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 leads straight into inequalities and there was clear evidence to illustrate that people who have untended dental cavities have a higher rate of heart disease and earlier mortality rates.

·       The board pointed out that the workforce crisis could be resolved by a more flexible and creative to approach to job roles within the profession and that an ST3 (Specialist Training) –style of training might make the profession and location more attractive.

·       It was suggested that the dental sector might benefit from adopting a similar model to that of Taurus Health Care and that NHS England and the ICS might consider investigating the viability of creating a dental federation/collaborative within the county.

·       The board noted the need to build on existing public awareness campaigns relating to dental health including the ‘brush, book, bed’ campaign and Talk Community’s ‘Time to Shine’ programme.

The board discussed and proposed additions (Sections b, c, d and e) to the recommendation to accommodate some of the points raised in relation to the report.

The amended recommendations were proposed and seconded and agreed unanimously. 

RESOLVED: That

a)    The Health and Wellbeing Board considers the report at Appendix 1 and provides comments and recommendations on the briefing

b)    Public Health will set up a meeting with relevant parties to maintain the momentum behind the report and consider how it might be possible to bring in an ST3 (speciality training) style approach to dentistry, with training for mixed roles.

c)    Public Health and ICS to monitor impact of Health and Care Bill on water fluoridation and continue to pursue and encourage fluoridation measures at a local level.

d)    NHS England, ICS and Talk Community to investigate the viability of applying local solutions to regional and sub-regional problems, through the creation of a dentistry federation/collaborative.

e)    Healthwatch, NHS England and Public Health to promote engagement with the public on dental health issues via a widespread information gathering campaign incorporating existing campaigns such as ‘brush, book, bed’ and Talk Community’s ‘Time to Shine’ programme.