Agenda item

The reports and discussion are to give assurance and identify improvement on the measures and services in place for the population of York on the prevention, treatment and maintaining good oral health.

Members considered a report that enabled a discussion on identifying improvements on the measures and services in place for the population of York on the prevention, treatment and maintenance of good oral health.

The Committee were joined by the following professionals:

·        Nurse Consultant in Public Health

·        Assistant Director of Public Health

·        Specialist Practitioner Advanced in Public Health

·        Dental Commissioning Lead, NHS England

·        Dental Consultant, Public Health England

·        Manager of Healthwatch York

·        Chief Executive of the Ebor Multi-Academy Trust

·        An Associate Dentist in York

·        A member of the North Yorkshire Local Dental Committee and the British Dental Association General Dental Practice Committee

The Nurse Consultant gave a brief introduction. She highlighted how good oral health was achieved, in that it required a system wide partnership approach from a number of organisations. Through understanding the needs of the local population, and by working collectively with partners, work could be undertaken to focus on recovery and identification of where policies, strategies and initiatives were required to improve oral health, early intervention, access to dental provision and reduce inequalities.  It was also noted that the Covid pandemic had exacerbated and heightened pressures on the system.

Each representative provided an update within their service areas.

The Specialist Practitioner Advanced in Public Health addressed the 5 key elements the Local Authority had responsibility for, as noted within the report:

1.   Oral health promotion.

2.   A biennial epidemiology survey. 

3.   Provision of leadership via an Oral Health Advisory Group (OHAG).

4.   The production of a children and young people Oral Health Strategy – written with partners.

5.   Supporting Flexible Commissioning in local dentists to reduce oral health inequalities.

The Dental Commissioning Lead addressed NHS England’s response to the challenges, noting that:

·        NHS England was responsible for the commissioning and contracting of all NHS dental services and that all primary and secondary care dentistry had been impacted by the pandemic.

·        Throughout the pandemic practices were required to meet a set of limited conditions, which had been increasing per quarter. The requirement was currently set at a minimum of 85% of normal pre-Covid activity, feedback received showed that some practices were struggling to deliver that level of appointments due to staff absences.

·        Given the challenges with access and providers working through their backlog, practices had been asked to prioritise seeing patients with the greatest clinical need, which would likely mean a delay for patients seeking non-urgent and more routine dental care, such as check-ups. A return to full capacity would be dependent on the further easing of Covid-19 control measures.

·        All of the funding NHS England received for dentistry was committed to existing national contracts that were agreed in 2006, with no end date. To address the significant delivery concerns and to improve access and reduce inequalities, NHS England introduced a Flexible Commissioning model across Yorkshire and the Humber in 2019. A number of other work streams were also going to be a focus throughout Yorkshire and the Humber, including the development of, subject to procurement, both a new out of hours urgent care service and a community oral surgery service in York.

The Chief Executive of the Ebor Multi-Academy Trust spoke on behalf of all primary schools across York. She informed the Committee that staff had reported children up to the age of 8 having dental decay or teeth extracted and there were concerns about the use of dummies, particularly in the schools which served the most disadvantaged areas in York. Parents had reported their struggles to obtain an emergency appointment and despite their primary focus on education, this was a real area of concern for teachers. 

A member of the North Yorkshire Local Dental Committee and the British Dental Association General Dental Practice Committee raised his concerns with the current dental contract. He informed the Committee that dental contract reform started in January 2009 and still no new dental contract had been negotiated. He explained how Government funding was allocated and used, noting that the current overall dental budget was £3.2billion. Members, were also informed that the overall dental budget had not increased since 2006. He clarified how the current system made it not financially viable for some NHS practices, and subsequently led to recruitment difficulties of attracting Dentists to work in the NHS sector.  He stated that this was a national issue and that the contract needed to be reformed.

An Associate NHS Dentist based in York also raised his concerns and frustrations with the current dental contract. He informed Members that he had written a blog during the pandemic that addressed why practices were converting from the NHS and what action was required to improve access to NHS services. It was agreed that a link to the blog would be emailed to Members.

Further discussions took place regarding the difficulties and challenges some residents had faced, with examples being provided by some Members. The national contract, funding, Flexible Commissioning and poor oral health in children was also discussed and in answer to questions raised it was confirmed that:

·        It was hard to influence the dental contract reform due to the national set model. 

·        If funding was sourced, the supervised tooth brushing service could be reinstated.

·        Poor oral health in a child would not be a standalone safeguarding issue, it would form part of a collective safeguarding approach that impacted that child.

·        The number one cause for children, aged 5 to 9, to be admitted to hospital was for extractions of teeth under general anaesthetic.

·        A biennial epidemiology survey would take place in 2024 with colleagues from across Yorkshire and the Humber.

·        Flexible Commissioning allowed Dental Nurses and Hygienists to deliver some non-complex treatments, other supplementary work and offer preventative advice, which provided Dentists with more time to focus on the clinically advanced treatments.

·        Should an NHS dentist practice close, that contract funding would be distributed in the constituency from which it had been returned.

·        A Dentist had to complete a Dental Foundation Training Programme to gain an NHS dentistry practice number. This usually took a year and there was an equivalent scheme for overseas Dentists. 

·        There had been no terminations or handback of contracts in York in the last 5 years. Dental practices determined their own patient list but most practices had a regular patient list that they used to recall people.

·         If a patient was listed with an NHS dentist practice they had a right to ask for their dental records through a General Data Protection Regulation (GDPR) request.

·        The North Yorkshire and Humber Dental Network supported commissioning conversations, serviced pathway reviews and encouraged communication between different providers across the dental pathway. The new Integrated Care System would be responsible for this from 2023.

·        The number of children admitted to hospital for tooth extractions during the pandemic had risen nationally due to the backlog.

Members were disappointed by the statistics highlighted within the Healthwatch York report. They noted the report recommended a rapid and radical reform to the way dentistry was commissioned and provided. All present agreed that the 2006 dental contract was failing the public and patients and given the seriousness of the issue, it was agreed that an appropriate letter be sent to the Secretary of State to share residents’ experiences in York, to highlight the concerns raised by professionals and to give support to serious work on reforms and contracting. Attendees were asked to forward any comments for submission into the letter to the Democracy Officer and it was suggested that signatories of support could also be sought from other professionals including the Oral Health Partnership Group.

Members thanked everyone for attending the meeting and for their contributions.

Resolved:

     i.        That the content of the reports be noted.

    ii.        That the implementation of the Oral Health Strategy be supported.

  iii.        That the further development of ‘Flexible Commissioning’ opportunities across the city to reduce inequalities be supported.

  iv.        That the oral health campaign be noted.

   v.        That a letter be sent to the Secretary of State.

Reason: To ensure a system wide approach to local need for a robust oral health pathway which was accessible and equitable and timely manner for the population of York.

[An adjournment took place between 7:14pm and 7:25pm and Cllr K Taylor left the meeting during this time]