Ayrshire and Arran Oral Health Strategy Volume

Transcription

1 NHS Board Meeting 5 December 2012 Paper 10 Appendix 1 Ayrshire and Arran Oral Health Strategy Volume The best oral health possible for the people of Ayrshire and Arran Compiled: October 2012 Department: Public Health Contributors: Maura Edwards and Ailsa Morrant with input from Oral Health Strategy Leadership Group

2 CONTENTS PAGE 1 Background and Strategy Development Process Current Service Profile Introduction to New Strategy Strategic Context Vision, Principles, Aim and Outcomes of this Strategy Future Outcomes Priorities NHS Ayrshire & Arran Oral Health Outcomes Models Engagement and Consultation Performance Management Framework Financial Framework Standard Impact Assessment Action Plan List of Abbreviations 39 Copies of supplementary documents are available on request from the Public Health Department: Volume 2 - NHS Ayrshire & Arran Oral Health Strategy Fact File NHS Ayrshire & Arran Oral Health Strategy Standard Impact Assessment 3 month public consultation report

3 1 B a c k g r o u n d a n d S t r a t e g y D e v e l o p m e n t P r o c e s s 1.1 This is the second Oral Health Strategy for NHS Ayrshire & Arran and builds on what has been achieved by the first Oral Health Strategy between 2003 and These achievements include: 2010 national target of 60% of P1 children free from obvious decay exceeded (63%) 2010 national target of 60% of P7 children free from obvious decay exceeded (70%) Improved access to Primary Care Dental Services by increasing the dentist to population ratios (80% of dentists accepting new NHS patients) Achievement of workforce targets for NHS dentists working in NHS Ayrshire & Arran Implementation of a Primary Care Dental Premises Strategy Exceeded targets for dental registrations across all population age groups (overall, 80% of Ayrshire and Arran population registered, compared with 74% of Scottish population) Establishment of Emergency Dental Services (EDS) to NHS QIS Standards 1 Implementation of the Childsmile programmes in nurseries, schools and dental practices Community development approach adopted for implementation of oral health promotion programmes Development and delivery of oral care training programmes for older people in care homes and adults with additional needs Pathway for access to dental services for homeless people established. 1.2 NHS Ayrshire & Arran developed an Oral Health Strategy in 2002, which was endorsed by the NHS Board in Following the publication of the National Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland in 2005, a revised local strategic five year action plan was developed for implementation between 2005 and The implementation was led by the CDPH (Consultant in Dental Public Health) and the activity and performance was monitored and co-ordinated by the Oral Health Strategy Steering Group. 1.3 Early in 2011, an initial Stakeholder event was held to review progress at the end of the five year action plan. A paper reviewing the strategic achievements was presented to the NHS Board in August 2011, where support was given to continue the strategic approach for oral health improvement, led by a CDPH. It 1 Healthcare Improvement Scotland took over the responsibilities of NHS Quality Improvement Scotland on 1 st April 2011 Page 1

4 was agreed to develop a new ten year oral health strategy for NHS Ayrshire & Arran, with an initial three year action plan. The development of this strategy has been led by the CDPHs, in collaboration with stakeholders. 1.4 The Oral Health Strategy Steering Group was temporarily disbanded in 2010 and an Oral Health Strategy Leadership Group established to develop the new strategy during The new strategy was developed utilising an outcome focussed planning approach. The CDPH-chaired Leadership Group has met regularly during 2011, and included representation from dental services, general dental practitioners, secondary care and PFPI. This approach attempted to ensure participation from all those partners who would be involved in the delivery of the new strategy. 1.5 The Leadership Group have focused their efforts on developing logic models and action plans for four life-stage groups children, adults, priority group adults (those with additional needs, prisoners and homeless people) and dependent older people. 1.6 This strategy is outlined in two volumes, which can be read independently. Volume 1 summarises the vision, priorities, outcomes and high level actions required to deliver the outcomes. Background evidence, such as demography, epidemiology and further details of current services, has also been gathered together and forms Volume 2 (Fact File) of the strategy. This is available on request from the Public Health Department, and available within NHS Ayrshire & Arran on AthenA. 1.7 A second Stakeholder event was held in June 2011 to discuss current drivers which might impact on local oral health services, such as the NHS Quality Healthcare Strategy and the West of Scotland Regional Review of Restorative Services, as well as the forthcoming Priority Group Strategy from the Scottish Government. Stakeholder contribution to strategic development was through discussion groups. 1.8 A third Stakeholder event was held in February 2012 as part of the engagement process, to discuss the draft strategy. The Leadership Group also developed an engagement plan and thereafter a consultation plan. 1.9 Following consultation on the proposed new strategy and Board approval, then an Oral Health Strategy Steering Group will be established to support and monitor strategic implementation of new strategy from 2013 onwards This new strategy aims to consolidate these successes, as well as addressing new challenges and future oral health priorities for the NHS across Ayrshire and Arran, through collaborative working with partner agencies. Page 2

5 2 C u r r e n t S e r v i c e P r o f i l e 2.1 NHS Ayrshire & Arran is in the mid south west of Scotland and covers a population of 366,860. The population and demographic changes are reported in Volume 2 (Fact File). The area is a mix of rural and urban communities. Within NHS Ayrshire & Arran there are economic and health inequalities. Areas of major deprivation in some cases are located next to areas of relative affluence. 2.2 Significant challenges to oral health improvement in Ayrshire and Arran include: Improved but persistently higher levels of dental decay in children from areas of deprivation An ageing dentate population Increasing numbers of dependent older people Ensuring appropriate flexibility and capacity of dental team workforce to meet need Geographic equity of access to services. 2.3 Provision of oral health services is complex, and requires a partnership approach between public health and both primary and secondary care as well as wider partnerships to achieve sustainable and effective oral health outcomes. 2.4 Much of the oral health improvement work in Ayrshire and Arran is led by Public Health in collaboration with service providers. There are strategic and operational elements to the work. The Consultants in Dental Public Health provide strategic leadership, and work closely with the operational service providers in primary and secondary care, as well as wider partners. 2.5 The Primary Care Dental Management Team has responsibility for the Community & Salaried Dental Service and reviews, monitors and supports the General Dental Services. Dental services are provided mainly by independent contractor general dental practitioners. The Community & Salaried Dental Service provide a safety net service to those who cannot access dental treatment, and also accept referrals for cases which are not suited to the independent contractor setting, e.g. general anaesthesia. The proposed Public Dental Service development would be managed within this structure. Page 3

6 2.6 The Oral Health Promotion Team is also included in the Primary Care Dental Management Team. The Oral Health Promotion Team delivers oral health improvement programmes set strategically by Public Health. The Team works in each of the three locality areas and provides group support directly to clients or indirectly to those caring for vulnerable adults, e.g. carers in care homes, staff at Kilmarnock prison. The Team also works closely with partners, e.g. Health Promotion, care homes, secondary school pupils, in delivering oral health improvement programmes. 2.7 Links are in place with the wider primary care team, including primary medical care, health visitors, public health nurses and pharmacy. Work also takes place with local secondary care, e.g. with regard to 18 week Referral to Treatment (RTT), shifting the balance of care, 12 week Treatment Time Guarantee. 2.8 There are regional connections via the secondary and tertiary services from Glasgow Dental Hospital, through the West of Scotland Regional Dental Planning Forum. There are also links with Glasgow Dental School and NHS Education Scotland for outreach dental student training. 2.9 Partner agencies included the Community Health Partnerships, Local Authorities and third sector organisations. Links are made with the public via PPF and PFPI. 3 I n t r o d u c t i o n T o N e w S t r a t e g y 3.1 The main oral diseases are caries (decay), periodontal (gum) disease and oral cancer, all of which are largely preventable. Good oral health is integral to overall health. Oral diseases can result in pain, infection, tooth loss, reduction in quality of life and, in the case of oral cancer, death. They cause significant morbidity, impacting upon general health, wellbeing and mortality rates. Their impact on the economy is also substantial. It is estimated that between 12 and 15 million working days are lost each year because of dental problems. 3.2 As with other chronic diseases, there are inequalities in oral health experience within the population, with the greatest burden of disease being experienced by those living in more deprived areas. Using the common risk factor (CRF) approach and tackling the causes of other public health issues (such as tobacco, alcohol and obesity) also prevents oral diseases (see Figure 1). There are currently four public health priorities identified within NHS Ayrshire & Arran (ATOM - Alcohol, Tobacco, Obesity and Mental Health) all of which impact on oral health improvement. Page 4

7 Figure 1 The common risk factor approach 4 S t r a t e g i c C o n t e x t 4.1 There are a number of key policy documents and drivers that support the development of the Oral Health Strategy. The National Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland remains a key driver. Activity started as a result of the Action Plan will continue to be monitored nationally via the Revenue Resource Allocation: Dental Services Bundles, and CDO-led Board monitoring visits, template completion and national reporting. The latest HEAT target that also contributes to continuing reduction of oral health inequalities is; HEAT target 9-60% of 3 and 4 year olds in each SIMD quintile should have fluoride varnish applied twice a year by March The priority groups identified in the Action Plan were also highlighted in the Equally Well Implementation Plan (2008). Page 5

8 A national Oral Health Strategy for Priority Groups was published by Scottish Government in 2012 and will be implemented locally. Achieving the 18 Weeks Referral to Treatment Standard in Dental Specialties. CEL 3 (2011) has implications for the structure of services and the interface between primary and secondary care, in order to meet the targets for waiting times. 12 week Treatment Time Guarantee has come into effect during The NHS Healthcare Quality Strategy will also be a driver for improving the quality of dental services. The Review of Primary Care Salaried Dental Services in Scotland (2006) has implications for the future structure and function of salaried dental services, where dentists are employed directly with NHS Boards. An Analysis of the Dental Workforce in Scotland: A Strategic Review (2010) considered the skill mix of all dental professionals currently providing dental care to the public in Scotland. A further workforce report was published in dentistry/resources/publications/dental-workforce-report-september aspx 5 V i s i o n, P r i n c i p l e s, A i m a n d O u t c o m e s f o r Thi s S t r a t e g y 5.1 The vision for this strategy is The Best Oral Health Possible for the People of Ayrshire and Arran. 5.2 The principles underpinning the development of this strategy are as follows; Reducing inequalities in oral health using proportionate universalism, i.e. action across the whole population, with more focused efforts targeted at areas of most need Adopting a multi-agency approach Promoting good oral health as the social norm All people have the right to good oral health Services should concur with current best practice and best available research Page 6

9 Using all available resources to engage partners and local communities in oral health improvement (whilst maximising other health improvement opportunities via CRF approach) The public and/or service users should be involved in the development of oral health services NHS Ayrshire & Arran should act as exemplar employers in working towards good oral health in the workplace. 5.3 The aim of this strategy is to improve and maintain the oral health of the population of Ayrshire and Arran, particularly targeting those in areas of greatest need, over a ten year period. This aim will be pursued within available finances and build on progress made between 2005 and 2010 through delivery of the objectives specified. 5.4 Actions will be taken at all stages of the life course, including for children, adults, priority group adults (such as those with additional needs, homeless people and prisoners) and dependent older people. Each of these will be underpinned by: Continuous improvement of service quality Development of workforce Enhancing premises Creating a culture which values good oral health. 5.5 It is the intention of this oral health strategy to ensure a balance between improving the oral health-related outcomes for the most vulnerable groups as well as for the whole population. This intent is reflected in the strategy s actions plans. 6 F u t u r e O u t c o m e s 6.1 Many of the achievements detailed in Section 1 continue to be key outcomes for the new strategy, and are reflected in the outcomes models outlined later in this document for the four life-course stages (see Section 8). To ensure continuous improvement, all targets which have been met will becomes standards to be maintained, and new targets will be set to be achieved. 6.2 This new strategy aims to consolidate the successes achieved so far, as well as addressing new challenges and future oral health priorities for the NHS across Ayrshire and Arran, through collaborative working with partner agencies. 6.3 The intermediate outcomes can summarised as follows: Increased population of children free from dental decay Page 7

10 Reduced burden of dental decay in those children experiencing it Improved health of hard and soft tissues of mouth (all population groups) Increased proportion of adults with their own natural teeth. 7 P r i o r i t i e s From the evidence available, including stakeholder feedback during the engagement process, priority areas have been identified across the life span. Actions will be taken in the four stages of the life course previously identified: children, adults, priority group adults (those with additional needs, homeless people and prisoners) and dependent older people. Some actions are applicable to each of the life course stages: Increasing dental registration Promoting equity of access Ensuring effective referral pathways are in place Delivering Specialist Services to meet population need and primary care demand Ensuring dental health is effectively monitored. 7.2 Other actions are more specific to each of the life course stages, as follows: Children Delivering and developing the Childsmile oral health programme Supporting the child protection agenda Training for education staff to support oral health in educational establishments Rolling out the oral health community development model within targeted communities. Adults Developing topic specific marketing and promotional campaigns programme Rolling out the Work your smile programme in the workplace. Priority group adults Delivering oral health improvement programmes for adults with additional needs, homeless people and prisoners Supporting the protection of vulnerable groups agenda. Page 8

11 Dependent older people Delivering oral health improvement programmes for dependent older people Supporting the protection of vulnerable groups agenda. These stakeholder priorities need to be addressed whilst building on existing achievements, enhancing partnerships and embedding continuous quality improvement processes within service delivery further. 8 N HS A y r s h i r e & A r r a n O r a l H e a l t h O u t c o m e s M o d e l s 8.1 There are currently no national outcomes models for oral health. Therefore, outcomes models were developed locally for the four life stage groups - children, adults, priority group adults (those with additional needs, prisoners and homeless people) and dependent older people. The development of these outcomes models was to ensure the link was made between the actions and priorities of this strategy and the national and local priorities and outcomes. It also enables the development of an effective performance management process. 8.2 The completed outcomes models for oral health are outlined on the following pages. Page 9

12 Child Logic Model Activities Short-term Intermediate Long Term Ongoing implementation delivery and development of Childsmile core, practice and nursery / school programme Actively work to support and promote equity of access and increase child dental registration Constantly improve the quality of child dental care Actively work to support the child protection agenda Childsmile toothbrushing programme in 100% of participating nurseries Childsmile toothbrushing programme in 20% most deprived primary schools, P1 and P2 All children receive scheduled core Childsmile resources Targeted* nursery population uptake Childsmile fluoride varnish Dental health information and significant dental events are fed back to named HV / PH nurse and incorporated into shared child health record All children receive age specific oral health improvement support in NHS, education, community and third sector settings through partnership working **Systematic approach to evaluation and monitoring in place Increased proportion of child population that are free of any obvious dental decay*** Reduced burden of dental decay in those children who experience it Improved health of hard and soft tissues of mouth Best oral health improvement for children and young people in Ayrshire and Arran Ensure child dental health is effectively monitored Ensuring effective referral pathways are in place and actively working to continuously improve these All education establishments have oral health programmes in place An oral health community development approach taken within targeted communities Deliver adequate and appropriate capacity and flexible secondary care Specialist Services to meet population need and primary care demand Targeted* primary population uptake Childsmile fluoride varnish General dental services and community and salaried dental services offer Childsmile Referral system to Childsmile dental health support workers in place Children are referred, registered and receive care they require from GDS / PC Gleam Embrace, the teenager, age specific oral health promotion programme is offered to all secondary schools throughout Ayrshire **All Board CS and National Dental Action Plan workstreams are monitored and reported to Scottish Government Specialist children s dental services are in place including Paediatric dentistry, sedation, dental general anaesthetic, orthodontics, oral surgery, maxillofacial surgery All dental services promote and embrace Getting It Right For Every Child values *20% most deprived nurseries and schools (SIMD 2009) **These outcomes have been provided nationally *** free of any obvious dental decay is the epidemiological term to define the level of decay being strategically monitored for the child population Provide strategic leadership Increase active child dental registration Page 10

13 Adult General Logic Model Activities Short-term Intermediate Long Term Develop and facilitate topic specific marketing and promotional campaigns Increased active dental registrations Increased proportion of adults with their own natural teeth Best oral health improvement for adults in Ayrshire and Arran Develop, evaluate and roll out Work your Smile programme Adults are referred, registered and receive care they require form General Dental Services/Community and Salaried Dental Services/Emergency Dental Services Reduced burden of oral hard and soft tissue disease Actively work to support and promote equity of access and increase dental registration Specialist dental services are in place including restorative dentistry, sedation, dental general anaesthetic, orthodontics, oral surgery/maxillofacial surgery, special care dentistry Actively work to constantly improve quality of dental care and patient experience Actively work to support the adult protection agenda Ensure adult dental health is effectively monitored Improved daily oral health care of adults All adults receive oral health improvement support in NHS, community, workplace and third sector settings through partnership working Ensuring effective referral pathways are in place and actively working to continuously improve Deliver adequate and appropriate capacity and flexible secondary care Specialist Services to meet population need and primary care demand Page 11 Provide strategic leadership

14 Adult Priority Group Logic Model Activities Short-term Intermediate Long Term Plan, develop and implement oral health improvement programmes for adults with additional needs, homeless people and prisoners Actively work to support and promote equity of access and increase adult priority groups for dental registration Increased active dental registrations Priority group adults are referred, registered and receive care they require fro General Dental Services/Community and Salaried Dental Services/Emergency Dental Services Increased proportion of priority group adults with their own natural teeth Reduce burden of oral hard and soft tissue disease Best oral health improvement for priority group adults in Ayrshire and Arran Actively work to constantly improve quality of dental care and patient experience Ensuring effective referral pathways are in place and actively working to continuously improve these Deliver adequate and appropriate capacity and flexible secondary care Specialist Services to meet population need and primary care demand Provide strategic leadership Specialist dental services are in place including restorative dentistry, sedation, dental general anaesthetic, oral surgery/maxillofacial surgery and special care dentistry Improved and maintained daily oral health care for adults with additional care needs ** Oral health care improvement programmes in place for adults with special needs, homeless people or those currently in prison **These outcomes have been provided nationally Ensure priority group adult dental health is effectively monitored ** Oral health care training programmes for carers of priority adult groups in place ** All prisoners are offered a basic assessment of their oral health at induction Suitable oral health information available at accessible venues to target homeless people Page 12

15 Dependent Older People Logic Model Activities Short-term Intermediate Long Term Plan, develop and implement oral health improvement programmes for dependent older people Actively work to support and promote equity of access and increase dependent older people s dental registration Actively work to constantly improve quality of dental care and patient experience Actively work to support the adult protection agenda Ensure adult dental health is effectively monitored Increased active dental registrations Dependent older adults are referred, registered and receive the care they require from General Dental Services/Community and Salaried Dental Services/Emergency Services Specialist dental services are in place including restorative dentistry sedation, dental general anaesthetic, oral surgery/maxillofacial surgery, special care dentistry Increased proportion of dependent older people with their own natural teeth Reduced burden of oral hard and soft tissue disease Best oral health improvement dependent older people in Ayrshire and Arran Ensuring effective referral pathways are in place and actively working to continuously improve Deliver adequate and appropriate capacity and flexible secondary care Specialist Services to meet population need and primary care demand Provide strategic leadership Improved and maintained daily oral health care for dependent older people Daily oral care in place ** Oral health improvement programmes in place Suitable oral health information available for dependent older people **These outcomes have been provided nationally ** Oral health care training programmes for carers of dependent older people in place Page 13

16 9 E n g a g e m e n t a n d C o n s u l t a t i o n 9.1 There has been extensive engagement and consultation to date. As noted in 1.7 and 1.8, Stakeholder events for development of the new strategy were held in June 2011 and February 2012, which were attended by a wide-range of representatives and key partners. 9.2 The Leadership Group developed an initial engagement booklet and subsequent consultation booklet to distribute to staff, partner organisations and members of the public, which aimed to gauge opinion on the current draft of the Ayrshire and Arran Oral Health Strategy. During engagement and consultation a total of 40 responses were received. It was apparent that the overwhelming majority of those who responded agreed with the vision and key areas of the strategy. All comments were considered and, where appropriate, were incorporated into the draft strategy and action plan. 9.3 In addition the Oral Health Strategy Leadership Group considered it essential to meet with various locality groups in each of the three Community Health Partnerships (CHP) areas, including the Officer Locality Groups (OLGs). Presentations were made at the following East Ayrshire CHP Forum East Ayrshire Children s OLG North Ayrshire CHP Forum North Ayrshire CHP Committee South Ayrshire Adult s OLG South Ayrshire Children and Young People s OLG South Ayrshire CHP Forum Within each locality, discussions were initiated into agreeing a mechanism as to how the strategy, when endorsed by the NHS Board and consulted on, will be implemented in each area. The locality plans to take forward the work may be slightly different; however all are committed to this being a priority. This will be facilitated by linking with the Lead Public Health Practitioner, CHP Facilitator, Health Promotion Manager and Public Partnership Forum (PPF) Lead in each locality. Page 14

17 9.4 Presentations were also given to various staff, including senior members of the Community and Salaried Dental Service, through the operational Primary Care Dental Leadership Group. This group consists of senior dental officers, team leaders for the dental hygienist and dental nurse teams, and co-ordinators of Childsmile and oral health promotion, as well as managers. In addition, presentations were made to the Public Health Department and the Head and Neck Directorate. Comments received at each of these presentations were also taken into account when developing the final strategy and action plan. 9.5 Focus groups were held with those deemed to be priority groups in the Scottish Government National Oral Health Improvement Strategy The focus groups included carers of older people, adults with a learning disability and their carers as well as homeless people and their support staff. Focus groups were also held with children of primary and secondary school age as young people are also a key target group. 9.6 A Children s oral health pathway/action plan consultation event was held involving all NHS key stakeholders. All comments were very positive and will be used to support and inform the implementation phase. 10 P e r f o r m a n c e M a n a g e m e n t F r a m e w o r k 10.1 A rigorous system of outcome monitoring and evaluation is required to ensure achievements for services, partners and the Board Performance management will be focused on how the outcomes of this Strategy are delivered and how these link to the wider strategic expectations of NHS Ayrshire & Arran. It will also link to existing performance measures such as the NHS Healthcare Quality Strategy, Ayrshire Single Outcome Agreements and HEAT. The Covalent system will be used to monitor performance management The implementation of this strategy and management of associated risks will be strategically led by the Consultants in Dental Public Health and overseen by the multi-agency Oral Heath Strategy Steering Group (see Figure 2). The detail of the performance management will be undertaken as part of the strategic performance framework NHS Ayrshire & Arran Performs. Other aspects of performance management will include clinical governance, which is monitored elsewhere. Page 15

18 Figure 2 - Structure for implementation and performance management of the Oral Health Strategy BOARD EXECUTIVE DIRECTOR OF PUBLIC HEALTH Strategic Leadership Consultants in Public Dental Health Oral Health Strategy Steering Group (membership to reflect Stakeholder Groups) Stakeholder Groups Senior Dental Management Team Head and Neck Directorate Area Dental Professional Committee West of Scotland Regional Dental Planning Group National Lead Officer/Chief Dental Officer Group 3 CHPs 3 rd Sector Groups Services Group e.g. oral surgery restorative GA/sedation Adults Group Children s Group Page 16

19 10.4 Financial performance management is also carried out. With regard to the dental bundles, this spending is monitored nationally via representatives of the Chief Dental Officer. Locally, spending of core Board funding for dental services will be monitored at strategic level (not operational level) by the Oral Health Strategy Steering Group A number of high level Performance Indicators have been proposed as follows: Children: Dental registration rates (active registration, once available) HEAT target for fluoride varnish Toothbrushing programme 100% compliance in target settings Adults: Dental registration rates (active registration, once available) Dental practice inspection programme 100% compliance Access target headcount of dentists (dentist:population ratios) Priority Group Adults: Prison waiting times equitable to general population Dependent Older People: % of care homes trained in oral health These will be worked up in detail at the implementation stage. 11 F i n a n c i a l F r a m e w o r k 11.1 Current finance for oral health improvement and services is derived from Scottish Government core funding and bundles as well as non-cash limited Scottish Government funding (for salaried and independent GDS). This strategy has been developed based on the prediction that there will be a continuation of the current levels of Scottish Government funding To meet existing and future challenges, improved efficiency in working will be required to ensure the most efficient use of available resources. Therefore, any investment stated or implied within this document will be met through rigorous reprioritisation of existing resources. 12 S t a n d a r d I m p a c t A s s e s s m e n t 12.1 This document has been written within the parameters of the Ayrshire and Arran Equality and Diversity framework, which ensures that non-discriminatory practices are being followed and NHS Ayrshire & Arran remains compliant with legislation: Page 17

20 addressing the needs of those people who require communication in an alternative format e.g. other languages or signing. Additionally, some patients may have difficulties with written material. This includes information for people with learning difficulties. addressing the oral health issues of people with physical disability or impairment. in some circumstances there may be religious and/or cultural issues which may impact on service delivery e.g. choice of gender of health care professional This strategy has been subjected to NHS Ayrshire & Arran s Standard Impact Assessment Process. Overall the strategy has a positive impact. A copy of the full report is available from the Public Health Department on request. Page 18

21 1 4 A C T I O N P L A N Children 0-17 years - Short Term Outcomes: C1 Childsmile toothbrushing in 100% of participating nurseries C2 Childsmile toothbrushing programme in 20% most deprived primary schools, P1 and P2 (SIMD 2009) C3 All children receive scheduled core Childsmile resources C4 Targeted* nursery population uptake Childsmile fluoride varnish programme C5 Targeted* primary school population uptake Childsmile fluoride varnish programme C6 General Dental Services and Community and Salaried Dental Services offer Childsmile C7 Referral system to Childsmile Dental Health Support Workers in place C8 Children are referred, registered and receive care they require from GDS/ PC Dental Service C9 Gleam Embrace, the teenager, age specific oral health promotion programme is offered to all secondary schools throughout Ayrshire C10 Increase active child dental registration C11 Dental health information and significant dental events are fed back to named HV/PH nurse and incorporated into shared child health record C12 All children receive age specific oral health improvement support in NHS, education, community and third sector settings through partnership working Systematic approach to evaluation and monitoring in place C14 All Board CS and National Dental Action Plan workstreams are monitored and reported to Scottish Government C15 Specialist children s dental services are in place including Paediatric dentistry, sedation, dental general anaesthetic, orthodontics, oral surgery/ maxillofacial surgery C16 All dental services promote and embrace Getting It Right for Every Child values Adults General Population - Short Term Outcomes: A1 A3 Increased active dental registrations Adults are referred, registered and receive care they require from General Dental Services/ Community and Salaried Dental Services/ Emergency Dental Services Specialist dental services are in place including restorative dentistry, sedation, dental general anaesthetic, orthodontics, oral surgery/ maxillofacial surgery, special care Page 19

22 A4 A5 Improved daily oral health care of adults All adults receive oral health improvement support in NHS, community, workplace and third sector settings through partnership working Section 3: Adult Priority Groups - Short Term Outcomes: P1 P2 P3 P4 P5 P6 P7 P8 Increased active dental registrations Priority group adults are referred, registered and receive care they require from General Dental Services/ Community and Salaried Dental Services/ Emergency Dental Services Specialist dental services are in place including restorative dentistry, sedation, dental general anaesthetic, oral surgery/ maxillofacial surgery, special care dentistry Improved and maintained daily oral health care for adults with additional care needs Oral health care improvement programmes in place for adults with special needs, homeless people or those currently in prison Oral health care training programmes for carers of priority adult groups in place Suitable oral health information available at accessible venues to target homeless people All prisoners are offered a basic assessment of their oral health at induction Section 4: Dependent Older People - Short Term Outcomes: D1 D2 D3 D4 D5 D6 D7 D8 Increased active dental registrations Dependant older adults are referred, registered and receive care they require from General Dental Services/ Community and Salaried Dental Services/ Emergency Dental Services Specialist dental services are in place including restorative dentistry, sedation, dental general anaesthetic, oral surgery/ maxillofacial surgery, special care dentistry Improved and maintained daily oral health care in place for dependent older people Daily oral care in place in care homes Oral health improvement programmes in place Suitable oral health information available for dependant older people Oral health care training programmes for carers of dependent older people in place Page 20

23 1: General Actions 1.1: Actively work to support and promote equity of access and increase dental registration Timeline: to be undertaken during Year 1 NO. ACTION/ SUB ACTION INPUT EVIDENCE OUTCOME All General Dental Practitioners (GDP) and Salaried General Dental Practitioners (SGDP) will provide Childsmile interventions as defined in the Statement of Dental Remuneration for all patients for whom they receive a capitation payment. General Dental Service (GDS) / Community & Salaried Dental Services (CSDS) PVR reports DRO inspections C6 C8 C All Community Dentists will provide Childsmile interventions as defined in the Statement of Dental Remuneration on all appropriate patients Primary care dental premises will have facilities, equipment and environment appropriate to the care provided in each setting and to suit the individual needs and preferences of the patient Individual clinician responsibility CSDS Individual clinician responsibility GDS/ CSDS Individual clinician responsibility Health Informatics Centre (HIC) system ISD reports Patient records/kodak R4 Practice inspections Suitable physical access in CSDS clinics for this client group LDU audits as they come on stream C3 C6 C8 C10 C6 C8 C10 D2 P Develop marketing strategy for primary care dental services to incorporate a social marketing Dental Management Team () Strategy written Monitoring of any increase in child/adult/older peoples registration figures A1 C6 Page 21

24 NO. ACTION/ SUB ACTION INPUT EVIDENCE OUTCOME approach to promote registration Survey of access to NHS dental care within General Dental Service is carried out regularly and distributed appropriately Carry out ongoing monitoring of workforce and availability of NHS dental services, ensuring the appropriate placement of Community & Salaried Dental Services to complement General Dental Services. Primary Care Manager (PCM)/Senior Oral Health Promotion Coordinator (SC) PCM/Assistant Dental Services Manager (ADSM) PCM/CDPH Evaluation of campaigns/strategy Evidence of survey results Distribution by WTE Dentists and Dental Care Professionals in GDS meet targets CSDS Clinical Review will show a change to services delivered appropriate to needs/patients ISD reports Access surveys to Dental Practices C8 C10 D1 D2 P1 A1 C6 C8 C10 D2 P1 P2 A3 C6 C8 C10 C11 D2 P Ensure the maintenance and development of Oral Health Promotion interventions across Ayrshire & Arran to promote dental registrations. PCM/SC/ CDPH Evaluation of projects for effectiveness Evidence of changing programmes to meet needs and demands of adults/children A1 C6 C8 C10 C12 Page 22

25 NO. ACTION/ SUB ACTION INPUT EVIDENCE OUTCOME Improve access to secondary care services All Primary Care Dental Services will provide appropriate dental care which meets the needs and preferences of their patients, and provide access to all items as defined in the Statement of Dental Remuneration for all patients for whom they receive a continuing care payment Promoting registration and ensuring attendance that is appropriate to the patients needs Head and Neck Directorate GDS/CSDS Individual clinician responsibility GDS/CSDS Individual clinician responsibility Establish orthodontic clinics at ACH Expansion of primary care services PV Monitoring Audit Prescribing monitoring Practice inspection CSDS to develop a examination and triage service for care homes PV meetings/reports Individual clinician responsibility PDP/appraisal/objectives in CSDS only Clinical notes reviews in managed service Peer review/pdps/appraisal in CSDS GDS more difficult to evidence ISD registration data Education/awareness policy D1 P1 C15 P2 A1 D1 P1 Page 23

26 1.2: Actively work to improve the quality of dental care and patient experience Timeline: to be undertaken during Year 1 NO. ACTION/ SUB ACTION INPUT EVIDENCE OUTCOME The primary care dental team will endeavour to secure and GDS/CSDS DRO Inspections (PSD) All short term outcomes where possible improve the oral Individual National Dental Inspection Programme health of their patients, whilst clinician D2 taking into consideration their particular circumstances responsibility P All primary care dental practitioners will ensure they have an understanding of when the need to refer exists and will follow appropriate referral pathways All secondary care practitioners will provide educational opportunities for primary care dental practitioners in relation to referral pathways All primary care dental practitioners will ensure robust and consistent reporting and completion of dental records. GDS/CSDS Individual clinician responsibility Head and Neck Directorate Head and Neck Directorate GDS/CSDS Individual clinician responsibility Evidence of Continuing Professional Development (CPD) events held locally Audit Evidence of distributing information Evidence of presentations by secondary care to primary care practitioners Evidence of CPD events held locally and presentations by secondary care to primary care Clinical audit PSD record checks (DRO) A3 C6 C9 C11 C14 P3 A3 C15 D3 P3 C6 C9 C11 C14 D2 P2 Page 24

27 NO. ACTION/ SUB ACTION INPUT EVIDENCE OUTCOME All primary care dental practitioners will be aware of GDS/CSDS Evidence of CPD events held locally Audit C6 C9 and comply with all new Individual Evidence of distributing information C11 requirements and support new clinician Appropriate monitoring dependent of initiative initiatives. responsibility D2 P Quality of primary care dental services will be monitored by the, with any areas of concern addressed appropriately Prescribing patterns of primary care dental practitioners routinely monitored by the and Senior Prescribing Adviser will monitor that Childsmile/adult interventions are being suitably carried out by General Dental Practitioners will carry out overall monitoring including random sampling of Community & Salaried Dental Service record cards to ensure quality of record keeping and to monitor that Childsmile/adult Dental Practice Advisor (DPA)/Clinical Director (CD - (CSDS) DPA/CD (CSDS) DPA CD (CSDS) PV monitoring (quarterly meetings at Health Board) DRO monitoring Quality activity monitoring Education support for CSDS Prescribing pattern monitoring for both GDS and CSDS PV monitoring meetings additional report required Clinical audit in-house CPD/training provided when appropriate PV Reports Record card recall C6 C9 C14 D2 P2 C6 P2 A3 C6 C10 D2 D3 P2 A3 C6 C10 D2 D3 P2 Page 25

28 NO. ACTION/ SUB ACTION INPUT EVIDENCE OUTCOME interventions are being carried P3 out Modernisation of skills to support the shifting balance of care into primary care PCM (DS) Working group for oral surgery Establishment of proposal and roll out of delivery of oral surgery Organise appropriate training programmes for clinicians to gain experience Informal clinical network between secondary care and primary care specialist practices A3 C6 C8 C11 D3 P Timely distribution of National guidance and legislation to all primary care dental teams as appropriate, and the provision of follow up training if required Compliance with requirements for prison dental services DPA/CD/ADSM CD(CSDS)/ PCM(DS) Evidence of NHS mail distribution list Evidence of CPD events/training Evaluation from events R4 Reports/Spreadsheets Access to Emergency care within 24 hours All short term outcomes D2 P2 P8 1.3: Actively work to support the child protection agenda Timeline: to be undertaken during Years 1 to 3 NO. ACTION/ SUB ACTION INPUT EVIDENCE OUTCOME The primary care dental team will ensure that they are aware of their responsibilities for child protection and GIRFEC. GDS/CSDS Individual clinician CPD/evaluation on GIRFEC Survey Monkeys for feedback on awareness of individual responsibilities C6 C8 C The primary care dental team will refer significant dental events to ensure compliance responsibility GDS/CSDS Individual Reporting events/info into FACE (CSDS) Datix Reports (CSDS) Evidence of liaison within patient notes, with C6 C9 Page 26

29 NO. ACTION/ SUB ACTION INPUT EVIDENCE OUTCOME with child protection and clinician other healthcare professionals and other GIRFEC. responsibility agencies when there are concerns regarding a will continue to raise awareness of child protection to all dental practitioners and the wider dental team Ensure all primary and secondary care dental and oral maxillofacial services promote and embrace Getting It Right for Every Child (GIRFEC) values. PCM(DS)/ ADSM Head and Neck Directorate child. CPD events Distribution of documents Practice GIRFEC protocol monitoring at local practice inspection Evidence of appropriate CPD attendance C6 C9 C6 C will encourage dental practitioners to complete the dental section of the Personal Child Health Record (red book) Implementation of Getting It Right For Every Child child protection and the improvement and development of links between all Dental Services and Children s Services PCM(DS)/ ADSM Education/CPD events Encourage better involvement with Health Visitors/Child Health for child patients Dental practice inspections Dental management governance monitoring of salaried dental services C6 C9 C10 C6 C9 1.4: Actively work to support the adult protection agenda Timeline: to be undertaken during Years 1 to 3 NO. ACTION/ SUB ACTION INPUT EVIDENCE OUTCOME The primary, secondary and oral maxillofacial care dental team will ensure that they are aware GDS/CSDS Individual CPD/evaluation on Protecting Vulnerable Adults (PVG) courses Survey Monkeys for feedback on awareness of D2 P2 Page 27

30 NO. ACTION/ SUB ACTION INPUT EVIDENCE OUTCOME of their responsibilities for adult protection and promote Promoting Vulnerable Groups (PVG) ethos team member responsibility individual responsibilities The primary care dental team will refer significant dental events to ensure compliance with adult protection will continue to raise awareness of adult protection to all dental practitioners and the wider dental team Ensure all primary care dental services promote and embrace ethos of protecting adults GDS/CSDS Individual team member responsibility PCM(DS) PC Delivery Group Public Health Protocols (adverse incidents) Datix (CSDS only) Reporting events/info into FACE (CSDS) Evidence of liaison with patient notes with other healthcare professionals when there are concerns regarding an adult CPD events/learnpro Send of education materials Distribution of documents Practice protocol P2 P4 D2 D2 P2 D2 D4 P2 1.5: Ensure dental health is effectively monitored Timeline: to be undertaken during Years 1 to 3 NO. ACTION/ SUB ACTION INPUT EVIDENCE OUTCOME Ensure that processes are in place for adequate reporting NDIP HIC and Childsmile monitoring reports All short term outcomes and monitoring is in place for all Scottish health survey individual elements of child and Adult health survey D2 dental health ISD P2 Page 28

31 NO. ACTION/ SUB ACTION INPUT EVIDENCE OUTCOME PV Development and delivery of the National Dental Inspection Programme National Dental Inspection Programme submitted annually on schedule to ISD C6 - C7 C9 C14 C15 1.6: Ensuring effective referral pathways are in place and actively working to continuously improve these Timeline: to be undertaken during Years 1 to 3 NO. ACTION/ SUB ACTION INPUT EVIDENCE OUTCOME Ensure appropriate systems are in place to review and monitor referrals and actively working to continuously improve care pathways and 18 Week Referral to Treatment Have in place appropriate systems for Childsmile referrals Ensure compliance with 18 Week Referral to Treatment for services. Incorporate with systems PCM(DS)/ADS M Head and Neck Directorate Waiting list management Regular monthly/quarterly reporting of referral patterns for discussion at management meetings Liaison with secondary care colleagues to ensure smooth running of links with General Anaesthetic sessions Regular reports prepared and run from PMS, then discussed Theatre utilisation reports monitored and discussed at management team for GA sessions Informal clinical network between secondary care and primary care services A3 C6 C8 C11 D2 D3 P2 P3 Scottish Government report card C6 C10 Regular monthly meetings Monthly MMI to Scottish Government PCM(DS)/ ADSM A3 C6 C8 C11 Page 29