Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland NHS Board Monitoring Report

Prepared by Information Services Division, NHS National Services Scotland, for the Scottish Government Health Directorates, April 2011 Contacts: Dr David Conway Consultant in Dental Public Health ISD Scotland [email protected]

Stephen Goold Dental Informatics Programme Manager ISD Scotland [email protected]

Contents Context Methods Results

3 3 3

1

Oral Health Improvement

4

1.1 1.2 1.3

Children Adults Supervised tooth brushing schemes

5 7 8

2

Workforce

2.1 2.2 2.3

Dentists Dental care professionals Training

9 10 11 12

3

Services

3.1 3.2 3.3 3.4

Children registered with an NHS dentist Adults registered with an NHS dentist Elderly people registered with an NHS dentist Emergency care

13

4

Quality of Services

4.1 4.2

Evidence of patient satisfaction with services Primary care practice standards

14 15 16 17

18

Glossary Bibliography / data sources Appendix - NHS boards’ Dental Action Plan Lead Officers

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19 19

20 21 21

Context The Action Plan for Improving Oral Health and Modernising NHS Dental Services was published in 2005. It set out the the n S cottish E xecutive’s p olicy a nd p lans f or dentistry a nd d ental p ublic he alth f or the ne xt 3 y ears (S EHD, 2005). This plan has brought considerable investment to dentistry: an increase in the NHS funding of primary care dental services. This has been continued with the Scottish Government. To ensure this investment is achieving its goals a range of targets has been set around o ral health improvement, primary c are d ental service delivery and quality, and dental workforce and training. This report monitors NHS boards’ progress made towards the targets at both local and national level and covers the last 6 months of the calendar year 2010. From November 2010, ISD Scotland is publishing these reports as Official Statistics.

Methods A pro forma data request form (ISD[S]37) was sent to each NHS board Action Plan Lead Officer in February 2011. This report has been completed using a combination of data collated by NHS boards, NES and ISD.

Results A traffic-light system for monitoring progress towards targets is employed in the report: · · ·

Red – target not reached Amber – within 10% of target Green – target achieved

In charts, targets are indicated by a green line and where possible the Scottish average is indicated by a blue line.

Abbreviations for NHS boards used in this report: AA B DG F FV G GGC H La Lo O S T WI

Ayrshire & Arran Borders Dumfries & Galloway Fife Forth Valley Grampian Greater Glasgow & Clyde Highland Lanarkshire Lothian Orkney Shetland Tayside Western Isles

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1

Oral Health Improvement

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1.1

Children

Target Figure 1.1.1a

60% of P1 children with no obvious decay experience by 2010 % of P1 children with no obvious decay experience (2010)1

100% 90% 80% 70% 60% 50% 40% 64.0%

30%

57.7%

20% 10% 0% AA

B

Target Figure 1.1.1b

DG

F

FV

G

GGC

H

La

Lo

O

S

T

WI

Scot 10

Scot 08

100% of P1 children to receive a Basic inspection in NDIP 2010 % of P1 children receiving a Basic inspection in NDIP 2010

100% 90% 80% 70% 60% 50% 88.6% 40%

84.9%

30% 20% 10% 0% AA

B

DG

F

FV

G

GGC

H

-5-

La

Lo

O

S

T

WI

Scot 10

Scot 09

Target Figure 1.1.2a

60% of P7 children with no obvious decay experience by 2010 % of P7 children with no obvious decay experience (2009)1

100% 90% 80% 70% 60% 50% 40% 63.6%

30%

59.1%

20% 10% 0% AA

B

Target Figure 1.1.2b

DG

F

FV

G

GGC

H

La

Lo

O

S

T

WI

Scot Scot 09 07

100% of P7 children to receive a Basic inspection in NDIP 2010 % of P7 children receiving a Basic inspection in NDIP 2010

100% 90% 80% 70% 60% 50% 83.2% 80.3%

40% 30% 20% 10% 0% AA

B

DG

F

FV

G

GGC

H

La

Lo

O

S

T

WI

Scot Scot 10 09

1. Although most NHS boards have met this target, within each board there are inequalities showing that in the most deprived areas the targets have not been met.

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1.2

Adults

Target

90% of adults to have some natural teeth by 2010.

The Scottish Health Survey 2008 reports that 88% of a dults in 2008 had a ll or some of the ir own natural teeth (91% of men and 86% of women). This is just below the 2010 target of 90%. The Adult Dental Health Survey (ADHS) 1998 reported that 82% of adults in Scotland had some natural teeth. Target Figure 1.2.2a

Improve oral cancer survival in males by 2010 % 5-year survival of those diagnosed with oral cancer2

60%

50%

40%

30%

Male Female

20%

10%

0% 1983-1987

1988-92

1993-1997

1998-2002

2003-2007

2. Due to small numbers, it is inappropriate to report these data at NHS board level.

Figure 1.2.2b

European Age-standardised Incidence Rates (EASR) of oral cancer for males and females per 100,000 person-years at risk (European standard population); 2008

35%

30%

25%

20% Males Females 15%

10% 16.2% 5% 6.6% 0% AA

B

DG

F

FV

G

GGC

H

La

-7-

Lo

O

S

T

WI

Scot 08

1.3

Supervised tooth brushing schemes

Target Figure 1.3.1

All Nursery Schools to offer supervised fluoride toothbrushing schemes Nursery Schools participating in toothbrushing schemes in school year 2009/10 as % of the number of Nursery Schools3

100% 90% 80% 70% 60% 50%

94.4%

40% 30% 20% 10% 0% AA

B

Additional, nonAction Plan target Figure 1.3.2

DG

F

FV

G

GGC

H

La

Lo

O

S

T

WI

Scot

100% of Primary Schools in most deprived SIMD quintile to participate in toothbrushing schemes Primary Schools in most deprived SIMD quintile participating in toothbrushing schemes in school year 2009/10 as % of the number of Primary Schools in most deprived SIMD quintile3

100% 90% 80% 70% 60% 50%

94.7%

40% 30% 20% 10% 0% AA

B

DG

F

FV

G

GGC

H

La

Lo

3. This information is sought only once a year (after the conclusion of the school year).

-8-

O

S

T

WI

Scot

2

Workforce

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2.1

Dentists

Additional, nonAction Plan target Figure 2.1.1a

20% increase in total NHS dentists (GDS, CDS and HDS, excluding double- / triplecounting) working in Scotland (headcount), based on September 2004, by 2010 % difference in headcount of dentists working in GDS, CDS and HDS (2004 to September 2010)4

100% 90% 80% 70% 60% 50% 40% 30% 20% 29.7% 10%

24.1%

0% AA

B

DG

F

FV

G

GGC

H

La

Lo

O

S

T

WI

Scot 10

Scot 09

4. The data in this chart take into account the i ncreases i n H and GGC that have resulted from these NHS boards “acquiring” dentists from Argyll & Clyde, which was absorbed into H and GGC in April 2006. Double- and triple-counting has been removed, where possible, to take account of dentists working in more than one sector.

Additional, nonAction Plan target Figure 2.1.2a

By 2010, 1 dentist per 1,750 population Ratio of (headcount of GDS+CDS) dentist : population (removing double-counting, if dentist works in more than one sector)

2.0 1.8 1.6 1.4 1.2 1.0 0.8 0.6

1.06

1.00

0.4 0.2 0.0 AA

B

DG

F

FV

G

GGC

H

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La

Lo

O

S

T

WI

Scot 10

Scot 09

Additional, nonAction Plan target Figure 2.1.2b

By 2010, 1 dentist per 1,750 population Ratio of (headcount of GDS+CDS+HDS) dentist : population (removing double-/ triple-counting, if dentist works in more than one sector)

1.8 1.6 1.4 1.2 1.0 0.8 0.6

1.17

1.10

Scot 10

Scot 09

0.4 0.2 0.0 AA

2.2

B

DG

F

FV

G

GGC

H

La

Lo

O

S

T

WI

Dental care professionals

Target Figure 2.2.1

Increase in number of registered Dental care professionals No. of salaried DCPs at 30 September 2010 (following national registration)5

2,000

1,600

1,200 1,916

1,769

800

400

0 AA

B

DG

F

FV

G

GGC

H

La

Lo

O

S

T

WI

Scot 10

Scot 09

5. DCPs (dental c are professionals) are dental nur ses, dental t echnicians a nd other d ental c are p rofessionals. S taff who work for national bodies or special NHS boards have been included in the Scotland total.

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2.3

Training

Target Figure 2.3.1

20% of practices involved in Vocational Training / Foundation courses by 2010 % of practices involved in Vocational Training / Foundation courses

100% 90% 80% 70% 60% 50% 40% 30% 20% 25.0% 24.3%

10% 0% AA

B

DG

F

FV

G

GGC

H

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La

Lo

O

S

T

WI

Scot 10

Scot 09

3

Services

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3.1

Children registered with an NHS dentist

Target Figure 3.1.1a

By 2010, 55% of 0-2-year-olds to be registered % of 0-2-year-olds registered at 31 December 20106,7

100% 90% 80% 70% 60% 50% 40% 30% 39.9% 40.0%

20% 10% 0% AA

B

Target Figure 3.1.1b

DG

F

FV

G

GGC

H

La

Lo

O

S

T

WI

Scot Dec 10

Scot Dec 09

By 2010, 80% of 3-5-year-olds to be registered % of 3-5-year-olds registered at 31 December 20106,7

100% 90% 80% 70% 60% 50% 86.8% 87.8%

40% 30% 20% 10% 0% AA

B

DG

F

FV

G

GGC

H

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La

Lo

O

S

T

WI

Scot Dec 10

Scot Dec 09

Target Figure 3.1.1c

By 2010, 90% of 6-12-year-olds to be registered % of 6-12-year-olds registered at 31 December 20106,7

100% 90% 80% 70% 60% 50%

94.7% 95.4%

40% 30% 20% 10% 0% AA

3.2

B

DG

F

FV

G

GGC

H

La

Lo

O

S

T

WI

Scot Dec 10

Scot Dec 09

Adults registered with an NHS dentist

Target Figure 3.2.1

By 2010, increase adult registrations (18-64 years) to 65% % of all adults (18-64 years) registered at 31 December 20106,7

100% 90% 80% 70% 60% 50% 40% 69.1% 66.3%

30% 20% 10% 0% AA

B

DG

F

FV

G

GGC

H

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La

Lo

O

S

T

WI

Scot Dec 10

Scot Dec 09

3.3

Elderly people registered with an NHS dentist

Target Figure 3.3.1

By 2010, increase elderly registrations (65+ years) to 50% % of all elderly (65+ years) registered at 31 December 20106,7

100% 90% 80% 70% 60% 50% 40% 30% 49.6% 20%

44.6%

10% 0% AA

B

DG

F

FV

G

GGC

H

La

Lo

O

S

T

WI

Scot Dec 10

Scot Dec 09

6. The po pulation and service profiles i n some NHS board areas ( e.g. island boards) are such that the Community D ental Service (which does not formally register patients) plays a greater role in treating some patients than the General Dental Service. Underrecording of data in these areas may also be a factor. 7. Since A ugust 2010, e nhancements i ntroduced to t his d ataset m ean t hat a nalysis h as b een b ased o n t he p ostcode o f t he registered p atient, r ather t han on th e p ostcode o f t he d ental practice where th e p atient is r egistered. P rior t o A ugust 2 010, the registration dataset also included some duplicate records and records of deceased patients, but such records have since been removed, so that the number of registered patients is no longer inflated by duplication. To further address the information deficit, from quarter ending December 2010 patient age has been sourced from MIDAS, which ensures there are no “unknown age” records present.

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3.4

Emergency care

Target

NHS board population served by participation in SEDS (Scottish Emergency Dental Service) % of population served by area-wide integration with SEDS8

Figure 3.4.1 100% 90% 80% 70% 60% 50%

94.3%

40% 30% 20% 10% 0% AA

B

DG

F

FV

G

GGC

H

La

Lo

O

S

T

WI

Scot 10

8. NHS boards estimate the level of population covered by SEDS. Some private patients and some registered neither privately nor with NHS practices may also be provided for via SEDS.

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4

Quality of Services

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4.1

Evidence of patient satisfaction with services

Target Figure 4.1.1

To be benchmarked No. of complaints about primary care dental services from latest available year’s data (2009/10)p,9,10

700

600

500

400 688 300 526

216

474

200 139 100

58

79 40

46

24

31

F

FV

15

24

H

La

0 AA

B

DG

G

GGC

Lo

-

-

8

8

O

S

T

WI

Scot Scot Scot 10 09 08

P. Provisional data from ISD centrally-held Family Health Services complaints database. 9. Family Health Services figures for H are estimates based on averages for 2006/07 and 2007/08. 10. Complaints from Argyll and Clyde regions are included under H and GGC NHS Boards respectively.

4.2

Primary care practice standards

Target Figure 4.2.1

100% of practices conforming to practice inspection criteria % of practices with completed practice inspection in latest 3-year, rolling inspection programme

100% 90% 80% 70% 60% 50%

100.0%

40% 30% 20% 10% 0% AA

B

DG

F

FV

G

GGC

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H

La

Lo

O

S

T

WI

Scot 10

Glossary ADHS

Adult Dental Health Survey.

Basic inspection; Detailed inspection

The National D ental I nspection Pr ogramme (NDIP) has tw o l evels: a Basic inspection (intended for all children) and a Detailed inspection (for a representative sample of a specific age group in alternate years to assist in planning). The Basic i nspection involves a s imple a ssessment o f t he m outh o f each child attending a local authority school, using a light, mirror and ball-ended probe. One of three c lassifications o f d ental he alth i s a ttributed to the child a ccording to the findings of the inspection, and a letter is sent to inform the child’s parents about the state o f dental health observed in the m outh of the child a t the ti me of the inspection. These letters vary, depending on whether a Primary 1 (P1) or a Primary 7 (P7) child was inspected, and are classified as follows: · · ·

Letter A - should seek i mmediate d ental ca re on a ccount o f severe decay or abscess. Letter B - should seek dental care in the near future due to one or more of the following: presence or history of decay, a broken or damaged front tooth, tooth wear, poor oral hygiene or may require orthodontics (P7 only). Letter C - no obvious decay experience but should continue to see the family dentist on a regular basis.

The results of the Basic Inspection are then anonymised and aggregated. The data are us ed t o m onitor the i mpact o f local a nd na tional o ral he alth i mprovement programmes, and to assist in the development of local dental services. The Detailed inspection is a m ore rigorous a nd c omprehensive a ssessment tha t involves recording the s tatus o f e ach s urface of e ach t ooth i n a ccordance w ith international epidemiological conventions. The goals of the Detailed Inspection are to determine, in detail, the current levels of established tooth decay experience and the impact of deprivation on the dental health of P1 and P7 children in Scotland. CDS (NHS Community Dental Service)

Provides treatment for people who are unable to access NHS General Dental Services (GDS). For example: · · ·

Only specialist CDS services are appropriate if someone has special needs (mental health problems, a physical disability, etc.). In s ome a reas, the re m ay be few G eneral Dental Pr actitioners (G DPs) providing NHS treatment. Someone needing dental services may be resident in long-stay care.

The CDS also plays a m ajor role i n dental health promotion and e ducation and in the National Dental Inspection Programme in local authority primary schools. DCP

Dental care professional.

EASR

European Age-Standardised Incidence Rates.

GDS

NHS General Dental Service.

HDS

NHS Hospital Dental Service.

ISD

NHSScotland’s Information Services Division.

MIDAS

Management Information and D ental Accounting System, the p ayment s ystem f or NHS GDS dentists.

NDIP

National Dental Inspection Programme.

NES

NHS Education for Scotland.

NHS24

Service providing c omprehensive up-to-date health information and self-care advice.

PCD

Profession complementary to dentistry.

SEDS (Scottish Emergency Dental Service)

Centralised, NHS24-coordinated, out-of-hours Scottish Emergency Dental Service.

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SIMD

The Scottish Index of Multiple Deprivation identifies small area concentrations of multiple deprivation across all of Scotland in a fair way. It allows effective targeting of policies and funding where the aim is to wholly or partly tackle or take account of area concentrations of multiple deprivation.

Bibliography / data sources Scottish Executive Health Department. Action Plan for Improving Oral Health and Modernising NHS Dental Services. Edinburgh: The Scottish Executive, 2005 Information Services Division, NHS National Services Scotland, Edinburgh NHS Education for Scotland, Edinburgh

Appendix - NHS boards’ Dental Action Plan Lead Officers (April 2011) AA B DG F FV G GGC H La Lo O S T WI

Ailsa Morrant Vacancy Valerie White Graham Ball Derek Richards Ray Watkins Karen Murray Ken Proctor Albert Yeung Robert Naysmith Moya Nelson Mike Collins Morag Curnow John Lyon

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