The British Dental Association’s leader has accused homeless people of being “no-hopers” and suggested it was sometimes acceptable to deny them treatment.

In leaked emails seen by the Guardian, Mick Armstrong, who chairs the BDA, said many practitioners were wary of taking on homeless patients.

“These are difficult patients who rarely complete a course of treatment and attend irregularly if at all,” he wrote to a colleague. “If we took in all the no-hopers who ring us ... I suspect we’d miss our targets by a country mile.”

Armstrong told the Guardian he regretted his choice of words and said he was frustrated by contracts that made it hard for dentists to treat vulnerable groups.

Many homeless people suffer poor dental health as a result of being unable to access treatment. Armstrong blamed the NHS dental contract, discredited among the profession, for penalising dentists who spent long periods of time on high-needs patients and therefore missed end-of-year activity targets and faced financial sanctions.



His email was mistakenly copied to the Labour MP Stella Creasy, who had previously written to the association to warn that many homeless people had “hit a brick wall” when they tried to access dental services.

Facebook Twitter Pinterest Mick Armstrong, the chair of the British Dental Association, said in a leaked email that homeless people rarely completed a course of treatment. Photograph: Jonathan Cole

She highlighted a recent study that showed one in six homeless people had pulled out their own teeth because they could not access dental services.

After he was challenged by the MP, Armstrong stood by his remarks. In a later email to Creasy, he wrote: “Irrespective of the terminology, the BDA have been battling for 10 years to allow us to direct resources to those most in need without fear of paying through the nose in clawback when we do this.

“No one understands the difficulties these patients have with oral health better than [us] and are all too aware of the impact on their general self-esteem, well-being and social mobility.

“The majority of these [vulnerable patients] need many appointments and are extremely time-consuming and frankly exhausting to treat ... These patients are immensely challenging and inexperienced colleagues are wary of those challenges being problematic in regulatory and contractual terms.”

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In another email, he said: “The difference in remuneration received mitigates against the ‘desirability’ of taking these patients on, on a financial basis... but we still do it. There has to be a positive incentive to provide such patients with treatment ... they deserve it.”

Creasy said: “To say I was shocked to hear any group of patients be described as ‘no-hopers’, let alone it acceptable to restrict their service access as a result, is an understatement. Homeless people are some of the most vulnerable residents in our communities and getting them registered so they can have checkups to prevent poor dental care is vital to protecting their health.”

The widely discredited target-driven 2006 NHS dental contract provides funding for just over half the English population. High street NHS dentists face significant barriers in treating homeless patients because, for example, they are required to provide the NHS with an address for a patient.

BDA surveys of NHS dentists have shown that 93% say chasing government targets is limiting their ability to care for high-needs patients, who require complex or repeat treatment.

The BDA has called for funding of dental appointment slots, especially for homeless people, which once booked would be funded whether patients attend or not. This would mean dentists attempting to treat these groups were not penalised. It also wants changes to NHS forms to enable a dentist to be paid for delivering treatment when the patient does not have an address and mobile services to proactively reach out to vulnerable people.

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A 2017 study by the homeless charity Groundswell found 15% of homeless people had been forced to pull out their own teeth; 70% reported having lost teeth since they had been homeless; 17% said they had lost teeth following acts of violence and 7% had no remaining teeth.

Responding to the Guardian, Armstrong said: “I regret the intemperate wording I used in my exchange with Stella Creasy. The language was inappropriate but born of the frustration that all NHS dentists in England feel working under a contract that’s decisively failed both patients and practitioners.

“I work as an NHS dentist near Wakefield and, like many colleagues, I treat homeless patients, but it is not easy under the current contract. The NHS effectively caps the number of patients we can treat and fails to cater for those most in need. Dentists are desperate for a system that will allow them to put their patients first.

“The BDA has long championed vulnerable patients, and has argued to ensure that they have access to services that are really tailored to their needs. Sadly, any headway seems impossible under the existing contract. We are still waiting for ministers to honour their pledges, and put an end to a system that puts government tick boxes and targets ahead of patient care.”

The Department of Health declined to comment. However, at health questions in the Commons last month, Jackie Doyle-Price, the health minister for vulnerable groups, said: “Notwithstanding our expectations of GPs and dentists in this regard, it is quite clear that homeless people do not always have access to the treatment they should have.”