Agenda item

Considered – A report and presentations by Dr Stefan Serban, Public Health England (PHE), Simon Hearnshaw and Debbie Pattinson, NHS England (NHSE) and NHS Improvement (NHSI) Yorkshire and Humber regarding how NHS dental services are commissioned, some of the problems associated with that process and how services are recovering from the pandemic.

County Councillor John Ennis welcomed County Councillors Annabel Wilkinson and Tony Randerson to the meeting.  They had an interest in NHS dental service for Looked After Children and recent changes to provision in Scarborough, respectively.

Dr Stefan Serban, Public Health England (PHE), gave a presentation on children’s oral health in North Yorkshire compared to elsewhere in Yorkshire and Humber and nationally, as summarised below:

·         One fifth of under 5-year olds in the county have tooth decay

·         Of those, by the time they are 5 years old they will have had nearly 3 teeth decayed extracted or filled

·         Children living in the more deprived area of the county are most at risk of and affected by tooth decay and extractions

·         Tooth decay is almost entirely preventable

·         The situation in North Yorkshire is better than the averages for Yorkshire and Humber and England

·         Tooth decay is still the most common reason for hospital admissions in the 6-10 year-old age group

·         Hospital extractions for children’s teeth cost around £40 million/year to the NHS in England

·         Reducing sugar consumption, regular brushing with fluoride toothpaste, routine visits to dentists will help promote good oral health.

There followed a discussion and during the course of which the following points were made:

·         The levels of sugar consumed by young children and much higher than expected and shocking

·         More could be done to enable access to NHS dental services by Looked After Children

·         The high costs associated with a hospital admission to have an extraction of a decayed tooth of a child could be saved if a fraction of that money was invested in prevention in those areas most at risk

·         More targeted work could be done with schools

·         Local authority Public Health has a lead role to play in prevention and early intervention work.

There then followed a discussion about the commissioning of and access to NHS dental services, based upon the report that had been provided by Debbie Pattinson of NHS England.

County Councillor Tony Randerson raised his concerns about the closure, at short notice, of the NHS dental practice at Eastfields in Scarborough, which is one of the most deprived areas of the county.  County Councillor Tony Randerson said that all people deserved easy access to NHS dental healthcare near to where they live.  He said that this had been a problem with NHS dental provision in Eastfields for the past 17 years and that the Council needed to bring pressure to bear upon the government.  He then asked what more could be done to encourage greater NHS dental provision in the area.

In response, Simon Hearnshaw said that work was underway to re-procure those NHS dental services in Eastfields that had been lost.  A limiting factor was the persistent workforce shortages on the east coast, something that affected all health services.

County Councillor Val Arnold asked when the NHS dental provision for Helmsley would be recommissioned.

Debbie Pattinson said that the pandemic had posed particular problems for dentistry as dentists were at heightened risk due to the nature of the work.  During the pandemic the focus had been upon emergency procedures and pain relief.  Much of the routine work and check-ups has been stopped and is only slowly being re-instated.

Debbie Pattinson said that it is important to note that dentistry is not free but a subsidised service that is delivered by commercial providers.  Dentists are businesses and so will prioritise private work.

Debbie Pattinson outlined the work that is underway to provide NHS dental services in areas of the county where services had recently been withdrawn, as summarised below:

·         In Helmsley, NHS dental services have been re-procured for urgent and emergency work and pain relief.  A procurement exercise is being planned for Helmsley, which should be able to cover the populations in Kirbymoorside, Pickering and Malton

·         In Eastfield, work is underway to re-procure those NHS dental services.  An urgent and emergency service will be in place as of 1 July 2021, elsewhere in Scarborough that people from Eastfields can access

·         Procurement work is also underway to restore services in the Sherburn and Tadcaster area.

County Councillor John Ennis queried what progress was being made with the review of the national contract for NHS dental services that was underway.  Also, whether the commissioning of NHS dental services would be absorbed into the new Integrated Care Systems (ICS) or whether it would stay part of NHS England.

Debbie Pattinson said that there was no clarity as of yet about whether dental health commissioning would be taken on by the ICS.  Also, that the national review was underway but at its very early stages.

Simon Hearnshaw said that the 2006 contract had caused most of the problems with access to NHS dental services.  Primary legislation would be needed to change the existing contract and whilst the issue of NHS dentistry has gained a renewed focus politically, it may take some time.

County Councillor John Ennis summed up, noting that the discussion had been informative and open.  He said that the problems arising from the 2006 NHS contract could not be resolved by the committee or colleagues from commissioning but that it was an issue for government.

Resolved:-

1)    That Debbie Pattinson keep the committee informed of the development of the ICS and any implications for NHS dental commissioning

2)    That Debbie Pattinson and colleagues feedback to NHE and NHSI the concerns of the committee about the 2006 contract and address the problems that have arisen as a result of that contract

3)    Debbie Pattinson to keep local members updated on progress with the procurement of NHS dental services

4)    That the role that the Council’s Public Health team has to play in prevention of and early intervention in oral health is further looked into.