Oral health improvement plan

Policy Statement

Introduction

This document follows the publication of the consultation exercise in September 2016 which set out the current landscape in NHS dentistry and included a number of proposals for the future direction of the policy.

As part of the consultation exercise there was a period of stakeholder engagement through a consultation questionnaire, roadshows for professionals and focus groups for the public. Each of these exercises proved invaluable in helping to identify the priorities for the future. The analysis of the consultation exercise was published in June 2017.

Both the consultation document and the analysis can be found at: https://consult.scotland.gov.uk/dentistry-division/oral-health-plan/

Oral Health and General Wellbeing

Our consultation exercise confirmed that patients were aware of the link between oral health and general wellbeing. During the patient focus groups it was acknowledged that “good oral health can impact on a number of issues depending on existing conditions or illnesses.” ^[1]

It is important to consider how we can take NHS dentistry forward in a way that will not only improve oral health but will also contribute to improvements in the general health of the population. The first section of this document, ‘Focus on Prevention’, highlights the need for a shift from restorative to preventive dentistry, which was well supported during the consultation exercise.

The World Health Organisation recognises that “The interrelationship between oral and general health is proven by evidence.” ^[2] Improvements in oral health cannot be achieved solely by providing dental services. It is important we tackle the broader issues which impact on poor oral health such as diet, smoking and alcohol intake. These issues were all recognised by respondents of the consultation as being factors which significantly contribute to an individual’s oral health.

The Scottish Government has made progress in addressing the challenges associated with alcohol, smoking and diet. We recognise however, there is still work that can be done. The 2016 Scottish Health Survey noted that “As a modern, developed society, Scotland faces substantial challenges to public health as a result of lifestyle behaviours and social-cultural norms that counteract positive health choice making amongst the population.” ^[3]

The Scottish Government will be publishing strategies on alcohol, smoking and diet, and it will be important for oral health to feature.

Action 1: The Scottish Government will ensure oral health is featured in future strategies on alcohol, smoking and diet.

The First Minister’s Programme for Government 2017 included a commitment to establish a national population health improvement body by 2019. ^[4] We want this body to be mindful of the importance of good oral health and our intention is to work with them to help us achieve our goal of improving oral health.

Action 2: The Scottish Government will ensure the new population health improvement body to be established by 2019, recognises dentistry and improving oral health as a priority.

Guiding Principles

Our main aim is to achieve good oral health for the whole population. To achieve this outcome, we will be guided by the following principles:

Effective policy making relies on strong evidence. An evidence-based approach may be defined as “helping people make well informed decisions about policies, programmes and projects by putting the best available evidence… at the heart of policy development and implementation.” ^[5]

Since the publication of the consultation analysis we have engaged with a number of experts who have helped us identify the current evidence and consider how it should be applied to the future development of policy on NHS dentistry and improving oral health.

We believe that everyone deserves to have good oral health. The World Health Organisation recognises that “Oral health means more than good teeth; it is integral to general health and essential for wellbeing.” ^[6] Poor oral health affects overall health, nutrition, quality of life, communication and appearance. Our ambition is that this plan will make a significant contribution towards improving people’s oral health.

In reducing health inequalities we will take a proportionate universalism approach. Proportionate universalism is defined as “the resourcing and delivering of universal services at a scale and intensity proportionate to the degree of need. Services are therefore universally available, not only for the most disadvantaged, and are able to respond to the level of presenting need.” ^[7]

GDPs will continue to be the mainstay for the provision of NHS dental care. For 70 years, since the beginning of the NHS, GDPs have delivered the majority of NHS provision and contributed hugely to the improvement in the oral health of the nation. They will continued to be complemented by the Hospital Dental Service ( HDS) and the PDS.

Scotland is a country of diverse geographies and socio-economic mix. The co-ordination and delivery of NHS dental services in remote and rural areas and deprived communities both have unique challenges. Addressing these challenges will require solutions which are appropriate to the needs of these areas and communities.

The solutions require everyone to be involved. We will be working with dental teams, third and independent sector organisations, schools, councils and HSCPs to ensure we take a holistic approach to the challenges we need to address.