Health prevention in the 2020’sNews
Posted by: The Probe 1st November 2019
Former Chief Dental Officer, Barry Cockcroft looks at current provisions within dentistry.
The Government published its long awaited green paper on prevention in July. There has been some coverage in the dental press since then but most of it has had a very narrow focus. The green paper makes specific reference to consulting on a new school toothbrushing scheme and makes probably the strongest statement of support for targeted water fluoridation that any government has done previously. Both of these are valuable opportunities and will need to be promoted and supported strongly by the profession if they are to develop into actual schemes. However, to focus purely on the direct references in the document would be to miss one of the wider essential points that it is making which has a direct relevance to oral health.
For years the NHS has been a service focused organisation, sometimes fixated by the efficacy of hospital procedures and the unacceptable waiting times, often focussing on the length of life rather than the quality of life. This paper emphasises that what we should also be measuring is the quality of life and how we can deliver more ‘QALYS’ rather than just increasing life expectancy. QALYS stands for quality added life years and for the first time, probably, recognises that life expectancy on its own is not a good measure. Many people of my generation have had to deal with helping to look after older relatives, which can be very difficult and sometimes distressing, while at the same time bringing up children; this is much more common now and an increasing issue.
So how do we increase the number of quality life years and how is it relevant to dentistry? Soon after I joined the Department of health in 2002, Ian Philp, the then ‘older persons czar’ produced a paper setting out what most improved the quality of life for older people which became known in the Department as the teeth and feet report. Ian said that setting aside ongoing existing medical conditions that clearly needed treating, the two things that most improved the quality of life for older people were healthy feet, enabling them to remain active and mobile, and a functioning natural dentition, to enable them to eat a healthy and varied diet and to be able to communicate effectively.
Having worked in the dental and eyecare division of the Department for health for over 10 years I would add good eyesight to this list. Over the last couple of decades the growth in the older population has been huge. Thankfully, most are now dentate, which helps them eat, but they will need oral healthcare to maintain their dentition in a healthy condition. The recent report by the Care Quality Commission on the availability of dental care for residents of care homes made grim reading, especially when you realise that there are more people being cared for, in some way or another, in their own homes than are actually residents in care homes. Perhaps NHS England should use some of the money it gets back from under delivered contracts to support this type of service. It may not need to always be dentists providing the help but other members of the dental team helping care home staff understand the oral health needs of their residents has been shown to be very beneficial.
Both eyecare and podiatry services seem to be even more like ‘cinderella services’ than dentistry. As we face the challenges associated with an ageing population, prevention needs to be taken just as seriously in the ophthalmic world as it does in dentistry. Setting aside the obvious benefit to the individual concerned, the cost to the social care budget of a person losing their sight in later life is huge. The same goes for podiatry where immobility leads to other complications which are unpleasant for the individual concerned and costly to deal with for the service.
In the run up to what looks like an inevitable general election the new Prime Minister has promised more investment in our hospitals but the answer to many of the problems now faced by our hospitals does not lie in giving them yet more money, it lies in greater investment in prevention and primary care where most people are best treated if at all possible.
In our area Primary Care Networks are being established but, so far, to me they look like networks of GPs, we need our medical colleagues to realise that other members of the healthcare workforce have a significant role to play… But I am not (yet) optimistic.