Agenda item

(10 min presentation and 10 min discussion)

The Chair invited Dr Maeve Gill, Public Health Specialty Registrar, and Dr Emma Waters, Public Health Consultant, to present their report.

Dr Gill reported that the implementation of the forthcoming Barnet Oral Health Action Plan would be overseen by the Health and Wellbeing Board. The Committee is asked to note the Children and Young People’s Oral Health Needs Assessment.

Dr Gill reported that the National Dental Epidemiology Programme Oral Health Survey 2019 estimated that just under a quarter of children under 5 have tooth decay. The HOSC had requested more information so the Public Health team is developing the needs assessment and some recommendations for Barnet. This has focused on 0-19 year olds, looked after children as a known vulnerable group, looked at the national context and at national guidance on effective preventative interventions. Barnet commissioned the Oral Health Promotion Service on 1^st April 2022.

Dr Gill added that the team conducted a focus group with parents of 3-4-year-old children in a nursery setting, in a deprived Ward in the borough. Further to this some recommendations had been made.

Dr Gill reported that oral health remains a problem nationally; preventable tooth decay is the leading cause of hospital admissions for 5-9-year-olds. There is good evidence on effective interventions based on prevention.

In Barnet there has been a reduction in access to dental services since the pandemic and  there is evidence of inequality by deprivation, which echoes the London-wide picture. Enhanced sampling has been undertaken in some Wards and it was found that in Burnt Oak 4/10 children experienced tooth decay. London-wide there was evidence of differences by ethnic group. Looked- after children are a known vulnerable group and pilots had been put in place to try to enhance access to dental services for looked after children. Also the community dentistry service had emphasised that children with Special Educational Needs (SEN) and children living in poverty were more at risk.

Dr Gill added that knowledge was found to be necessary but not sufficient. Parents reported knowing the key health messages but in practice not having sufficient time or not carrying out intended actions for other reasons. Also sugar preferences of children are partly shaped by the environment, and there is national evidence about the need to focus on shaping the environment children are in. Training needs in early years, social care and foster care staff were identified.

Dr Gill reported that the pandemic had impacted on partnerships, and the new oral health provider is currently settling in.

The main recommendations could be met with the current resources, and focused on:

• developing the Barnet Oral Health Partnership to renew relationships
• implementing the co-produced Barnet Oral Health Action Plan and focusing on how to maximise the impact of the oral health promotion service
• training for health, education and social care workforces as part of the Healthy Child Programme
• Quality assuring the  supervised toothbrushing pilot.
• Ensuring the toothbrushing pilot targets areas of deprivation.
• Reviewing the provision of toothbrush and toothpaste in response to cost of living pressures.
• Considering how to commission in order to improve intelligence – additional resource would be needed for this – for example gathering Ward-level data
• Targeted fluoride varnishing programmes and improving dental access for looked-after children who are placed outside London.

The Chair enquired whether the number of dental checks had improved since the end of the pandemic. Dr Gill said data could be brought back in the future when more data is available.

Dr Djuretic noted that overall dentists are short-staffed, have a huge backlog and are struggling to maintain practices which were unsustainable under NHS contracts. NHS England, which commissions community dentistry, attended JHOSC recently to discuss recovery post-pandemic. Paediatric dentistry is most affected. London Public Health Directors had asked requested additional resources, particularly for paediatric dental health care.

The Chair asked how toothbrush and toothpaste are provided. Dr Waters responded that this can be coordinated through suppliers of dental health products. Health packs were supplied prior to the pandemic via health visitors, and the team is looking at also using food banks. Cllr Stock noted that involving manufacturers worked well in the United States. Also she noted that it can be cost effective to employ a dentist to visit areas of deprivation, and visit schools, picking up problems early.

Dr Djuretic noted that NHS England would need to agree to employ a dedicated dentist to visit schools and at the moment resources were limited. Public Health Directors currently work with manufacturers of dental care products and this could be taken to the Association of Directors of Public Health to take forward at a national level.

Cllr Hutton suggested writing to the Secretary of State for Health about the concern on the shortage of dentists. Dr Djuretic noted that this could also be escalated via the JHOSC who could invite NHSE back to speak to the Committee. The Chair suggested that this be put on the JHOSC agenda.

Action: Chair

Cllr Chakraborty raised concerns about the amount of tooth decay in his Ward, West Hendon as well as Childs Hill and Burnt Oak. West Hendon appears in the report as not so income deprived and for obesity as some Wards so he wondered why, and how the team could be sure that the recommendations are applicable across the Borough if reasons are not clear in the data.

Dr Gill responded that enhanced sampling was carried out in 2019 with five Wards selected for this on the basis of deprivation. This was a small sample of 280 children and it was not possible to know how significant the data is due to how it was gathered. However nationally there is a relationship between deprivation and tooth decay. There is additionally London-wide evidence of a relationship between oral health outcomes and ethnicity.

Cllr Chakraborty commented that West Hendon was not included in the pilot for Young Brushers (Page 35 of the report). Dr Gill responded that West Hendon Ward was not excluded – initially nurseries in more deprived areas were contacted and asked to be involved in the programme and now the programme is taken forward beyond this so West Hendon Wards I included.

Cllr Chakraborty asked whether Members could be involved, working with community and faith groups to highlight the importance of toothbrushing. Dr Waters responded that this help would be well received, as well as help getting eligible nurseries involved in the scheme.

Action: Dr Waters

Cllr Gordon noted that he would be happy to help with contacting manufacturers. Dr Waters would look initially into conflicts of interest but thanked Cllr Gordon for offering his assistance. Cllr Stock offered to make contact with an individual already involved in this for more information.

Acton: Dr Waters, Cllr Stock

The Chair asked whether Oral Health Champions, referred to in the report are the aspiration. Dr Gill responded that this is one of the performance indicators within the Healthy Child Programme.

Cllr Innocenti enquired about translation services given that some areas in Barnet have residents who speak little English. Dr Gill responded that this is available and would be noted in the Action Plan.

Action: Dr Gill

Cllr Hutton enquired whether the statistics would take into account the fact that anecdotally some dentists report receiving payment for NHS dental care from parents whilst offering to check their child’s teeth free of charge. Dr Waters responded that the team did not have data on this but is aware that it happens in Barnet.

Cllr Innocenti enquired about waiting lists, for example could a dentist refer to another area. Dr Gill reported that there was a government announcement in November introducing a new duty on dental practices to be part of ‘find my dentist’ to help people to search for a dentist. Dentists must state if they are accepting new NHS patients and must do so regularly.

The Chair thanked the officers for the report and their presentation.

RESOLVED that the Committee note the Children and Young People’s Oral Health Needs Assessment, including the recommendations, and note that the forthcoming Barnet Oral Health Action Plan, will be presented to the Health and Wellbeing Board who will oversee its implementation.