Oral Healthcare in England: Workforce Perspectives and Public Priorities

Abstract

The oral healthcare system in England comprises of the National Health Service (NHS), offering a variety of services accessible to everyone, and a private sector. However, persistent oral health inequalities and issues regarding accessibility of NHS dental appointments suggest a system performing sub-optimally. This thesis investigates the factors which influence dental professionals’ decisions about where to work, and patients’ views and priorities for NHS dentistry. Chapters 4 and 5 present data from qualitative interviews held with dental professionals (n=17) and the general public (n=20), analysed using a framework approach. The evidence presented demonstrates a range of push and pull factors which influence where dental professionals provide labour, highlighting the ideological commitment to the NHS, but that the working conditions detract from patient-centred care. The findings from the public interviews demonstrate a variety of interpretations of oral health and clinically necessary treatment under the NHS. The private sector was discussed as supplementary, but raised equity concerns. Chapters 6 introduces a preference elicitation exercise (a Benefit Trade-Off, or BTO) to establish if members of the general public (n=1,688) are willing to sacrifice efficiency (larger oral health gains) to reduce oral health inequalities. A series of methodological investigations follow in Chapter 7. The results from the BTO indicate that inequality aversion is low, meaning that maximising oral health is prioritised relative to reducing inequalities for most. The methodological results show that how the scenarios are presented can impact the result. This thesis offers significant contributions to our understanding of NHS dentistry. The qualitative studies identify key factors which drive the workforce and presents public desires for oral health under the NHS. The BTO provides the first insight into inequality aversion in oral health globally. Future policies need to reflect the diversity of perspectives and be underpinned by sustainable approaches to improving oral health.