NHS Dental Services

December 2008

Report of the Topic Group

INDEX

Foreword 3

1.0 Purpose of Report 4

2.0 Recommendations 4

3.0 Background 6

4.0 Access to NHS Dental Services within the County 7

5.0 Children’s dentistry 9

6.0 Quality of dental treatment 11

7.0 Specialist treatment 13

8.0 The impact of the reconfiguration of acute health 14 services in Hertfordshire on actual dental services

9.0 Conclusions 14

Appendix 1 Scoping Document

Appendix 2 Membership of the Topic Group, Witnesses, Documents & dates

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Appendix 3 Dentistry and Oral Health in East and North Hertfordshire and West Hertfordshire PCT’s

FOREWORD

In presenting this Topic Group Report on NHS Dental Services I acknowledge the support and advice we were given by the Primary Care Trust Commissioning Lead Officer, Jane Robinson, Dr Sue Gregory, Consultant in Dental Public Health, and Lynda Dent, Head of Public Engagement Hertfordshire PCT. Between them most of our queries and questions were answered and the complexities of providing this essential service, so important for the health of us all, became clearer.

We received helpful evidence from several dental practitioners, which gave us a greater understanding of their concerns.

Our greatest challenge was to gain the public’s response to dental service provision, and I do thank those people who took the trouble to contact us with their views.

You will find within this Report our recommendations, and some background to the scrutiny we carried out. During 2008/09 and for 2009/10, the PCT has made considerable additional investment in dental practices to ensure improved access for patients that will strengthen dental services available to patients county-wide.

Finally can I thank Victoria Griffiths our Scrutiny Officer, along with Elaine Gibson for noting all the details of our Topic Group meetings, and drawing up this report.

County Cllr. Doug Drake

Chairman of the NHS Dental Services Topic Group

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HERTFORDSHIRE COUNTY COUNCIL

Report of the NHS Dental Services Topic Group

Author: Victoria Griffiths, Scrutiny Officer Tel: 01992 588385

1. Purpose of report

1.1 To report on the work of the NHS Dental Services Topic Group which was set up to assess the following issues: The accessibility of NHS dental services in the county Children’s dentistry The quality of dental treatment, including customer satisfaction and

emergency provision Specialist treatment such as orthodontics, domiciliary and sedation The impact of the reconfiguration of acute health services in

Hertfordshire on the provision of acute dental services within hospitals.

1.2 Appendix 1, the scoping document, provides further details of the planned work of the topic group.

2. Recommendations

2.1 The PCT should ensure that effective communication is deployed and reviewed on a regular basis for the following areas:

a) How to access NHS dental treatment, particularly when there are no dentists able to offer treatment on the NHS locally (see 4.5-4.9).

b) What treatment is available on the NHS and what the charge will be (see 6.2-6.6).

c) How to access treatment in an emergency or out of hours (see 6.9).d) How to make a complaint (see 6.7).

2.2 The PCT should continue to ensure that the public can access appropriate and clinically necessary dental treatment on the NHS through the redistribution of dental activity and further investment as more funding becomes available. (See 4.6-4.9).

2.3The PCT should work to increase and improve communication with dental contract holders in order to

a) Promote among dental practitioners the advantages of NHS contracts for the provision of dental services. This might instil a more positive feeling and encourage new dentists to choose to provide NHS dental services (see 4.11).

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b) Provide guidelines and advice on the delivery of the contract. (see 6.13).

c) Ensure greater understanding of the administration of the contract (see 6.13).

2.4 The PCT should consider ways to ensure that all children, including the most disadvantaged children, in the County are receiving quality dental services”.(See 5.5).

2.5 The PCT should ensure that dentists with NHS contracts are displaying the NHS posters explaining the banding charges and that leaflets are available in reception areas. (See 6.2-6.5).

2.6 The PCT should work to ensure effective monitoring of the Out of Hours service to improve access to emergency treatment outside of normal working hours. (See 6.10-6.12).

2.7 The PCT should more closely monitor the clinical data received on a quarterly basis from the Business Service Authority and any other performance information available to them on the quality of NHS services provided by dental practices in Hertfordshire. In particular the PCT needs to be aware of any reduction in complex treatments and ensure that this is not due to a disincentive among dentists to carry out this type of treatment. (See 6.10-6.12).

2.8 The PCT should ensure that effective communication is deployed and reviewed on a regular basis for the following areas:

a) How to access a home visit (domiciliary visit) and what the patient can expect (see 7.6).

b) The requirements for accessing sedation treatment on the NHS (see 7.5).

c) The requirements for accessing orthodontic treatment and where alternative orthodontic treatment can be accessed if patients are faced with a lengthy waiting time (see 5.6-5.8 and 7.4).

2.9 The PCT should more thoroughly examine the quality and accessibility of domiciliary and sedation services in order to determine actions to improve these services where necessary. (See 7.3). In particular, the PCT should work to establish clear and consistent guidelines for dentists delivering domiciliary visits. (See 7.6).

2.10 The PCT should work to improve access to orthodontic treatment by reducing the length of waiting times between referral and treatment. (See 5.6-7and 7.4)

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3. Background

3.1The NHS Dental services topic group considered a variety of evidence over the course of five meetings in order to assess the issues outlined in paragraph 1.1 above. Membership of the topic group, details of officer support and information on witnesses consulted can be found in Appendix 2.

3.2 It is important to note that the scrutiny undertaken relates to NHS dental services under the new General Dental Services contract introduced across England in April 2006. This made significant changes to the way that NHS Dental services were delivered, notably:

Primary Care Trusts (PCTs) were given powers to commission services to meet local needs (previously commissioning had been done centrally by the NHS).

The charging system for patients was simplified.

The system by which dentists were remunerated changed from a fee-per-item of treatment provided to payment in return for an agreed annual level of service provision.

3.3The cost to the patient now takes the form of a banded charging system as follows. The patient pays one of three charges depending on the type of treatment they receive:

Band 1 (£16.20) covers an examination, diagnosis (e.g. x-rays), advice on how to prevent future problems, and a scale and polish if needed.

Band 2 (£44.60) covers everything listed in Band 1 above, plus any further treatment such as fillings, root canal work or if your dentist needs to take out one or more of your teeth.

Band 3 (£198.00) covers everything listed in Bands 1 and 2 above, plus crowns, dentures or bridges.

The patient pays the charge for the highest band that applies to their course of treatment. Only one charge applies to each course of treatment.

3.4 Dentists receive the following Units of Dental Activity (UDA’s) for each band:

Band 1 1 unitBand 2 3 unitsBand 3 12 units

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The value of the unit varies between dental contracts from between £18 to £29. This was determined by the level of activity that took place during the test period in 2004/05. During this period it was also determined how many UDA’s a practice would be allocated each year. The contract holder is paid in monthly instalments based on the agreed annual contractual value less patient charges received.

3.5 In addition, there is no longer a system of patient registration as a patient may expect to be seen and receive the same treatment by any dental practitioner holding a contract with the NHS.

3.6 The following sections provide a summary of the information received against each of the topic group’s areas of interest.

4. Access to NHS Dental Services within the County

4.1It was noted by the topic group that a significant strength of the new arrangements is that it allows PCT’s to influence where new dental contracts are established. A number of dental practitioners who attended meetings to give evidence identified that, after 1st April 2009 when the three year funding guarantee ends, the ability of the PCT to commission services should allow it greater flexibility to ensure that funding is targeted to areas of need.

4.2 In addition to this, figures that were presented to the group in a presentation from Dr Sue Gregory, Consultant in Dental Public Health and Mrs Jane Robinson, Primary Care Trust Commissioning Lead, indicate that Hertfordshire’s figures for population per dentist compare favourably with the region and England. (See slides 11 and 12 in Appendix 3).

4.3Similarly, responses to a patient questionnaire carried out between April 2007 and September 2008, indicated that waiting time for an appointment had not been a significant issue for the majority of patients. Approximately 87% of patients in both East & North and West Herts said that the time taken to get an appointment was as soon as was necessary. However, it was noted that this survey was only of patients receiving treatment and did not indicate whether there are problems for those who have not been seen on the NHS during this period.

4.4The topic group also received information on the complaints passed to the PCT during the period 1 April 2007-31 March 2008. West Herts PCT had received only two formal complaints which concerned access, whilst East and North Herts had received none. Other informal complaints had been received, although as these were informal, they are not documented.

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4.5Despite evidence that there is suitable NHS dental service provision in the county so that access should not be a significant issue, there were a number of indications that access to an NHS dental appointment could sometimes be difficult.

4.6The majority of dentists who gave evidence to the topic group suggested that the nature of the new contract could sometimes restrict patient access. This is largely due to the fact that the number of UDA’s1 allocated to a dental contract holder based on their activity during the test period was not representative of the dentists’ typical activity or had not taken into account the future growth of the practice. One dentist commented that the dental contract holders who had been most disadvantaged were those that were doing more complex work than they had during the test period because the terms of the new contract oblige them to see a fuller range of cases that spans the treatment bands mentioned in section 3.3.

4.7There was general frustration expressed that the lack of flexibility in the contract meant either turning patients away or over performing on the contract, for which they would not be remunerated. On occasions, dentists also offer private treatment due to a lack of units of dental activity to accommodate everyone who wishes to be seen on the NHS. It was noted that patients lack an understanding of the system and so are often frustrated when they cannot access an appointment.

4.8 It was also acknowledged by both dental practitioners and PCT officers that, due to negative messages in the media, the public perception across England is that NHS dental services are hard to access. It was felt that this factor may discourage residents from trying to arrange a routine appointment, waiting until there was a real emergency before seeking treatment. The national removal of patient registration may have also exacerbated this problem as patients may be unsure how to access an appointment if their local dentist, with whom they were previously registered, is unable to see them.

4.9Despite a generally good spread of practices providing NHS treatment across the county, it was noted that some rural areas in Hertfordshire are not as well provided for. This was particularly the case in areas of East Herts where sometimes a limited number of practices are also under strain from picking up patients living across the borders in Essex. Evidence from the presentation given (see Appendix 3) showed that in East and North Herts around 10% of Hertfordshire residents go out to neighbouring counties to receive treatment, whilst around 20% come in from other counties to receive treatment in Hertfordshire. The topic group discussed with PCT officers the possibility of finding more creative ways to improve access for these rural areas such as through the provision of transport for those who might find it difficult to travel to urban areas for an appointment, or through the possible use of mobile practices visiting more isolated areas.

1 See section 3.4 for an explanation of Units of Dental Activity (UDA).

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4.10 The topic group also looked at a number of other issues in order to determine whether access might be a problem now or in the future. This included looking at whether there are a sufficient number of newly qualified dentists providing NHS services, and whether there are any cases of residents going abroad or to A&E with dental health issues which might indicate difficulties in accessing an appointment.

4.11 When asked whether there was a trend among newly qualified dentists to start private rather than NHS practices, dental practitioners felt that there was a generally negative perception of the current contract among new dentists that might discourage them from committing to the NHS. However, at present there is a good mix of ages of dentists with NHS contracts within the county and it is felt that the current economic climate will encourage dentists to seek NHS contracts at least in the short term.

4.12 There is no record of whether patients are going abroad for treatment, although it was suggested that there were dangers associated with this as treatment abroad can differ and cause problems later on when a patient needs continuation of treatment by a dentist locally.

4.13 Similarly there have been no reports from hospitals to indicate that they have seen a significant number of people at A&E who should have seen a dentist, which suggests that this is not an area for concern.

5. Children’s dentistry

5.1 The majority of dental practitioners who gave evidence to the topic group did not feel that children were particularly disadvantaged by the new contract. However, there were some concerns raised.

5.2In particular, it was expressed that the new contract did not promote preventative work, which whilst effecting all patients, would significantly impact children who were most likely to be in need of this type of treatment. Further information about this can be found in section 6.

5.3The topic group questioned the degree to which schools are involved in the promotion of children’s dental health. Children no longer have dental health checks in schools due to evidence that such checks did not have much effect or benefit. Schools can choose on an individual basis whether to cover dental health as part of Personal, Social and Health Education.

5.4The topic group were presented with statistics that indicate that the dental health of children is generally good (see slides 37 and 38 in Appendix 3). This was also supported by evidence from a 2006 Health Related Behaviour survey of over 9600 young people in Hertfordshire aged 9 to 15. This showed that 87% of pupils reported that they cleaned their

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teeth at least twice on the day before the survey (the recommended frequency) and only 17% reported that they had to have a filling last time they visited the dentist.

5.5However, the PCT reported that the challenge remains to reach children from the most disadvantaged backgrounds who are likely to have the poorest dental health. It is unlikely that these could be reached through the school system as they would require parental consent for a dental health check and often come from families where this consent is hard to acquire.

5.6Another concern about children’s dentistry was raised in the area of orthodontics. There are currently long waiting times for treatment at some orthodontic practices and this may have a negative impact on children where it is important that orthodontic treatment is in line with children’s growth patterns.

5.7 In some cases children were referred to alternative orthodontic practices where they could access treatment faster, however evidence suggested that they then might be required to travel quite lengthy distances to other parts of the county. This could involve a longer period of time out of school for each appointment and hence interfere with school attendance.

5.8There also seemed to be confusion among parents of children accessing orthodontic treatment. The Index of Orthodontic Treatment Need (IOTN) used to assess whether children are eligible for orthodontic treatment on the NHS was said by orthodontists to be subjective, making assessment difficult. Some parents seemed to be unaware of this, so that they could not understand why one child in a family could be eligible for NHS orthodontic treatment while their other child was not. Parents that were aware of the index system could sometimes put pressure on orthodontists to tweak the measurement for a child to tip them over into the eligibility criteria for NHS support.

5.9With regard to the performance of child-only contracts, where dentists will see children on the NHS whilst treating their parents privately, it was reported to the topic group that there are not many of these now in Hertfordshire and there are no real issues. The majority of dentists see all-comers.

5.10 The topic group were reassured that children with specialist needs, such as anxiety or behavioural problems, or children looked after, are seen through the PCT dental service, the performance of which is considered in section 7.7 of this report. This is with a view to integrating them back into general dental services when and wherever possible.

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6. Quality of dental treatment

6.1A number of areas were considered by the topic group in relation to the quality of NHS dental treatment in the county. Whilst generally there seemed to be no evidence that pointed to a significant cause for concern in this area, in many instances, it was felt that better communication to the public could hugely improve the service provided.

6.2There is a requirement under the NHS dental contracts that practitioners provide patients with a treatment plan showing cost for treatment. In addition, contract holders are supplied with posters and leaflets for display and distribution at their practice. However, evidence received by the topic group suggested that there is much confusion among the public regarding the charging system, suggesting many do not have or do not understand their treatment plan and that either the posters and leaflets are not being displayed by all practices, or that they are not effective in informing the public of the costs of treatment.

6.3The chairman of the topic group wrote a letter to the local press asking residents to get in contact regarding their experience of NHS dental health care. Around 60 responses were received. Whilst around a third of these were very positive about the dental treatment they received, two thirds were not, and many of the comments centred around the difficulty in understanding charges. Indeed, many seemed to have paid a private charge in addition to the NHS charge and did not know why.

6.4Further to this, responses to the patient questionnaire carried out from April 2007 to September 2008 indicated that there was some confusion as to what patients had been charged for. Around 100 patients were unsure or could give no response about their understanding of the treatment they had received and whether this was covered by the NHS. A small number believed they had received only private treatment when they had actually received at least some treatment on the NHS in order to be eligible to complete the patient questionnaire (see slide 32 in the presentation in Appendix 3).

6.5The topic group felt that it is of the utmost importance that patients are better informed about their treatment and the cost of treatment, particularly as many may not be able or willing to challenge the costs if they are unsure about them. The topic group recommended that different methods of communication be explored and that these are reviewed on a regular basis. Some suggestions included the distribution of leaflets in other public places such as libraries and citizens advice bureaux. It was also suggested that training could be considered for receptionists and dental nurses so that they might better support dentists in communicating patient charges.

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6.6Better methods of communication could also be employed around other aspects of NHS dental services in order to improve the service received by patients. For example, which materials can be used for fillings under the NHS, and why the length between check up times can differ between patients.

6.7With regard to the complaints service, information presented to the topic group on the complaints received between 1 April 2007 and 31 March 2008 indicated that there were no significant issues. Only 40 complaints had been passed to the two PCT’s during the whole year, 18 of which were about care and treatment, 16 regarding charges with others covering topics such as hygiene, access, manner and attitude. This reiterates the need for better communication around charges. It was also felt that the public could be better informed about how to make a complaint if they so wished.

6.8Customer satisfaction results presented to the topic group indicated that 92% of patients responding to the patient questionnaire between April ’07 and September ’08 were completely or fairly satisfied with the dentistry treatment they had received.

6.9The dental practitioners, who attended the topic group to give evidence, felt that the telephone triage service for out of hours emergencies could be improved. Some had received complaints from patients that there was a lack of access in an emergency, and others commented how they had sometimes seen patients with a cosmetic issue whilst others who were in pain had complained that they had not been able to get an appointment. There was a feeling that the lack of patient registration was detrimental to patient care in an emergency as it was unlikely that a patient would be able to see their regular dentist and instead might be required to travel some distance for an appointment. Again, it was felt that better information about what to do in an emergency would help to improve this service.

6.10 Another significant issue which was raised was the fear that the new contract arrangements might be creating a disincentive for dentists to carry out some restorative work. A number of dentists pointed out that under the new banding system, they were remunerated the same for carrying out some very complex and time-consuming restorative work e.g. a root canal, as they would be for something more straightforward such as an extraction.

6.11 Whilst the number of complex treatments carried out in Hertfordshire has reduced under the new contract this does not differ from the rest of the region or England as a whole and could be due to better dental health care amongst the population in general. In addition, the PCT do regularly receive reports from the Business Service Authority’s (BSA) cycle of clinical inspections of practices which would highlight any unusual areas of low activity or unusual continuation of treatment.

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6.12 Nevertheless, some of the dental practitioners did feel that the PCT could challenge contract holders more to show how they are performing to the required level as it is possible to ‘cherry pick’ the cases examined by the BSA. Better monitoring of performance information would place the PCT in a stronger position to identify any unusual activity. This would support the intention of the new powers they hold in the commissioning process to promote high standards of professional practice.

6.13 Dental practitioners also felt that the quality of the service they provided could be improved through better communication with the PCT and more guidance about how to handle the contract and access additional funding to see more patients. They also felt that the system could be improved by a more transparent and consistent approach in the way the contracts were administered.

7. Specialist treatment

7.1The topic group considered access to and quality of a number of specialist services; sedation, domiciliary, orthodontics and the service delivered by the PCT dental service to those who cannot access treatment under the general dental services contract due to anxiety, behavioural or learning difficulties, disability or other special needs.

7.2Eight of the responses received to the Chairman’s request to the public for information indicated some difficulty in accessing specialist services. Of these four concerned orthodontics, two concerned maxillofacial services delivered at A&E for broken teeth, one on disabled access and one on the PCT dental services clinics for those with special needs.

7.3With regard to domiciliary and sedation services there is insufficient evidence to come to a conclusion about the quality of this service. The PCT are soon to start a review of these services in order to better understand current circumstances.

7.4 In the case of orthodontics, the topic group received figures in a presentation (see slides 25 and 26 in Appendix 3) that indicates that waiting times for this service can vary greatly between practices. The problems associated with this have already been discussed in section 5.6-8. There was concern expressed by PCT officers that there were some children on the waiting list for orthodontic treatment that were too young to start the course of treatment but were slowing down the referral time for others as they would need to be reviewed regularly whilst on the waiting list. The PCT plan to look at a central referral mechanism as an option to reduce waiting list lengths.

7.5Again there seemed to be a problem with communication around NHS entitlement under these services. In the case of sedation, dentists are

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required to assess whether or not sedation is clinically necessary for a patient and is therefore eligible to pay NHS charges for the treatment. A patient can pay privately if they choose to have the treatment carried out under sedation when the dentist does not deem sedation clinically necessary. The topic group heard from one member of the public who had been wrongly charged for sedation and had been refunded by the dentist.

7.6Dental practitioners also pointed out that the contract does not create much incentive to carry out domiciliary visits, as even though this takes longer to deliver, the payment received is no different. Practitioners complained that there was a lack of guidance and consistency about domiciliary visits and doubted that many members of the public were aware of them or what service they would receive from a home visit.

7.7 In terms of the service delivered by the PCT dental service, survey results indicated a good level of satisfaction with this service. 87% of patients of the PCT dental service clinics who completed a patient questionnaire during October-March 2008 indicated that overall they had found the service they had received excellent, and a further 10% reported it to be good. However, it should be noted that only a third of patients completed a questionnaire and there was one complaint received from a member of the public whose experience had not reflected these generally good results.

8. The impact of the reconfiguration of acute health services in Hertfordshire on acute dental services

8.1 The topic group received information in the presentation delivered by Dr Sue Gregory and Mrs Jane Robinson that the reconfiguration of acute hospital services in Hertfordshire will have little effect on primary care dental services. (See slide 56 in Appendix 3).

8.2 Currently, patients attend a number of hospitals for dental surgery and the majority of dental services are delivered to them as outpatients. Dr Sue Gregory reported that the quality of care given by these services is felt to outweigh the inconvenience of travelling to a central location for the treatment.

9. Conclusions

9.1 The NHS dental services topic group have identified a number of areas where the PCT might make improvements to the provision of NHS dental services in Hertfordshire. Recommendations are largely around communication and clarification of the services provided and the costs involved both for the public and dental contract holders.

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9.2 However, the topic group also felt there was some work to be done around improved access, particularly for those who are most vulnerable, whether it is those isolated in rural areas of the county, or children from the most disadvantaged backgrounds. There is also further work to be done around the redistribution of dental activity and further investment as more funding becomes available. The waiting time for those in need of orthodontic treatment also needs to be reduced.

9.3 The PCT could improve the service further by building on their understanding of the patient’s experience of accessing services and the quality of care they receive. This could be gained through effective monitoring and management of performance information regarding the quality of service provided by dental practices and a thorough review of aspects of the service such as sedation and domiciliary care.

9.4 The topic group recognise that there are a number of developments and pieces of work planned over the coming year by the PCT. These should place the PCT in a strong position to respond to these recommendations.

9.5 In 2009 further PCT funding will be made available for investment in primary care dentistry. The extra funding will be used to support patient access, as well as improve public awareness and education through a communications plan. Improved access will also be supported by the planned reallocation of UDA’s for contracts that are over and under performing.

9.6 Further to this, a survey of public behaviour in relation to dental services in the county is to be commissioned in early 2009. These results will help to provide further information about the best ways additional funding can be spent.

9.7 The PCT will also be monitoring more clinical data which will be benchmarked against the PCT area, the East of England and England as a whole.

9.8 Detailed work is also planned on domiciliary and sedation services and a commitment has been made to guarantee a maximum waiting time of 18 weeks from referral to treatment for all NHS services, including orthodontic treatment, by April 2010.

9.9 The PCT should ensure that the recommendations from the topic group are incorporated in to these future developments.

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APPENDIX 1

Health Scrutiny Committee

TOPIC: NHS Dentistry

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FRAMEWORK FOR SCRUTINY:Issues and Questions to be addressed:NB. The topic group will prioritise consideration of the first two questions.

1) Are NHS dentists in Hertfordshire sufficiently accessible?a) Are there waiting lists, and if so, what needs to be done to address them?b) Are measures taken to make sure that access is equal for all, in both rural and

urban areas? Is there any difference between the different urban centres?c) Is there evidence that residents are going outside the county for treatment

because they cannot access a dentist in their local area (including making trips abroad)?

d) Is there a trend in Hertfordshire of more young dentists choosing to move into the private sector or moving abroad to practice dentistry overseas?

e) Is there evidence of dental practices reducing their quota of NHS provision?f) Is there evidence of people going to A&E or to their GP’s regarding dental care?

2) What are the facilities for children’s dentistry?a) Is there suitable access and quality of care? If not, what are the key issues and

what steps are being taken to address these?b) Are child only contracts performing adequately? If not, what are the key issues

and what steps are being taken to address these?

3) What is the quality of NHS dental treatment in Hertfordshire?a) Do patients understand their treatment and the costs of treatment; is it

communicated sufficiently to them and in a timely manner?b) What is the process for handling complaints and is it suitable?c) How is customer satisfaction measured? What are the outcomes and results?d) How easy is it to access emergency or out of hours treatment?e) Is there evidence that more complex treatment has reduced and if so does this

indicate that the health of the population has improved? What monitoring activities are undertaken?

4) What is accessibility and quality of care like for specialist treatment? This includes:

a) Orthodonticsb) Sedationc) Domiciliary servicesd) The PCT dental service

5) Is the reconfiguration of acute health services in Hertfordshire likely to have an impact on the provision of acute dental services within hospitals?

CONSTRAINTS: The topic group will focus on independent practices delivering NHS treatment through contract with the PCT. The PCT is unable to provide information on purely private practices though information will be sought from the British Dental Association.

METHOD: Topic Group Target Start date: May 2008

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MEMBERSHIP:Doug Drake (Chairman)Mary BayesEddie RoachRoy ClementsOne vacancyDistricts:Brian White, Three RiversOne vacancySOURCES OF EVIDENCE/ WITNESSES: Jane Robinson, Primary Care Trust British Dental Association Practicing NHS dentists PatientsHOW THE ITEM HELPS DELIVER HCC’s CHALLENGESN/A as for Health Scrutiny Committee.

The HCC challenges1. Helping people feel safe &

secure2. Maximising opportunities for

children & young people3. Supporting the independence of

the growing number of older people

4. Tackling the causes and impact of congestion

5. Dealing with worn out roads and pavements

6. Reducing the impact of new development on the environment

7. Maximising efficiency savings

HOW THE ITEM DELIVERS THE CfPS (Centre for Public Scrutiny) OBJECTIVES

Providing ‘critical friend’ challenge to the PCT

Will be calling on members of the public for evidence and opinions

Is carried out by governors independent of Health and the County Council

Aims to help drive improvement for NHS Dental Health Care in Hertfordshire.

CfPS Objectives

Provides ‘critical friend’ challenge to executive policy-makers and decision-makers

Enables the voice and concerns of the public

Is carried out by ‘independent minded governors’ who lead and own the scrutiny role

Drives improvement in public services

SUPPORT: Scrutiny Officer: Vicky Robb

Lead Service Advisor: Jane Robinson, PCT

Democratic

Services Officer: Elaine Gibson

Other:

Approved by the Topic Group on 5th June 2008.

APPENDIX 2

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Members of the Topic Group

Doug Drake (Chairman)Mary Bayes Roy ClementsEddie RoachBrian White, Three Rivers District Council

Executive Member for Adult Care and Health: Sally Newton

HCC WEBSITE LINK: http://www.hertsdirect.org/yrccouncil/civic_calendar

PCT Representatives

Jane Robinson, Commissioning Lead Sue Gregory, Consultant in Dental Public Health Gill Lowey, Clinical Director Lynda Dent, Head of Public Engagement Jenny Greensheilds, Finance LeadChristine Neal, Hertfordshire Complaints Service

Officers

Victoria Griffiths, Scrutiny OfficerElaine Gibson, Democratic Services

Witnesses

Rumeet Patel, DentistShajee Ali, DentistSab Bhandal, DentistSteven Wagner, OrthodontistShamique Ismail, OrthodontistStephen Des Clayes, DentistNikki Davey, Dentist and Chairman of Local Dental Committee Richard Elvin, Dentist and member of Local Dental Committee

Documents provided by the PCT

Dental Services – update for PEC, January 2008Dental Contracts and Dentistry Services in Hertfordshire, Boards, March 2008Dental Access Paper, PEC, September 2008 (subsequently split as appropriate for each Board in September)NHS Dentistry – Finance, August 2008Specialist Services/Quality of Care, September 2008 Monitoring Performance of Specialist Services, October 2008 NHS Dental Complaints, 1st April 2007 – 31st March 2008 How to make a Complaint about the NHS

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BSA Patient Responses to Questionnaires Summary for West Hertfordshire PCT, April 2007 – March 2008 BSA Patient Responses to Questionnaires Summary for East & North Hertfordshire PCT, April 2007 – March 2008 Oral Health Needs Assessment for Hertfordshire PCTs, a Working Document, August 2008 Hertfordshire PCT Dental Service, Information Report, April 2007 – April 2008DOH Information to Patients leafletContributed to Glossary of Terms produced by HCC

Dates of Meetings

5 June 20086 August 200811 September 2008 17 November 2008 10 December 2008

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Slide5