Agenda item

Dental Health and the Impact of Covid-19 - Evidence from Healthwatch South Tees

Rebecca Morgan (Project Development Manager) and Lisa Bosomworth (Project Lead) will be in attendance to provide:


·        information on the local population’s views and experiences of accessing and using NHS dental services; and

·        details of the impacts of Covid-19 on members of the public being able to see a local dentist for both regular check-ups and emergency treatments.


The Project Development Manager and the Project Lead from Healthwatch South Tees were in attendance to provide:


·        information on the local population’s views and experiences of accessing and using NHS dental services; and

·        details of the impacts of Covid-19 on members of the public being able to see a local dentist for both regular check-ups and emergency treatments.


The Project Lead advised that for the period between 1 April 2022 and 31 March 2023, Healthwatch South Tees had received 198 contacts via a variety of different mechanisms, such as the information signposting function, general engagement and focus groups.


Members heard that on a quarterly basis, community intelligence was gathered by Healthwatch South Tees and shared with relevant stakeholders in primary care, secondary care, social care and public health.


For the period between 1 April 2022 and 31 March 2023, of the 198 contacts, 57 of those related to dentistry. Local residents had contacted Healthwatch because they were unable to access NHS dental care, even though at times, they had highlighted that they were in pain.


The scrutiny panel was advised that the following issues had been highlighted by the local population:


·        residents had been de-registered/de-listed by their dental practices, without notice;

·        there were no NHS dental practices accepting new patients;

·        residents who were new to the area were unable to register with an NHS dental practice;

·        residents were only being offered private appointments; and

·        residents had been unable to access emergency appointments via NHS 111.


It was commented that the most common issue reported to Healthwatch South Tees, was residents being deregistered and removed from their regular dental practice patient list. It was explained that because residents had not been accessing NHS dental services during Covid-19, they had been subsequently removed from patient lists. As a result of that, Healthwatch South Tees had developed a myth buster document, which aimed to dispel the most common rumours relating to NHS dentistry.


Members heard that Healthwatch South Tees had been informed that dentists would prioritise residents ‘in pain’. However, feedback received from local residents would suggest that was not the case. 


Members heard that Healthwatch South Tees had contributed to the work of Healthwatch England in lobbying the Government and calling for a recovery plan for NHS dentistry. The evidence received from communities across the country had made it clear that the lack of access to NHS dentistry needed to be addressed.


Concerns were expressed by Healthwatch South Tees in respect of how the independent statutory body should respond to dentistry enquiries - as, locally, there were no available NHS appointments.  Previously, Healthwatch had been advising local residents to contact NHS 111. However, now NHS 111 call handlers were recommending to residents that they contact their local Healthwatch.


It was commented that it was highly important that dental practices regularly updated their details on the NHS Choices website, as that enabled Healthwatch to access current information on availability for local people.


For the period of 1 April 2023 until 31 October 2023, Healthwatch South Tees had received 100 information and signposting contacts and 23 of those related to dentistry. The main issues reported by the public, during that period, referenced being removed from their regular dental surgery patient list, experiencing problems when trying to arrange access to dental care for children and the lack of dental provision in care homes.


The following local case studies were outlined to the scrutiny panel:


·        A woman had contacted her dental practice, after a few years, as her teeth had deteriorated and she was in pain. Despite her partner and son still being registered at the practice, she had been delisted. The lady managed to get an appointment at another practice, however, the dentist refused to treat her due to the amount of work that would have been required. The woman’s poor oral health had negatively impacted on her self-esteem and had resulted in reduced social interaction.

·        A man required urgent care from a dentist and was unable to find a practice that would treat him, he therefore called NHS 111 and in response, the call handler advised him to contact his local Healthwatch.

·        A man had contacted every dental practice listed on the NHS website, he then called the number provided for NHS England Customer Contact Centre and the call handler recommended that he contact his local Healthwatch.

·        A teenager had problems with decay and her wisdom teeth, which was causing her pain down one side of her face. She had contacted lots of dental practices and no appointments were available.


The Project Development Manager advised that the national Healthwatch England survey had reported that over 70% of respondents had found it difficult to access NHS dental appointments. Therefore, lack of access to NHS dental care continued to be a problematic for people across England, not just the South Tees area. In light of the evidence gathered across England’s communities, Healthwatch had reported that a fundamental reform of NHS dentistry was required, given the problems people that had been experiencing with accessing and affording an NHS dentist.


A concern reported by Healthwatch was the lack of NHS dental appointments widening health inequalities. It had been reported to Healthwatch that people in the UK had been forced to pull out their own teeth, at home, because they could not access or afford an NHS dentist.


Regionally, Healthwatch South Tees had been working with the North East and North Cumbria Integrated Care Board (ICB). Since April 2023 integrated care boards (ICBs) had taken over responsibility for commissioning primary, secondary and community dental services. Discussions had taken place between Healthwatch and the ICB to consider the immediate actions required to stabilise services that were already in place. In addition, medium-term and longer-term approaches were being explored. As part of that process, it was planned that Healthwatch would report on data and information gathered across communities to provide an evidence-base for decision-making. It was commented that in terms of the longer-term solutions, those would primarily focus on preventative measures to reduce the pressure on dentistry.


Healthwatch South Tees had been requested by the ICB to develop a proposal, focussing on two main areas of NHS dental services. It was planned that one area would focus on the views and experiences of those residents requiring access to emergency dental services and the other would focus on the views and experiences of those wishing to access routine check-up appointments. Another area, that the ICB was keen to obtain views on, was communication and the information that was currently available for those wishing to access NHS dental services.


It was commented that further updates on the regional consultation would be shared with the scrutiny panel in due course.


Dental practices were paid in “units of dental activity” (UDAs). Therefore, current contract arrangements meant that dentists were paid for every patient they treated, rather than receiving a fee for every single treatment. For example, a dentist was paid the same fee, regardless of whether they performed one filling on a patient or 10. It was acknowledged that residents from deprived areas had poorer oral health and subsequently more deprived local authority areas had fewer NHS dentists than those in more affluent areas.


Members expressed concerns that the pandemic had resulted in patients being de-registered. In response, the Project Development Manager advised that, although accessing NHS dentistry had been an issue for many years, the pandemic had exacerbated the issue and had resulted in an increased number of residents struggling to access timely dental care.


A Member expressed concern that an NHS patient had been unable to register her children at the same practice, as she was not a private patient. It was commented that there was a need for the NHS to make access to NHS dental services equal and affordable for everyone. It was highlighted that affordability was a major barrier to dental care.


A Member raised a query regarding Healthwatch’s role in securing future improvements in NHS dentistry. In response, the Project Lead advised that Healthwatch’s role would involve gathering the views and experiences of the local population in respect NHS dentistry, which would be utilised to inform decision-making and formulate solutions across the region. A Member commented on the importance of an evidence-based approach being taken by the ICB and Healthwatch to determine future plans.


A Member raised concerns regarding the impact of the NHS dentist shortage on the diagnosis of mouth cancer. The Project Lead commented that locally, data was not currently collected on the link between access to dental care and detection of mouth cancer. A Member commented that it would be advantageous to obtain information on how lack of access to dentistry had impacted on other health services.


A Member raised a query on the potential solutions that could be implemented to improve access to NHS dentistry. In response, the Project Lead commented the current contract arrangements, which paid dentists for NHS ‘units of dental activity’ (UDAs), was not fit for purpose and needed reform.


A Member raised a query regarding the oral health of Middlesbrough’s population. In response, the Director of Public Health advised that work was being undertaken to consider a water fluoridation scheme across the North East.


A discussion ensued and concerns were raised that both NHS 111 and Healthwatch had been answering calls from patients they could not help due to the lack of NHS dental appointments.


It was commented that, once timescales and next steps had been confirmed by the ICB, it would be advantageous for Members to encourage their constituents to submit their views and experiences of NHS dentistry to Healthwatch, to ensure all local communities were represented.




That the information presented at the meeting be considered in the context of the scrutiny panel's investigation.