NHS dental payment reform: equality impact assessment record

Stage 1: Framing

Results of framing exercise

The framing exercise has identified a number of potential impacts on the protected characteristics.

Age - Evidence shows that prevalence of natural teeth reduces with age and therefore older people are more likely to be impacted by the increased costs given that they are more likely to require laboratory based treatments such as dentures. Although younger people are more likely to be in relative poverty and earn less than the living wage compared to older adults, those aged under 26 years of age will not be affected by the increased costs as they will continue to receive free dental treatment. There will no longer be a distinction between children and adults in the new system and therefore all patients, regardless of age, will have access to the same range of treatment.

Disability – Patients with learning disabilities may experience a positive effect of the new policy given that the new system will be simplified and easier for patients to understand. However, disabled people may be impacted by the increased costs to a greater extent compared to non-disabled people given that evidence has shown that poverty and unemployment rates are higher for those who are disabled. Furthermore, patients with mental health disorders are less likely to regularly visit the dentist and maintain their oral health which can lead to periodontal disease. Patients in this category will therefore require more dental treatment and will be impacted by the increased costs to a greater extent.

Sex – There are minimal impacts of the new policy on sex. However, evidence shows that women are less likely to be in full time employment and therefore may be impacted by a greater extent to the increased costs compared to men given that they are less likely to be on a full time salary.

Gender Reassignment – No impacts identified.

Sexual Orientation – Poverty rates have been consistently higher for LGB+ adults compared to straight/heterosexual adults, and they are also more likely to live in the most deprived areas. Therefore LGB+ patients may be affected by the increased costs to a greater extent than straight/heterosexual adults.

Race – Patients with difficulties speaking English will continue to have access to a translator and the simplified system will be easier for translators to explain and for the patients to understand. Furthermore, Gypsy/Traveller patients who may be less likely to be registered with a dentist, will now be able to access the full range of treatment items given that there will no longer be a distinction between registered and unregistered patients. Additionally, evidence has shown that oral health was better among non-White groups and therefore ethnic minority groups may be less impacted by the increased costs given that they will require less treatment. However, unemployment and poverty rates are higher for ethnic minorities and therefore they will be affected by the increased costs to a greater extent compared to white people when treatment is required.

Religion or Belief – As Muslims are the most likely religion to be in poverty, live in deprived areas and also have the lowest employment rate, they may be impacted by a greater extent to the increased costs compared to other religions.

Pregnancy and Maternity – Patients who are pregnant or have given birth in the last 12 months will continue to receive free NHS dental treatment. There will no longer be a prior approval requirement for this group to receive composite fillings and therefore patients in this group will receive this type of treatment sooner than they are currently able to.

Socio-Economic Status - People from deprived areas are more likely to have decayed teeth, poor oral hygiene and higher levels of periodontal disease and are therefore more likely to require dental treatment compared to those living in less deprived areas. Therefore patients in this category will be affected by the increased costs to a greater extent. Furthermore, patients living in the lowest SIMD areas are more likely to have no (or less) natural teeth compared with people living in the least deprived areas, and will therefore be impacted by the increased cost of laboratory based items (such as dentures) to a greater extent.

Extent/Level of EQIA required

Whilst the new policy will help to improve oral health, the increased cost of dental treatment will be experienced by all patients who pay for their dental treatment during a cost of living crisis. This may affect patients with protected characteristics to a greater extent compared to the general population.

Given the concerns around the increased costs, evidence was gathered from Public Health Scotland colleagues to gain a greater understanding on the impact of patients in lower socio-economic groups.

Therefore we have included a comprehensive review of the impact on the protected characteristics as described below.