An apology for absence was received from Amanda Moss, Chair of the Voluntary Sector Network.

It was reported that, in accordance with the wishes of the Conservative Group, the membership of the Sub-Board had been amended to include Councillor Barbara Lewis in place of Councillor Twelves and Councillor Tolchard in place of Councillor Bryant.  The Conservative vacancy for the Sub Board had not been filled for this meeting.

The minutes of the meeting of the Sub-Board held on 12 October 2023 were confirmed as a correct record and signed by the Chairwoman.

Presented by the Public Health Specialist, Torbay Council.

Mark Richards, Public Health Specialist, Torbay Council, explained that dental commissioning had recently been transferred to the Integrated Care Board (ICB).  This provided a good opportunity for Public Health and Local Authority Teams to work with the ICB to improve access to dental care and collaborative working was already underway to achieve that.  The new Peninsula Oral Health Steering Group had been established by Devon and Cornwall ICB’s to oversee dental reform work across the peninsula following the transition of dental commissioning functions and all three Devon Local Authorities, including Torbay, were represented.  There was a commitment to working with Health Inequality Leads, Local Authority Oral Health Improvement Leads, the Dental Teams and key partners to improve access to oral health improvement advice and interventions for those in greatest need together with increased access to dental services.

Members were informed that there was a lack of take up of the NHS Dental Contract nationally which was why a high number of dental practices were not taking on new NHS patients. In the South West 98% of dental practices were not accepting new NHS patients and as at September 2023, there were 3,656 Torbay residents on the NHS dental waiting list in total, consisting of 3,081 adults and 484 children and young people.

It was recognised that dental care providers were still working through a substantial backlog of work which had resulted from the impact of the Covid-19 pandemic and general population need and this also contributed to the current difficulty in accessing dental care.

The main areas of concern in Torbay were:

·         access to NHS dental care;

·         wait numbers (which were the highest they have been historically);

·         hospital admissions for tooth decay resulting in tooth extractions for the 0-19 years and 18+ age bracket and the impact of dental problems on children and young people; and

·         oral cancer registrations and mortality rate.

Members were informed of current and planned oral health improvement projects designed to help tackle these areas of concern which included:

·         First Dental Steps which was an initiative delivered by Health Visitors;

·         Supervised Toothbrushing Scheme which was delivered by At Home Dental;

·         incorporating advice on oral hygiene and dental access into Your Health Torbay (Lifestyles offer) for all triage appointments;

·         advice and guidance for Family Hubs, Early Years, 0-19 and Children’s Social Worker Teams regarding oral hygiene, registering for a dentist and what to do if in urgent dental need, including a staff training plan and accompanying advice regarding nutrition and hydration;

·         toothbrush and toothpaste packs for Family Hubs and looked after children and young people;

·         Fluoride Varnishing Programme;

·         Open Wide Step Inside – an initiative engaging with schools and Year 2 students to improve oral health and hygiene;

·         Homelessness Pathway which provided oral health support to the homeless;

·         establishing Oral Health Champions in Care Homes and Domiciliary Care settings; and

·         the Community Dentistry initiative which provided routine and emergency dentistry for adults and children with complex needs who find it difficult to access dental services.  ...  view the full minutes text for item 16.

To receive an update on the NHS England and NHS Improvement South West Dental Reform Strategy presented by the Director of Commissioning Primary, Community and Mental Health Care NHS Devon; the Consultant in Restorative Dentistry, NHS Somerset Foundation Trust and the Programme Manager (Devon, Cornwall and the Isles of Scilly, Somerset, Dorset) Dental Team, South West Collaborative Commissioning Hub.

https://www.england.nhs.uk/south/info-professional/dental/dental-reform-stratgey/

Jo Turl, Director of Commissioning, NHS Devon and Matthew Jerreat, a Consultant in Restorative Dentistry and Chair of the Local Dental Network provided Members with an update and presentation.

Members were informed that the commissioning of NHS Dentistry was transferred to ICB’s in April 2023 and that approximately 50% of the population were funded for NHS dentistry.  The NHS Contract had not been updated in some time and was seen as out of date and not fit for purpose.  The issues affecting Torbay were also national issues and the NHS had been trying to make improvements locally for some time now against the back-drop of the existing NHS Dentistry Contract.

It was explained that the NHS Contract was an ‘in perpetuity’ contract which meant that the contract could not be taken away from dental practices unless they under performed for three years consecutively.  Since Covid-19, some dental practices had found it hard to deliver to the expected level under the Contract and the NHS was currently working with those dentists and their teams to find out what they were doing to achieve the contractual level of activity.  In reality, a lot of practices had been adversely impacted by the loss of staff and dentists which had led to under performance and therefore workforce was a significant issue in some NHS dental practices being able to deliver against expected levels of performance.

High street dentistry practices were also independent businesses operating under contracts and some were finding it difficult to make the NHS Contract work for them and so offered private dentistry services instead or as well as.  It was recognised that, as independent businesses, they were responsible for the cost of employing their own staff and meeting the costs of their own premises.

It was explained that, under the NHS Contract, dental services were commissioned by Units of Dental Activity (UDA) which was a unit used to measure dentistry activity to ensure that the correct amount of patient charges were collected.  In the event of an underspend there was a clawback opportunity in the following year only.  It was confirmed that there was no ringfenced budget available for dentistry this year.

Currently the performance list indicated that there were enough dentists in Devon to meet demand but a lot of those dentists were doing private work because they could not make the NHS Contract work for them or they had chosen to work in private dentistry.  Since dental commissioning had been transferred to ICB’s, it had presented an opportunity for the ICB to work with the local dentists to encourage them back into the market of NHS work.

Members were informed that the South West Dental Reform Programme was set up in late 2020 to bring together NHS England Commissioners with key stakeholders with responsibility for oral health in the region.  The aim was to inform the strategy for the future of NHS dental services that would contribute to the overall improvement of oral health for people living  ...  view the full minutes text for item 17.

Key Lines of Enquiry identified:

·         Is there sufficient NHS dentistry capacity in Torbay and what action is being taken to address long waiting lists to access urgent and non-urgent dentistry, especially for children and young people, the elderly or vulnerable patients?

·         Will the ICB consider using the annual claw-back of unspent Torbay specific UDA funding to design and develop innovative solutions to oral health improvement, prevention 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   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, whilst recognising that a percentage of TQ3, 4 and 5 are in the Devon County Council area); total UDA commissioned (number and value) and the amount of money unspent (percentage and amount).

Key Lines of Enquiry identified:

1.         Was there sufficient NHS dentistry capacity in Torbay and what action was being taken to address long waiting lists to access urgent and non-urgent dentistry, especially for children and young people, the elderly or vulnerable patients?

Members were informed that high street dentists were struggling to make the existing NHS Contract work for them, so either took the decision to provide private dental services or supplement NHS work with private dental work to meet costs.  This impacted NHS dentistry capacity to meet demand.  NHS England in the South West had been working on flexible commissioning for some time now and examples were the pilots on stabilisation and child friendly practices.  It was too early to measure the impact of these projects but the hope was that they would offer the opportunity for dental practices to focus on the patients in most need of dental care and to recruit additional staff, working towards retaining NHS dentists and bringing others into the market.  The focus of the pilots at present concentrated on assisting vulnerable groups first as a priority and it was confirmed that the urgent care list had been reduced as a result of stabilisation.

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

(a)  explanation of how Units of Dental Activity work;

(b)  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, whilst recognising that a percentage of TQ3, 4 and 5 are in the Devon County Council area); total UDA commissioned (number and value) and the amount of money unspent (percentage and amount).

            It was explained that under the NHS Contract, dental services were commissioned by Units of Dental Activity (UDA) which was a unit used to measure dentistry activity to ensure that the correct amount of patient charges were collected.  In the event of an underspend there was a clawback opportunity in the following year only.  It was confirmed that there was no ringfenced budget available for dentistry this year.  Additional information regarding budget lines would be circulated to the Sub-Board.

Prior to the meeting, Members of the public had been encouraged, via a press release, to submit questions for consideration by the Sub-Board.  The questions were collated into subject headings and responses were provided as follows:

Wait times and numbers

·         It was explained that in terms of existing waiting times, figures had come down and that had been helped by the additional funding, but that there was further work to do in revalidating the list which was expected to naturally reduce the current waiting list.  ICB had spoken with providers recently and some individuals had been taken off the waiting list as they no longer required assistance; 

·         There  ...  view the full minutes text for item 18.