Agenda item

To receive the report of the Executive Director – People, providing an overview of primary care dental care and oral health promotion provision for Enfield residents; understanding about residents’ oral health needs; and highlighting how the Local Authority, North Central London Integrated Care System and NHS England are working together to improve oral health.

Cllr Alev Cazimoglu (Cabinet Member for Health and Social Care) and Dudu Sher-Arami (Director of Public Health) introduced the report of the Executive Director – People, identifying the dental care needs in Enfield and oral health promotion activity in the borough.

A detailed presentation was received from:

• Dr Rakhee Patel (Public Health and Primary Care / Lead for Ageing Well and Dental Public Health, NHS England London Office)

• Kelly Nizzer (representative of the London Dentistry, Optometry and Pharmacy Commissioning hub)

• Mark Eaton (Director of Strategic Commissioning & Procurement, NHS NCL ICB)

Enfield was near the London average of one in four children having some untreated dental decay and in hospital admissions for dental caries. However, Enfield had the highest average number of extracted teeth and third highest average number of filled teeth in five-year-olds in London: this was noted as a positive indication of access to dental care.

The ICB inherited dentistry from NHS England in 2023 and had been proactive and supportive, with additional investment and encouraging dentists to do more activity. The dental services available in Enfield, including community, urgent, and secondary services were highlighted.

The effects of the Covid-19 pandemic and backlog of dental patients was noted. A dental recovery plan had been put in place in London, including a financial uplift to practices for a unit of dental activity and a patient premium incentive scheme in respect of a new patient appointment.

Oral health promotion service colleagues added information about their work, which was mainly related to children and young people, visiting settings for under-fives and schools, and providing training to staff. The fluoride varnish programme for 22 schools in Enfield was highlighted as an evidence-based preventative treatment and targeted within the borough to wards with the highest levels of obesity and percentage of disease.

Questions were invited from Members.

The Chair asked about children’s access to dental care, parents’ behaviour and need for oral health promotion. It was confirmed that there was evidence from the data as set out in the report and that promotion and intervention in respect of children’s oral health should be constant, integrating with wider issues such as healthy eating. An example of that was the collaboration with Tottenham Hotspur Foundation to reduce consumption of sugary drinks by raising awareness with children. Whittington NHS Foundation Trust provided oral health promotion across North Central London and included targeted promotion at early years settings and supervised tooth brushing.

Members raised the concern of advertisement of sugary drinks linked to TV football coverage. It was advised that the work with the charitable arm of Tottenham Hotspur Foundation would be subject to evaluation by the ICB.

In response to further queries regarding prioritising of interventions, it was confirmed that there were many common factors around oral health and obesity mainly due to sugar intake, and this informed the approach. All children of the right age groups in the prioritised schools were offered fluoride varnish treatment. The most effective intervention was to younger school children around age five, for preventative treatment and awareness raising regarding healthy eating and oral health. Early years settings and family hubs were also used for promotional work. It was acknowledged that poor oral health often had its roots in poverty and deprivation and the wider determinants of health. The challenges around data collection and its validity were acknowledged.

Officers noted Members’ points around promotion of breastfeeding of babies and request for an event in the borough in support of breast feeding awareness month in August. It was confirmed that appointment of a breast feeding co-ordinator was being progressed, and part of their remit would be promotion of shops and other premises in the borough which provided breast feeding facilities. Dudu Sher-Arami noted that an event in August could fit in with the family hub programme and agreed to take this forward.

ACTION:  Dudu Sher-Arami

Members were also given more detail on dental health support for looked after children, for whom there was good care and automatic access. It was important to raise awareness of the pathway and the dedicated pan-London phone line. The communications pack and poster would be shared with Panel members and with officers in Children’s Services for greater promotion. An agenda item was suggested for Corporate Parenting Board to increase awareness.

In response to Members’ queries regarding the patient premium payments, it was confirmed these applied to adult and child patients and related to new patient appointments and clearing of the backlog, and should get the patient ‘dentally fit’. The limitation on ICB action was confirmed, and that it was unable to amend the General Dental Contract locally.

Further detail was provided on the underspend in dental services, related to longer treatment per patient needed since the Covid-19 pandemic, and the opportunity taken to redirect that money.

Members asked about the findings in the Healthwatch report that there was no NHS dental provision in some postcodes in the borough. It was confirmed that it was not required for every postcode to have a dental practice and that good local transport in London facilitated reaching a dental practice. The ICB had not found big geographical gaps in coverage, but if there was any additional funding any gap would be looked at. Needs assessments were carried out, which included consideration of transport links, and if a practice contract was terminated it was looked to be replaced or surrounding practices to be enhanced.

In response to Members’ queries regarding water fluoridation as a whole population intervention, it was advised that this was implemented in some parts of the country but was challenging to introduce in London due to the number of boroughs and the numerous water supply sources. A consultation had been run last year, but this would be something for the government to decide. Officers confirmed that at the right dosage, water fluoridation was very safe, and that comparison data showed benefits to children’s oral health in the geographical areas where this was done.

The Panel noted that the amount of untreated dental decay in children in the borough was concerning and put forward a recommendation that the Council’s Communications Team should promote an information campaign in respect of children’s oral health and promotion of visiting the dentist. Dudu Sher-Arami confirmed that colleagues could work together on such a communication to take this forward.

ACTION:  Dudu Sher-Arami

The Panel AGREED:

I. To recognise the importance of good oral health for residents in Enfield and to note analysis regarding oral health among Enfield residents.

II. To note the current arrangements for residents to access dental care.

III. To note current arrangements and provision of oral health promotion service.

The Panel RECOMMENDED that the Council’s Communications Team should promote an information campaign in respect of children’s oral health and promotion of visiting the dentist.