Uniting to find a solution

Representatives from the dental and care sectors met at the British Dental Association to discuss the findings of the Care Quality Commission report on the poor state of oral health in care homes.

Collaboration, education and awareness have been decided as the key components to improving oral health in care homes at a conference of dental professionals following a damning Care Quality Commission (CQC) report into the matter.

Smiling matters: oral health care in care homes is the result of six months of field work that began in October 2018, building on three to four years work within the sector. The CQC visited 100 care homes for the review and found that 52% did not have a policy to promote and protect oral health of their residents, while 17% didn’t review oral health on admission.

The report found that many people living in care homes are not being supported in maintaining and improving their oral health, and three years after the publication of the NICE guideline (NG48), oral health in care homes is still not a priority.

It also revealed that 39% of care home managers were not aware of the NICE guidelines about oral healthcare. Of the 28% who had heard of it, 39% felt they had fully implemented the recommendations and inspectors found many of the oral health plans lacked detail. And 47% of care homes visited admitted their staff didn’t receive any oral health training.

The conference, held at the BDA headquarters in London on 1 July, aimed to present the findings and evidence, and make the report’s recommendations a reality.

Janet Williamson, deputy chief inspector at the CQC, opened saying it is a ‘call to action in terms of what we can do to make a difference to people across England’.

She added: ‘Every care home we visited took very practical steps. In the next 12 to 18 months we want to review these findings and see if they have made a difference for those people in care homes.’

Report summary

The report gave six recommendations for action:

  • People who use services – their families and carers need to be made more aware of the importance of oral care
  • Care home services need to make awareness and implementation of the NICE guideline ‘Oral health for adults in care homes’ a priority
  • Care home staff need better training in oral care
  • The dental profession needs improved guidance on how to treat people in care homes
  • Dental provision and commissioning needs to improve to meet the needs of people in care homes
  • NICE guideline NG48 needs to be used more in regulatory and commissioning assessments.

Antony Hall, head of inspection at the CQC, presented a summary of the findings and said the report is ‘a catalyst for improving the care sector and in the dental sector’.

He said: ‘Many of the care plans we saw were “support Mr X on his teeth” or “Mrs X needs her dentures cleaned at night”. That was the oral health plan. We did actually find a more comprehensive plan for hairdressing than we did oral health.

‘Homes looking after people with dementia were the most likely to not have anything in care plans around oral health, whereas the smaller homes looking after those with learning difficulties did have a plan in place. People didn’t know how to complete assessments, there was no training so it didn’t get completed.’

Mr Hall also addressed the monetary factor of who pays for dental visits, both for the care home resident and the dentist themselves.

He said: ‘When someone enters the care home, the relationship with the dentist stops. More often than not the relationship only connects in an emergency or when someone is in pain. Who pays for this? Who pays for the care home to take two staff off the floor to accompany somebody to a dental surgery? Is it the family? It the person’s own budget? Is it the care home? No one was quite sure.

‘From the dentist’s perspective, who is going to pay for this? We don’t get paid for going in a care home: some dentists say they don’t know how to deliver this treatment.

‘This isn’t a blame game of [singling out] one individual part of the system – it’s all of our business to make sure good oral health has a greater priority and becomes all of our responsibility.’

Panel discussion

To assess and reflect on the report’s recommendations, CQC senior national dental adviser John Milne chaired a panel session consisting of Charlotte Waite and Martin Woodrow from the BDA, deputy chief dental officer Janet Clarke, Carol Reece of NHS England, Anita Astle of the National Care Association and Sandra White of Public Health England.

Charlotte Waite was first to speak, saying: ‘We must strive to break down barriers to care and end the postcode lottery. We need a true collaboration across health and social care, ensuring that care and services are underpinned by robust needs assessments and adequate commissioning services.

‘This requires nothing short of a revolution in the approach to dentistry and oral care in care homes.’

Janet Clarke talked about the need for consistency and using the funds we have in dentistry in a flexible way.

She added: ‘The situation locally, oral health in care homes has been highlighted in the long-term plan. We saw the publication of the long-term plan implementation guide and that talked about a local system approach, which should be in place by November 2019. We need to get our local dental networks, local dental committees and our commissioners to work together.’

Anita Astle said: ‘My plea is let’s all get smarter. We need the guidance and the evidence space, but also we need it to be simple so everybody can embrace it.’

Sandra White spoke of the time she was called out to help a care home resident: ‘I have 21 years as a clinical dentist. I got a call from a care home at five to five on Christmas Eve to ask if I could look at a resident.

‘When I got there a lady couldn’t eat: she had a problem with her gums. But she had never had an assessment, never had her teeth cleaned, and I don’t think they knew she had a partial denture.

‘With some difficulty I took out the partial denture past all the bleeding gums and we cleaned her up. But this is what we’re talking about: when people are missed and can’t even eat their Christmas dinner.’

During the Q&A session, BDA chair Mick Armstrong suggested a need for better education and asked where the budget for this would come from.

In response, Carol Reece said: ‘It has to be a local decision. Primary care networks, local care network chairs, the whole community will make the decision on what needs to be commissioned to meet the needs of that local population. How can we utilise the resource we have available to us in the best interest of the patients?’

Call for unity

To close the conference, Dr Williamson called for unity in the profession and between the representatives from the various groups present.

She said: ‘What we have in front of us is a unique opportunity for people in care homes and their relatives. What matters is making sure granny has her toothbrush, or making sure grandad or uncle or aunt have the things they need. These people are very vulnerable and it’s for us to unite across the system to try to make a difference.

‘It’s easy for us to stand here and comment and say what needs to be done, but what matters is we collectively put our energy into solving that. It requires good leadership and behavioural change, and the leaders who will make this happen are in this room.’

To read or download Smiling matters: oral health care in care homes, visit www.cqc.org.uk/publications/major-report/smiling-matters-oral-health-care-care-homes.

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