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Health Housing and Adult Social Care Scrutiny Committee |
2 April 2025 |
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Report of the Director of Public Health |
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Oral Health in York
Summary
1. This report outlines the Oral Health commissioned projects by Public Health, and the collaboration projects with the ICB and other partners. The paper is for members’ information and to provide an update on the work currently being completed.
Background
2. Oral health inequalities are disparities in oral health that are preventable and both unfair and unjust. They are more than just inequalities in oral health status between rich and poor people. As with overall health, there is a continuous downward relationship across the whole social spectrum, with dental health deteriorating at each stage as people fall down the social ladder.
Tooth decay is the most common oral disease affecting children and young people in England. Children from disadvantaged backgrounds are disproportionately more likely to be admitted to hospital to have teeth extracted. In England, almost one-fifth of such admissions were for children from the most deprived tenth of the population. In contrast, the least deprived 10% accounted for just 4% of admissions with a primary diagnosis of dental caries (tooth decay).
Tooth decay is almost entirely preventable good oral health is important from the eruption of the first tooth and a practice that should continue throughout life.
The most recent dental survey shows that whilst the prevalence and severity of dental decay in 5-year-olds in York is less than the Yorkshire or England average, those children that are most affected have almost 4 teeth decayed, extracted or filled by the time they reach 5 years of age.
Public Health funded initiatives.
a. Provision of toothbrushing packs at Health Visitor 9-month visit. A universal programme where all Health Visitors (HV) give toothbrushing packs to all children at the 9-month statutory visit. This enables the HV to introduce the importance of toothbrushing from the eruption of the first tooth, provide information on brushing technique and signpost to further information.
b. Oral Health Promotion. Jointly commissioned with North Yorkshire Council this service offers two core elements:
· Supervised Tooth Brushing Programme. This service delivers a supervised tooth brushing programme in all special schools and targeted early years settings. The main settings targeted are nursery or pre-school provision with some primary schools being targeted due to the IMD (Indices of Multiple Deprivation) scores[1], in these cases only reception class included. All years in special schools have access to this programme.
· Oral Health Training and Development of wider workforce. Development and delivery of a programme of tailored training, which is evidenced based and relevant to roles.
The contract is for a period of 3 years, and it is due to finish in November 2025.
c. Dental Epidemiology: A key PHOF (Public Health Outcomes Framework) [2] indicator locally, despite going out to tender twice with NYC, we have not been able to secure a provider within budget. Therefore, we have no data current data and without access to current epidemiological data and regular updates, it is challenging to establish baselines and measure the impact of any new preventive interventions.
Recent discussions have taken place at a regional level and with the ICB to identify how this may be rectified. The ICB are currently in the process of commissioning Community Dental Services [3]– with a new contract to go live from 1 April 2025. Previously this contract has been held by Harrogate and District NHS Trust (HDFT) for York and North Yorkshire Local Authority geography. In the past the dental epi survey formed part of the CDS contract, but this element was handed back some years ago due to cost and workforce capacity pressures.
As a short term measure HDFT have been commissioned under an urgent contract award to provide the CDS service for 2025/26 only and this includes completion of the epidemiology survey.
ICB/ICS collaboration projects.
a. Prevention, Access and Treatment (PAT). Led by NHS H&NY ICB (Health and Care Partnership) [4]and the Hull based “Teeth Team” they have designed a model of care to improve oral health within targeted schools across Humber and North Yorkshire (H&NY). The scheme only commenced in York at the end of 2024, but prior to that Public Health provided data which ranked primary schools by proportion of students on Free School Meals and/or the IDACI (Indices of Deprivation Affecting Children Index) score. This summary had been further developed to show the dental provision in those areas that could be aligned to specific schools.
Prevention, Access and Treatment programme for primary school children, includes volunteer dental professionals who visit schools on a bi-annual basis, providing toothbrushes and toothpaste, teaching the children the basics of good oral hygiene and providing examinations and fluoride varnish applications. This offer is made to all years in the primary school.
There is no cost to participating schools and all funding is provided by the NHS Humber and North Yorkshire Integrated Care Board (ICB). There is no indication that this funding will cease, with assurance that this is not a pilot project but a roll-out and there is national support for this way of working.
Flexible Commissioning. Led by the Dental Team within NHS H&NY ICB. Flexible commissioning allows several qualifying dental providers to work collaboratively with local networks to support referrals into dental practices from key population groups.
York has a referral protocol which outlines the process for CYC Healthy Child Service and Children’s Social Care Services to refer 0-19’s (up to 25 with SEND and Care Leavers) who are not under the care of a regular dentist and need dental care (criteria applies). Referrals are made to a participating Flexible Commissioning Dental Practice for regular care. This also includes children and young people cared for by the Local Authority and care leavers.
Flexible commissioning practices must be NHS dentists. There is no cost associated with this for the local authority. The York Flexible Commissioning practices are listed below.
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Provider |
Address |
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Clifton Moor Dental Centre |
Tower Court Health Centre, Oakdale Road |
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Hopkins & Poyner Dental Surgery |
29 High Petergate |
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Perfect Smile Clinic (UK) Limited |
175 Boroughbridge Road |
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Petrie Tucker & Partners Limited |
Unit C , Stonebow House |
Consultation
3. No consultation
Options
4. Members are asked to consider and note the content of this paper.
Analysis
5. In real terms the Public Health grant has been reduced by over 25% since 2014/15. Which has resulted in budget pressures. The budget for the epidemiology survey has not increased and has resulted in no competitive providers coming forward who are able to complete the survey within budget.
6. However significant inroads have been made with the ICB funded projects and this will have a positive impact on the dental health of children in York.
7. Oral Health Promotion is part of a wider system which is facing challenges nationwide including:
a. A challenging NHS dental contract has been in place for some time the review of this is currently underway and may provide some support going forward. It is expected that this will form part of the NHS
b. Unfortunately, the dental contract is a national issue and the ICB are unable to mitigate against the lack of NHS dentists in York. However, the PAT programme was partly built to mitigate against the NHS contract to retain NHS dentists.
c. Previous government introduced a “golden hello” for practices to take on new NHS patients –30 “Golden hello’s” in Humber and North Yorkshire region. Nationally only 5 have been taken up.
d. Water fluoridation remains a contentious issue with a pilot in the North East currently underway.
Council Plan
8. The Council Plan: One City for all, 2023 to 2027, outlines six council priorities the first is “Health and Wellbeing: A health generating City for children and adults”. The aim of which is for residents to live happy, healthy, independent lives … where the current trend od widening health inequalities is reversed, and people are supported to manage their health and wellbeing…”.
9. Supporting those most at risk to poor dental health and supporting access to dental care and treatment supports this priority.
Implications
10.
· Financial No finance implications
· Human Resources (HR): There are no HR implications.
· Equalities. There are no Equalities implications
· Legal. There are no Legal implications.
· Crime and Disorder: There are no C&D implications.
· Information Technology (IT): There are no IT implications.
· Property: There are no property Implications.
· Other: None
Risk Management
11. Tooth decay impacts on children and families, children who have toothache or who need treatment may have; pain, infections and difficulties with eating, sleeping, speaking and socialising. They may have to be absent from school and parents may also have to take time off work to take their children to a dentist or to hospital. Children’s poor oral health links to other key policy areas such as getting the best start in life, inequalities, child obesity, school readiness and development of speech and language.
Recommendations
12. The purpose of this report is to update Health Scrutiny on the Oral Health Programmes that are being offered to address the issues with dental provision within the city. Offering dental care, access and treatment to those who have the most acute need or may experience disadvantage.
13. Health Scrutiny are asked to:
a. Note the content of this report
b. Support, where possible, the provision of dental care access in communities.
Contact Details
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Author: |
Chief Officer Responsible for the report: |
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Philippa PressPublic Health SpecialistPublic Health Directorate Tel No. ext. 5756
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Peter RoderickDirector of Public Health
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Report Approved |
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Date |
25 March 2025 |
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Wards Affected: |
All |
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For further information please contact the author of the report |
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Annexes
None
Abbreviations
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Abbreviations for Scrutiny report on Oral Health. |
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Abbreviation |
In Full |
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IMD |
Indices Of Deprivation |
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PHOF |
Public Health Outcomes Framework |
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ICB |
Integrated Care Board |
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HDFT |
Harrogate and District NHS Foundation Trust |
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NHS H&NY ICB |
NHS Humber and North Yorkshire Integrated Care Board |
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IDACI |
Income Deprivation Affecting Children Index |
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SEND |
Special Educational Needs and Disabilities. |
Background Papers
None