Colette Bridgman Chief Dental Officer

1. Colette Bridgman Chief Dental Officer Taking Oral Health Improvement and Dentistry Forward in Wales Morgannwg Local Dental Committee 24th April 2017

2. Over the course of the next 20 mins I will: • Outline the key challenges and needs (as I understand) • Explain the purpose of direction I am taking • Share the priorities and framework content • Leave 10 minutes to hear your views Context: I am just over 8 months into role A fresh perspective can add value…….. Welsh Government

3. Welsh Government •Prosperous & Secure •Healthy & Active •Ambitious & Learning •United & Connected OH and dentistry relevant to all…….. Our task!

4. Key Welsh Government themes - Importance of First 1000 Days Reducing Adverse Childhood experiences Accessible Dental Care and OHI contribute to all Increased skill mix would allow us to go further faster………………… Increasing Employability

5. So Oral Health, Trends & Challenges? What do we know? In a nutshell….. • Increasing numbers of older people and more dentate • Persistent disease in very young children but improving • Increasing health in least deprived who also attend frequently and use most of available resource • Persistent oral health inequality and social gradient in disease experience and access to care • Contract for primary dental care not supporting innovative skill mix or needs led care delivery • Self care and OH literacy is low particularly young adults – knowledge, skills and valuing OH What is the evidence?

6. The dmft of young children….trends

8. Need to use up to date evidence…… Disease trajectories with 95% CIs of children dmft=0 and dmft>0 at baseline So Aim: Keep as many children as possible decay free by 5! Hall-Scullin et al. J Dent Res in press

9. Prudent healthcare - thinking differently about services and the relationship between professionals and patients – and the related idea of only-do-what-only-you-can-do, which means that healthcare professionals should be working at the maximum of their clinical competency

10. NHS BSA Data - Use of services …….

11. In summary …… How do we protect OH and keep as many children, decay free by 5, as possible? How do we maintain the health of those that do attend and help improve the health of those that don’t? Make more efficient use of resources through contract reform, widen impact and reach of D2S ……………... & ensure OHI is everybody’s business!

12. So what I have been doing? • Outlining the strategic intent for taking Oral Health Improvement and Dentistry Forward in Wales • Describing how dentistry can contribute to the Programme for Government to make a bigger impact for patients and population more quickly. • Considering how to strengthen clinical leadership (GDS in particular) and participate within LHBs and with PHW CsDPH • And working to achieve alignment to improve oral health, reduce inequalities, and embed best practice in all dental service and programme delivery across LHBs in Wales

13. Taking OHI and Dental Services Forward in Wales • Framework - approved by Cab Sec – published 28/03/2017 • Sets out key priorities for OHI and dental services going forward • Will inform update of NOHP 2018 • Offers direction and permission to act now • Supports dentistry to align and respond to WG programme for government

14. Priorities framework on WG CDO web page 28/3/17

15. http://gov.wales/topics/health/professionals/dental/?lang=en

16. 3 Priorities and Intentions • Designed to Smile – refocus - going from good to great! • Contract reform – expanding new ways of working within primary care – general dental practitioners engaged and contributing • Connectivity e-referrals, PACS same day consultant/specialist advice To finish a few slides to illustrate……

17. Aim – decay free by 5 ………. OH everyone’s business 1st 1000 days • 0-5 focus for investment. Step down FS >5s and data collection burden • Improve engagement with dental practices, HV etc to find missing 1000s. • Develop and test D2S resources to support clinical teams contribute • Develop and test tools to support dental practice teams to deliver evidence-based prevention and target resources • Improve dental access and preventive intervention for 0-5 year olds • A new Welsh Health Circular to support the refocus

18. Contract Reform Current picture Clinical & LHB engagement needed to… Exploit flexibility in current contract Develop need and outcome clinical measures Substitute - UDAs Develop use whole team Number of patients and need matter! ….for a given contract value. We have a Licence to…. • New Contract • UDAs - Not incentivising nor rewarding increasing access, prevention or teams to welcome and treat higher needs patients. • Prototypes delivering well • How do we replicate?

19. £ £

20. OHNA Draft Risk & Need Assessment Tool Reported back to practice

21. n Reporting format - needs data – requires very different service delivery approach Practice 2 -Affluent area Practice 1 in very deprived area

22. Finally connectivity….. • NWIS – IMTP Vision: • All referrals electronic • Core data set to support decision making and service planning used • Viewed by Cons/specialist within 24/48 hours • Integrated system enabling high quality image transfer between primary, secondary and community care • Up and functioning need to implement in Wales!

23. In summary ….. WG, clinicians, public health CsDPH and LHBs are poised to exploit the flexibility within the contract and make changes Population oral health need is understood, as is evidence of what works, and the pace and scale needed to make a real difference We need to establish clinical leadership for dentistry to support clinical teams and communities understand what actions are necessary to improve and protect OH There is the potential to secure timely benefits, that improved oral health, and responsive and effective dental services would make Good oral health could increase productivity and well-being that would unlock potential for many adults and children

24. Diolch yn fawr