operator assistance," said the machine, "say: 'Operator'."
"Operator."
"Operator, is that correct?" asked the machine.
"Yes."
"Connecting you to operator…"
It cut me off.
I rang again; it cut me off again. I rang again, and got put through to "Referrals", where a new machine offered me two further options and then cut me off. I rang again and this time actually made it, properly, into Referrals, where I even spoke to a human being. Mysteriously, Referrals couldn't trace my case; nevertheless, they said, Periodontals would definitely know, but that, they feared, would mean my ringing in from outside. And when I did, the number was dead - it turned out later it had been out of commission since March 2004.
A new operator then said try this other one, and when I rang it, lo! It answered. And I got my verdict. Periodontals said they'd written to my dentist long ago, telling her I'd been turned down. The letter had been sent in September and they'd no idea why it hadn't arrived. But no, they couldn't give me the actual date when they sent it out, as they didn't do dates, only "date as postmarked".
I asked them to write to me direct, and an unsigned, undated refusal letter duly arrived (the postmark date was November 9, nearly two months after the referral date of September 22) which I duly punted on to my dentist. A month's further pause and, in response to many phone calls (my dentist was undoubtedly very busy) I received a message via her secretary to say that I now had just "two options": monthly hygiene sessions or… private treatment. As I presumably needed something more than hygiene sessions - I'd been having them for years - we had arrived, after three months, right back where we had started.
And there began to grow a great green, anger in my soul. Hadn't Tony Blair himself promised, back in 1999, access to NHS dentistry for everyone within two years? Yet not only had mile-long queues erupted the moment new NHS dentists opened shop but worse, even if you were already in the system like me, you couldn't get treated; not for anything remotely complicated, anyway. Nevertheless, I decided - no surrender.
I called the British Dental Health Foundation, I called the British Dental Association, I called the Patients Association, I even called NHS Direct. The voices were sympathetic, resigned - yet all agreed: teaching hospitals aside, all vastly oversubscribed, affordable gum disease treatment was ungettable, in real terms, on the NHS. I even tracked down the dental school in Leicester Square where I had been referred, years back, by a previous dentist. It had been turned into a hotel.
I fought on. I spent 102 minutes filling in an on-line form for NHS direct. Two days later, the computer got back to me to explain that "we require the name of the condition or treatment needed in order to provide information" ("Gum disease", clearly doesn't do it for the NHS). When I finally got through to an actual, if palpably bemused, live NHS adviser, her best suggestion was, yes, a teaching hospital! Maybe one out of London. Her computer suggested I could try Bristol, maybe, or even Sheffield or why not Newcastle?
I approached the experts. Why couldn't local dentists do the straightforward thing, and do the job - on the NHS?
"The answer, quite simply, is economic," said Nigel Carter, chief executive of the British Dental Health Foundation. "Plenty of NHS dentists can do such work, technically; the trouble is they can't afford to. Suppose, say, that the gum problems you describe take a dentist like me, say, three hours to treat. The current fee structure means I might get paid, say, £30, which roughly equates to half an hour of work; so two and a half hours, or five sixths of the job are on the house. Altruism has its limits."
Nor, reckons Nigel, is the government's much vaunted new dental health contract, introduced last April, going to make much difference; such work will still be uneconomic for local dentists - unless, of course they are working privately, in which case they could charge as much as £300-£500 an hour. "So that then it becomes uneconomic for the patient."
So what can be done? One thing that is needed, plainly, is more money. While NHS spending has increased by 75% since 1990-91, spending on NHS dentistry has gone up only 9%; but then, as my dentist points out, dental problems are "rarely life-threatening". Moreover, argues Paul Batchelor, senior lecturer and honorary consultant in dental public health at University College, London, there has been a cultural change among dentists themselves. "If, like most of today's graduates, you leave university with a £20-£25,000 overdraft, you don't feel much obligation to serve the state."
I went back to my dentist and, after hearing about my adventures, she said she'd write a second, stronger letter to another London teaching hospital, King's - which she did. And after the routine knockabout farce - there was a letter to me, yes, but no letter to my dentist (though they told me they have known hospitals send the same letter five times). This time I was offered an appointment, but the letter emphasised it was strictly for "assessment". "Well done!" said my dentist, and then, a touch disconcertingly, "Good luck!"
But the bureaucracy managed one last touch of surrealism. Two days before my appointment, the phone rang while I was out. My wife answered it."Is that Ian Cotton?" a metallic voice enquired - it was a machine! A machine, from King's, that rang you up pro-actively! So what to do? My wife wasn't Ian Cotton, she was my wife, and so she said so - in terror all the time that this would ruin everything. And as all the machine's other "options" proved impenetrable she eventually hung up; and when I got home later and rang the machine's office back, they'd closed.
Nevertheless, further phone calls did indeed confirm my appointment. And on the due day, almost eight months after my dentist's first diagnosis, I arrived at King's College Hospital in search of the Department of Periodontology.
"Upstairs," said a resigned-looking receptionist. The call mechanism on the lift was out, and so I walked up; the consultants' waiting room, decorated in the look known as Late High Comprehensive School (but more battered), contained another receptionist, also sad. She explained the clinicians were out to lunch. A sound of sawing came from behind temporary wooden panelling that cut off half the room, while six other patients, two in wheelchairs, sat in silence. Another patient came in, ran a finger over the seat beside me, smiled, and shrugged.
And then - these higher beings appeared: the clinical staff, back from lunch. It was another world. Spruce, smiling, the dental assistants among them swiftly ushered myself and the other patients to our consultants. Mine was Dr Mena Soory, gentle and kind-eyed, who did a detailed assessment with consummate care, passed me to an Australian radiographer, friendlier still, and then, finally, Dr Soory announced, an hour later, that I had moderate periodontal disease - and King's could treat me. I was through!
How different from all those earlier months outside. It felt as if, having fought my way through a ring-fence of fortifications - I had penetrated to this clear calm place where proper practice was still being carried on. I was once again a human being. Perhaps the key point was that the clinicians were themselves being treated, by the system, as human beings.
As the appointment wound up, I asked Dr Soory when treatment would start. "Now let me see… it could be … 18 months." She must have seen the alarm in my eyes because she added "Of course, given the delay, you might prefer to be treated locally."
"Nooooaaaah!" I nearly shrieked. "Anything but that!" It was, yet again, the nightmare vision of return-to-go. "Treat me, treat me," I beseeched, "however long it takes, please treat me!"
"All right, we'll treat you," said Dr Soory, kindly, and, indeed the confirming letter duly turned up as promised (direct to my dentist, this time ) within two weeks.
I may yet die before it actually happens, but, on paper at least - I'm in.
Reader comments
Thank you for writing this article. I have been having the same problem. Even when I called the Eastman Hospital Peridontal Department and begged to be treated privately I was told I could see them without a referral from my doctor. But they already had a referral from my doctor and I had been waiting for months. Actually, new research suggests that advanced gum decease can be life threatening as it can affect the arteries and the heart. In other words "Systemic inflamation may impair vascular function, and epidemiologic data suggests a possible link between periodontitis and cardiovascular discease. Trails showed that intensive periodontal treatment resulted in acut, short-term system inflamation and endothelial dysfunction. However, 6 months after therapy, the benefit in oral health were associated with improvement in endothelial function." I'm still looking for a private specialist and saving my pennies. The NHS does not function very well at all and it seems a false economy to wait for changes to be made while your health deteriorates.
Posted by: D Cox | 01/04/2008 17:44:03
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