For the Board to consider the report at appendix 1 by NHS England, NHS Improvement Commissioning Team Managers and Consultants in Public Dental Health.

The board received a report by NHS England and NHS Improvement on dental provision in Herefordshire as of March 2022. Terrance Chikurunhe (Senior Commissioning Manager Primary Care Commissioning NHS England) and Nuala Woodman (Deputy Head of Primary Care Commissioning for West of England) explained that the report had been developed between NHS England and NHS Improvement Commissioning Team managers and Consultants in Dental Public Health. NHSE/I had also provided specific information on children’s access and the issue of identification of oral cancers. Local Healthwatch had been engaged to assist in identifying and responding to further issues of concern and to specific local access issues in Herefordshire.

Mr Chickurunhe and Ms. Woodmantook the report as read and then proceeded to focus in on a number of key points impacting the delivery of dental health in the county:

·       Covid-19 had impacted every area of the service; it had limited capacity to see patients, scared patients away from attending appointments and created a significant backlog of work that would take time to deal with.

·       Two dental practices (Ross-on-Wye and Bromyard) had surrendered NHS services.

·       Workforce issues, including recruiting and retaining dentists, was proving difficult, the county’s rurality and relative lack of training facilities were cited as potential factors in Herefordshire’s poor standing.

·       Public-facing staff, such as receptionists, were leaving the sector due to increased levels of abuse from frustrated patients who could not access the service.

·       NHS contracts were perceived as being overly complex, inflexible and economically unviable, and younger dentists were increasingly favouring carrying out cosmetic work over more traditional activity.

During the course of the debate the board noted the following points:

·       The board noted and was concerned to discover that none of the population in Herefordshire currently benefits from water fluoridation and the impact of this could clearly be seen in the level of tooth decay in 5 year old children compared with comparative regional and national figures.

·       It was pointed out that the Health and Care Bill; water fluoridation detailed government plans to transfer responsibility for water fluoridation from local authorities to the Secretary of State, but felt that this didn’t mean fluoridation measures couldn’t be encouraged and monitored at a local level.

·       Concern was expressed that from a safeguarding point of view, poor dental hygiene and dental health can be a symptom and signpost of chronic neglect. When children and families struggled to access the service it became harder to spot this neglect and created a potential gap in knowledge around identifying risks for a number of children.

·       The board noted that good dental health and a healthy smile were key to a sense of self and self-image, which impacted children’s health and wellbeing.

·       It was noted the service was struggling before the pandemic and that the pandemic had made things much worse.

·       The board agreed that the current situation gave rise to serious public health issues and was not just about teeth, but also about children, the preventative agenda, safeguarding and domestic abuse. Poor dental health  ...  view the full minutes text for item 30