Emergency! Who You Gonna Call?

On Pain, Dentists, and the Death of Solidarity

Many years ago, I went to a martial arts class in New York where the sensei, at the end of a hard session, would have us running round the room chanting ‘What is pain? A state of mind, sensei!’ over and over again. It felt vaguely ridiculous, but I tried to embrace the idea, because it was appealing for a young man to believe that there was no pain that couldn’t be overcome if you put your mind to it.

I didn’t fully appreciate that our sensei was evoking a tradition, common to many philosophies, religions, and sports, which believes that physical pain is a kind of choice.

As Marcus Aurelius puts it, ‘If you are distressed by anything external, the pain is not due to the thing itself, but to your estimate of it; and this you have the power to revoke at any moment.’ Most Tour de France riders and marathon runners will have attempted to put this philosophy into practice, regardless of whether they have read the Stoics. But there are moments when pain cannot be ignored, either because the pain is too strong or the mind is just too weak.

Two weeks ago, I developed a vicious wisdom tooth infection for the second time in a month. The first time it came on during a Bank Holiday, and of course there was no emergency appointment available. I managed to keep it to a bearable level through painkillers, before getting an appointment with my local dentist on the Tuesday, where I am an NHS patient.

That morning the dentist tried and failed to extract the tooth, even after four injections. Finally, after much fruitless wrenching and pulling, he prescribed a course of antibiotics instead.

The antibiotics worked for a couple of weeks, enabling me to go on holiday. But then the pain came back, moving inexorably from ‘sensitivity’ to the kind of full-on, writhing-on-the-ground, Marathon Man, hot-needle-in-the-jaw pain that makes you want to howl and bang your head against a wall.

By Sunday the pain had become the ‘unshareable’ physical pain that Elaine Scarry writes about in The Body in Pain, which ‘does not simply resist language but actively destroys it’, and ‘unmakes’ the world in the process.

In short, it wasn’t something the Stoics could help with, and a cocktail of painkillers had no effect either. And so for the second time in a month, I rang the NHS helpline on a Sunday, desperate for deliverance, and tried to get a dental appointment in Sheffield. As on the previous occasion, there were none available, unless I wanted to go to Grimsby.

Nothing against Grimsby, but it is more than an hour away, and there was no guarantee that whoever was there could do anything about it.

Instead - and this is the point of this mournful tale - I did something I’ve never done before, and decided to go to a private dentist. As soon as I made that decision I discovered that my options were almost limitless. I chose the nearest practice, just around the corner, and three hours later, the tooth was expertly extracted. Within minutes my mind returned to my body, and even the thought of the three hundred pounds I had just forked out was not enough to spoil my relief.

Nevertheless, as Marcus Aurelius insisted, pain can be instructive. And as I walked home, I couldn’t help wondering what other people do if they find themselves in the same situation, and don’t have enough money to buy their way out of it.

The late socialist and GP David Widgery often wrote powerfully and movingly about the NHS, and I remember a piece that he wrote many years ago in which he described an NHS operating theatre as part of a web of solidarity that connected millions of strangers together - a web carefully and intentionally constructed for precisely that purpose.

I hadn’t thought of the NHS like that before, but over the years I have learned that Widgery is absolutely right. The NHS did not come into existence by chance, but because a political and also a moral decision was taken, with a fundamental principle at its core: that high quality health care should not be available only to those who could afford to pay for it.

This was why ‘disease’ was defined as one of the five ‘Giant Evils’ which the advisory panel on Home Affairs on Reconstruction presented to the coalition government in 1942. As the report put it:

Attack on disease is a matter of prevention; second of cure. Prevention, beginning with health services in the narrow sense, spreads outwards into the problem of sanitation, housing, nutrition and local government. As to cure, opinion both public and professional, is probably ripe for a general re-organisation of the medical service of the community- so as to ensure that the best science of the community- so as to ensure that the best that science can do is available for the treatment of every citizen at home and in institutions, irrespective of his personal means. There are practical difficulties and sectional interests to be overcome in this field as in dealing with want, but no fundamental political issues.

Today that web of solidarity has become badly-frayed, despite the heroic response of the NHS to the pandemic. Long waiting lists; understaffed wards; difficulty in getting GP appointments; an overstretched ambulance service - all these outcomes are part of a crisis that is undermining the core achievement of the post-war welfare state, to the point when more and more people are turning to private healthcare, while those who can’t afford to do that must wait, suffer, and sometimes die.

There are many reasons for this: Tory governments first of all; Brexit; lack of investment; poor pay and terms of service; changes in demographics and health care needs - take your pick. But the worse things get, the more likely it is that there will be someone or some company looking to make money out of it, and that, rather than any notion of human solidarity, will be their main aim.

A Dental Dystopia

Other countries have functioned like this for a long time, but what is maddening about our collective descent into healthcare dystopia is that we once had systems that worked relatively well, and they have been deliberately run down, and we haven’t been able to stop it.

Which brings us back to dentistry. Because you might think that teeth are boring to think about, let alone write about, but nearly all of us will need dental care at some point in our lives, and it is becoming increasingly difficult to get and increasingly expensive, even if you can.

The statistics tell the story: less than half of children in the UK saw a dentist last year; 91 percent of NHS practices are not accepting new adult patients, rising to 97 and 98 percent in some parts of the country; 79 percent are not accepting new child patients.

Why is this happening? Some of the reasons are common to the NHS in general: a crisis in recruitment; poor staff morale and falling staff retention.

Brexit - no surprise here - has also negatively impacted British dentistry in various ways, from the lack of mutual qualifications recognition agreements, to the fall in the numbers of EU dentists who previously kept UK dentistry afloat.

The result of all this is that there aren’t enough dentists to meet demand, and according to the British Dental Association last year, some 75 percent of dentists are planning to reduce their NHS workload, while 65 percent of practices still have vacancies.

The BDA attributes the crisis to ‘ a discredited NHS contract, which funds care for barely half the population and puts government targets ahead of patient care.’ The BDA is calling for an additional £880 million a year simply to restore funding to what it was in 2010 - note that date, because you know what happened then.

This, in short, is why I couldn’t get an appointment, and why you probably won’t get one either, if you find yourself in the same position. We haven’t reached that tipping point when people turn to private insurance packages as the only way to access dental care and/or healthcare, but we may not be that far away from it.

Many people will not be able to do this, and if they end with an infected tooth like the one I had, they will be forced to follow my former sensei’s advice, and declare pain a state of mind. Or perhaps they will have to seek the treatment in the picture that illustrates this piece.

Because slowly, but inexorably, the UK is slipping back to an era that existed before Beveridge and the advent of the ‘enabling state’, before Widgery’s web of solidarity was created, when those without money were abandoned to their fate or forced to seek what help they could get from charity.

None of this needed to happen. And the fact that it is happening is due as much to political choices as the creation of the NHS itself.

Our new generation of ‘proud British’ nationalists routinely urge us to take pride in our country and our sovereignty. But how can you be proud of a country in which you better not get sick, or old, or lose your job, or get toothache?

And what is the use of sovereignty, if you find yourself in an emergency with l no one to help you, except the voice at the end of the helpline, who most likely will not be able to offer any help at all?