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​Care homes face uphill struggle as new rules give them responsibility for oral health

1 October 2019


The BDA has warned care homes in England face significant barriers in securing access to NHS services, as the Care Quality Commission (CQC) today rolls out new measures on oral health to benchmark their effectiveness.

Dentist leaders have welcomed the new questions being posed by inspectors - which ask homes to assess both their policies and access to dental services - but warned that support and resources are not yet in place to help homes provide dental care to their residents. 

NHS dentists across England now anticipate high demand for dental visits to meet the new standards, but are unequipped to assist owing to NHS England's failure to commission dedicated services for residents. The BDA understands local authority funded oral health promotion teams will also struggle to meet new training needs, owing to sustained cuts to public health budgets.

Before 2006 NHS dentists in England could provide domiciliary care as a matter of routine. Since then reform has left practitioners unable to make visits without a dedicated contract.

The recent CQC Smiling Matters report noted that one of the main challenges in providing access to NHS services was lack of domiciliary care provision. BDA analysis of Freedom of Information data suggests levels of commissioning are low and falling, equivalent to providing coverage to less than 1.3% of the population whose activity is significantly limited by disability or ill health.

The report noted that 52% of the homes it contacted did not even have an oral health plan for residents, and 47% of staff never received training specific to dental care. 73% of care plans only partly covered or did not cover oral health at all, with homes specialising in dementia less likely to do so.  


The BDA's England Community Dental Services Chair, Charlotte Waite, said: 


"From today care homes finally have a responsibility to protect the oral health of their residents. It's not before time, but staff picking up the phone for help will find they have nowhere to go. 


"Health commissioners can't keep pretending hundreds of thousands of elderly residents don't exist. We will keep seeing horrific cases of neglect, until a plan and resources to ensure access and training are in place.


"Many care homes may well struggle come inspection time, but the main victims here are vulnerable residents. Officials must recognise their duty to attend to basic health needs."


John Milne, National Professional Dental Advisor at the Care Quality Commission said:

"Maintenance of good oral health is a vital factor in overall wellbeing and we are sure that care homes will respond positively to meet the recommendations raised in our Smiling Matters report.

"We have already seen several good examples of how care home residents were helped to care for their mouths and look after their teeth. Access to dental care is clearly a challenge, and we hope that both commissioners and the profession will work together for the benefit of all".


New mandatory questions, which will now form part of the 'Effective' measure in CQC reports

1. Do all staff have training in oral health care?

  • Is oral health covered in induction?
  • Is oral health a mandatory component of regular training?
  • Do staff feel confident in supporting oral health care?
  • Do staff know what to look for to identify deterioration in oral health?
  • Do staff consider poor oral health when assessing reasons behind weight loss, infection, or tissue viability?

2. How do you ensure oral health care is assessed, considered and delivered as a part of a person's care plan?

  • Is the service aware of the NICE Guideline NG48?
  • Is oral health assessed fully on entry to the care home in line with this guideline?
  • Is there a detailed oral health care plan in place?
  • Do people have easy access to toothpaste, toothbrushes, denture cleaning fluid?
  • Do people have access to routine and emergency dental care?