Addressing the challenges Eric Rooney Deputy Chief Dental Officer Office of the CDO

Five Year Forward View NHS England’s plan for a sustainable NHS Strong emphasis on the need for a joined up approach across health and social care Strong emphasis on prevention, recognising the determinants of health and the commonality of them An opportunity for collaboration on wider health issues such as obesity in childhood A recognition that we need some national consistency, but local flexibility Opportunity for us all to work together to improve oral health

A health & social care system that supports good oral health provides timely access to dental care professionals when necessary through a streamlined patient journey, supported by specialist advice & delivered to nationally expected standards of care provision

NHS England Department of Health Contract Reform Programme A health & social care system that supports good oral health provides timely access to dental care professionals when necessary through a streamlined patient journey, supported by specialist advice & delivered to nationally expected standards of care provision Health Education England Commissioning General Dental Council Care Quality Commission Delivering Better Oral Health National and Local Dental Networks Public Health England BDA Royal College of Surgeons Faculties Standards Negotiation Advice Pathway development Workforce review Specialist Societies Specialist Societies COPDEND Commissioning Oral Health LOCAL AUTHORITIES

The approach to prevention 6 Source: Watt RG. From victim blaming to upstream action: tackling the social determinants of oral health inequalities. Community Dent Oral Epidemiol 2007;35: 1–11

7 Local AuthoritiesNHS England

The approach to dental care Contract reform Led by DH with input from NHS England and PHE From the start – clinical pathway focussed on prevention and supporting delivery of DBOH 2nd evidence and learning report shows positive change in risk status for decay Preventive philosophy and approach supported by patients and practitioners alike. Now 80 or so Prototypes testing the commercial aspects

The Patient’s journey – an illustration

Level 3Level 2 Level 1 Overall lifetime pathway approach Oral Surgery pathway 0rthodonti pathway The Patient’s journey – an illustration \ Restorative pathway

Specialty Commissioning Guides

Commissioning Guides Since 2013 NHS England has been working with the profession to develop commissioning guides with a view to providing a more consistent approach to its commissioning of services. About to publish on 3 more areas including paediatric dentistry Working groups have in the main been chaired by leading clinicians, and had input from the specialist societies Provides the opportunity to set out the care pathways and standards for better care

Local initiatives and scaling up Areas of innovation based on the approaches outlined Initiatives tend to be small and isolated Not a good track record of scaling up these interventions Using Local Dental Networks to disseminate One of the things which drive change is a focus on outcome measures NHS outcomes framework Decayed teeth Extractions in secondary care for children

Currently dentistry direct commissioned by NHS England Limited appetite for co/ delegated commissioning at present Devolution Balance of local accountability and national consistency Building on Local Dental Networks to Provide a clinically led approach Ensure safe services Secure current and develop new integrated services Provide continuity and build local links Future proof as local transformation takes place The approach to Commissioning

In Summary We know that inequalities exist in oral health status and in access to dental services We are clear that the 2 main dental diseases – tooth decay and gum disease can be prevented and that for the others – oral cancer- risks can be minimised. We need to ensure prevention is prioritised across the public health and patient care systems We need to provide ready access to simple and complex treatment in a consistent manner We need to evaluate the commercial approaches to the prototype contracts We need to develop our local dental networks to support clinically led, place based commissioning We need to build a consensus of support for this from patients and public, politicians and the profession.

Addressing the challenges Eric Rooney Deputy Chief Dental Officer Office of the CDO