Oral health improvement plan

Ministerial Foreword

Introduction

Let me introduce you to Scotland’s Oral Health Improvement Plan ( OHIP). The purpose of this document is to provide the strategic framework for improving the oral health of the next generation.

Regardless of age, the impact of a healthy mouth on general health is significant. In children it can mean the difference between regular attendance at school or not. For older people not only can there be an increase in oral cancer, poor oral health can affect their ability to eat, speak and socialise.

As you may be aware we have been on a journey for some time now that began with the publication of our initial consultation exercise in September 2016.

During this period, we have had the opportunity to engage with members of the public and a wide range of professionals. The consultation exercise has helped shape our thinking on what to include within the Plan and we would like to reiterate our thanks to everyone who took part in this process.

Preventive Care Pathway

As the oral health of the population improves there are new challenges in taking forward NHS dentistry. The system at present is mainly about restorative services provided to patients by General Dental Practitioners ( GDPs), while our focus in the future must be to encourage a more prevention-based provision recognising the benefits of anticipatory care.

To do this we will introduce a preventive care pathway and an Oral Health Risk Assessment ( OHRA). In time, all adult patients will receive an OHRA on a regular basis with intervening reviews between assessments. Each patient will receive a personalised care plan based on an assessment of the level of risk to their oral health.

Oral Health Inequalities

We also need to find innovative ways to tackle oral health inequalities in Scotland, recognising first and foremost that we need to enable people to have more health promoting behaviours. Despite the considerable success of the Childsmile programme in improving the oral health of young children through intervention by health visitors, education staff and dental teams, it remains particularly difficult to achieve good oral health in some of our most deprived communities in Scotland.

We want to supplement the Childsmile programme with community-led initiatives supported by a Challenge Fund, which will allow our partners in the third sector to bid for resources for projects aimed at supporting communities to improve their oral health. The Childsmile programme will continue to expand and we also intend to change the payment arrangements to GDPs to ensure that older children and young people receive sufficient levels of preventive care.

Ageing Population

We also need to recognise that the population of Scotland is ageing, presenting new challenges that we have to meet. More older people have their own teeth than we have ever seen before. While many people continue to see their dentist on a regular basis, this changes when they become housebound and have to rely on domiciliary care services. We face particular challenges in ensuring that residents of care homes also continue to receive regular effective dental care.

As a first step, the new domiciliary care arrangements will enable an accredited practitioner to be assigned to a care home to provide routine preventive oral health care to care home residents. These practitioners will work in partnership with care home staff to ensure the maintenance of good oral health and hygiene. It is also important at this stage to acknowledge the complementary role provided by the Public Dental Service ( PDS) in providing domiciliary care, and we envisage that this role will continue.

Conclusion

Continuing to improve the oral health of the population and providing high quality NHS dental services in the years to come will require the involvement of all parts of our society. We will depend on our dental workforce and Health and Social Care Partnerships ( HSCPs) working together with local communities in order to achieve a joined up approach.

We need to be ambitious but at the same time realistic and we will need time to implement the changes required. We recognise that change can cause uncertainty for patients and service providers. We are therefore committed to a pace of change that balances the need to make progress but does not jeopardise the substantial achievements we have made to date nor the sustainability of practices.

I look forward to working together to realise our ambitions as set out within this plan.

Shona Robison
Cabinet Secretary for Health and Sport