Straight Talk
Sir Robert Francis QC • Chair • Healthwatch England

Following the Care Quality Commission’s recent report into oral health in care homes, Sir Robert Francis QC shares his views about the importance of this topic and the work Healthwatch England are doing to help put things right.

Access to good dental care is a fundamental need for everyone. However, feedback gathered by Healthwatch England has shown that access to an NHS dentist can be a real struggle for some people living in care homes. This is a cause for concern, as it can have major effects on people’s oral health, their health more generally and on their quality of life.

Access to dentists, particularly in care homes, is an issue which Healthwatch England has raised many times. We published a report, Access to NHS Dental Services: What people told local Healthwatch in 2016. Our more recent What’s it like to live in a care home? report reinforced our original findings. Since the original report was published, local Healthwatch have continued to monitor what is happening in their areas.

Our network looks at all services. It explores how services work together and how people experience using services. Most recently we have heard:

  • In 2018, Healthwatch Dorset reported that 38% of residents in homes that responded to a survey received no dental services at all and 59% of the homes that responded said that their residents received poor or average dental services. Issues of concern included long waiting times, a lack of home visits and a lack of services supporting people with dementia.
  • Healthwatch Sefton has found problems for care home residents, including availability of home visits from dentists, ability to register with an NHS dentist, and care home managers not being aware of any local dementia friendly dentists.
  • Healthwatch Derby found that many care home residents they surveyed last visited a dentist more than two years ago, mainly due to local dental services not offering visits to the home.

At present, the problems facing care home residents are not always identified by the NHS or those responsible for ensuring quality, such as the Care Quality Commission (CQC).

For example, primary care dental services and care homes are regulated/inspected separately – so asking about the oral health of care home residents does not necessarily fall under the remit of either team of inspectors. In addition, domiciliary care is not covered within the standard NHS dental contract.

Healthwatch has raised this with a range of national bodies who have responsibility for commissioning and regulating dental services, and last year the CQC looked more closely at the oral health of care home residents.

Their dental inspection teams joined adult social care inspectors on routine unannounced inspections of 100 homes. The CQC report – published in June – highlighted both a lack of access to dentists and insufficient support provided by care home staff.

Around half of care homes did not provide training to their staff on oral health care, while nearly-three quarters of individual care plans did not cover oral health sufficiently. One in six care homes also said they did not assess residents’ oral health on admission and one in three said they could not always access dental care.

CQC is recommending a cross-sector approach to oral health care, including sharing best practice, repeating and reinforcing the guidance, mandatory staff training, oral health check-ups for all residents moving into a care home and the creation of a multi-agency group to raise awareness. Healthwatch agrees with this. We have long argued that all care home residents should have an oral health assessment when they enter a care home, with recommendations for ongoing dental care included in their personal care plan, and that care home staff should be properly trained to look after the oral health needs of residents with confidence.

And, of course, care home residents should have access to local dental health services when needed in the same way the wider community does. We would also like to see the CQC alter its adult social care inspection framework to include looking at oral health in care homes in further detail.

This tallies with the commitment in the recently published NHS Long Term Plan to ‘ensure that individuals are supported to have good oral health in care homes’. However, there was no mention of a similar commitment for older or disabled people who use domiciliary care agencies and we want this to be urgently addressed.

Our network of 152 local Healthwatch branches are able to spot these issues because they look at all services, how they work together, and people’s experiences of them – rather than just looking at individual services in isolation.

There are simple things that could vastly improve the oral health and quality of life of people who are living in care homes across England. We are calling for this to be addressed as a priority and for change to be implemented at the earliest opportunity to protect the health of those living in care homes.

Sir Robert Francis QC is Chair of Healthwatch England. Email: Twitter: @HealthwatchE

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