Val: [00:00:00] Welcome to another episode of Stories. Labels are misconceptions. Co-hosted by me, Val Barrett, Dr Jeremy: and I'm Dr. Jeremy Anderson, 

Val: and it's a podcast where we like to share our stories, our experiences and explore solutions to the issues we face today within public services.

Val: Hi Jeremy. 

Dr Jeremy: How's your week 

Val: I've been having problems with my eyes for years. 

Dr Jeremy: Yes. 

Val: Niagara Falls, that's how my eyes are. 

Dr Jeremy: It 

Val: was getting Hospital now going to a place that specialises in eyes 

Dr Jeremy: that 

Val: You're going to get the best care

Val: That was his response. 

Dr Jeremy: Do you think it was allergies or something you're exposed to 

Val: said the best thing to do is move. He assumes I have the funds to move, or even that I want to [00:01:00] move.

Dr Jeremy: I'm trying to figure out if something about London is triggering this. 

Val: We can't move. 

Dr Jeremy: No. 

Val: You see what I mean? So I went back to my GP because since I went to see that consultant, I was at traffic lights in my car, no air con, on my eyes start streaming. As I wiped my eye, my hand moved the steering wheel. When the lights turned green, I went and I nearly smashed into this Lamborghini. And I thought, I can't even afford the key. 

Dr Jeremy: Yeah. 

Val: I went online, I think it's called consult, when you send a message to your doctors.

Val: I wrote everything down, and they made an appointment for me I said, I can't live like this. I'm having [00:02:00] accidents. It's affecting my balance. 

And 

Val: I told her what the consultant said. I said, Please don't send me back there. So she sent me to Chelsea and West, just off the road.

Val: And it was brilliant. I went in to see him after some tests and told him what happened before. I said, I just need to know, can anything be done? Can I get the plugs? There's something they can plug off in the eyes to stop the trip, but then he explained if you do that, he's going to go somewhere else.

Val: That's what I think he said. 

Dr Jeremy: Okay. 

Val: So I thought, thank God I didn't do that because I was going to go private. He looked at my list of medications. He goes, you take medication for your heart. Blood pressure, he told me which ones are contributing to my dry [00:03:00] eye.

Val: We've come up with a plan. He was nice. Understood it is affecting my life, so he said, I'm going to give you this prescription. Use it six times a day and wear your glasses. All the time. 

Dr Jeremy: Okay. 

Val: I said, okay. Thank you. He bothered to check my medication.

Val: He didn't dismiss me and think, oh, it's just dry eye. We have problems, people have problems with their hearts and whatever. It didn't dismiss me, and I went to the pharmacist, and as the pharmacist gave me the prescription, she was smiling. She said, This is good.

Val: I've been using it, and today I got a letter. He's going to follow up. I'm going back to the same clinic where I got [00:04:00] zilch from the last one. 

Val: The reason why I'm telling you this story is because we make this assumption that just because our hospital specialises in one thing, that's the absolute best it's supposed to be.

Val: But people are people. 

Dr Jeremy: Yes. 

Val: And this doctor, Chelsea West, they, as many departments. 

Dr Jeremy: Yes. 

Val: This doctor took his time. 

Dr Jeremy: Yes. 

Val: He took time to understand why it was affecting my life. He bothered to talk about my medication and explain what was contributing. To my dry eye. 

Dr Jeremy: Yes. 

Val: So that was a service I got there, which to me was really good compared to the service. I didn't get a specialised place that 00:05:00] only does eyes. 

Dr Jeremy: That's a good example of the importance of a breadth of knowledge, not just depth

Val: Exactly. 

Dr Jeremy: So, someone who knows about conditions and treatments outside one's area, you 

of 

Dr Jeremy: specialisation. He recognised, Oh, yes. This thing you're taking that isn't part of your eyes is affecting your eyes. 

Val: Exactly. He looked at my health holistically because we know certain medication might give you dry eye.

Val: Nausea, whatever, but he took the time he did his job to me. And he was really nice, 

Dr Jeremy: Fantastic. 

Val: Just made it even better. So I just thought I'd share that, people are people wherever they work. Let me quickly update you.

Val: I got it. a text. We did Ayesha's story a couple of weeks [00:06:00] ago. 

Dr Jeremy: Yeah. 

Val: She sent me texts saying she got a letter from the housing ombudsman. They sent the report, and she won against Peabody. 

Dr Jeremy: Fantastic. 

Val: Yes. They didn't want to touch the floor.

Val: Because of the asbestos, that's going to cost them a hell of a lot more. So they've decided to move her. 

Dr Jeremy: Which is exactly what you wanted, right? 

Val: Wanted, but God help the next person they put there because they're going to put someone else there. But 

Dr Jeremy: That's 

Val: Not our concern, wish her well.

Dr Jeremy: Okay. 

Val: That's the update. 

Dr Jeremy: Fantastic. 

Val: Ironic today. We're going to talk about dentistry.

Dr Jeremy: Yes. 

Val: Got toothache. 

Dr Jeremy: You have a toothache? 

Val: Got toothache. Shit. 

Dr Jeremy: Oh. 

Val: Is it in sympathy? Is it the universe telling me something? 

Dr Jeremy: I don't know. I just remember the last [00:07:00] time I had a bad toothache.

Dr Jeremy: It was when my wisdom teeth needed to come out. It, and I was brewing a good little infection in my gums. And it's absolutely miserable when you have a toothache and have to wait to see somebody. I managed to see a dentist. But they couldn't take the wisdom tooth out. They had to give me antibiotics and let the infection calm down before they could do anything. Even just a couple of days waiting to get an appointment with someone. 

Val: Didn't take out the pliers. 

Dr Jeremy: No, I'm not. I wasn't going to do anything. 

Val: Know. 

Dr Jeremy: No, there's something about tooth pain. I don't know if it's the proximity to the brain, but it's so excruciating. The pain of the nerve in your tooth is unlike any other pain. 

Val: Isn't it? 

Dr Jeremy: I remember in my training when I was doing a pain course, the instructor was explaining that someone he, a professor he worked with many years ago, who studied pain by stimulating tooth pulp, which was very [00:08:00] euphemistic way of saying pain. Like jamming into someone's tooth. He wanted to use tooth pain because he considered tooth pain to be pure pain. 

Val: That pains. 

Dr Jeremy: No, it's a kind of pain that doesn't feel like something else. If you stick your finger on a hot stove, yes, that burns, but it's it hurts? It's pain, but it's also a burning sensation. You have cold pain that feels cold and it hurts, or it feels like it's, if you cut your finger, paper cut, or something, you're feeling the sharp cut of a cut of something. 

Val: What about your toe? 

Dr Jeremy: Your toe is like this crushing pain. It's like all these kinds of pain have an adjective you can describe it with. 

Val: But haven't you noticed when you stub your toe? It takes a while to reach the brain is it because it's further away from the brain? I don't know. 

Dr Jeremy: When you stub your toe, you get two pains: an initial sharp pain, then a second later, you get the [00:09:00] throbbing, pounding, excruciating pain. And that really is because the two different nerves conduct signals at a different rate.

Dr Jeremy: But dental pain, tooth pain, it's like, it's a kind of pain where there's no adjective to say that this is just agony. That's why he studies it. 

Val: That's weird because I know you as a man will never experience labour pains. 

Dr Jeremy: No, 

Val: That's painful.

Dr Jeremy: Yeah. 

Val: I don't know when it comes into comparison with toothache with tooth pain,

Dr Jeremy: I can't. 

Val: I know you don't, but eventually, when things are sorted, the pain goes well, I don't know, in my head, I'm going back 30 odd years since I had it. I can't remember the pain. It's weird. 

Dr Jeremy: That's interesting, the way you feel you're experiencing the moment. 

Val: Yeah. 

Dr Jeremy: It's different than the way you remember something. The way human beings remember [00:10:00] things. I may have talked about this before. It's called the peak end rule. Have we talked about this before? No, 

Val: I would have remembered that 

Dr Jeremy: There was a guy named Daniel Kahneman. He's a behavioural economist, which means psychologist, but paid better. He just recently died, but he is the only psychologist who's ever won the Nobel Prize. He won a Nobel Prize for economics. In what he calls behavioral economics and what he and his co collaborator Amos Spursky did was they they studied all these kinds of cognitive biases. You hear people talk about, you're biased, and that's biased and all this kind of stuff. This is what, He focused on cognitive biases and one of the things that he is some of his collaborators and he looked at was the way people experience a thing versus how they remember a thing and what he came up with was that the way you remember something depends on two things, intensity, how good or bad it was. How did it [00:11:00] end 

Val: Because I had a baby 

Dr Jeremy: at the end, you have a baby, right? So, as you remember it later, you don't quite remember it as bad as it was. We actually neglect. How long something was 

Val: Okay. 

Dr Jeremy: How much pain you had over time is just what was the worst part 

Val: Yeah.

Dr Jeremy: How did it end? 

Val: Yeah. 

Dr Jeremy: And he illustrated that with a really funny. Study that showed how crazy it is. They studied people having colonoscopies, back in the 90s when the technology was not as small, so the procedure was quite painful.

Val: Which one's that again? 

Dr Jeremy: It's not going down your throat, it's going up the other end. 

Val: I don't, somebody might not know. 

Dr Jeremy: Yes. That's the one where you get a camera on a tube inserted up your rear end, 

Val: Really 

Dr Jeremy: Back in the nineties, it used to be a fairly painful procedure. I don't think it's pleasant now, but [00:12:00] it's actually, it was actually quite painful. One group got a normal colonoscopy and rated the pain. Beginning peak pain, which is when it's moving around and then how did it end? And they got and then they got their rating and then what they did with the experimental group they got a regular colonoscopy, but then they left the probe in for a couple extra minutes So at the end of the procedure, it hurt because it's still in there but it doesn't hurt as much because it's not moving and by giving so what they did is they had all the pain of the first group. Plus extra pain from having this procedure last two extra minutes. But it ended better. Okay. They rated the experience the same in the moment, but then when they contacted them a month later and said, How would you rate the pain? The people who got the extra chunk of pain they did it less painful than the other [00:13:00] group.

Val: OK 

Dr Jeremy: What's more, the experimental group that got this extra time and pain were more likely to show up to their follow-up colonoscopy. So it's this weird situation 

Val: Were you in that group?

Dr Jeremy: No, I wasn't I wasn't in the study. But it's this weird thing where, objectively, this experimental group, they had more pain, the pain lasted longer, but it doesn't matter because people don't pay attention to duration of the pain, only the peak and how it ends, and if you can have a better ending, then it's worth it. You remember it as less bad, and that raises the question: Do you want an experience that is less painful, or do you want to spend your whole life remembering it as more painful? 

Val: I don't want to remember it. Would you? Because you're likely to do it again. If you remember the pain like labour pains and giving birth, you're unlikely to be popping them out every minute. 

Dr Jeremy: Exactly. 

Val: It's no way. We have [00:14:00] digressed 

Dr Jeremy: Okay. 

Val: But I think you were in that group, or you're just not being honest, Dr. Jeremy. 

Dr Jeremy: No, I've never had one. No, I've turned the big five. Oh, and so I know at some point I need to have one, but I've never had one. ~So ~

Val: ~really? ~No. 

Dr Jeremy: No. I'm that age now. I'm supposed to go for it. ~So ~

Val: You should. Then come back and let us know.

Dr Jeremy: Report back. ~Yeah. ~

Val: ~Can I ~come along? 

Dr Jeremy: Ryan Reynolds filmed his, 

Val: he filmed 

Dr Jeremy: Yeah. And shared it on the internet. Not the direct video, 

Val: The noises brought it 

Dr Jeremy: A camera crew to film him getting it to promote people doing this, men, get over your fear and have it done.

Dr Jeremy: Yeah. 

Val: I haven't seen that. 

Dr Jeremy: Yeah. That was a few years ago

Val: It's men's health week coming up ~soon. ~

Dr Jeremy: Okay. 

Val: Perhaps you should take your own camera crew, you never know. I'll come along and film. 

Dr Jeremy: You're not allowed to come, why 

Val: need her. Helps with my anxiety. 

Dr Jeremy: Somehow, I think you probably don't want to be doing a lot of [00:15:00] laughing. As little movement as possible needs to happen. 

Val: Be doing the laughing. 

Dr Jeremy: Be clenching any sphincters 

Val: Please. 

Dr Jeremy: Okay. 

Val: That. 

Dr Jeremy: Okay.

Dr Jeremy: Okay. 

Val: Oh dear. Take a breather. Bloody hell.

Dr Jeremy: Yes. 

Val: When we talk about the NHS, people miss out dentistry. 

Dr Jeremy: Yes. 

Val: Do you know what I mean? They talk about everything else. 

Dr Jeremy: I hadn't thought about that, but since you mentioned this topic I was doing a bit of research My wife told me Mark Carney, the newly elected prime minister of Canada. One of the first things he did was expand Canada's healthcare plan, dentistry, to everyone. So it used to be that only the elderly and people with disabilities had access to dentistry on public healthcare. But he's rolled it out to everybody because he thinks dentistry is important. Dentistry is part of healthcare and has a huge impact on people's health. Not [00:16:00] just in terms of what you're capable of eating, right? If you're supposed to eat, I don't know, lots of nuts and fibre and stuff. Hard to do that if you have bad teeth~ yeah, ~beyond that, dental health is associated with a number of other. Illnesses and condition, including heart attacks and brain conditions 

Val: Yeah. And we know that West Streeting, in the Secretary of State for Health, has a plan to recover and reform the NHS dentistry because it is part of primary care.

Val: It doesn't really get mentioned and talked about as much as other things within primary care. 

Dr Jeremy: Course. 

Val: More dentists are opting out of the NHS. 1 in ten Londoners haven't seen a dentist in more than two years. I see my dentist a bit too much with, on friendly terms, [00:17:00] I go to all my appointments. I've been reading and doing the research on this. I suppose I'm very lucky to have one. But I've never been without one. I just haven't, so to hear that a lot of people up and down the country, postcode lottery, that always happens, so that creates a lot of health inequality, ~divide and blah, blah, blah.~

Dr Jeremy: ~I wonder, ~the numbers you have, that two-year figure of not having seen a dentist, has that changed? Do you know if that changed? Because of the lockdown or COVID 

Val: But one of the downsides is if you're not seeing your dentist, cause there's loads of things the dentist can spot.

Dr Jeremy: Yes. 

Val: Mouth cancer, oral cancer. 

Dr Jeremy: My dentist checks under the tongue for cancers. 

Val: It's not just about your teeth. Yeah. It's a whole mouth, everything. And [00:18:00] when you're not going, you don't know what you've got, sometimes people don't think about the dentist until they feel pain, that physical pain.

Val: And sometimes people don't go to the doctors until they feel physical pain. But yet you'll service your car, you'll take your car to have its MOT and everything like that. You'll pay your contents insurance. But you don't look after yourself, it's about going when you are well and looking at preventative care. We talked about that way back. 

Dr Jeremy: Yeah. 

Val: We don't do preventative care enough.

Dr Jeremy: It's like an oil change, you don't wait for the engine to seize before you realise there's something that you should have been doing with the oil.

Dr Jeremy: You just change the oil.

Val: In 2023, [00:19:00] research from the BBC and British Dental Association found that 90 per cent of dental practices across the UK. We're not accepting new adult patients, and 80 per cent were not taking children 

Dr Jeremy: Children are covered under NHS.

Val: Yes, but even adults are adults. That don't work or their income is low, right? So they weren't even accepting them. So in Wes Streeting's plan, the NHS dentist will be given a new patient payment of 15 to 50, depending on the treatment need. To treat patients who have not seen an NHS dentist in two years or more.

Val: That began in March 2024, because don't forget this report was 23. [00:20:00] And it's time-limited to end of the financial year of 2425. Yes. We haven't got the figures that, you know, how how many did they see? So that hasn't come out yet. 

Dr Jeremy: A third said they tried to extract their own teeth. And here's the thing that seems crazy to me. It says 32 per cent had tried to give themselves feelings. 

Val: Yes. 

Dr Jeremy: How do you do a whole yeah. No, I think when it comes to feelings, I'll leave it to the professionals. 

Val: I think even seeing that, my tooth, I don't know, I'm feeling weird, 

Dr Jeremy: don't know, 

Val: So we know that the funding for dental care has been falling since 2006.

Dr Jeremy: The UK spends the least on dental care services among the G7 

Val: Some Americans always make fun of British people's teeth.

Dr Jeremy: Yes, that is the stereotype around the world that British people have bad teeth. 

Val: Yeah. As of May, [00:21:00 2022 3, 000 dentists stopped providing NHS services. That's nearly 45%. And that had reduced the NHS services since the pandemic. And they said they would reduce the NHS commitment in the next 12 months. So now we're going to have a breakdown of it up and down the country. 

Dr Jeremy: Which places have the least dentists or the most dentists? 

Val: Now, West Norfolk had the fewest. They've got only 3 4 per 10,000 of the population. Bradford City came out top with 12 6. 

Dr Jeremy: Okay. 

Val: You've got North Lincolnshire at 3 4, East Riding of Yorkshire 3.

Val: [00:22:00] 6, North Staffordshire, 3. 7, South Lincolnshire 3. 8. And also in the top area under Bradford is Horsham and Mid Sussex at 9. 7, Crawley at 9. 2, Hammersmith and Fulham 8. 8, and South Teenside 8. 6. Wow. 

Dr Jeremy: Okay. 

Val: What are the options? 

Dr Jeremy: So these are all NHS dentists or just dentists generally 

Val: NHS 

Dr Jeremy: dentists.

Val: There's a lot of private, but not all dentists want to opt into the NHS because something to do with the pay the money that they get from government. I don't know, but. They're not doing that, and more and more are opting out, which is why people [00:23:00] cannot find a dentist. I remember watching the news some time ago, and a new dentist had opened, and there was a queue. Around the block. That's how much they needed that. 

Dr Jeremy: People clearly want the care. 

Val: Of course 

Dr Jeremy: They can't afford it. 

Val: And it says if there are no NHS dentists near you, you can contact dental practices outside your local area, but then that doesn't make sense, everywhere is suffering. If I didn't have one where I lived, and I went in the next borough, there's bound to be people in the next borough. They're also looking for what, do you know, do you want to mean? 

Dr Jeremy: Of course. 

Val: So it but it is something that they've got to sort out. In fact, the whole of primary care needs to be sorted out because if you don't 00:24:00] sort out things in primary care, as we talked about before, it gets moved to acute care.

Val: All it does. Problem doesn't go away, move somewhere else. That's all you're doing. So it's going to cost you more when it gets moved because then it's gotten worse. 

Dr Jeremy: Yes. 

Val: Let's have a look at private dental. So, as we know, some of them offer payment plans where you can spread the cost 

Val: So generally, private dentists offer a wider range of treatment than the NHS does, as we know. Yeah. And 

Dr Jeremy: You would expect that there's going to be newer, more expensive treatments that won't necessarily be covered by the NHS. ~Yeah. ~

Val: ~So ~NHS dentists focus on care based on clinical need.

Val: Ensuring your teeth, mouth, and gums are healthy. The main difference between NHS and private dental care is that the NHS doesn't provide cosmetic [00:25:00] treatments, 

Dr Jeremy: No, not using taxpayer money, ~no. ~

Val: ~No. ~It says if you need false teeth, crowns, or dental bridges, you can also get them as an NHS patient.

Dr Jeremy: Okay. 

Val: Yeah child need orthodontic treatment, for example, braces to straighten your teeth, these may be. Available on the NHS if you meet the relevant criteria, generally, these must be a medical need.

Val: Private dental care, wide range of treatment. We've heard of people flying out to Turkey to get so-called Turkey teeth as our guest. Alicia. Yes, the veneers and things.

Val: Veneers in Turkey, she had a few issues. These treatments can include whitening of your teeth, composite bonding. I have no idea what that means. 

Dr Jeremy: I don't know what that is. [00:26:00] I was just thinking about repairing teeth, like a broken tooth. 

Val: They do that. 

Dr Jeremy: Interesting to see that. 

Val: Yeah, I'm sure. Porcelain veneers. 

Val: And you know the invisible braces? Yes. You can't see them because they are Invisible I remember the big wire ones you can see.

Dr Jeremy: Train tracks. ~Yeah. ~

Val: ~Oh yeah. ~The train tracks. 

Dr Jeremy: Yeah. 

Val: Some people want the nice invisible ones, but that's going to be costing you, so it's, it just depends if you're willing to pay and you can afford to pay. So, things about affordability. NHS it's just about okay. I wouldn't say just basic, a bit above that, we'll take teeth out, we'll treat toothache, but if you want fancy stuff, it's private, do you want to talk about the [00:27:00] charges? 

Dr Jeremy: So there's three different bands. that reflect the complexity of the different treatments. So it says band one is routine checkups, X-rays, emergency treatment, each treatment costing 25. 80. Band two, so that's fillings, root canals, extractions, that's 70. 70. And band three, is Oh, wow. That's okay. That's 306. 80. And that includes crowns, bridges and dentures. So that's like a full replacement. 

Val: A full what? 

Dr Jeremy: Guess if you're getting dentures, that's everything, right? 

Val: Yes. 

Dr Jeremy: So it's not about repairing a tooth or taking care of the teeth. It's just getting rid of the tooth and putting something else in.

Dr Jeremy: Those are NHS dentist costs, but private dentists they can charge anything they want.

Val: Yeah. Do you have any problems with yours? 

Dr Jeremy: I go to a private dentist. 

Val: Why? 

Dr Jeremy: [00:28:00] Yeah, that was the one my wife chose, so that's where we go. It is frustrating trying to find a dentist, but

Val: Do you believe that those that obviously we do have that rule where people and people that work pay? So do you think to free up NHS dentistry, that people that work that are over that threshold that can pay for their own should only use private? 

Dr Jeremy: I can imagine a system where people pay more, but they also pay into the public system rather than a private system. 

Val: Yeah. 

Dr Jeremy: I could imagine something like that where, you know, people who can pay are actually contributing to the welfare of the overall system. If people only use the public system because they can't afford it, then who [00:29:00] pays for that? It's in taxes, but another way of doing it would be.

Dr Jeremy: To say everyone's public on the public system, people who can afford to pay more, so it doesn't cost everyone so much. So I suppose there's a few different ways you could do it. 

Val: This list surprises me. 

Dr Jeremy: Most expensive places for an initial consult. ~Yeah. ~

Val: ~Yeah. ~The most expensive Exeter. 95. Carlisle 95. Is 88. Bristol 87 Norwich 79. The cheapest ones are the ones that I'm quite surprised. Glasgow 59. Newport 64. Manchester 65.

Val: Newcastle 68, London 70. Imagine that the city, the capital [00:30:00] is cheaper than Exeter, Carlyle, Liverpool, Bristol, Norwich, where you would think that one of the most expensive places for consultation. 

Dr Jeremy: Yeah. The difference between the cheapest and the most expensive is not huge. 

Val: Huge, but I would still expect. London to be more than 70 pounds, a lot more, Oh, good grief.

Dr Jeremy: When people are in pain and taking opiate medications for a long time, and particularly certain formulations, people can have a lot more tooth decay. And so they end up losing teeth. There's something that isn't well appreciated about the kinds of medications people use when you use painkillers for a long time. People find that it will affect their teeth, and they will lose teeth. 

Val: Okay. 

Dr Jeremy: And yeah. And [00:31:00] so people, if they have an NHS dentist, yeah, they can get a tooth extracted. But not necessarily a crown replacement or denture, people end up going years with missing teeth, and it affects the shape of their face. It affects the way people talk. It affects their confidence. It affects what kind of food they can eat. 

Val: The first thing people see, the teeth aren't really, you've got missing teeth, or the people look at that. 

Dr Jeremy: Yeah, 

Val: You just don't feel good, that you don't want them done. You can't find anywhere to get them done. 

Dr Jeremy: And even if you have an NHS dentist, if a set of dentures is going to cost 308 pounds and you don't have 308 pounds, you're still not getting the work done. 

Val: Yeah. 

Dr Jeremy: And it has a huge impact on people. When you're not able to pay and you're missing teeth, it affects your quality of life in many ways. People who really are not able to pay [00:32:00] should have a full set of teeth, you should be able to have enough teeth to eat and not be disfigured by a lack of teeth 

Val: But I remember, you didn't grow up here, you didn't go to school here. We used to have. School nurse who used to have the dentist come in, 

Dr Jeremy: We had the same thing in Canada.

Val: Okay. 

Dr Jeremy: Yep. 

Val: Because 27,000 children in England were waiting for specialist dental care January 2023. 

Dr Jeremy: Yeah. Oh, 

Val: Wow. In Cornwall, 857 children had been referred. A specialist dental treatment with an average weight of 12 weeks, often leaving them in agonising pain for months.

Dr Jeremy: Who wants to 

Val: See their child in pain? 

Dr Jeremy: Yeah. Tooth pain is excruciating, and if you're being left in [00:33:00] pain because there isn't enough care available that people can afford. That's clearly a problem, right? 

Val: One of the main issues was the newest NHS dental was 160 miles away, a round trip of at least eight hours. That just doesn't make sense. 160 miles, mine's practically next door. 

Dr Jeremy: Yeah. 

Val: It's when I come out my home, there's five dentists, I'm not sure if all of them are NHS, just the one I go to, and I have five hospitals, five 

Dr Jeremy: In close proximity to where you live.

Dr Jeremy: Yeah. 

Val: Yeah. 

Dr Jeremy: Yeah. 

Val: And the area where I live, I admit 

Dr Jeremy: the 

Val: I'm central to a lot of things. My pharmacy. Is across the road open till 12 at night, every day of the 00:34:00] year, 

Dr Jeremy: It's different in rural communities, yes. 

Val: All rural some towns. I'm not having dentists for miles and miles,

Dr Jeremy: I grew up in Northern Canada. The capital city of Yukon territory, and we had dentists, but we did not have any orthodontists. So what we had was a travelling orthodontist. 

Val: What is the difference? 

Dr Jeremy: Orthodontist straightens teeth, is the guy who braces on the teeth. So the orthodontist would travel to multiple towns throughout the north and would be in town once every six weeks. That was the capital city of the territory. And didn't have a single resident orthodontist at the time. But I think there is a huge need, and if we reflect on Mark Carney is offering dentistry on the public health system for everybody. So I think that kind of thing needs to be available. [00:35:00] In the UK 

Val: But we can say that about a lot of things in primary care. Today I heard something on the news. Somewhere was cutting back on palliative care, which conflicts with the fact that we're talking about assisted dying, do you know what I mean?

Dr Jeremy: Yes. 

Val: One thing or the other. 

Dr Jeremy: I heard the NHS in England is talking about cutting 

Val: back on 

Dr Jeremy: services, including palliative care and talking therapies 

Val: Yes. 

Dr Jeremy: Which I found strange because both of those. Can't be huge. These are not pits you throw money into, right?

Dr Jeremy: That they don't cost very much, right? Talking therapies is a fairly cheap way of reaching person to person. A lot of talking therapies. Are low-paid individuals. Not speciality consultants. Offering groups and working phone lines, they're often at an earlier stage of training. And [00:36:00] so they're being paid a relatively small wage for what they're doing. And when you think about the cost of other areas of medicine,e, duct therapies, have a massive impact on people's lives, but don't cost much. So I'm not sure why they think they're going to save a lot of money with that. 

Val: Like we said, it will just move somewhere else. And this is the thing. I saw something written, and I can't remember where, but I wrote it down. It says poverty costs money and displaces costs onto other services.

Dr Jeremy: Yes. 

Val: Like the NHS, meaning that the cuts to social security. May achieve 2 per cent of their planned savings, but it goes somewhere else. 

Dr Jeremy: Exactly. 

Val: So a department in isolation might achieve their target at [00:37:00] the consequence of going somewhere else. 

Dr Jeremy: If you closed a mental health ward, you've saved that budget.

Dr Jeremy: But the people who were there, if they need care and they're not getting it, where are they showing up? They're showing up in A& Es now, right? 

Val: Do you know how much it is for the mental health budget the government spends a year? 

Dr Jeremy: I don't know.

Val: Shall I give you a quiz? 

Dr Jeremy: Quiz me or enlighten me. 

Val: Is it 100 billion? No. 200 billion or 300 billion a year, 

Dr Jeremy: I'm going to say a billion 

Val: is 300 billion. You lose ~again, ~

Dr Jeremy: ~300 billion. ~So they pay 300 billion on mental health care, 

Val: mental illness, cost, 

Dr Jeremy: mental illness, cost. 

Val: It's 300 billion a year.

Dr Jeremy: So, is that 300 billion going to mental health services or 

Val: costs 

Dr Jeremy: [00:38:00] to other services when it's not made 

Val: I can't be 100 per cent sure. It's just to do with mental illness, whether it's a service that delivers care. It wasn't specific because I was looking at the breakdown of costs.

Dr Jeremy: It would be interesting because those figures of estimated costs include disability claims. For mental health. If someone's not able to work and that's costing an insurance company or the benefit system, if they're drawing benefits rather than a salary and not paying taxes, all that goes into the figure. But that doesn't mean the government is spending that money on treating people. 

Val: But there again, if your toothache is really bad, and your child's is really bad. And you couldn't get. Any dental care, wouldn't you go to A&E? 

Dr Jeremy: I think that's all you 00:39:00] could do.

Dr Jeremy: Short of pulling out the pliers and using it yourself. I wouldn't recommend. 

Val: No, I wouldn't. So you know the cost of A& E. So that's between 137 to 445. A visit 

Dr Jeremy: that'd 

Val: be cheaper 

Dr Jeremy: to have an NHS dentist. 

Val: Exactly. They do have dental care in hospitals. 

Dr Jeremy: Yes. 

Val: So, if you can imagine a child might stay the night, the cost of hospital is 536 pounds to 935 pounds.

Val: Think that's the bed cost, double check, but yeah, it is a huge cost. They said the biggest drain on the NHS is drugs. 

Dr Jeremy: Cost of drugs. 

Val: We talked about that. Last week? We talked about paracetamol. 

Dr Jeremy: Yes. You talked about them [00:40:00] spending lots of money.

Val: Stop prescribing that! 

Dr Jeremy: Stop 

Val: The last government spent 240 million on Rwanda. I think three people went. Our governments waste a lot of money, it's all well and good them saying they're going to cut for us, the people, we're the ones that suffer the cuts, but they need to also look at their. They, I'm sure that they are probably doing that, but to allow GPs to continually write prescriptions for those drugs that should have stopped in 2008 and 18. And it's continuing. That says a lot, everyone's got their part to play. And I think the government need to lead by 00:41:00] example. Do they have a freeze on their pay? Are they rejecting the last offer? What are they doing? A lot of them have more than one job. 

Dr Jeremy: Yeah. 

Val: Because it's easier once you've got food on your plate, other people come, want more food, get more food, they get more offers of work because some news channel think, yes, I've got an MP on our show. So it's easier for them to get loads and loads of jobs. So you do have that inequality of opportunity, so how are they to understand? It's like when you don't have any opportunity, if you haven't worked for a long time, who's going to employ you? It's easier to leave one job on a Monday and walk into another at the end of the week than to have been off work for 10 years for whatever reason. And find it hard to get into work [00:42:00] skills, everything changes in those years, technology has changed. 

Dr Jeremy: Yes, 

Val: The way we do things is completely changed, so they've got to upskill, instead of giving everybody a stick or starving people to death. For them to get up and go and work, you need to offer something, they really do. They need to be kinder. 

Dr Jeremy: Yes. 

Val: Because I don't believe anybody says to themselves, I want my life to be really shit. I want to be poor. I love poverty. I love the inequalities. I really don't think anybody is saying that to themselves.

Dr Jeremy: No, I think we've talked about this before. When people have a condition or a disability, or their level of disability is fluctuating, they get some secure benefits. And the one thing you don't want is 00:43:00] for those benefits to be at risk.

Dr Jeremy: If the government wants to entice people into looking for work or becoming more productive, they have to be able to do that. In a way that doesn't put them at risk, it can't be that just trying out for a job means you're deemed to be able to work. And so we're going to cut you off like that.

Dr Jeremy: Can't be the way it works. And so as long as it's like that, no one's going to be willing to. To take a chance. 

Dr Jeremy: I did hear about a program recently. I'll have to look into it. A colleague was looking into it. A new scheme where the government is trying to help people get into some form of work without risking their benefits, or at least that's the claim. I'll have to look into that. 

Val: Yeah. 

Dr Jeremy: We can talk about that on a future episode. 

Val: I know there are different schemes in different parts of the country. 

Dr Jeremy: Yes. 

Val: It depends if it's successful, they might roll it out, I've heard of a [00:44:00] scheme in the Midlands where people are trying self-employment and it's not affecting their benefits.

Dr Jeremy: Exactly. 

Val: So there are different schemes depending on where you live. Perhaps they should be radical and say, high costs of living, people need to eat better, Exercise. Take care of themselves, you have to be able to afford that.

Val: So perhaps they need to look across all departments, at where the displaced money is going. If we don't take care of X, Y, Z in primary care at cost, say 50. When it goes to A&E, it's costing us 250 and then from A&E into the ward, it's costing another couple of thousand pounds. Do you see what I mean? So instead of all that, [00:45:00] why don't we uplift the benefits? 

Dr Jeremy: Yeah. 

Val: Just say, it's going to sound weird, and people are going to think, you shouldn't get it. I don't know, but the way things are, people are getting more into debt, not turning their heating on, there's a cost, and it's always the elderly and the vulnerable. 

Dr Jeremy: And it contributes to 

Val: cost. 

Dr Jeremy: Yeah. And once again, it contributes to the damp and mould. Yeah. Properties. So it just contributes to the higher maintenance costs. 

Val: Yeah. But I don't know when they meet, everything is discussed in department, and everyone has their own budgets.

Val: Maybe people from Britain in those budgets, 

Dr Jeremy: But don't 

Val: live in budget. 

Dr Jeremy: No. 

Val: If you have a disability, your life is going to be reflected throughout social care, [00:46:00] education, benefits, whatever, transport. So your life is going to fall into a lot of departments. We don't live. Structurally, we don't live in one labelled box, if you don't give us that box, we're going to cost you another two boxes. 

Dr Jeremy: Yes. 

Val: Or three. 

Dr Jeremy: Yes. And just bringing it back to Mark Carney, I can't say he's done that analysis, but we know he's a banker. He was the governor of the Bank of Canada and England. I think he's got to see the value in giving people, and I'm sure it's for the reasons we're aligning here where, there there's a short-term cost, but a much bigger long-term gain and maybe England can take a page out of our Carney's book. 

Val: Looking at the money now on Monday, it might cost you a thousand pounds. But you will get that back [00:47:00] eventually down the road. So instead of paying that thousand, that spending that thousand pounds, you want to get away with spending 300 pounds because you're looking at the cost now. But then down the road. It's going to cost you triple because you don't want to spend that now; they've got to look more long-term.

Val: I don't know how they come to these things. I don't work in government. I could be talking a load of shit. I suppose it's easy to say, then perhaps do it, but it can be easy to just do it. Just bloody do it. Apply some common sense. I don't know. 

Dr Jeremy: Yeah.

Val: Let's do it. You want to get people back working. What do they really need to get themselves to work? What do they need? Are you telling us what we need, or are we telling you? What we need, 

Val: I don't know if you put the world to rights today, but[00:48:00] 

Val: It's a start.

Val: Do you want to do? Stories, labels, conceptions, episode, 

Dr Jeremy: Do it for the last one. We didn't do much of a personal story today. 

Val: Look at dentistry. That was our main story. 

Dr Jeremy: We 

Val: Stay on that theme, the main story is. There's not enough NHS dentists.

Val: Yeah, I suppose so. What would your label be? 

Dr Jeremy: The notion of cost-cutting is a label, but as we've said, certain kinds of costs that if you cut them now in the short term, you're not cutting costs because they come back to cost you more later.

Dr Jeremy: There's a misconception that by cutting costs now, you're saving, but you're actually not. You're just kicking it down the road 

Val: and so 

Dr Jeremy: That's the main thrust of today's episode ~for me. ~

Val: ~Yeah. ~I agree with that.

Val: They probably [00:49:00] see it as a luxury. That's another label. Only the wealthy. 

Dr Jeremy: That's another misconception that this is all just wasteful. A perk, a luxury.

Dr Jeremy: When it's really not, this is basic care. ~But there again, as we ~

Val: ~talked, that care, ~it can result in somebody having mouth cancer. Yeah. Therefore, they'd have to have treatment on the NHS. And the sooner they catch it, the better the outcome is. Yeah, exactly. I think the day dental care as not that as important as other care within primary care services.

Dr Jeremy: Okay. 

Val: Thinking that way. 

Dr Jeremy: Yeah. That's a great wrap-up up Val. We'll end there. In future episodes, I'm hoping to entice someone I know who does animal research to talk about how we develop medications 

Val (2): medications 

Dr Jeremy: They test on animals before human trials. I think it makes sense if [00:50:00 you're. If you're trying to, I don't know if you, if your drug is to help someone lose weight, and you inject a rat with a drug and it loses weight. That's pretty objective.

Dr Jeremy: That's obvious. It's easy to measure, but if the medication is to help something like depression or anxiety or pain or, subjective experience that someone's having, I don't know how you test those on rats or guinea pigs I. I don't know how you do that. So it would be interesting to talk to someone and say, What do they do? So I'm talking to this person, or I'll try to get them to come on.

Val: If you've listened this far, leave us a review. ~You must ~

Dr Jeremy: ~like it. So please ~leave a review, subscribe, 

Val: and follow us wherever you get your podcasts.

Val: See you next week. 

Dr Jeremy: See you next week. 

Val: Bye. 

Dr Jeremy: Bye