Agenda item

Members to receive a report and presentation updating on Dental Services across Leicester, Leicestershire and Rutland to include coverage; access and recovery following the impact of Covid 19 along with data on tooth decay rates.

Members received a report containing an update on NHS Dental services commissioned in Leicester, Leicestershire and Rutland and an update on the impact of Covid 19 upon those services.

Rose Lynch, Commissioning Manager, Primary Care Dental Services presented an update on dental service coverage across Leicester, Leicestershire, and Rutland, referring to the challenges arising from deprivation issues, areas of deprivation with a comparison of deprivation levels, the location and volume of dental services across the area as well as the recovery of services following the impact of Covid 19 and ongoing steps to improve.

Members were reminded that there were challenges in accessing dental services prior to the Covid 19 pandemic and that Leicester City was rated 11^th highest  for deprivation issues.

During the presentation reference was made to the NHS contracts in primary and community dental care as well as the dental services offered, including out of hours service and secondary care.

Adam Morby, Regional Chief Dentist NHS England highlighted issues around oral health and dental decay in young people; this included a comparison of tooth decay rates for 5 year old children and discussion about the effectiveness of water fluoridation as a safe public health measure to reduce dental decay.

Members were asked to support the Health & Social Care Bill and the fluoridation of water across the area to help improve dental decay levels.

Members noted there were currently no water fluoridation schemes across Leicester, Leicestershire, and Rutland and were concerned about the committee being asked to lobby fluoridation of water without being presented with all the facts and evidence. Members noted that dental decay was not just related to fluoridation of water and other aspects needed addressing. Members commented that dental decay leads to more serious disease that will put other pressures on NHS Services.

Adam Morby responded that fluoridation reduced decay by 63% in areas where there was decay. It was also reiterated that there was close work with other partners to educate people, encourage brushing regimes, promote healthy eating and low sugar diets and to promote oral health.

Members commented that it was increasingly difficult to access an NHS dentist or affordable dental services and queried the lack of detail within the report, such as levels of people entitled to free dental services who were currently not receiving it and what more was being done to encourage dentists to take more NHS patients. Concerns were expressed that not enough information was given about what was being done to secure dental services for those in areas who were unable to access services particularly across challenging rural areas.

Members were advised that dental practices were independent businesses who made their own decisions about how much NHS provision they gave. Most NHS dentists had a mix of NHS and private patients and that percentage varied. General dentistry was provided through an annual contract and the Golden Hello was a scheme for dentists that provided £15k to target and encourage dentists to particular areas for a period of 5 years.

In terms of those on low income affording dental services it was noted there was a patient low income scheme that helped towards dentistry costs. The HC1 form allowed exemption for those on low income not just benefits. It was acknowledged this was not well publicised and more work was being done around messaging and promoting schemes for the public and patients including marketing access to dental services.

As far as the recovery of dental services to pre pandemic levels for access and treatment it was noted that dental practices had effectively stopped in March 2020 but had re-opened in June 2020 following stringent guidelines, but increasing their provision month by month. Dental practices were still struggling to get to full capacity due to infection prevention measures in place. During the pandemic, procurement had also been paused but was now resuming and would help to get better access to dental services across the area. Members were advised that recovery of services post pandemic would improve.

Members remained troubled by aspects of the report and presentation and felt there were contradictions to what was being said, for instance they were told the Golden Hello was to target new dentists to areas of deprivation then told it was to target rural areas. It had been suggested there were areas of deprivation, but that Rutland was not deprived, however there were areas of deprivation there too, where people couldn’t afford basic dental treatment, and this involved people being entitled to free dental care and not being able to access it.

Members reflected further on the effects of deprivation, the economic diversity of the whole of Leicester, Leicestershire and Rutland and the health inequalities that were presenting and how that impacted on dental health. It was stated that in rural areas the cost of housing was very significant, and people were presenting as homeless because housing benefit did not cover the cost of rent in those areas. 70% of homeless families in Rutland had an adult in employment so it was a much wider issue than just people on income support or universal credit. It was felt that these issues and real people were not being considered. It was also stated that people from wards in the City were presenting at GP appointments and even hospitals with dental issues as they could not see a dentist and immediate measures were needed to make the situation better.

The report was criticised for referring to dental practices handing back their licences, yet it omitted that a very large practice in Rutland was no longer an NHS provider and therefore people in Oakham could not get access to routine dental checks as other practices would not take on NHS patients; also, for suggesting that none of the practices in Rutland had taken up NHS initiatives when there was no NHS dental care in Rutland.

It was noted that Healthwatch had contacted every dentist in Rutland, and none were doing any emergency or check-up appointments. Harsha Kotecha from Healthwatch agreed to send the information gathered in relation to accessing dentistry to share with members outside this meeting.

Members discussed issues with NHS contracts in primary and community dental care, referring to their first-hand experience of how the contracts were operating and the dire state that dentistry was in because of the poor contracts. Members noted the situation had worsened since the NHS had changed the contracts and it was suggested that NHS leaders needed to value the work being done by dentists and improve the contracts to increase availability of an NHS provision of dental services.

Responding to the concerns raised it was accepted there were clear challenges to dentistry; and advised that since the pandemic dental services had been provided a safe threshold in terms of their contractual expectations.  As far as incentives to new dental provision, expressions of interest were sought across the whole East Midlands region with incentivised uplifts for the provision of week end access. Regarding Rutland there were plans to intersperse dental services provision within the area and NHS England was working with colleagues in public health to understand where most need was. Members were told that NHS England did recognise the urgency there.

Rob Howard, Consultant in Public Health referred to initiatives around the promotion of oral health and gave assurance that all stakeholders attending the area Health and Wellbeing Board were engaged in tackling the issues of health inequalities and dental decay. Members were advised that the city public health team had just produced an Oral Needs Health Assessment and both counties (Leicestershire and Rutland) were in process of completing theirs. There was an action plan in place which had led to some improvements. The Oral Needs Health Assessments would be used to review and redevelop the action plan. The Public Health team advised they would be willing to share that in terms of the partnership work being done to improve and address health inequalities and oral health.

Members were informed that the Oral Health Needs Assessment was important in terms of next steps as it was a systematic assessment of the needs of the population. Assurances were given that public health officers would be working closely with county colleagues in terms of what needed to be done as a result of those assessments.

In terms of communications and partnership working it was emphasised that partnership working was taking place, and all stakeholders were engaged in relation to promotion and improved publicising of initiatives and the help available such as the low income scheme, not just to those in receipt of benefits but also those in hardship or on low incomes.

Regarding joint and integrated working Members noted there was now an opportunity to talk about dentistry as it would form part of the delivery of NHS care through the Integrated Care System. Steven Claydon, NHS England agreed to liaise and meet with Andy Williams CEO Integrated Care System, Rose Lynch and Jasmine Murphy outside of this meeting to start a discussion around working together to address dentistry issues raised across LLR and to discuss the transition of commissioning.

Drawing the discussion to a close the Chair noted the depth of feeling on this topic and the concerns and issues raised by the committee. The Chair agreed with the view that the dental practice contracts needed revisions by the NHS to help improve accessing provision.

Given the strength of feeling about the issues raised during discussion of this item it was proposed, seconded and upon being put to the vote agreed that it was appropriate to write to the Secretary of State regarding those concerns and to seek assurances that steps were being taken to address those issues.

The Chair asked that a further report updating on the provision of dental services across Leicester, Leicestershire and Rutland be brought to the committee in 12 months.

18.47 Councillor O’Donnell and Councillor Pandya left the meeting.

Meeting remains quorate.

AGREED:

1.    That the contents of the report and presentation be noted,

2.    That Steven Claydon, NHS England shall liaise and meet with Andy Williams CEO Integrated Care System, Rose Lynch, and Jasmine Murphy to explore working together to address the dentistry issues raised across LLR and to discuss the transition of commissioning,

3.    That the Secretary of State be written to regarding the concerns raised during this meeting and to seek assurances that steps are being taken to address those issues,

4.      That a further report updating on the provision of dental services across Leicester, Leicestershire and Rutland be brought to the committee in 12 months.