Oral health and dental services – a new focus on outcomes

Earlier this year I had a chance to meet up with a local dental practice in Cefn Coed to talk about the importance of oral health and dental care in our local health and social care services.

In spite of some significant initiatives like Designed to Smile  the rates of dental disease amongst local children and adults remain too high. Many of the risk factors are common to other conditions and can be changed by behaviour. Campaigns like Baby Teeth Matter – initially launched in Merthyr Tydfil – are important.

The meeting emphasised to me the importance of preventative work from early in life and the action we can all take to improve oral health. The conversation also pointed to the importance of directing our funds towards this preventative agenda and not just focusing on payment for activity rates. Somewhat bizarrely I learnt that the dental contractual arrangements – NHS Unit of Dental Activity (UDA) -pays for treatment and not prevention. Yet again it is an example of the clear need to focus resources on outcomes – improved oral care- and not just for activity outputs.

So I took a keen interest in the publication of “The oral and dental services response” in July 2018 as part of  A Healthier Wales – the new new plan for Health and Social Care in Wales.

In moving oral health forward this new strategy seeks to support new models of care and strengthen leadership within dental teams for improving local delivery within a framework of national standards. The strategy recognises that the contract needs to reform more quickly so that other members of the dental team can deliver the preventative interventions required in our communities.The strategy states that the Welsh Government will expect Health Boards, NHS Business service Authority and dental teams to measure need and outcome in all apsects of dental care delivery. This is to be welcomed as the evidence suggests that a disproportionate amount of NHS dentistry resource is spent on a cohort of patients who have relatively low rates of oral disease. I heard about the local experience of this during my visit.

So NHS primary dental care services will strengthen their work in delivering evidence-informed personalised preventative-led care.

Oral health care will also be a bigger factor in the wider determinants of health so we encourage living and working environments that can improve oral health.

So the commitment to Designed to Smile   will continue with a programme to keep children decay-free by age 5.

The Welsh Government will encourage reforms to existing contracual arrangements so we se more sustainable, innovative practice that can embrace technological change and the skills mix in  local dental teams and networks with greater use of hygenists, therapists and specialist services. the Welsh Government will use innovation fund monies to facilitate these changes.

So for the 2018-2021 period the Welsh Government say that success in dentistry will have five key features:

  • Timely access to prevention focussed NHS dental care,
  • Sustained and whole system change underpinned by contract reform,
  • Teams that are trained, supported and delivering,
  • Oral health intelligence and evidence driving improvement,
  • Improve population health and well-being.

So here is another example of an important preventative and treatment service on a journey of reform but I for one welcome the increasing emphasis on outcomes  – better oral health in Merthyr Tydfil and Rhymney.

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