Addressing the challenges Eric Rooney Deputy Chief Dental

Addressing the challenges Eric Rooney Deputy Chief Dental Officer Office of the CDO www. england. nhs. uk

www. england. nhs. uk

Five Year Forward View • NHS England’s plan for a sustainable NHS • Strong emphasis on the need for a joined up approach across health and social care • Strong emphasis on prevention, recognising the determinants of health and the commonality of them • An opportunity for collaboration on wider health issues such as obesity in childhood • A recognition that we need some national consistency, but local flexibility • Opportunity for us all to work together to improve oral health www. england. nhs. uk

A health & social care system that supports good oral health provides timely access to dental care professionals when necessary through a streamlined patient journey, supported by specialist advice & delivered to nationally expected standards of care provision www. england. nhs. uk

Health Education England NHS England Department of Health Public Health England Workforce review Commissioning Contract Reform Programme Delivering Better Oral Health COPDEND Pathway development Commissioning Oral Health National and Local Dental Networks Royal College of Surgeons Faculties Standards Specialist Societies LOCAL AUTHORITIES Advice A health & social care system that supports good oral health provides timely access to dental care professionals when necessary through a streamlined patient journey, supported by specialist advice & delivered to nationally expected standards of care provision Care Quality Commission General Dental Council BDA Negotiation Specialist Societies

The approach to prevention Source: Watt RG. From victim blaming to upstream action: tackling the social determinants of oral health inequalities. Community Dent Oral Epidemiol 2007; 35: 1– 11 6

Local Authorities 7 NHS England

The approach to dental care Contract reform • Led by DH with input from NHS England PHE • From the start – clinical pathway focussed on prevention and supporting delivery of DBOH • 2 nd evidence and learning report shows positive change in risk status for decay • Preventive philosophy and approach supported by patients and practitioners alike. • Now 80 or so Prototypes testing the commercial aspects www. england. nhs. uk

The Patient’s journey – an illustration

Level 1 Restorative pathway Oral Surgery pathway 0 rthodonti pathway Level 2 Level 3 The Patient’s journey – an illustration Overall lifetime pathway approach

Specialty Commissioning Guides www. england. nhs. uk

Commissioning Guides • Since 2013 NHS England has been working with the profession to develop commissioning guides with a view to providing a more consistent approach to its commissioning of services. • About to publish on 3 more areas including paediatric dentistry • Working groups have in the main been chaired by leading clinicians, and had input from the specialist societies • Provides the opportunity to set out the care pathways and standards for better care www. england. nhs. uk

Local initiatives and scaling up • • Areas of innovation based on the approaches outlined Initiatives tend to be small and isolated Not a good track record of scaling up these interventions Using Local Dental Networks to disseminate • One of the things which drive change is a focus on outcome measures • NHS outcomes framework • Decayed teeth • Extractions in secondary care for children www. england. nhs. uk

The approach to Commissioning • Currently dentistry direct commissioned by NHS England • Limited appetite for co/ delegated commissioning at present • Devolution • Balance of local accountability and national consistency • Building on Local Dental Networks to • Provide a clinically led approach • Ensure safe services • Secure current and develop new integrated services • Provide continuity and build local links • Future proof as local transformation takes place www. england. nhs. uk

In Summary • We know that inequalities exist in oral health status and in access to dental services • We are clear that the 2 main dental diseases – tooth decay and gum disease can be prevented and that for the others – oral cancer- risks can be minimised. • We need to ensure prevention is prioritised across the public health and patient care systems • We need to provide ready access to simple and complex treatment in a consistent manner • We need to evaluate the commercial approaches to the prototype contracts • We need to develop our local dental networks to support clinically led, place based commissioning • We need to build a consensus of support for this from patients and public, politicians and the profession. www. england. nhs. uk

Addressing the challenges Eric Rooney Deputy Chief Dental Officer Office of the CDO ericrooney@nhs. net www. england. nhs. uk