Ayrshire and Arran Oral Health Strategy Volume

Transcription

1 NHS Board Meeting 23 May 2012 Paper 7 Appendix 1 Ayrshire and Arran Oral Health Strategy Volume The best oral health possible for the people of Ayrshire and Arran Compiled: March 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 7 7 Priorities NHS Ayrshire & Arran Oral Health Outcomes Models Engagement Consultation Performance Management Framework Financial Framework Standard Impact Assessment Action Plan List of Abbreviations 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 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 the CDPH. 1 Healthcare Improvement Scotland took over the responsibilities of NHS Quality Improvement Scotland on 1 st April 2011 Page 1

4 It 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. 1.9 Following consultation on the proposed new strategy and Board approval, then an Oral Health Strategy Programme Board will be established to support and monitor strategic implementation of new strategy from 2012 onwards. The Management of Successful Programmes approach (MSP) will also be adopted 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 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). 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 2014 Page 5

8 The priority groups identified in the Action Plan were also highlighted in the Equally Well Implementation Plan (2008), and are due to be the topic of a strategy to come from Scottish Government in 2012 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 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. 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 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 Page 6

9 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 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. Page 7

10 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 establishments educational 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. Dependent older people Delivering oral health improvement programmes for dependent older people Supporting the protection of vulnerable groups agenda. Page 8

11 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 9.1 There has been extensive engagement 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 engagement booklet to distribute to partner organisations and members of the public, which aimed to gauge opinion on the current draft of the Ayrshire and Arran Oral Health Strategy. In total, 32 responses were received. It was apparent that the overwhelming majority of those who responded (83%) 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 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. 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. A presentation was also made at the Public Health Department Development Day. Comments received at each of these presentations were also taken into account when developing the final strategy and action plan. Page 14

17 10 C o n s u l t a t i o n 10.1 This paper will be presented to the NHS Board with a request that it is endorsed for a period of formal consultation. During this time a consultation framework guided by the Patient Focus and Public Involvement Team will be utilised, and the final document presented to the Board for implementation. 11 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 11.1 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 Programme Board (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 - Strategic and Performance Management Structure NHS Board Director of Public Health CDPH Oral Health Strategy Programme Board Subgroup Children Subgroup Adults Subgroup Services Head & Neck Directorate Profession ADPC Partners CHPs/OLGs Third sector Regional GDHS S Primary Care Oral Health Promotion 11.4 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 Programme Board A number of high level Performance Indicators have been identified 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 dental examination within six weeks of arrival Page 16

19 Dependent Older People: % of care homes trained in oral health 12 F i n a n c i a l F r a m e w o r k 12.1 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. 13 S t a n d a r d I m p a c t A s s e s s m e n t 13.1 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: 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 17

20 1 4 A C T I O N P L A N Section 1: 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 C13 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 Page 18

21 1.1: Ongoing implementation, delivery and development of Childsmile Core, Practice and Nursery/School Programmes Compliance with Standards SDCEP Guidelines Childsmile Coordinator Health informatics Centre (HIC) system HEAT target achievement C6 C8 C9 C10 C Allocation, distribution and monitoring of Childsmile resources Appropriate training for all Childsmile programme staff Improved consent rate for the Toothbrushing Programme Compliance with Standards National Toothbrushing Standards Maintenance of 100% nursery school participation in the Toothbrushing Childsmile Programme Childsmile Coordinator Childsmile Coordinator Childsmile Coordinator Childsmile Coordinator Childsmile Coordinator Health informatics Centre (HIC) system Scottish Government monitoring report card Local NHS training programmes NES training report to Childsmile Co-ordinator Health informatics Centre (HIC) system Scottish Government monitoring report card Monitored by NQIS Health informatics Centre (HIC) system Scottish Government monitoring report card C13 C1 C6 C7 C10 C13 C14 C15 C1 C7 C9 C10 C13 C15 C1 C2 C1 C2 C1 C2 C10 Page 19

22 1.1.7 Improved consent rate for the Childsmile Nursery/School fluoride varnish Programme Childsmile Coordinator Health informatics Centre (HIC) system Scottish Government monitoring report card C4 C Compliance with Standards protocol for fluoride varnish applications in nurseries and schools Ongoing delivery of Childsmile Nursery Programme (fluoride varnish) to 20% identified nursery schools (SIMD 2009) children age 3 and Maintenance of participation of 20% identified primary schools Primary 1 and Primary 2 pupils in the Toothbrushing Programme Ongoing delivery of Childsmile School Programme (fluoride varnish) to 20% identified primary schools (SIMD 2009) to Primary Ongoing delivery of Childsmile practice programme Childsmile Coordinator Childsmile Coordinator Childsmile Coordinator Childsmile Coordinator Childsmile Coordinator Local dental clinical governance monitoring Health informatics Centre (HIC) system Scottish Government monitoring report card Health informatics Centre (HIC) system Scottish Government monitoring report card Health informatics Centre (HIC) system Scottish Government monitoring report card HEAT target monitoring ISD Health informatics Centre (HIC) system Scottish Government monitoring report card C4 C5 C4 C5 C10 C1 C2 C10 C4 C5 C10 C6 C10 C13 C The development and establishment of the universal dental health surveillance pathway in local and national Child Health Programme Childsmile Coordinator Childsmile staff input to the Functional Analysis in Care Environments (FACE) system Early years governance group monitoring C1 C6 C8 C10 C13 Page 20

23 delivery Health Informatics Centre (Childsmile, HIC), Functional Analysis in Care Environments (Community Nursing FACE, electronic child health recording mechanism) 1.2: Actively work to support and promote equity of access and increase child dental registration 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) PV Reports DRO Inspections C6 C8 C10 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 Individual clinician CSDS Individual clinician GDS/ CSDS Individual clinician Health informatics Centre (HIC) system ISD reports Patient records/kodak R4 Practice Inspections C3 C6 C8 C10 C6 C8 C10 Page 21

24 and to suit the individual needs and preferences of the patient Develop marketing strategy for primary care dental services to incorporate a social marketing approach to promote child 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. Dental Management Team () Primary Care Manager (PCM)/Senior Oral Health Promotion Coordinator (SOHPC) PCM/Assistant Dental Services Manager (ADSM) PCM/CDPH (CDPH) Strategy Written Monitoring of any increase in Child Registration figures 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 C6 C8 C10 C13 C6 C8 C10 C6 C8 C10 C Ensure the maintenance and development of Oral Health Promotion interventions across PCM/SOHPC/ Evaluation of projects for effectiveness Evidence of changing programmes to meet needs and demands of children C6 C8 C10 Page 22

25 Ayrshire and Arran to promote child dental registrations. CDPH C12 1.3: Constantly improve the quality of child dental care The primary care dental team will endeavour to secure and DRO Inspections (PSD) All short term outcomes where possible improve the oral Individual health of their child patients, clinician National Dental Inspection Programme whilst taking into consideration their particular circumstances All primary care dental practitioners will ensure they have an understanding of when the need to refer exists and will follow appropriate referral pathways. Individual clinician Evidence of Continuing Professional Development (CPD) events held locally Audit Evidence of distributing information C6 C9 C11 C13 C All primary care dental practitioners will ensure robust and consistent reporting and completion of dental records All primary care dental practitioners will be aware of and comply with all new requirements and support new initiatives Quality of primary care dental services will be monitored by Individual clinician Individual clinician Clinical audit PSD record checks (DRO) Evidence of CPD events held locally Audit Evidence of distributing information Appropriate monitoring dependent of initiative PV monitoring (quarterly meetings at Health Board) C6 C9 C11 C13 C14 C6 C9 C11 C13 C6 C9 C13 Page 23

26 the, with any areas of concern addressed appropriately. Dental Practice Advisor (DPA)/Clinical Director (CD - DRO monitoring Quality activity monitoring C Prescribing patterns of primary care dental practitioners routinely monitored by the and Senior Prescribing Adviser will monitor that Childsmile 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 interventions are being carried out Support the modernisation of skills to support the shifting balance of care into primary care (CSDS) DPA/CD (CSDS) DPA CD (CSDS) PCM (DS) 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 Working group for oral surgery Establishment of proposal and roll out of delivery of oral surgery Organise appropriate training programmes for clinicians if appropriate to gain experience C6 C6 C10 C13 C6 C10 C13 C6 C8 C Timely distribution of National guidance and legislation to all primary care dental teams as appropriate, and the provision of follow up training if required. DPA/CD/ADSM Evidence of NHS mail distribution list Evidence of CPD events/training Evaluation from events All short term outcomes Page 24

27 1.4: Actively work to support the child protection agenda The primary care dental team will ensure that they are aware of their responsibilities for child protection and GIRFEC. Individual clinician CPD/evaluation on GIRFEC Survey Monkeys for feedback on awareness of individual responsibilities C6 C8 C9 C The primary care dental team will refer significant dental events to ensure compliance with child protection and GIRFEC will continue to raise awareness of child protection to all dental practitioners and the wider dental team Ensure all primary care dental services promote and embrace Getting It Right for Every Child (GIRFEC) values 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 Individual clinician PCM(DS)/ ADSM PCM(DS)/ ADSM Reporting events/info into FACE (CSDS) Datix Reports (CSDS) Evidence of liaison within patient notes, with other healthcare professionals and other agencies when there are concerns regarding a child. CPD events Distribution of documents Practice GIRFEC protocol monitoring at local practice inspection Evidence of appropriate CPD attendance 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 C13 C6 C9 C13 C6 C9 C13 C6 C9 C10 C13 C6 C9 C13 Page 25

28 1.5: Ensure child dental health is effectively monitored Ensure that processes are in place for adequate reporting and monitoring is in place for all individual elements of child dental health NDIP HIC and Childsmile monitoring reports All short term outcomes Development and delivery of the National Dental Inspection Programme National dental inspection programme submitted annually on schedule to ISD 1.6: Ensuring effective referral pathways are in place and actively working to continuously improve these C6 - C7 C9 C14 C 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 child general anaesthetic / PCM(DS)/ADS M 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 Mgt Team for GA sessions C6 C8 C11 SG report card C6 C10 C13 Regular monthly meetings C6 C8 PCM(DS)/ C11 Page 26

29 services. Incorporate with systems Ensure appropriate Service Level Agreements are in place for Paediatric Specialist Services (e.g. Glasgow Dental Hospital) to work to improve IT infrastructure across all primary care dental services, to encourage the safe and timely transfer of referrals. ADSM C13 CDPH SLA C15 PCM(DS) Attendance at re-formed PC IT manager meetings to raise profile of dental issues Work with PC Dental IT facilitator and have regular meetings to keep updated on all National & local issues. Monitoring of SCI Gateway usage and issues C8 C15 Page 27

30 1.7: All educational establishments have oral health programmes in place across all age groups Develop and deliver nursery school oral health promotion programmes Develop and deliver primary school oral health promotion programmes Develop and deliver secondary school oral health promotion programmes Oral Health Promotion (OHP) OHP OHP Monitoring of number of nurseries participating in programmes Evaluation of oral health promotion programmes Monitoring of number of primary schools participating in programmes Evaluation of oral health promotion programmes Monitoring of number of secondary schools participating in programmes Monitor number of young people adopting oral health champion role Evidence gathered of update of healthy snack policies Evaluation of oral health promotion programmes C12 C1 C6 C8 C10 C6 C8 C10 C12 1.8: An oral health community development approach taken within targeted communities Implement oral health programmes in identified targeted communities OHP Monitor number of services participating in oral health promotion activity Evidence gathered of type of activity being delivered in identified communities C1 C6 C8 C10 C12 Page 28

31 1.8.2 Develop and deliver community pharmacy within targeted community projects in Ayrshire OHP Monitor number of pharmacies participating in the programme Monitoring data gathered from each participating community project C6 C8 C10 C13 1.9: Deliver adequate and appropriate capacity and flexible secondary care Specialist Services to meet population need and primary care demand Meet 18 Week Referral To Treatment requirements for referrals e.g. Orthodontics Monitoring of theatre utilisation and provision of data Ensuring utilisation of theatre sessions for community dental team ICPS-Planned Care ICPS-Planned Care PCM(DS)/ ADSM Reduce waiting times for first out-patient appointment to 6 weeks where possible. This leaves a remaining 12 weeks for any treatment that needs to be commenced. Undertake a review of case notes to determine when clock stops took place for those over 126 days Theatre utilisation discussed on a weekly basis and passed on to relevant Consultant to comment on if there appear to be obvious delays in utilisation PMS OPERA Theatre System C8 11 C13 C8 C11 C13 C15 Page 29

32 1.10: Provide strategic leadership Chair Oral Health Strategy Programme Board, Child Oral Health sub group to lead, facilitate, develop, co-ordinate, monitor, evaluate and strategically manage implementation of Children s Action Plan CDPH Meeting papers quarterly Scottish Government bi-annual monitoring report Local NDIP report Annual strategic update to Director of Public Health C1 C16 Page 30

33 Section 2: Adults General Population Short Term Outcomes: A1 A2 A3 A4 A5 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 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 2.1: Develop and facilitate topic specific marketing and promotional campaigns Plan local marketing/ promotional campaign based on identified need Identify existing and/ or develop new resources to support topic specific campaigns Evaluate campaign resources to measure any changes in oral health knowledge, attitudes, values and beliefs OHP OHP OHP Marketing plan produced Evaluation of marketing and promotional campaigns and associated activities Evaluation of current and new resources to ensure objectives are met Evaluation of current and new resources to ensure aims and objectives are met A1 A5 A5 A5 Page 31

34 2.2: Develop, evaluate and roll out Work your smile programme Implement oral health promotion activities in line with Work your smile logic model Develop oral health toolkit based on findings from evaluation Evaluation of the toolkit and associated oral health promotion activities OHP OHP OHP Logic model and programme paperwork produced Monitoring data gathered pertaining to programme activities Interim and final evaluation reports produced Evaluation of toolkit for effectiveness of activities Monitor number of workplaces adopting the toolkit Monitor the number of activities adopted Evaluation of toolkit for effectiveness of activities Monitor number of workplaces adopting the toolkit Monitor the number of activities adopted Staged roll out of toolkit OHP Monitor number of workplaces adopting the toolkit Monitor the number of activities adopted A1 A2 A5 A5 A5 A5 2.3: Actively work to support and promote equity of access and increase dental registration All Primary Care Dental Services will provide appropriate dental care which meets the needs and preferences of their patients, Individual clinician PV Monitoring Audit Prescribing monitoring Practice inspection A2 Page 32