Agenda item
Children's Oral Health in Brent
The report outlines the oral health outcomes for children in Brent and the local authority plan for 2017 to tackle oral health issues.
Minutes:
Dr Melanie Smith (the Council’s Director of Public Health) introduced the report, outlining that Brent children had some of the worst oral health outcomes in England, with dental extractions remaining the top cause for elective hospital admissions in children. She stressed that although there had been some improvement, levels of tooth decay remained unacceptable bearing in mind that it was almost entirely preventable. Dr Smith said that National Health Service England (NHSE) had awarded a new five-year Community Dental services (CDS) contract to Whittington Health from 1 April 2017, with funding for oral health promotion staff remaining with NHSE with a section 75 agreement being put in place meaning that Brent Public Health would provide £20,000 for resources. Jeremy Wallman (Head of Acute and Specialised Dental Commissioning at NHSE) commented that this had made Brent the first borough council that fully recognised that oral health promotion resource sat within the contract (section 75 agreement). Claire Robertson (Public Health England) said that failures of prevention had contributed to high levels of disease and noted that the contract would enable the delivery of an integrated service by several partners. Ian Niven (Healthwatch Brent) said that Healthwatch Brent recognised this problem and it would prioritise it for the year ahead.
Members asked questions that related to the overall picture of children’s oral health, uptake of dental care, investment in dental services and public health prevention, and lessons that could be learned from other boroughs, such as Enfield, where tooth decay rated had been lowered. Dr Smith said that there was a strong correlation between tooth decay and deprivation, with decay being a universal problem in Brent, which meant that there was not an area where oral health was satisfactory. As far as funding was concerned, she informed the Committee that the right level of funding was available, however, oral health promotion needed to be targeted at young children as there was a common misconception that problems with milk teeth did not transfer to permanent teeth. Moreover, there was a generational issue as often parents who did not visit the dentist would not take their children to regular check-ups. Therefore, behavioural change would take time and it might be a good idea to encourage registration with a dentist (free of charge) when people register with a General Practitioner (GP) or when a new Council Tax account was set up. Mr Wallman commented that this would improve uptake of dental care as at present obligation ceased when a patient finished their treatment at a dental surgery. Kelly Nizzer ?(Regional Lead London Dental, Pharmacy and Ophthalmic Services at NHSE) said that NHSE had run similar campaigns and that leaflets had been distributed to pharmacies about nine months ago, with an electronic version sent to them so they could print additional copies. In relation to measures taken in Enfield, Dr Smith said she would see more information from the Director of Public Health at Enfield and Ms Robertson added that a fluoride varnish programme and other sustained programmes had been implemented in the borough. As far as capacity was concerned, Ms Nizzer informed the committee that NHS practices underperformed due to the lack of patients registering and various campaigns had been run to address this, with performance being measured by how many children visited dentists. It was noted that data presented in the report had been provided by the NHS and information from private practices had not been included.
In relation to questions about dental checks in schools and children centres, Ms Robertson explained that there was no evidence demonstrating that screening at school would necessarily transfer to an appointment as letters often did not reach parents. Moreover, there was not information about a correlation between the withdrawal of dental checks in schools and children’s oral health. Dr Smith said that all children centres were part of the Healthy Early Years award scheme and Gail Tolley (the Council’s Strategic Director for Children and Young People) added that dental checks and immunisations were part of the expectations from foster carers, with children in care being monitored by a Looked After Children (LAC) nurse. She emphasised that oral health was linked to attainment as it had impact on speech and language development and attendance at school.
A Member of the committee asked what outreach work had been done to promote sugar reduction and better tooth brushing. In response, Councillor Hirani (Cabinet Member for Community Wellbeing) said that work had been undertaken with children centres to address not only oral health, but also obesity as there was a close correlation between the two. He said that prevention could help combat both issues and he talked about the Slash Sugar campaign. In addition, Ms Tolley said that the under five group was a concern as by the time they reached school age, took decay might have started. Dr Smith commented that there had been a strong partnership between Public Health, NHSE and Brent’s dental practices, which had demonstrated that efforts to improve children’s oral health had been coordinated. In terms of work with community groups, Dr Smith referred to the Making Every Contact Count and Making Oral Health Everybody’s Business programmes which had to be promoted and training had been provided to the school nursing service and would be offered to all front line staff in the Community and Wellbeing Department.
As far as future priorities were concerned, Dr Smith noted that it would take time for the outcomes from the 2017-2018 oral health promotion programme to become visible, but options for intervention prior to birth had been explored as pregnant women could be encouraged access dentists during pregnancy ( the service was provided free of charge). This statement was echoed by Ms Robertson who said that a programme had to be in place for a number of years so a whole cohort could go through it in a sustainable way.
RESOLVED that:
(i) The contents of the Children’s Oral Health in Brent report, be noted;
(ii) The following potential recommendations be identified by the Committee for further consideration:
1. Promote fluoride varnish as part of the Make Every Contact Count programme
2. Consider ways to encourage residents to register with a dentist as part of the Brent Landlord Registration Scheme – this could be incorporated into new Council Tax registrations.
3. CCG and Public Health England could make better use of Brent’s website to promote campaigns.
4. Re-examine the notion of school visits by dentists, with a pilot on a smaller scale.
5. Collect data about visits at dental practices on a wider scale
6. Consider a Harlesden-specific recommendation to address the issue of high number of dental admissions in hospital and events taking place between tooth decay and dental update.
7. Address the issue of publicity not reaching parents, adhering to national policy guidelines.
The meeting was adjourned for a comfort break between 8:51 pm and 8:56 pm.
Councillor Mili Patel left the meeting at 8:51 pm
Supporting documents: