Plus ça change...

Posted by Dr Henry Clover on 26/07/2018
Cabinet minutes

I must confess to a penchant for little-known facts. Keeping this relatively on topic, take dental floss, for example – the secret weapon of toxophilites to establish nocking points. More unusually, while Tim Robbins used a combination of Raquel Welch and a rock hammer to aid his escape from Shawshank, a certain inmate in a West Virginian penitentiary in 1994 obviously had too much time and too much floss on his hands. He braided this oral hygiene aid into a rope, scaled the perimeter wall and literally slid away. History does not record whether the raw material was waxed or unwaxed, although the former would have been, from a friction perspective, much more comfortable.

Only very recently I learned of another dentally related fact that gives us real insight into government  thinking in the very earliest years of the NHS – and I am indebted to my good colleague Roger Matthews for sharing the labours of his detective work. Cabinet Minutes are subject to the ‘thirty year rule’ before being released to the publically available National Archive. So, if you have time and patience, you too could unearth the above snippet, penned by none other than Aneurin Bevan, Minister for Health, on 23rd May 1949.

Let me decipher; it reads: ‘Dentists – soured public opinion by {their} behaviour. Couldn’t have got their co-operation at lower fees. Allowed them to misbehave to get atmosphere for cut – now cutting 40% net from 1st June.’

So dentists at the time had just eight days’ notice of this draconian fee cut. Let’s put this into context; dentists earned around £1,000 in 1948, before the inception of the NHS. In that year the Spens Committee set the projected income for NHS dentists at around £1,778 for a 33 hour week – or £66,179 in today’s money. So it was an attractive proposition. However, with the ‘backlog’ of unmet demand, principally in the form of F/F dentures, dentists simply worked longer hours. By January 1949 – some six months into the new system – many dentists had exceeded an income of £4,800 per annum – or £178,600 today. So, in February of that year, any fees earned above £400 per month were cut by 50%. Then Bevan’s across the board 40% fee cut came just four months later. 

Hansard, on 19th January 1949, records that Bevan’s parliamentary secretary told the House: “At the
outset, there was no suggestion that a full dental service could be provided in this country at the beginning of this dental service scheme”. 

Roll the clock forwards nearly 70 years. Tension between the profession and the paymasters. Attempted control over colleagues running independent businesses. Budgetary constraints and the risk to clinical care. 

Perhaps nothing much has changed after all.

Around the time the NHS started, Dr Charles C Bass invented modern nylon floss to replace its silk forbear. With the NHS funding some 33 million sets of dentures in the first nine months alone, perhaps a modern denture cleaner might have been a better business venture.