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IMPROVING DENTAL CARE AND ORAL HEALTH – A CALL TO ACTION Barry Cockcroft Chief IMPROVING DENTAL CARE AND ORAL HEALTH – A CALL TO ACTION Barry Cockcroft Chief Dental Officer NHS England

Call to Action • What is it? • What informs it? • Key challenges 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 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 Nov 2013 General practice call to action Dec 2013 Feb 2014 Improving National Update Nov 2013 General practice call to action Dec 2013 Feb 2014 Improving community pharmacy Improving dental care and oral health May 2014 Eye health call to action OCT 2014 Primary care strategic framework

The NHS is 60 years old… The NHS is 60 years old…

3 Challenges for Dentistry • Finance • Population demographics • Improving outcomes 3 Challenges for Dentistry • Finance • Population demographics • Improving outcomes

Changes in Mean dmft/DMFT Over Time for Children in UK Source: National Children’s Dental 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/asset. Root/04/12/32/53/04123253. pdf

The population in England is growing % population aged 65+ by CCG 2012 Data The population in England is growing % population aged 65+ by CCG 2012 Data source/s: ONS mid-year population estimates; NHAIS

The prevalence of periodontal (gum) disease increases with age and is more likely for The prevalence of periodontal (gum) disease increases with age and is more likely for those who did not visit the dentist regularly In 2009 17% of adults with teeth had no evidence of periodontal (gum) disease 1. Good periodontal health was much more prevalent amongst adults under 45 years than in older age groups. It can also be seen that regular attendance is associated with good periodontal health *Excluding Data source/s: Adult Dental Health Survey 2009 Scotland

International comparisons of dental health for 12 year-old children Average number of decayed, missing International comparisons of dental health for 12 year-old children Average number of decayed, missing or filled teeth, 12 year-old children, 2006 (or latest year available) Data source/s: Health at a Glance 2009: OECD Indicators Decline in average number of decayed, missing or filled teeth, 12 year-old children, 1980 -2006

Children’s dental health has also been improving over time Results of caries surveys of Children’s dental health has also been improving over time 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. ‘d 3 mft’, 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 (d 3 t). 12 NHS | NHS England Improving Dentistry | [February 2013/14 Data source/s: Children's Dental Health Survey and National Epidemiology Dental 5 -year old dmft Survey

Improving Oral Health – Quality and Prevention • Coalition government commitment to contract reform 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 • Findings relate to patients who had an OHA Sept 2011 RAG status changes • 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 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 Regional and deprivation variations in children's dental health – a survey of 5 year-old children 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 Least deprived There is regional variation in the prevalence of tooth decay in the 5 year olds surveyed. Most deprived 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. Data source/s: Public Health England National Dental Epidemiology 5 -year old dmft Survey

The number of patients accessing NHS dentistry has increased steadily since 2008, to 29. The number of patients accessing NHS dentistry has increased steadily since 2008, to 29. 9 million patients in 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. Data source/s: Health and Social Care Information Centre NHS Dental Activity Statistics: March 2006 - December 2013

Equity of access • Ease of access • Access for those with special needs 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 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 • 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 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 [4] Healthier is Time series and future projection of adult dental health: 1998 -2030 [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. Data source/s: Adult Dental Health Survey, 1998 & 2009

Who should respond Everyone: • Providers of services • Patient and public groups • Who should respond Everyone: • Providers of services • Patient and public groups • Commissioners of services • Professional bodies

How do you respond? • Please submit your response by 16 May 2014: • 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. [email protected] net • Post: Martin Smith, Primary Care Strategies, NHS England, Room 4 E 56 Quarry House, Leeds, LS 2 7 UE • If you have any questions or comments about this “call to action” please contact Martin Smith (Senior Programme Manager) at martin. smith [email protected] net (011382 51040)