Sir, There is significant focus on the hospital service, given the industrial action taking place for hospital-based dental trainees and consultants within England.

The picture amongst our members is of a group who have endured real terms pay cuts for over a decade and have worked through the COVID-19 pandemic, facing a significant backlog of patients requiring urgent care. A combination of difficulties in recruitment (where for some specialty dental core training (DCT) posts we are seeing vacancies of over 20%) in addition to the significant pressures on consultant and staff and associate hospital dentists has led to a workforce whose morale is quite low.

Earlier this year the CCHDS had a win on pay for trainees. This was a fantastic achievement by the CCHDS and is a testament to the hard work of consecutive committees over the past few years. NHS Employers have informed us of an agreement that nodal point 5 will apply from ST4/ST5 for dental training pathways, as equivalent to ST6/ST7 for medical pathways, from 1 April 2022. This will result in a direct financial benefit for hospital dental trainees in England worth approximately £14,000 over two years (approximately £7,000 per annum).

The recruitment of ST4 trainees is a perennial problem for the teams running national recruitment. Whilst we would hope that the outcome of the industrial action will secure better terms and salaries to make these positions more attractive and viable in the long term, the extra £14,000 that we have secured for senior trainees will hopefully go a long way.

We are, of course, continuing with our pressure on NHS Employers and NHS England to return this benefit to all ST4/5 trainees who should have benefited from Nodal Point 5. The position of CCHDS remains that a significant error, dating back to 2020 when the 5th nodal point was introduced into the Junior Doctor contract, has been accepted by the employer side and therefore the backdating should apply right back to its inception.

However, the landscape we find today has one, large shadow. It would be remiss not to mention the impact that the pandemic had on the mental health and wellbeing of doctors and dentists working in the hospital services. We had a lot of members who were drafted into ICU and made significant and valued contributions to their respective Trusts‘ efforts to deal with the impact of COVID-19.

Following the pandemic, there was improved team spirit and camaraderie amongst colleagues working together to get through that challenging time. However, wave after wave of infections, alongside the realisation of the huge backlog that was facing us made those gains drop off after time. It was difficult to ‘move forwards' when there was pressure from endless waiting times. Whilst positives such as hybrid working have helped improve the work-life balance of those working in the hospital service, the further erosion of salaries could not have come at a worse time for our members who are also, like others, experiencing the impact of the current costs of the living crisis.

Allied to this, there is constant management pressure to count referrals and clinical activity, losing sight of quality of care, which is demoralising for clinicians. Previous CCHDS surveys of members have shown morale to be low. The staff morale SAS grades is lower than that of primary care dentists, with feelings that they are undervalued and their voices are not heard. Experienced clinicians could be lost due to early retirement, which would impact on the ability to deliver services and also impact the workforce available to train the next generation of hospital dentists.

As mentioned above, we have somewhat of a perfect storm that has led to balloting within Scotland and industrial action across the English hospital service. However, all those taking part in strike action are united in the hope that we can achieve fairer working conditions and salaries in order to secure a NHS that is fit to meet the demands of the future.

Unfortunately, we feel that repeated rounds of industrial action may continue into 2024. The BDA will continue to stand with the BMA in supporting members through this. We can only hope that an upcoming election and the hammering that Rishi Sunak's plan to ‘cut NHS waiting lists' is taking will result in the government taking a more sensible attitude to trade union negotiations. As can be seen from the success our trainees had with the Scottish government, if you make it a priority to ensure that the NHS is robust for the future, then compromises can be reached that allow us to continue to provide the best possible service for our patients.

Despite the issues that the hospital workforce is facing, those working within secondary care dental services are passionate about the work they do and strive to deliver the highest standards of care for the patients. Alongside clinical duties, there is continued delivery of teaching and training, which is a fundamental role of hospital dentists and is a key reason we enjoy our roles.

The CCHDS will continue to deliver educational events next year, including the highly successful careers webinar series, annual study day and contributing to the BDA careers guide for dental students and recently qualified dentists. We hope that we will inspire a new generation to pursue a career in the hospital dental services.