North Yorkshire Council
Health and Adult Services
Executive Member Meeting
27th August 2025
REPORT TO Director of Public Health, in consultation with the Executive Member for Health and Adult Services
Oral Health Improvement Service
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1.0 Purpose Of Report
To seek approval from the Director of Public Health, in conjunction with the Executive Member for Health and Adult Services, to procure an Oral Health Promotion service. The service will maintain support to targeted Early Years Settings participating in Supervised Toothbrushing Programmes and provide a virtual workforce development offer to North Yorkshire Council’s Children and Young People and Health and Adult Services.
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2.0 Summary
To procure an oral health promotion service from April 2026 for 5 years (3+1+1) with a whole-life value of £225,000.00 (£45,000 per annum).
There will be two core elements to the Oral Health Promotion Service:
· The service will aim to improve the oral health of North Yorkshire’s under 5 population through a daily supervised toothbrushing (STB) programme in areas of greatest need. As a minimum this would involve maintaining the existing level of provision to targeted Early Years Settings and Special Schools.
· This will be delivered alongside a virtual workforce development programme to those in adult and children’s services supporting vulnerable population groups to ensure the workforce has the confidence and skills to deliver evidence based oral health promotion advice and support in their day-to-day roles.
Intended service outcomes:
· The service will support delivery against the public health outcomes framework indicator “Tooth decay in five-year-old children.”
· Reduced inequalities in oral health, with a priority focus on children and young people supported by NYC’s children and family services, children living in deprived areas, children attending NY Special Schools, older people, vulnerable adults and health inclusion groups.
· Embedding evidence based oral health practice within workforces and settings in North Yorkshire.
It is proposed that we continue to jointly commission this service with City of York Council (CYC), with North Yorkshire Council (NYC) as the lead commissioner.
3.0 Background
3.1 Local Authority (LA) dental public health function
LAs, as part of their dental public health function, are statutorily required “to provide or commission oral health promotion programmes to the extent that the Authority considers appropriate for improving the health of the people in its area.” This is set out in The NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations 2012.
Within this, an oral health promotion programme is defined as “a health promotion and disease prevention programme where the underlying purpose of which is to educate and support members of the public about ways in which they may improve their oral health.”
National Government provides an evidence-based toolkit for prevention which includes specific guidance on carrying out the statutory requirements: Local authorities improving oral health: commissioning better oral health for children and young people: an evidence-informed toolkit for local authorities and Commissioning better oral health for vulnerable older people - GOV.UK.
The National Institute for Health and Care Excellence (NICE) public health guideline (PH55) Oral health: local authorities and partners recommends supervised toothbrushing schemes for nurseries and primary schools in areas where children are at high risk of poor oral health. Supervised toothbrushing schemes also support the NHS Core20PLUS5, an approach to reducing health inequalities for children and young people, of which oral health is one of the clinical priorities for children.
In March 2025, the Department for Health and Social Care (DHSC) announced a financial uplift for oral health, targeted at stabilising and expanding current provision to improve outcomes and reduce inequalities in 5-year-old tooth decay. This is in addition to the main Public Health grant. The policy is to ensure that all 3 to 5-year-olds living in the 20% most deprived areas are brushing daily. Supervised toothbrushing activity in targeted settings is an established initiative that can be expanded to meet this full requirement. There is also flexibility to provide additional provision beyond this priority population. This might include older or younger children, children living in other deprived communities, those with Special Educational Needs and Disabilities or those from “PLUS” groups, aligned with the CORE20PLUS5 framework and oral health needs assessments. The funding recognises the prominent position of educational settings in children’s lives and their ability to influence health outcomes.
3.2 Impact on education and school readiness
Oral health is an integral part of overall health; when children are not healthy, this affects their ability to learn, thrive and develop. Good oral health can contribute to school readiness.
The Child of the North Report “An evidence-based plan for improving children’s oral health with and through education settings” documents well the impact that poor oral health can have on CYP’s education and learning CotN_Oral-Health_Report_8.pdf.
3.3 Economic impact
Childhood determines long-term health, and the state of a child’s oral health is the best predictor of their oral health as adults. Prevention of tooth decay is an investment for a healthy population across the life course.
The costs of treating tooth decay in CYP are substantial, including costs of primary care and specialist treatment. Hospital admissions for tooth decay-related extractions in 0- to 19-year-olds alone cost the NHS over £40 million in the 2022-23 financial year.
Alongside this there are lost working days to the economy due to parents/carers needing to have time off work to care for their children, or indeed taking sick leave from work for their own dental pain.
3.4 Needs assessment
The most prevalent oral disease amongst children and young people (CYP) in England is tooth decay. In the 2023-24 survey of 5-year-olds in England, Oral health survey of 5 year old schoolchildren 2024 - GOV.UK, the national prevalence of children with enamel and/or dentinal decay was 26.9%.
Children living in the most deprived areas of the country were more than twice as likely to have experienced dentinal decay (32.2%) as those living in the least deprived areas (13.6%).
In North Yorkshire the highest proportion of hospital admissions for tooth extraction is the 5-9 year old age group (414.3 per 100,000 children, HES data 2023-24). In England, dental caries remains the most common reason for all hospital admissions in this age group.
Alongside children’s oral health, an all-age oral health needs assessment completed in March 2023 identified additional system-wide priorities for North Yorkshire, several of which reflect the anticipated needs of North Yorkshire’s ageing population
4.0 Detail of Substantive Issues
4.1 Additional Department for Health and Social Care (DHSC) STB Funding
Subsequent multi-year funding for STB from DHSC is subject to this year’s Spending Review. It is not known at present whether NYC will continue to receive an allocation for this from April 2026. Using the current DHSC underspend over the duration of the contract provides stability to the proposed provision.
If we receive longer term funding for STB from DHSC and we do not have an existing provider there will be a risk to the continuity of supervised toothbrushing for existing settings whilst we re-commission a provider to deliver this. This is likely to:
· Leave a gap in provision whilst a new service is commissioned.
· Create difficulties in re-establishing links with existing settings who may lose trust in the local authority after ceasing provision at the end March 2026.
Whilst settings could self-fund, in practice we have seen few settings do this without the support of a programme that provides the initial training, advice and ongoing support, annual quality assurance visits and resources.
4.2 Humber & North Yorkshire Integrated Care Board (HNYICB) Prevention, Access and Treatment (PAT)
The service will also be expected to engage in collaborative working with additional prevention programmes, such as the HNYICB PAT, where this may encourage uptake of supervised toothbrushing or develop appropriate pathways to improve access to prevention and care.
PAT offers Supervised Toothbrushing in Primary Schools alongside fluoride varnish and onward dental care for children where dental treatment is identified. 64 North Yorkshire Primary Schools are currently participating in the PAT programme. This programme is funded by the NHS through NHS contract variations with participating NHS general dental practices.
The HNY PAT programme has been initially funded for 3 academic years from September 2024. We will continue to work closely with this programme to ensure any primary schools in the 20% most disadvantaged areas and those with high numbers of pupils in receipt of Free School Meals would be a priority if we were to receive continued DHSC STB funding.
5.0 Performance Implications
Contract performance will be monitored by Public Health leads with support from the Health and Adult Services Contracting function. Key performance metrics for services and population health are reviewed on a regular basis through service performance reporting.
6.0 Policy Implications
The proposal aligns with several strategic priorities:
· DfE’s “Giving Every Child the Best Start in Life” strategy (2025).
· NHS Core20PLUS5 framework – reducing hospital admissions for dental extractions.
· DHSC financial uplift to Public Health grants for STB (March 2025).
· NICE PH55 guidelines (2016), NICE NG48 promoting good oral health for adults in care homes (2016), CQC Smiling Matters update (2025), NDEP Survey 2024-25 Oral Health in Care Homes.
7.0 Alternative Options considered
Health Education England’s eLearning for health platform (eLfh) includes a number of oral health online learning modules which are free to access once an account is created. Whilst the training is not tailored to local needs it does provide evidence-based material which could be accessed by the wider workforce.
There is therefore scope to reduce the workforce development offer but there would need to be a co-ordinated plan to ensure existing evidence-based training is disseminated and overseen by service leads. We would not be able to evaluate attendance or adapt the training to meet local needs or respond to local service requests e.g. this year the provider tailored training specifically for our Living Well and Livewell Smokefree teams which involved discussion with Service leads to ensure this met their needs.
8.0 Financial Implications
· Supervised toothbrushing programmes are effective in reducing the prevalence and inequalities in tooth decay and are cost effective. For every £1 spent on supervised toothbrushing programmes, there is an estimated return on investment of £3.06 over a 5-year period. Improving the oral health of children: cost effective commissioning - GOV.UK
· Recent market engagement shows that there is interest but limited financial flexibility in the budget in providing an oral health promotion service.
· This proposal includes reprofiling of the DHSC underspend from this year’s grant over the life of the new contract. With this underspend the anticipated whole life costs of the oral health promotion service (3+1+1years) is not expected to exceed £225,000.
· Due to the contract value and the recent market engagement, it is proposed that any public health financial uplift is passed onto the provider as part of the new contract in addition to the figure outlined above.
· If NYC receives any additional DHSC funding for STB any variation to the service and contract would comply with the Procurement Act 2023.
· City of York Council intend to continue to contribute to the contract.
9.0 Legal Implications
The procurement process will be in accordance with the Procurement Act 2023. Contracts will be drafted by Legal Services to include appropriate terms and conditions and will be entered into in accordance with the Council’s Procurement and Contract Procedure Rules. TUPE implications will also be considered and the Employment Legal Services team consulted, if necessary, with any requirements being set out in the procurement and contract documents.
10.0 Impact on other services/organisations
The service aims to:
· Reduce inequalities in oral health, with a priority focus on children and young people supported by NYC’s children and family services, children living in deprived areas, children attending NY Special Schools, older people, vulnerable adults and health inclusion groups.
· Have a positive impact on school readiness.
· Embed evidence based oral health practice within workforces and settings in North Yorkshire.
11.0 Contribution to Council priorities
This proposal supports the delivery of the North Yorkshire Council plan, in particular the ambition around health and wellbeing for residents of the county.
It supports the following NYC’s Public Health Priorities:
· Reducing health inequalities through healthy place shaping and targeted work with vulnerable groups/ communities.
· Work with our NHS partners to maximise our joint effectiveness and impact on health outcomes.
· Ensuring babies, children and young people have a good start in life.
· Ensure older people are able to age well.
12.0 Human Resources Implications
Internal resource from Public Health, Procurement, Legal and Contracting teams is required to deliver the initial procurement process and ongoing contract management.
13.0 Equalities Implications
The service will aim to reduce inequalities by targeting Special Schools and early years settings in areas of higher deprivation. It will embed evidence based oral health practice within workforces and settings in North Yorkshire who are supporting more vulnerable population groups. As part of the procurement process, an Equality Impact Assessment screening form has been completed in adherence to the governance process.
14.0 Climate change implications
The service will require travel for set up and annual audit visits to settings participating in the scheme. However termly audits can be done virtually and by telephone. We would seek a provider who can demonstrate effective use of time in terms of visiting settings in geographical clusters where possible to minimise carbon footprint.
We have worked with the existing provider to put online learning onto accessible platforms such as the NYC’s Learning Zone and NHS platforms for non-NYC staff. It would be built into the service specification that we would expect the service provider to consider innovative ways of using technology. It is anticipated that most of the training will be offered digitally or through online webinars unless there is a specific requirement to be considered.
As well as improved outcomes for Children & Young People and their families and reduced costs to the NHS, oral health prevention work also aligns with the environmental sustainability agenda. Prevention reduces carbon emissions through multiple methods including fewer patient journeys, reduced manufacturing, and fewer materials. It also means less waste and pollution.
15.0 Reasons for recommendation
· To fulfil one of NYC’s statutory dental public health functions.
· To improve the oral health of priority population groups living in North Yorkshire, which will have a positive impact on reducing health inequalities.
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16.0 Recommendation
To request approval from the Director of Public Health, in consultation with the Executive Member for Health and Adult Services, to proceed with the procurement of an Oral Health promotion service for 5 years (3+1+1).
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Name and title of report author Catherine Baker (Public Health Manager)