It was reported that, in accordance with the wishes of the Liberal Democrat Group, the membership of the Sub-Board had been amended to include Councillor Dudley in place of the Chairwoman, Councillor Johns, who attended the meeting remotely due to having Covid-19 and therefore was unable to be a formal member of the Sub-Board).

As apologies had been received from the Chairwoman, Councillor Johns, Councillor Douglas-Dunbar was elected Chairwoman of the Sub-Board for the meeting.

To confirm as a correct record the minutes of the meeting of the Adult Social Care and Health Overview and Scrutiny Sub-Board held on 27 October 2022.

The minutes of the meeting of the Sub-Board held on 27 October 2022 were confirmed as a correct record and signed by the Chairwoman.

1.         To receive an update on the NHS England South West Dental Reform Strategy (see documents via the website at https://www.england.nhs.uk/south/info-professional/dental/dental-reform-strategy/).

2.         To consider if there is sufficient NHS dentist capacity in Torbay and what action is being taken to address long waiting lists to access urgent and non-urgent dentistry, especially for elderly or vulnerable patients.

Additional Key Lines of Enquiry:

1.         Will NHS England consider using the annual claw-back of unspent Torbay specific UDA funding to design and develop innovative solutions to oral health improvement and access to dental services in Torbay (with Torbay Council and wider partners)? This question also requires:

o        Explanation of how Units of Dental Activity work.

o        Explanation how the clawback is prioritised and spent once back with NHSE.

o        Budget lines for the last five years showing:

§     The amount of money contracted with high street dental practices in Torbay for areas TQ1, 2, 3, 4 and 5 (note % of TQ3, 4 & 5 are in the Devon County Council area. Postcode look-up tool supplied).

§     Total UDA commissioned: number and value.

§     The amount of money unspent (% and amount) and clawed-back into NHSE.

2.         Local Authorities have the statutory duty for oral health improvement but not the budget – this remains within NHSE. 

o        What is the current NHSE stance on the disaggregation of oral health improvement budgets from NHSE back into local authorities?

o        NHSE and Devon County Council completed this transfer of budget in 2019 – how can NHSE achieve parity for other local authorities such as Torbay, who have not seen oral health improvement budgets disaggregated and returned?

3.         It is requested that NHS England provide a regular update to Torbay Adult Social Care and Health Overview and Scrutiny Sub-Board on improvements in dental access and planned oral health improvement initiatives, including outputs and key performance indicators – the format and frequency to be agreed at the meeting.

Key Documents:

1.            Dental Access for Adults and Children in Torbay.

2.            NHS England and NHS Improvement Oral Health Needs Assessment South West of England January 2021 (Appendix 2 Devon STP Analysis).

(Note:  Lou Farbus, Head of Stakeholder Engagement and Melanie Smoker and Amy Claridge - NHS England South West, Mark Richards – Public Health Specialist, Wendy Okurut - Brixham Town Councillor have all been invited to take part in this discussion.)

Melanie Stoker (Senior Programme Manager), Amy Claridge (Dental Team) and (Head of Stakeholder Engagement) from NHS England provided an update on dentistry provision in Torbay and responded to the following questions:

·                     How was dentistry funded and how were the units of dental activity (UDA) calculated which meant that dentists were paid different amounts across the country.

·                     When and how could contracts be changed.

·                     What work was being done to encourage children to visit the dentist.

·                     There were other benefits of visiting the dentist including overall oral health and spotting other disease e.g. cancer, what was being done in the community to encourage people to have better oral health and raise awareness of potential early warning signs of other health issues.

·                     There were a lot of pilots being carried out, how soon could they be rolled out in Torbay and what more could be done sooner to improve access to dentists and improve oral health.

·                     How soon was it expected that numbers of children visiting dentists would be back to pre-pandemic levels.

·                     What follow up action was being taken on the pilots e.g. the teeth brushing in schools to ensure that parents also follow this up with teeth brushing before bed and that support in school would not result in less support at home.

·                     What was being done to improve waiting times for adults and vulnerable children.

·                     What could be done to encourage more people into dentistry (e.g. improved working conditions, access to housing etc.) and to use dentistry staff for other roles to enable more patients to be seen.

·                     Dentists were expected to meet 96% target otherwise funding was clawed back, how does this process work and what was the impact.

·                     Yorkshire has dental access centres in their town centres was this something that could be looked at for Torbay.

·                     What work was being done to focus support on areas of deprivation and how this linked to schools (it was suggested that free school meals may be a good indicator to use to identify suitable children and families to support).

·                     How can we ensure that money clawed back from dentists in Torbay was invested in preventative and good oral health for people in Torbay.

·                     Were vaping and fizzy drinks considered bad for oral health.

·                     How were we monitoring the success of the dental reform programme.

Lincoln Sargeant (Director of Public Health, Mark Richards (Public Health Specialist), Wendy Okurut (Brixham Town Council) and Pat Harris (Healthwatch) also took part in the discussions and debate.

Resolved (unanimously):

That NHS England/the Integrated Care Partnership be requested to provide an annual update to the Torbay Adult Social Care and Health Overview and Scrutiny Sub-Board on improvements in dental access and planned oral health improvement initiatives, including key outputs and key performance indicators via an accessible dashboard (the content of which to be agreed with the Director of Public Health).

To receive an update on the One Devon Partnership Integrated Care Strategy.

(Note:  Lincoln Sargeant, Director of Public Health will be in attendance for this item.)

The Director of Public Health (Dr Lincoln Sargeant) outlined the submitted paper which provided an update on the development of the One Devon Partnership Integrated Care Strategy which was produced by the One Devon Integrated Care System (ICS) setting out the direction for the system on how NHS commissioners, local authorities, providers and other partners could deliver a more joined up, preventative and person centred care for the whole population across the course of their life.  The Director of Public Health responded to the following questions:

·                     How could the Sub-Board fully comment on the document when it did not include target performance indicators to consider.

·                     There was a brief mention of workforce, what more could be included to reflect what was proposed to improve workforce planning.

·                     How would we ensure and measure the impact of prevention.

·                     What other community initiatives would be considered to help with prevention (e.g. community event in the library for free mouth cancer checks).

·                     How would the ICS ensure that patients only have to tell their story once as they move through the system.

·                     How would the ICS ensure that any housing targets did not conflict with the housing targets and strategies from the member Local Authorities. 

·                     Would targets around improving housing standards be more appropriate.

Resolved (unanimously):

That the Board notes the progress of the One Devon Partnership Integrated Care Strategy and recommends that further details around prevention, housing and workforce are included as well as ensuring the voice of the child and young person is heard.

To receive an update on the implementation of the actions of the Sub-Board and consider any further actions required (as set out in the submitted action tracker).

The Sub-Board noted the submitted action tracker.