Agenda item

The Committee are to receive reports on oral health in Westminster.

The papers from Westminster Public Health are to follow.

6.1       The Committee received a report from NHS England Dental Service on Oral Health in Westminster (represented by Dr Huda Yusuf and Jeremy Wallman) and Westminster’s Public Health team.  The Committee also welcomed as external expert witnesses Martin Skipper (Head of Policy, London Dental Committees Confederation) and Emilie Szasz (a practising NHS dentist and owner of a dental practice in Westminster Chair of the Kensington, Chelsea and Westminster Local Dental Committee)

6.2       The Committee discussed the following topics in detail:

•           the treatment charge system, the cost of materials and the balance between acute and emergency treatment;

•           the decay statistics for children under 5 and supporting parents for improved outcomes;

•           oral health inequalities and the procedures for oral health care in care homes;

•           oral heath provision for the homeless and rough sleepers, in particular the impact of substance misuse on oral health;

•           the use of social media for promoting oral health, the costs of oral health treatments and the fear of visiting the dentist; and

•           the ability to register with NHS dentists and the fluoridation of the London water supply.

6.3       The Committee discussed the pricing and charge structure outlined in the report.  The Committee queried whether COVID-19 delays had resulted in more extensive and more costly dental work, and whether this had caused issues.  Responding to the Committee’s query, Martin Skipper advised the Committee that, from a commissioning point, this was an issue as routine issues had become urgent, and practices were seeing more complex and long-drawn-out treatments.  Emilie Szasz advised the Committee that costs had increased, including the cost for materials.  She added that patients were coming in large numbers and because the UDA system does not measure access it is very difficult for the commissioners to know exactly what is happening

6.4       The Committee noted the 3 measures required to tackle the problem of decay amongst for children did not appear to be complex.  It noted that one third of children were suffering from tooth decay and the position had worsen over the last 5 years.  The Committee wondered if there should be more work to educate parents.  The Committee suggest that social media should be used as another tool to promote oral health as nearly all parents will have a smart phone.

6.5       Dr Huda Yusuf (Senior Clinical Consultant, Public Health England) observed that “victim blaming” parents was not constructive and that the focus should be on issues that impact on child oral health, such as child poverty, deprivation, and access to education and opportunities.  It was also felt that the ‘Commission Better Oral Health’ guidance providing an evidence-based intervention was a key tool. It was noted that Westminster had implemented a number of these interventions such as training of the wider workforce, health education and social care, empowering parents to take control over their lives. 

6.6       Anna Raleigh (Director of Public Health) confirmed that using social media to promote improved oral health was certainly something that the Council would look at, as the Change4Life programme was using social media and she would find out further details.  She advised the Committee that, with regards to the oral health of children and young people, there was more work to do.  The Committee was advised that the Council was working from a baseline of 2007 and, whilst there had been some improvements, there was still further work required to improve.  Ms Raleigh also advised that much of the work commissioned involved direct work with parents and families to raise awareness.

6.7       The Committee considered that the main cause of tooth decay related to sugary drinks, and that this did relate to parents.  The Committee also sought clarification on the guidance for dental care in Care Homes.  For example, it had been brought to the Committee’s attention that carers had been told not to brush the teeth of people with mental health issues or people with no teeth at all.  The Committee wanted confirmation that residents in care homes were having their teeth brushed.  Ms Yusuf observed that this information was not current and advised the Committee that there had been recent training of staff in care homes across London, with an oral health assessment being conducted for every person entering a care home and regular review of the initial assessment.

6.8       Olivia Clymer confirmed that Healthwatch was running a project with dignity champions on oral health.  She advised the Committee that the picture was more positive, with people stating that they were content with dental care and support they received, though the picture was less clear for those with dementia or without capacity The Committee requested data on the brushing and flossing of teeth for Westminster’s elderly residents, especially for those without capacity.

6.9       The Committee considered if the Community Hubs could be a place where dental advice was offered.  The Committee also sought confirmation on how the Council supported the homeless and rough sleepers with oral health care.  Huda Yusuf advised the Committee that this was an area of focus and NHS England had conducted an oral health needs assessment on a pan-London basis, including focus groups with dental practitioners and peer groups.  She also advised that there were bespoke dental surgeries and a clinic in Soho specifically for rough sleepers and the homeless population.

6.10     The Committee discussed the widely held fear of going to the dentist and the provision for support in NHS practices.  The Committee noted that residents had not only complained that it was difficult to get a dentist appointment, but it was also difficult register with a dentist.  The Committee also queried whether it was possible to add fluoride to the London water supply.  Jeremy Wallman advised the Committee that there had been no formal registration of patients since the new contract started in 2006.  It was explained that to add fluoride to the London water supply would be complicated, hopefully with the white paper there will be a move in that direction, but it would not be any time soon.

6.11     RESOLVED: that the Committee note the report.

The Committee Requested:

·       Data on the brushing and flossing of teeth for Westminster’s elderly residents, especially for those without capacity.