Agenda item

The Committee received a report which informed Members of the feedback following the consultation process and provided an opportunity for final comments on the draft strategy 2023- 2028 before progressing to Health and Wellbeing Board (HWBB) in March 2023. Members of the Children and Young People’s Overview and Scrutiny Committee were invited for this item (for copy see file of minutes).

A Healy, Director of Public Health clarified that the Local Authority were responsible for oral health promotion and the NHS were responsible for dental health care. She explained that the previous oral health strategy was in place from 2016-2019 and that the impact of the COVID-19 pandemic had halted implementation of a new Oral Health Strategy until now. She stressed that oral health was a priority and looked forward to gathering more comments from Members regarding the draft strategy. 

M Baldwin, Public Health Strategic Manager DCC Starting Well provided a detailed presentation which highlighted that in County Durham, 1 in 4 five-year-olds had experienced tooth decay, and that vulnerable groups were at a higher risk of poor oral health. She explained the plan to improve oral health within the County and noted the key actions for children, adults, and the vulnerable groups. It was also noted that the Health and Care Act 2022 had moved the responsibilities for initiating and varying schemes for water fluoridation from local authorities to the Secretary of State.

Councillor Quinn advised that for some people brushing their teeth was not a priority and buying toothpaste was an added expense. She believed that fluoridation in water was beneficial and helped prevent tooth decay. She commended the oral health champions in nursing homes noting that they were a generation that was often forgotten and that issues with their teeth contributed to problems with eating and weight loss. Councillor Quinn gave an example of a retired person who for health reasons had not attended his registered practice for dental check-ups for a few years and had subsequently been removed from the register as an NHS patient. The practice advised that they were unable to re-register the patient as no money was being received from Government. Councillor Quinn also expressed concern regarding younger adults who had not had the opportunity to register for NHS dentistry and felt that their oral health had the potential to deteriorate as a result. Councillor Quinn noted that the work referenced in the strategy was great, however as there was a significant number of people who had been lost by the system, she asked if there was anything further that could be suggested or asked nationally to address the outstanding issues.  

The Public Health Strategic Manager advised that the Local Authority were working with schools and residential care homes and across the board to promote and encourage good oral health. She clarified that the responsibility for dental care was not within the remit of the Local Authority and asked if colleagues within the NHS were able to provide Councillor Quinn with further information.

The Director of Public Health noted that there was great support for water fluoridation and confirmed that it did increase dental health. She advised that in a previous letter from the Secretary of State, they confirmed that the system in County Durham was ready for fluoridation but explained that a public consultation would need to take place before it could be introduced. The Director of Public Health confirmed that water fluoridation was a priority and thus retained within the oral health promotion strategy. She assured Members that she would continue to engage with Government regarding water fluoridation and report on the progress of this.

In response to the question raised by Councillor Quinn regarding funding for practices, P Fletcher, Senior Primary Care Manager (Primary Care Dental Commissioning Lead – North East and North Cumbria), NHS England North East and Yorkshire, acknowledged the challenges with access to NHS dentistry and explained that there was a backlog following the Covid-19 pandemic, in addition to issues regarding workforce recruitment and retention. She clarified that unlike general medical services, there was no formal registration for dentistry and that the capacity to deliver services at individual practices was dependant on the workforce of the practice. The Senior Primary Care Manager noted that recruitment and retention of staff was the main concern locally, rather than concerns with funding. She advised that locally, additional funding had been provided to practices who were able to deliver more services and explained that this had addressed some of the issues relating to urgent care. She also advised that Durham was a target for the Golden Hello Scheme which provided financial incentives to bring dentists into the area. The Senior Primary Care Manager explained that sadly there was no immediate solution to dental access, and that the focus was on urgent care, and those that had a dental need, but explained that prevention of poor oral health was key. She advised that there was also a focus on the recall process explaining that the regularity an individual was seen was dependent on their oral health requirements.

T Robson, Chair of the County Durham Local Dentistry Committee advised that a unique pilot scheme to recruit overseas dentists was currently being developed which would soon recruit twelve dentists and noted that some of these would be appointed to the County Durham area. He explained that Health Education England would provide a comprehensive training package and it was hoped that this would address some of the workforce challenges. He offered to report on the progress of the scheme at a future meeting of the Committee. 

Councillor Quinn welcomed the great work that the NHS and the Local Authority were doing but emphasised that the dentist practice in question who had removed an NHS patient from their register had refused to re-register the patient as they had claimed that no money was coming from Government. She stressed that practice staff must communicate the correct information to the public. With regards to the regularity of recalls, Councillor Quinn was concerned that if patients did not attend for a period of time, there was the potential that they too could be removed from the register.

The Senior Primary Care Manager explained that the focus on recalls was to ensure that the workforce was operating in the most cost-effective way. With regards to funding, she confirmed that this was available and asked Members to feedback any funding related issues to NHS England. The Principal Overview and Scrutiny Officer offered to obtain the details of the dental practice from Councillor Quinn and share this information with the Senior Primary Care Manager.

Councillor Martin expressed concern regarding the oral health data for young people and vulnerable groups. He welcomed that specific training was being provided for foster parents but noted that there was no intervention for parents of children who suffered from tooth decay. He acknowledged that parents had to manage many responsibilities and because of this, it was difficult for some families to ensure good oral health routines. He asked whether this could be an avenue for intervention.

The Public Health Strategic Manager noted that although increased support was offered to those who were vulnerable, parents and carers were also supported via the school nurse and health visitors who educated parents on how to brush their children’s teeth from a young age, increasing their knowledge and awareness regarding good oral health.

The Chair suggested there be a specific champion for schools to check children’s teeth. She explained that the champion did not need to be a qualified dentist and that this would be an inexpensive way of identifying children who had any obvious oral health concerns. The Chair stressed that it was vital for children to be educated regarding oral health from a young age. The Public Health Strategic Manager agreed that it was key to educate young children and confirmed that the supervised teeth brushing scheme was actively encouraged.

Councillor Varty advised that in previous years, dental nurses had attended Sure Start buildings and brought along large teeth props to educate children and their parents on good oral health care. She advised that free toothpaste and toothbrushes were offered at the end of the sessions and that positive feedback had been received from the parents who had attended. The Public Health Strategic Manager advised that the large teeth props were still being utilised for educational sessions.

Councillor Robson echoed the comments raised by Councillor Quinn regarding dental practices not registering new patients and hoped that this issue would be clarified. He noted that the Local Authority had done various health promotions over the years and suggested that a new promotion on oral health would be beneficial to enhance awareness. He also suggested that children be provided with samples of toothbrushes and toothpaste to promote and encourage good oral health. He felt that the education system in schools was key and that this could be utilised further by providing a presentation showing images of the results of poor oral health and tooth decay. Further to the Chair’s suggestion regarding a school champion for oral health, he suggested that student dentists could be a good source for this role. 

The Public Health Strategic Manager advised that providing toothbrushes and toothpaste to children in need was being considered.

Co-opted Member, A Stobbart was aware that there was capacity for NHS patients to register at some dental practices in the County Durham area, such as Murton, and asked if it was possible to make people aware of this. The Public Health Strategic Manager agreed to do some active promotion around this. The Senior Primary Care Manager explained that there was a UK website which indicated whether dental practices had capacity for new NHS patients and advised that a contractual requirement had been introduced for practices to update this website. She advised that people who were unable to book an appointment should contact 101 and would be signposted accordingly.

Resolved

The Committee noted the content of the report and presentation and agreed the comments as the Committee’s response to the Oral Health Promotion Strategy.