Health Access Initiative for Adults with Learning Disabilities in Central London

1. Health Access Initiative for Adults with Learning Disabilities in Central London 6th July 2012 John Whelan BDS

2. Today’s Session • Background • Service Outline • This is what we found • This is how we did it • Barriers • Lessons Learned • Recommendations

3. Background National evidence of poorer oral health in people with learning disabilities A need to build up our local knowledge base A need to review our dental pathway We formed a small working group

4. The Community Dental service provides care for people who cannot access high street dentists for various medical and behavioural reasons. Service Outline • Dentist • Dental Therapist • Dental Nurses • Podiatrist • Dietician • LD Community Nurse • Looking for: • Optician • Audiologist The Team

5. This is what we found Health Facts: 28% had dental decay 11% had no teeth Observed oral health hygiene: 70 % received support with brushing from others 15% were able to be independent 73% were fully mobile Demographics: 73% were Caucasian 17% were Afro Caribbean 5% were Arabic 3% were Asian Aims of the Oral Health Needs Assessment (JSNA) Improve oral health in people with LD Improve access to services Reduce the need for emergency admissions Reduce the need for GA

6. Extremely low uptake of care from ‘high street’ dentists Need for great improvement in Oral Hygiene of people in residential care Greater training for family members/ social care staff The DNA (did not attend) rate is far greater for LD patients. Higher number of service users require dental treatment under sedation or general anaesthetic, than general population

7. This is how we did it • Outreach work in residential homes, day centres and drop in centres • Oral Health Action Plans in place to improve self care and management • Providing training on Oral Hygiene & Tooth brushing • Building relationships through Multiagency / disciplinary approach, engaging with people, organisations and other networks at the interface (WLDP, Podiatrists, Dieticians, Community Nurses) • Holistic “Health MOT’s” meeting the needs of service users and improving access

9. The Oral Health Action Plan project 411 on the register of which 318 have been contacted and 269 seen Only 30 had their own ‘high street’ dentist and were happy to continue seeing them 95% seen from residential placements or live with their families As a result of this project the number of people receiving treatment within the Community Dental Service has almost doubled 111 new patients 11 have their treatment with help of inhalation and/or oral sedation 30 referred to UCLH/Guys Hospital for treatment under General Anaesthetic 3 referred for specialist consultation in restorative/Oral Surgery/Oral Medicine

10. Progressive project working with young people to ensure a seamless transition from child oral health into adult oral health care – Young People in Transition (YPT) Screen higher classes in specialist schools and providing oral care workshops to the specialist school staff Rolling out service across CLCH borough’s starting with Kensington & Chelsea and soon to follow Hammersmith & Fulham Flagging to GP’s to inform them that their patients are accessing the service. Poor response to communication so far…

11. Barriers Some resistance from service providers Accessing people who live independently Making oral hygiene a priority for everyone Other priorities for people with complex medical conditions Large uptake from Black Caribbean ethnic minority but low uptake within the Asian and Bengali community Often relying on support workers and carers Building trust and a working relationship is key

12. Successes & Recommendations The Oral Health Action Plan now raises oral awareness in people with learning disabilities More people are now registered with our service with the lowest hospital admissions for tooth ache in London Oral Health has improved and can be evidenced through the number of reductions in patients requiring GA and reduction in treatment rates to maintenance Oral health awareness is much higher in carers and support workers and considered an integral part of general health & wellbeing Patients lost to Podiatry Service now back on recall Several referrals to Choosing the Chance to Change Greater education for service users and carers/family members to achieve and maintain good oral hygiene A more consistent approach needed towards improving oral hygiene within care homes Starting work in Special Schools YPT screening

13. Contact • John Whelan • john.whelan@clch.nhs.uk • The Medical Centre • 7e Woodfield Road • London W9 3XZ