Dentists have a key role to play – Minister
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- Published: Sunday, 14 February 2016 09:04
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Health Minister, Alistair Burt MP, said that dentists have a key role to play in improving child dental health through prevention. He also said that a new contract, based on the outcomes of the current prototypes could be rolled-out nationally in 2018-19. He was replying to a House of Commons debate, imitated by dentist MP, Sir Paul Beresford. The minister will address the BDA conference on May 27.
Opening the debate, Sir Paul Beresford MP said that, for dentists and their teams, their biggest concern was probably child dental health. He told MPs that dentists felt that their small branch of general health is seen as a “Cinderella” service and a side-line within the national health service. Increasingly, the biggest problem they faced was child dental health in the form of dental caries. ‘This disease is almost entirely preventable, but it is not being prevented’, he commented. Dental decay was the No. 1 reason for children aged five to nine being admitted to hospital in the UK.
The biggest single factor in dental caries was sugar. However he did not agree that we needed a tax on sugar; he did not believe that it would ‘make one iota of difference after a few months’. The key to success was, he said, prevention and he pointed to the success of the Childsmile programme in Scotland. Every child in a primary school should visit the dentist at least once a year. Dentists will obviously have to be involved and “persuaded, if not bullied or forced, into such a system.”
Finally he turned to water fluoridation by far and away ‘the proven and most successful way of reducing tooth decay among children. He concluded by saying that the “extent of dental caries among children in England is sad and it is a disgrace. It has been a disgrace for decades. It is preventable and, if we prevent it, we can make considerable savings to our health service and save the pain and suffering of England’s children”.
Replying the Minister for Community and Social Care, Alistair Burt MP, told MPs that it was a fact that the two main dental diseases, dental decay and gum disease, “can be almost eliminated by the combination of good diet and correct tooth brushing, backed up by regular examination by a dentist. He said that data still showed that we have among the lowest rates of dental decay in Europe, but “we must do more”. There was a disparity of experience between the majority of children who suffer little or no tooth decay, and the minority who suffer decay that is sometimes considerable and can start in early life. “The fact that we know that such decay affects children in particular circumstances makes us weep”, he commented.
He announced that from April 2016, a new oral health indicator will be published in the NHS outcome framework based on the extraction of teeth in hospital in children aged 10 and under. “That indicator will allow us to monitor the level of extractions, with the aim of reducing the number of children who need to be referred for extractions in the medium term.” He said that extractions are a symptom of poor oral health, and the key is to tackle the cause of that. “Today I commit that my officials will work with NHS England, Public Health England and local authorities to identify ways to reach those children most in need, and to ensure that they are able and encouraged to access high-quality preventive advice and treatment.”
Local authorities were now statutorily obliged to provide or commission oral health promotion programmes to improve the health of the local population. In order to support local authorities in exercising those responsibilities, Public Health England had published “Local Authorities improving oral health: commissioning better oral health for children” in 2014. That document gave local authorities the latest evidence on what works to improve children’s oral health.
Public Health England was also addressing oral health in children as a priority as part of its “Best Start in Life “programme. It is important, he said, that health visitors, midwives, and the wider early years workforce had access to evidence-based oral health improvement training to enable them to support families to improve oral health. The National Institute for Health and Care Excellence (NICE) has also produced recent oral health guidance that made recommendations on undertaking oral health needs assessments, developing a local strategy on oral health, and delivering community-based interventions and activities for all age groups, including children. He agreed that diet was key to improving children’s teeth and Public Health England published “Sugar reduction: the evidence for action” in October 2015. Evidence from the report showed that a number of levers could be successful, but it was unlikely that a single action alone would be effective in reducing sugar intake.
Dentists had a key role to play, the Minister said. “Delivering Better Oral Health” provided clear advice for dental teams on preventative care and interventions that could be delivered in dental practice and school settings. Regular fluoride varnish was now advised for all children at risk of tooth decay. Such varnishes now equated to 30.9% of all child treatments, compared with 25.2% last year, which was ‘encouraging progress’. The continued provision of high quality NHS primary dental services will continue to be an important part of ensuring that every child in England enjoys as high a standard of oral health as possible, he said. NHS England had a duty to commission services to improve the health of the population and reduce inequalities and also a statutory duty to commission primary dental services to meet local need.
The minister remarked that children’s access to NHS dentistry remained “consistently high”, with the number of children seen standing at 8 million, or 69.6% of the population, although there were localised areas where children had access difficulties. But, he said, “the more common problem is that the parents and carers of the children most at risk do not seek care until the child has developed some disease”.
The Government remained committed to reforming the current system of primary care dentistry to ‘improve access and oral health further’. We needed an approach in primary care dentistry that can “provide a focus on prevention, while also incentivising treatment where needed.” The Government were now prototyping a whole possible new system ‘remunerated through a blend of quality, capitation and activity payments’. The new approach will be tested until at least 2017. If the subsequent evaluation was successful numbers in the scheme will increase “with a possibility of a national roll-out for 2018-19.”
The Minister concluded by saying he hoped he had been able to demonstrate the seriousness with which the Government take this subject, “a seriousness that I know is accepted by the whole House. It comes back to some fundamental issues of inequality in health that are depressingly familiar and which we are all absolutely dedicated to removing.”
The full debate can be seen at:
http://www.publications.parliament.uk/pa/cm201516/cmhansrd/chan110.pdf
See: Column 1046 p74 to Column 1054 p78
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