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.
Minutes:
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.