NHS Yorkshire and the Humber

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NHS Yorkshire and the Humber

• Dental PH Background
• National dental health picture
• Commissioning for Health
• Needs assessment
• Health Equity Audit
• Where are we now?
• Local Examples?
• Expectations of today?

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Dental health of 12-year old children (average
number of Decayed, Missing and Filled teeth),
European comparisons (as at 2004) WHO Global
Database
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Dental Caries Experience 5 Year old children
2005/06
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Dental decay experience 5 year olds 2005/06 and
No. of dentists per 100,000 population by SHA
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11 year old children - Decayed, Missing and
Filled teeth (DMFT) by PCT, 2004/05

• Blue better oral health
• Red poorer oral health
• Black no data !!

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11 year-old mean DMFT
UDAs per dentist
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What is commissioning for health?

• The process by which the health needs of a
  population are assessed responsibility is taken
  for ensuring that appropriate services are
  available which meet these needs and the
  accountability for the associated health outcomes
  is established
• c.f. contracting for services

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• An Oral Health Plan for
• England
• Department of Health 2005

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Choosing Better Oral Health-overarching
principles

• Enabling people to make healthy choices for
  themselves
• At the heart of the plan is the need to integrate
  oral health into general public health

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How are we going to improve oral health and
reduce inequalities?

• Key elements of the Oral Health Plan
• Common Risk Factor approach
• Reducing sugar intake in food drink
• Community fluoridation programmes
• Fluoride toothpaste
• Tobacco control and sensible alcohol use
• Reducing dento-facial injuries

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Supplementary Strategies

• Smokefree and smiling helping dental patients
  to quit tobacco published May 2007
• Evidence based preventive toolkit September
  2007
• Improving Oral Health for Children and Adults
  with Impairment and Disability November
  2007
• Improving oral health in ethnic minority
  populations
• Spring 2008

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The Preventive Toolkit

• An evidence based toolkit for the dental team
• For every dental practice and primary care dental
  clinic
• Its useconfirmation for PCTs of a preventive
  approach

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Our NHS our future The Darzi Review

• A world class NHS that is-
• Fair
• Personalised
• Effective
• Safe

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Our NHS our future The Darzi Review

• Dental members of Darzi Groups in YatH
• Children Stephen Fayle LDI
• Urgent care Lee Worthington
  Sheffield OoH Contractor
• Long term conditions Gill Heyes SPDCS
• Staying Healthy Nigel Thomas CDPH BDR PCTs
• Planned Care John Beal CDPH - SHA

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What should PCTs be doing to Commission for Oral
Health?

• Collect appropriate information on oral health as
  required by regulations
• Consider having a local Oral Health Strategy as
  part of their LDP
• Consider using the key elements of Choosing
  Better Oral Health as a basis for this
• Undertake Oral Health Needs Assessment
• Ensure that they receive appropriate advice in
  meeting Dental Public Health requirements

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PCT Commissioning - 3 FUNCTIONS
Engaging with its local population to improve
health and well-being
Commissioning a comprehensive and equitable range
of high quality responsive and efficient
services, within allocated resources

Directly providing high quality responsive and
efficient services where this gives best value
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• Why is the undertaking of oral health needs
  assessment critical?

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What is need?

• Normative deviation from normal
• Norm(al) professional/clinically defined ?
• Self Assessed prompt for action?
• (YatH PH Observatory 5 yr.olds 2003/4)

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What is need?

• Demand need?
• Demand without need
• Need without demand

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What is need?

• What turns need into demand?
• How is demand expressed?
• What is supply?
• Practices/ dentists/ hours/ UDAs?

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PCTs need to undertake and review OHNA to

• Understand oral health needs of their population
  to shape and scope what is required, What, where
  for whom?
• Take stock of the current dental services
  provided. What is being provided to who?
• Consider the potential in primary dental care for
  redesigning services to better meet need
• Take a rational approach De / Commissioning
  dental services 
• Thereby provides the basis for determining
  priorities

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Resources to assist PCTs
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Health Equity Audit

• Inequalities (unfairness) in access to services
• Measure supply?
• Measure need disease experience?
• Measure demand use of services?
• - patient/public
  feedback?

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HEA Criteria

• Linked to PCT priorities
• Potential to make an impact
• Measures of need and resource exist
• Measurable outcomes /changes
• Resources for making change exist
• Potential for change within 2 years

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Health Issue - Sheffield

• Large inequalities in health generally
• 14 year gap in life expectancy
• 5 times difference in oral health (5 yrs.)
• Mal-distribution of dental practices and dental
  hospital
• Possible inverse care law operating in dental
  services

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What we did Health Equity Audit

• Health Equity Audit a guide for the NHS DH
  (HDA) 2003
• http//www.dh.gov.uk/en/Publicationsandstatistics/
  Publications/PublicationsPolicyAndGuidance/DH_4084
  138
• Public Health Analysts

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Measures of need ( and demand)

• Dental Survey data 5 yrs census/map
• DPB registration data
• Dental calls to NHS Direct
• Use of Dental Hospital walk-in
• Deprivation - on income support

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Measures of supply by ward

• Dental Practice locations
• Number of dentists
• WTE of dentists
• Number of UDAs commissioned

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Dental decay (dmf) by Ward
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Deprivation and dental decay
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Mapping dental decay the impact of water
fluoridation
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Registrations by ward
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Deprivation and NHS D calls
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Deprivation and dental services
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Summary analysis - extract
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The Future

• Patient attendances by postcode
• Enhanced data set treatment level within bands
• Case-mix gender/age/treatment need
• Cross-PCT attendances ( orthodontics)
• Patient Public input to planning

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Where are we now?

• Health Needs Assessments?
• Health Equity Audits?
• (Health Impact Assessments)
• Orthodontic needs assessments?
• Specialised care MOS/Endo/Domi.
• Patient Public involvement LINKs?

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Orthodontic Needs Assessments

• South Yorkshire
• Cross boundary issue network role
• Mismatch between funding and fast growing
  practices
• Managing public/GDP expectations

• Managing MPs concerns historic flows
• Funding the backlog
• Emerging from transition
• 18 weeks !!

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Local Examples

• Assessing Need
• Evaluating Service capacity
• Local commissioning ( specialist?)
• Expectations of today?