Improving Oral and Dental Health in Wales

Lisa Howells, Clinical Dental Adviser, Welsh Government / Public Health

Wales

Programme for Government in Wales- Relevant Objectives

• Access to dental care• Designed to Smile• Helping citizens to take responsibility for their

own health• Fundamentals of Care – oral health and

hygiene• High quality and safe services

The National Oral Health Plan

Structured under three key areas consistent with Together for Health

• Health Improvement and Prevention• Service Development and Delivery• Quality and Safetylinks with – Standards for Health Services, Quality Delivery Plan,

Together Against Cancer and National Clinical Audit Plan

Key factors affecting dental need and future services

• More people keeping their own teeth in older age

• Social background and dental / oral ill health • Technological advances• Balancing patient’s clinical needs with demands

for treatment• Changing dental team workforce

Addressing access

Review of GDS contract and pilotsGovernance framework to support HB working

with dental practices / contractingOrthodontic reviewsRing fenced dental budgetsNICE recall guidance95% overall patient satisfaction rate -majority positive

about all aspects of the service

Designed to Smile Wales participation rate of 80.9%

1223 settings were targeted, with 954 settings brushing and a further 35 settings agreeing to take part but deferring to a later date

155,077 home packs were distributed across 1,050 settings

6265 and 3514 parents took part in group and one to one OHE sessions respectively.

Comparison of 5 year olds dental health in Wales and England

Mean dmft 5 year olds - 2007-08 - Wales compared with selected English

regions

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

2.00

2.20

2.40

2.60

2.80

3.00

North Wales Mid and West South East WALES Best Region- SECoast

Middle Region -South West ranked

6th (from Best-Worst)

Worst Region - NW ENGLAND

dmft

Designed to Smile outside schools• It is important that brushing in schools translates to

brushing at home - home brushing packs provided• Children who brush 2 times per day or more experienced

less dental caries than those who brushed once per day or less

(Chestnutt et al. 1995)• Children only in school 195 days a year

Crucially important that brushing in school translates to brushing at home

What do parents feel about D2S? High level of support for the scheme

Some said it was easier to brush children’s teeth now

Happy with the consent process and parent meetings

But felt a lack of ongoing communication

Said that their GDPs were unaware of, but interested in, the scheme

Helping citizens to take responsibility for their own health

• Working in partnership with patients• Providing clear information in a variety of

formats and media• Evidence based information – consistent

across all professional groups• Addressing the main public health concerns - diet and nutrition - alcohol, smoking, sun - oral hygiene

Addressing Fundamentals of Care audit results – oral health and hygiene

Improving Mouth Care for adult patients in hospital

• Multi professional working across nursing and dental teams.• Development of a single all Wales Assessment Tool • Wales wide procurement of appropriate resources• Patient information leaflet drafted• Launch of “Mouth Care Bundle” and first 1000 Lives plus Learning

Set• Nurse and HCSW Training • All HBs and Velindre Trust involved

Quality and Safety

• Improving against the Standards for Health Services

• The Maturity Matrix Dentistry• Audits – including antimicrobial prescribing

and cross infection control (HTM 01-05)

The Maturity Matrix Dentistry A team development tool

• A straightforward self evaluation system, facilitated by Practice Development Tutors

• A practice based tool for the whole dental team• 12 topics (dimensions) – including the GDC core

topics, Standards for Health Services and GDC proposals for revalidation

• Sources of Help and Advice provided

• 3 hours Verifiable CPD for all participants

MMD GridGDC Core Topic GDC Core Topic GDC Core Topic GDC Core Topic

1Clinical Assessment and Clinical

Risk Management

2Disinfection and Decontamination (Infection Prevention and Control –

IPC)

3Radiological Standards

4Legal and Ethical

1.1 Patients have up-to-date MedicalHistory on record

2.1 Evidence of basic IPC procedures only and awareness of HTM-01-05

3.1 No written radiological protection systems in place

4.1 All staff are appropriately registered with the GDC and provide annual evidence of this

1.2 Patients Medical and Social History influences treatment planning

2.2 The practice environment is kept clean, well-maintained and fit for purpose

3.2 Basic written radiological systems in place

4.2 All staff are aware of their responsibilities for patient confidentiality and receive appropriate training P2

1.3 Patients records are up-to-date, complete and stored safely

2.3 Practical IPC written procedures in place but not regularly reviewed

3.3 Radiation Protection Adviser and Radiation Protection Supervisor appointed (ref IRR 1999)

4.3 All staff have appropriate CRB2 checks with records kept safely in an appropriate place. P5

1.4 Practice team have receivedbasic training in dealing with medical emergencies

2.4 Regular review of IPC policy and procedures and compliance with essential requirements of HTM-01-05

3.4 Relevant staff have radiological training and continuing education in compliance withIR(ME)R1 2000 **CL3

4.4 Registered staff have appropriate Medico-legal indemnity

1.5 The practice has appropriate emergency equipment which is available when required and all staff know where it is located. ** CL1

2.5 Evidence of practical compliance with Advice sheet –A12 and HTM-01-05

3.5 Evidence of ongoing Quality Assurance in place and subsequent actions to improve quality **CL3

4.5 Staff understand their responsibilities in respect of GDC Guidance on Standards for Dental Health Professionals, including equality and diversity

1.6 Practice team have annual training by approved trainer in dealing with medical emergencies, use of emergency drugs and defibrillator **CL1

2.6 Evidence of continued training, updating and audit of compliance with relevant protocols **CL4

3.6 Evidence of radiological audit within last 2 years and any necessary steps taken to improve quality **CL3

4.6 Evidence that practice team are kept up-to –date on their ethical and legal responsibilities P2

* SHS 7,8,16,20, 26 * SHS 6,12,13,26 * SHS 6,16,26 * SHS 2, 9,25,26

1 Ionising Radiation (Medical Exposure) Regulations, 2 Criminal Record Bureau, 3 Community Health Council, 4 Protection Of Vulnerable Adults, 5 Radiation Protection Advisor, 6 Health and Safety Advisor, 7 National Institute for Health and Clinical Excellence, * “Doing Well – Doing Better: Standards for Health Services in Wales”, April 2010, ** Links to GDC Draft Revalidation Standards and Evidence Framework

Working togetherCHCs and Dental Teams

• Comment on the National Oral Health Plan• Promote the main preventative health

messages• Help to publicise effective use of services - failed appointments - NICE recall guidance

Any questions ?

• Lisa.howells2@wales.nhs.uk