IMPROVING DENTAL CARE AND ORAL HEALTH – A CALL TO ACTIONBarry CockcroftChief Dental OfficerNHS England

Call to Action

• What is it?

• What informs it?

• Key challenges

• Who should respond?

• How do you respond?

What is it?

• NHS England is developing a 10-year strategy for the future of primary care

• There have already been similar consultations on GP services and pharmacists

• The intention is to produce a report on the outcome of the dental consultation and then produce a document on the overall strategy for dental care

National Update

The NHS is 60 years old…

3 Challenges for Dentistry• Finance

• Population demographics

• Improving outcomes

Percentage adults with no teeth (England)

0%

5%

10%

15%

20%

25%

30%

35%

40%

1968 1978 1988 1998 2009

Changes in Mean dmft/DMFT Over Time for Children in UK

Source: National Children’s Dental Health Surveys 1973 to 2003. Harker R and Morris J (2005). Office for National Statistics, London. In Choosing Better Oral Health, Department of Health (2005): http://www.dh.gov.uk/assetRoot/04/12/32/53/04123253.pdf

The population in England is growing

Data source/s: ONS mid-year population estimates; NHAIS

% population aged 65+ by

CCG2012

The prevalence of periodontal (gum) disease increases with age and is more likely for those who did not visit the dentist regularly

Data source/s: Adult Dental Health Survey 2009

In 2009 17% of adults with teeth had no evidence of periodontal (gum) disease1.

It can also be seen that regular attendance is associated with good periodontal health

*Excluding Scotland

Good periodontal health was much more prevalent amongst adults under 45 years than in older age groups.

International comparisons of dental health for 12 year-old children

Data source/s: Health at a Glance 2009: OECD Indicators

Average number of decayed, missing or filled teeth, 12 year-old children, 2006 (or

latest year available)

Decline in average number of decayed, missing or filled teeth, 12 year-old

children, 1980-2006

Germany (1980-2005)

United Kingdom (1983-2005)

Denmark (2006)

Luxembourg (1982-2006)

Netherlands (1980-2005)

Sw itzerland (1980-2005)

Sw eden (1982-2005)

Australia (1980-2004)

Belgium (1983-2001)

Ireland (1980-2002)

Finland (1979-2003)

France (2006)

Italy (1980-2003)

Spain (2005)

United States (1980-2004)Austria (1980-2007)

Portugal (1979-2006)

OECD

New Zealand (1980-2006)

Norw ay (1982-2006)

Japan (1981-2005)

Turkey (2007)

Greece (2005)

Iceland (1983-2005)

Korea (2006)

Slovak Republic (2006)

Czech Republic (2006)

Hungary (1980-2001)

Poland (1980-2000)

Children’s dental health has also been improving over time

NHS | NHS England Improving Dentistry | [February 2013/1412

‘d3mft’, seen on this graph, is a standardised way of measuring dental health, which involves visual-only examination for missing teeth (mt), filled teeth (ft) and teeth with obvious dentinal decay (d3t).

Data source/s: Children's Dental Health Survey and National Epidemiology Dental 5-year old dmft Survey

Results of caries surveys of five-year-olds in England from the Children’s Dental Health Surveys and NHS Dental Epidemiology surveys*, 1973 to 2012

*The orange sections represent the Children's Dental Health Survey results and the blue the 5 year old dmft surveys. the For the 2007/08 and 2011/12 surveys positive consent was needed for children to be included and therefore these years are not directly comparable to the previous surveys.

Improving Oral Health – Quality and Prevention

• Coalition government commitment to contract reform 2010 based on capitation, registration and quality.

• Pilots to test specific elements of contract reform started in 2011 including a preventative care pathway approach.

• Good evidence and learning from the pilots to date.

• Further engagement planned with the profession for May 2014.

• This will inform the approach for the next stage of the contract reform process.

RAG status changes

26% 24%

67%65%

6% 11%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

OHA OHR

RAG status change in adults, from OHA to latest OHR

Green

Amber

Red

11% 9%

32% 31%

57% 59%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

OHA OHR

RAG status change in children, from OHA to latest OHR

Green

Amber

Red

• Findings relate to patients who had an OHA Sept 2011- Mar 2012 who returned for an OHR by Mar ’13

• Net improvement where there is complete data• Adults: 2% reduction in red patients and 4% increase in green• Children: 2% increase in green patients and 2% reduction in red

Health inequalities affects outcomes

• people from deprived backgrounds

• people from black and minority ethnic communities;

• people with physical or learning disabilities.

• people who are easy to ignore, e.g.

• homeless people;

• sex workers;

• gypsies and travellers;

• people in prisons and offender institutions.

Regional and deprivation variations in children's dental health – a survey of 5 year-old children

Data source/s: Public Health England National Dental Epidemiology 5-year old dmft Survey

Percentage of 5 year-old children with decay experience including 95% confidence limits, by Government Office

Regions, 2012

Correlation between the rate of decay among 5 year-old children and deprivation score. Lower tier local

authorities in England 2012

For those 5 year olds with decay, the extent of the decay correlates with deprivation. The more deprived the area the higher the rate of decay found in the 5 year olds surveyed.

There is regional variation in the prevalence of tooth decay in the 5 year olds surveyed.

Most deprivedLeast deprived

The number of patients accessing NHS dentistry has increased steadily since 2008, to 29.9 million patients in December 2013

Data source/s: Health and Social Care Information Centre NHS Dental Activity Statistics: March 2006- December 2013

Access is measured by the number of patients who have had visited an NHS dentist in the preceding two years.

This time period was chosen as NICE (National Institute of Clinical Excellence) guidelines recommended the public should visit the dentists at least once every two years.

Equity of access

• Ease of access

• Access for those with special needs

• Access to urgent care and emergency care

Pathway approach• Securing excellence in commissioning NHS dental services February

2013

• Single commissioning body for all dental services

• Commitment to commissioning services using a pathway approach

• This allows clarity, consistency and equity in service delivery

• Increase integration across primary, community and hospital settings

Integrated Care• Management of patients with long-term conditions

• Shared care arrangements

• Flow of information

• NHS Healthchecks

Workforce• Need to match workforce to needs

• Numbers

• Skills

• To reflect the changing demographic and oral health needs

• Education and training needs to correctly support workforce

Time series and future projection of adult dental health: 1998-2030

Data source/s: Adult Dental Health Survey, 1998 & 2009

[4] Healthier is defined as those having 18 or more sound, untreated teeth.

Less healthy is defined as those with less than 18 sound, untreated teeth.

Who should respondEveryone:

• Providers of services

• Patient and public groups

• Commissioners of services

• Professional bodies

How do you respond?

• Please submit your response by 16 May 2014:

• Online: http://www.england.nhs.uk/ourwork/qual-clin-lead/calltoaction/dental-call-to-action/

• Email: england.sfcpc@nhs.net

• Post: Martin Smith, Primary Care Strategies, NHS England, Room 4E56 Quarry House,

Leeds, LS2 7UE

• If you have any questions or comments about this “call to action” please contact Martin

Smith (Senior Programme Manager) at martin.smith8@nhs.net (011382 51040)