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A missed opportunity: The future of oral health in Scotland

Blog Author Robert Donald

Blog Date 13/12/2016

​We hoped the Scottish Government's consultation exercise, focusing on the 'The future of oral health services' could herald a real break from treating dental disease and move the focus onto real prevention. But we are concerned that, as it stands, it's a missed opportunity for government to back their words with action (and appropriate funding). It's also concerning that the consultation appears to miss some of the key elements that could really improve our nation's oral health.


We have submitted our response, written in consultation with our range of BDA committees across the crafts, and we held an extraordinary meeting of the Scottish Dental Practice Committee in October to discuss our approach and focus for this consultation.


We've encouraged dentists across Scotland to attend the Scottish Government roadshows, and we provided a briefing to help BDA members understand some of the main issues, and our concerns about the future of dentistry in the country, and to help them ask appropriate questions.


One of our major concerns is the potential impact on our businesses – the proposals appear to be suggesting increased control over our businesses and this could have major ramifications for the way we operate.


We have said we are strongly opposed to the idea that any dental services can be commissioned by health and social care partnerships, as these currently have no dental representation at board level.


We also oppose the idea that there needs to be a formal written contract between NHS boards and practice owners – we feel that associates need to maintain their own clinical accountability, and this is essential for practitioners stability in the current circumstances.


Tackling the problem of the growing oral health inequalities in Scotland is a task which we believe cannot be done in isolation. Government, commissioners and healthcare professionals from across the sectors will need to work together to have any chance of alleviating the problem. Dentistry plays a vital role however, in ensuring that preventative care is valued and taken up from a young age.


We are concerned that registration rates do not give the whole picture when it comes to who is actually accessing dental care. We've highlighted that approximately 1.4 million of the registered patients in Scotland have not actually visited their dentist in over two years.


In the areas of greatest deprivation in Scotland only just over half (63%) of patients have seen their dentist in the previous two years.


Fluoridation gets zero mention in the consultation, which strikes me as a serious omission. Research bears out that targeted water fluoridation is both safe and a cost-effective way of improving oral health outcomes, particularly in areas of high deprivation and for the hardest-to-reach populations.


In fact, Public Health England's recently-published Return on Investment tool shows that such schemes have significantly reduced decay rates in 5-year-olds, and could generate a saving of almost £22 for every £1 spent, after 10 years – which is by far the greatest return of any intervention they studied. Granted, it's a controversial topic for government to have to deal with, but figures like that can't be ignored given the unacceptably high levels of caries we still see. We believe that all the options need to be put on the table for discussion.


In our response, we were pleased to note that the Scottish Government has taken on board a number of the key issues we've raised over the past few years, including some of the points from our 2016 manifesto.


However, we don't think the principal challenges in terms of NHS dentistry have been fully addressed by the consultation paper, particularly the issue of adequate funding for NHS dentistry to deliver on the prevention agenda. Dentists need to be properly remunerated for the modern care they offer and for the provision of oral health advice and oral health improvements.


The issue of provision for periodontal care, care of the elderly in their own homes, and a workable oral cancer strategy are also glaring omissions, we feel, from the proposed consultation document.


We've also highlighted our concerns about the damaging impact of poor oral health for the future generation of Scotland's children. In spite of the positive advances being made by the Childsmile Programme, this has only been running for five years and more still needs to be done to iron out the shocking inequalities that we see in Scotland, depending on where you live. We've agreed with Glasgow MP Alison Thewliss, who told Parliament that Childsmile has made a difference, but it's time Government went further in tackling Scotland's health inequalities.


One in five (210,000) of Scotland's children are officially recognised as living in poverty – defined as living in a household with less than 60% of median household income. These are the children most at risk of illness and early death in adulthood.


The figures from the National Dental Inspection programme show the huge gap between 5-year-olds from more affluent areas and the lowest income households. Only 55% from the most deprived areas are free from tooth decay compared with 82% from the least deprived.


We've called for continuing investment and for it to be extended to 5-12 year olds and we've said that the oral health strategy needs to be part of a joined-up approach by Government to address the factors which drive child poverty, and to combat the cycle that poverty creates in terms of poor oral health and poor general health.


A strategy is just a first step toward this, implementing it effectively will need the expertise of a range of stakeholders, and we plan to make dentists voices heard to ensure the best for our patients, and we'll continue to call for real investment in NHS dentistry to achieve better outcomes for all.


Robert Donald

Chair, BDA Scottish General Dental Practice Committee