Changes affecting NHS Dental Epidemiology in England Gill Davies BASCD NHS Epidemiology Co-ordinator

Key changes  Arrangements to support compliance and consistency  National Protocol  Consent  Dealing with this in preparation  Afterwards  Lighting  Change of primary sampling unit  Larger frames  Mismatches

Current issues identified by Tony Jenner regarding dental epidemiology in England □ Lack of direction □ Lack of consistency □ No performance management □ Lack of quality control □ Not linked to NHS Public Health Intelligence Strategy

Developments □ National Public Health Information Strategy □ North West Public Health Observatory □ Lead PHO for Oral Health in APHO □ The Dental Observatory □ Undertakes coordinating function in the North West □ Strategic Health Authorities

Proposed Process □ Supporting Directions to NHSDH □ Programme specificationNHS □ Programme advisory group BASCD NHS DH

Proposed Process □ Performance management cascade SHA □ Protocol design TDO NWPHO □ Training TDO commisssion □ Calibration TDO commission

Proposed Process □ Appoint regional coordinatorPHO SHA □ Regional training/ calibrationRCs □ Data collection PCT □ Data analysis and QA TDO Further analysis and links NWPHO □ PHO data sets NWPHO

Proposed Process □ Dissemination/Conference TDO NWPHO □ Data for compendium NWPHO □ Data for APHO profiles NWPHO □ Paper for CDH DHSRU

Key changes  Arrangements to support compliance and consistency  National Protocol  Consent  Dealing with this in preparation  Afterwards  Lighting  Change of primary sampling unit  Larger frames  Mismatches

CDs for each PCT □National Protocol □National SP II Format □Reporting form with Excel support □Questionnaire for reporting consent experiences

Key changes  Arrangements to support compliance and consistency  National Protocol  Consent  Dealing with this in preparation  Afterwards  Lighting  Change of primary sampling unit  Larger frames  Mismatches

National Protocol - consent □Principles □Local methods of collection □Suggested letter with form □Tracking sheet to help schools □Importance of recording information on all children approached

Tracking table

Data collection - coding for sample and consent 8.Child identity number |__|__|__|__|__|__| 9. Month/Year of birth |__|__|__|__|__|__| 10.Postcode |__|__|__|__| |__|__|__| 11.Sample group code|__| 0 - Main BASCD sample (co-terminous) 1 - Additional sample A 3 - Additional sample B 4 - Additional sample C 5 - Additional sample D 6 - Additional sample E 12.Consent status |__| 0 - form not returned 1 - consent refusal 2 - positive consent provided 13. Examination type |__| 0 - Main 1- repeat 2 - training 3 - absent 4 - child refused

Dealing with consent bias  Centralised assessment of samples  Centralised production of synthetic estimates  Comparison between previous estimates and new ones  Reporting of local outcomes – questionnaire  Reporting to Dept Health  RCT in North West

Key changes  Arrangements to support compliance and consistency  National Protocol  Consent  Dealing with this in preparation  Afterwards  Lighting  Change of primary sampling unit  Larger frames  Mismatches

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Key changes  Arrangements to support compliance and consistency  National Protocol  Consent  Dealing with this in preparation  Afterwards  Lighting  Change of primary sampling unit  Larger frames  Mismatches

4. Sample The primary sampling unit will be Local Authorities and samples also need to be taken to produce estimates for PCTs. In most cases the Local Authority and PCT will be coterminous so one sample will suffice. In the minority of cases where the PCT and LA are not co-terminous careful consideration of the geographic boundaries and populations within them should be undertaken to ensure that sampling produces the estimates for Local Authorities and for Primary Care Trusts.

4.1 Survey population The survey population is defined as all those children attending maintained schools within the Local Authority who have reached the age of five, but have not had their sixth birthday on the date of examination (Excluding special schools). A minimum sample size of 250 children is required per Local Authority and per PCT, from a minimum of 20 schools. This is unlikely to produce a sufficiently large sample to facilitate local planning for many PCTs, in which case larger samples will be required.

Relationship between geographiesPrimary population sampling frame 1 Multiple LAs to 1 PCTLocal Authority 2 1 LA to 1 PCT matchLocal Authority 3 1 LA to multiple PCTsPCT – weighted means may be necessary 4 LA wholly within non-co-terminous PCT Local Authority 5 LA spans multiple PCTsIndividual consideration – help of statistician advised

Relationship between geographiesPrimary population sampling frame 1 Multiple LAs to 1 PCTLocal Authority 2 1 LA to 1 PCT matchLocal Authority 3 1 LA to multiple PCTsPCT – weighted means may be necessary 4 LA wholly within non-co- terminous PCT Local Authority 5 LA spans multiple PCTsIndividual consideration – help of statistician advised

Primary Care Trusts containing non- coterminous Local Authorities Berkshire East Buckinghamshire Eastern Cheshire Western Cheshire Derbyshire County East Sussex Downs and Weald Hastings and Rother Lincolnshire Mid Essex Milton Keynes North East Lincolnshire North Staffordshire Oxfordshire Surrey Swindon Tameside and Glossop West Essex

Local Authorities spanning multiple PCTs – probably the PCTs listed above Aylsbury Vale Braintree City of Stoke-on-Trent Crewe and Nantwich High Peak North Lincolnshire Runnymede South Oxfordshire Staffordshire Moorlands Vale of White Horse Vale Royal Wealden

Table in Protocol showing relationships between LAs and PCTs R efLACodePCTCode 3Birmingham00CNSouth Birmingham5M1 1Mid Sussex45UGWest Sussex5P6 1Worthing45UHWest Sussex5P6 4Chester13UBWestern Cheshire5NN 4Ellesmere Port and Neston13UEWestern Cheshire5NN 2City of Westminster00BKWestminster5LC 1Kennet46UBWiltshire5QK 1North Wiltshire46UCWiltshire5QK 1Salisbury46UDWiltshire5QK 1West Wiltshire46UFWiltshire5QK 2Wirral00CBWirral5NK 2City of Wolverhampton00CWWolverhampton City5MV 1Bromsgrove47UBWorcestershire5PL 1Malvern Hills47UCWorcestershire5PL 1Redditch47UDWorcestershire5PL 1Worcester47UEWorcestershire5PL 1Wychavon47UFWorcestershire5PL 1Wyre Forest47UGWorcestershire5PL 5Aylesbury Vale11UB Non-coterminous so relationship needs to be defined 5Braintree22UC Non-coterminous so relationship needs to be defined

Data Collection – coding of geography Appendix L – Data Collection Form 1.LA code |__|__|__|__|__|__| 2. New PCT code |__|__|__|__|__|__| 3.Old PCT code |__|__|__| 4.Examiner __________________________5. School name _________________________________ 6. School postcode |__|__|__|__| |__|__|__| 7. Date of examination |__|__|__|__|__|__|