1. The Hive visit to the Special Care Dental Service, Southmead
Healthwatch and The Hive Avon, a local organisation working with people with Learning Disabilities, have been working together to understand the issues people with learning disabilities face when assessing dental services.
Healthwatch had heard from people with learning disabilities that they sometimes find it hard to access GP services and wanted to know if the same difficulties applied to dental services.
Healthwatch and The Hive want to see how accessible dental services are to people with physical and learning disabilities.
When we talk about a service being accessible we mean both in terms of physical access but also information and communication provided needs to be accessible and understood by.
Healthwatch contacted the Special Care Dental Service, run by University Bristol Hospitals Trust (UBHT) who run one of their dental surgeries in Southmead. They were very welcoming and positive about allowing a visit.
A visit to the Special Care Dental Service was held on 28th March 2017.

2. The inspection team
Will and Ali are members of The Hive and identify as having learning disabilities.
They are Healthwatch Champions and have been involved in a range of activities at The Hive including Wellbeing Days, focus group events and Self-Advocacy courses.
Will and Ali had previously worked with Healthwatch on an inspection of a GP surgery.
Dominic the Advocacy Manager at The Hive prepared the easy read ‘Inspection form’ which was used to guide the visit.
Louise Spencer from Healthwatch facilitated briefing sessions with the ‘inspectors’ and attended the visit to support them.
The visit was arranged and supported by Healthwatch and Liz Belringer from Oral Health Promotion.
The staff at the Special Care Dental service were helpful during the visit and were on hand to answer all the team’s questions.
The team would like to thank UHBT staff for allowing the visit to go ahead and for the information they provided to the Healthwatch Champions.

3. Key findings and recommendations
Outside of the building
The surgery is in a good location behind a shopping area. The area is serviced by public transport and there is street parking in the immediate area. There were no car park signs and the team didn’t know if it was a public or staff car park. The bay marked Ambulance Only (painted on the tarmac) did not have a sign for approaching visitors. The car park is well located. There were two disabled bays properly marked, although the logos were very faded. A third space could not be formally identified as disabled parking by the team.
The surface of the car park was even. Pedestrian access to the building from the road is paved and there are no barriers across the walkways. Some paving stones were cracked.
Signposts were large, clear and easy to follow. Outside the main doors were the opening times and out of hours contact details.
A signpost stating public car park / Ambulance only parking
Re-painting the disabled parking bays to make them more visible. Introducing more disabled parking bays.
Maintain paving stones so they are not cracked further over the winter months.
Access to the Building
As there are three services being provided from one building, the team wanted to explore how patients find the correct entrance. Signposts outside the building showed arrows to areas where services are located.
The entrance doors are labelled as ‘Automatic’ so people know what to expect. The doors opened easily and stayed open for a good time. There is a slight slope and no steps so access is maximised for disabled patients. The team felt that someone with mobility issues would not have difficulty gaining access to the building without help.

4. Key Findings
Recommendations
Reception
The separate GP and the dental services reception areas were clearly signed. In the entrance lobby is a large frame with pictures of staff; the team thought this was a good idea, although there were no identifying details with the photos.
The reception desk for dental services was too tall for someone in a wheel chair. There was no other space at or near the reception desk for people to sit at a table to fill in or sign forms. The Reception staff were friendly and the team felt it was a private area.
Label each staff member photo so patients know who does what.
Provide a table and chair near the reception desk to assist people to complete paperwork.
Appointments
The service receives referrals from other health services, although people can self-refer. Staff told the team they offer longer appointments where appropriate which is important to people with additional needs. Information about appointments was not visible in reception. Future appointments are booked at reception following treatment.
Appointment letters
Information about appointments to be made available in reception for new patients.
Consider telling patients the number of disabled parking bays available rather than referring to ‘limited disabled parking’ on the appointment letter.
Waiting area
The waiting area was bright and airy with lots of natural light. There was plenty of comfortable seating with lots of space for people to move around and for wheelchairs.
There were leaflets, and posters on the wall giving health information. The waiting room was quiet and the team felt it was calm.
To consider introducing magazines and other reading material for waiting patients.

5. Key Findings
Recommendations
Waiting for an appointment
The team observed patients coming to their appointments. Patients rang a doorbell to the Special Care Dental services. The door was opened promptly by staff and they were offered a seat. The staff member gave them NHS forms to complete before the appointment. This process was carried out in an efficient and sensitive manner.
Provide a table and chair near the reception desk to assist people to complete paperwork.
Notices and signs
Signs to services on the wall continued the colour theme from external signs and were clear and well placed. The font was large and the team were able to understand what the notices were saying.
There were no notices in the waiting room about appointments.
The toilets were in the corridor by the main entrance and located by the team.
Access to treatment rooms
The treatment rooms were ground floor and accessible by wheelchair.
The team visited one treatment room and found it to be clean and well lit, with room for carers and support staff during consultations.

6. Key Findings
Recommendations
Special Care Dental Services written information
Letters are sent out for appointments. The letter states that people can ask for another format such as Easy Read. The letter is in large type and arial font. Printed pictures give a view of the centre entrance and map. Important information relating to benefits are in the letter.
At appointment, staff use communication aids such as Maketon signs and a leaflet produced specifically for children. Staff have a copy of the UBT Accessible Information and refer to this when required.
Where payment is required for personal dental treatment, a form uses visual cues to describe the treatment involved.
Appointment letters could be made even more accessible with the use of short sentences and where possible simple language. Where difficult words are used such as ‘inconvenient’, there should be an explanation of its meaning.
To consider providing Easy Read communication for adults with learning disabilities at appointment.
To continue to review all documents and communication methods against the Accessible Information Standard to ensure standard specifications are met.