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  1. 1. PHS Oral Health Coordinating Committee May 6, 2005 9:30 a.m. – 12:00 p.m. Building 31, Conference Room 7 Minutes Attendees Imad Al-Dakkak, NIDCR, NIH Raman Bedi, DH, England Tim Brown, DH, England Penny Burgeon, OD, NIH Conan Davis, CMS, DHHS Bruce Dye, NCHS, CDC Isabel Garcia, NIDCR, NIH Kevin Hardwick, NIDCR, NIH Kathy Hayes, NIDCR, NIH J.T. Hoffeld, OSR, NIH Alice Horowitz, NIDCR, NIH Tony Jenner, DH, England Dushanka Kleinman, NIDCR, NIH Ray Lala, HRSA, DHHS Jim Lipton, NIDCR, NIH William Maas, CDC, DHHS Nick Makrides, BOP, DOJ Kevin Mulry, FDA, DHHS Scott Presson, CDC, DHHS Lee Shackelford, OCCO, OS Robert Selwitz, NIDCR, DHHS Telephone Jay Anderson, HRSA, DHHS Susan Goodman, HRSA, DHHS Chris Halliday, IHS, DHHS William Kohn, CDC, DHHS Rich Manski, AHRQ, DHHS A) Acceptance of minutes from last meeting Minutes from February 25, 2005 meeting were accepted. B) International Congress on Oral Cancer RADM Kleinman informed the group about a WHO co-sponsored International Congress on Oral Cancer that was held in Crete, Greece, April 18-24. Participants from 57 countries unanimously agreed upon the Crete Declaration, which is a statement on approaches for effective control of oral cancer at global level. A copy of the Crete Declaration was distributed.
  2. 2. A) Dr. Raman Bedi, Chief Dental Officer of England The majority of the meeting was focused on the seminar presented by Dr. Raman Bedi, and the following discussion led by him. Dr. Bedi was accompanied by Dr. Tony Jenner, Head of Policy Development, Office of the Chief Dental Officer, and Mr. Tim Brown, his Private Secretary. Dr. Bedi provided a comprehensive set of slides that he used for his presentation. The slides are found in Attachment 1. Dr. Bedi referred to several recent publications and web sites that describe in detail current activities and future plans for dentistry and oral health care in England, as well as the entire National Health Service. These are found in Attachment 2. B) Discussion with Dr. Bedi Dr. Bedi’s presentations raised many questions, both specific to England and for dental public health in general. Topics raised during the lively discussion with Dr. Bedi included the following: • Approaches to balancing public demands for cosmetic dentistry with preventive care • Use of sealants • Monitoring care provided by dentists in the National Health Service in local regions • Role of the general dentist in public health • National Institute for Health and Clinical Excellence (NICE) • Most appropriate interval for dental visit recall • Non-restoration of primary teeth in order to focus time and costs on restoration of permanent teeth • Identifying useful community-based outcome measures of care • How the National Health Service adjusts to technological advances; how are decisions made as to implementation? • Development of diagnosis codes in the UK; comparison with SNODENT and ICD-9 • Differences between dental care for general populations and for institutionalized groups, such those in prison; current efforts to improve prison dental health care C) Summary and Action Items – RADM Kleinman • Distribute additional information about the National Institute for Health and Clinical Excellence (NICE) in England (see website in Attachment II) • Summarize plans for what can be done in the future to enhance the infrastructure of dental public health (J. Lipton with input from PHS OHCC members to be posted on website) • Schedule a brown bag lunch meeting to discuss follow-up for training general practice dentists in dental public health (Lead R. Lala and C. Halliday) • Plan for future discussion of SNODENT (for next PHS OHCC agenda) • Send Kevin Hardwick’s presentation to the DePAC about international dental care and key organizations to PHS OHCC • Follow up on CAPT Selwitz’s comments about the ICDAS (spell out) system • Prepare highlights as necessary for PHS OHCC from upcoming meetings that include: o Global Health Summit, June 5, 2005 o COA Meeting, June 6-9
  3. 3. o 60th anniversary of water fluoridation o AGD, AAWD, NDA, FDI, Women’s Leadership Conference o International Preventive Dentistry Conference in Liverpool, England o ADA • Read article in latest Journal of the APHA on Alaska dental therapists NEXT MEETING – OCTOBER 28, 2005, site and time to be determined
  4. 4. ATTACHMENT 1 Who are we? Delivering Oral Health Care in England – an agenda for change • Professor Raman Bedi – CDO England • Dr Tony Jenner (Head of Policy Development) Professor Raman Bedi • Tim Brown (Private Secretary to CDO) Chief Dental Officer Department of Health Professional Public Health Policy Structure Government Health Ministers Challenges • Access to care Chief Medical Officer Department • Growing cosmetic demand Professor Sir Liam Donaldson of Health Civil Service • Workforce – retention Chief Dental Officer Professor Raman Bedi - flexibility • Willingness to pay Deputy CDO Private Office Head of Policy • Business of dentistry Our Vision The Vision • Create a caries free child and young To build an NHS dental service that: people population • Improve access for everyone • Offers access to high quality • Motivated and diverse workforce treatment for the public and • Regain the vocational and professional voice choice to patients when they • International collaborations need to see a dentist. The Vision The Vision To build an NHS dental service that: To build an NHS dental service that: • Gives a fair deal to dentists and • Focuses on preventing disease their teams and improves their and improving oral health so working lives. that everyone, and in particular • Develops vocational and children, can enjoy healthy professional aspirations teeth for life.
  5. 5. Presentation • Oral health in England – An Overview • Inequalities Oral Health in England • Oral health programme in England • Current status of fluoridation in the UK • Reforming NHS dentistry • International recruitment programme • Joint working Dental Caries Experience (DMFT) of 12 Year old – Europe Average D(d)mft per child in England 9 8 7 5.0 6 4.5 4.0 5 UK Figure D(d)mft 3.5 4 3.0 2003 15 year olds 2.5 3 2.0 1.5 2 1.0 0.5 1 0.0 K a nd e ain d n ia Po d R ay nd l y ia ark d ary nia 0 R m De n e Slo s ga alt lan ec n an U pru lan nc e s tr iu k rw la la ch la ed Sp ve rtu to ng M nm va re lg erm Ire Fra Po Fin Au g N' Cy No ze Es Sw Be En Slo G Hu C G 1973 1983 1993 2003 5 Years 12 Years 15 Years Percentage adults with no teeth (England) Changing social class inequalities in children's dental health in Britain 1937-1993: the prevalence of caries-free 5 year olds 40% 35% 90 30% I-IIINM 77 % 25% IIIM-V 64 61 20% 60 15% 43 38 10% 30 5% 23 22 0% 11 1968 1978 1988 1998 0 Year 1937-39 1973* 1983* 1993* Year Oral Health Inequalities • Adults in the north of England are twice as likely to have no natural teeth as Improving oral health those in the South • Wide differences in the oral health of young children between regions Fluoridation in England Implementing Fluoridation in England • Fluoridation in the UK started in the 1950s in a number of small schemes • Water Act 2003 – Fluoridation Section • Birmingham fluoridated 1964 approved in Parliament • Newcastle fluoridated in 1970 • Regulations for fluoridation accepted by • Water fluoridation Act 1985 but few new schemes Parliament – March 2005 • Fluoride toothpaste in 1970s • Guidance to be published in June 2005. • Fluoride has had a significant impact on • NHS starts to consultant and implement improvements in oral health new schemes from Summer 2005
  6. 6. Dentistry within the NHS • NHS started in 1948 • High levels of oral health need Reforming NHS Dentistry • Fee per item encouraged dentists to treat • Fluoride toothpastes introduced in 1970s • Oral Health improves • Need to move to a system of remuneration more suited for 21st century Increasing Capacity of NHS Increasing Capacity of NHS Dentistry – short term dentistry – longer term • 1,000 whole time equivalent dentists to be • 25% increase in dental students (2005 intake) recruited by October 2005 • “Ethical international recruitment” through • Increase in numbers of Professionals Government to Government agreement Complementary to Dentistry • Returning to practice initiatives • Increasing role of the dental team NHS Dentistry Dentistry Spending per Head of Population New Ways of Working 180 160 Spending per head (£) 140 Total • Improving access to NHS Dentistry 120 Public 100 80 • Reforming and improving NHS Dental 60 40 services 20 0 US nd nd ce k ia da ds ar al gla an la lan na nm str Fin Fr Ca En er Au De th Ne Average gross fees per adult course of Percentage of Courses of Treatment which involve treatment % any intervention £55 Exempt or remitted 80 £50 70 Exempt or remitted £45 60 £40 50 £35 Paying full charges £30 40 £25 Paying full charges 30 £20 20 £15 10 £10 £5 0 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 0 1997 2002 Personal Dental Services NHS dentistry - access • Already 25% of dental practices in • Access centres – salaried services England are working in new ways • Contracting with the NHS to provide care based on outcomes rather than • Oral health need v cosmetic services outputs (public and private debate) • Preventive focus
  7. 7. Improving access to NHS What makes a health Dentistry professional? • Oral Health inequalities  Principle of primacy of patient welfare • Improving oral health • Flexible  Principle of patient autonomy - workforce - location  Principle of social justice - education training Charter on Medical Professionalism Annals of Internal Medicine, 2002; vol 136; 243-246. Dental services for the 21st Century  Oral health inequalities  System reform - dental associations - regulatory body  Flexible and motivated workforce  Leadership and courage  Focus on child oral health Potential areas of USA/UK joint working “There is nothing more difficult to take in hand, • Improving child oral health – global child more perilous to conduct, or more uncertain in dental task force its outcome, than to take the lead in the • Fluoridation advice and support introduction of a new order of things” • Diversity in dentistry • Dental education reforms Niccolo Machiavelli • Informatics and IT in dentistry • International agenda
  8. 8. ATTACHMENT 2 Useful websites about the National Health Service, dentistry and oral health care in England include the following: 1) UK Department of Health – contains information about the entire National Health Service, its programs, policies, publications, statistics, news and many other interesting items. Some of the key pages in this site include: • Information about the Chief Dental Officer and oral health issues is found at • “Choosing Health: Making Health Choices Easier.” This White Paper sets out the key principles for supporting the public to make healthier and more informed choices in regards to their health. dGuidance/PublicationsPolicyAndGuidanceArticle/fs/en? CONTENT_ID=4094550&chk=aN5Cor • “NHS Dentistry: Options for Change.” This report proposes a new NHS dental service for England. Fifty-four years after the foundation of the NHS, this report contains recommendations to begin radical changes, designed to provide a first class NHS dental service, responsive to local needs. dGuidance/PublicationsPolicyAndGuidanceArticle/fs/en? CONTENT_ID=4008017&chk=SDok3X • “Reforming NHS Dentistry: ensuring effective management of risks.” • “The NHS Plan: a plan for investment, a plan for reform.” The NHS Plan outlines the vision of a health service designed around the patient: a new delivery system for the NHS as well as changes between health and social services, changes for NHS doctors, for nurses, midwives, therapists and other NHS staff, for patients and in the relationship between the NHS and the private sector. dGuidance/PublicationsPolicyAndGuidanceArticle/fs/en? CONTENT_ID=4002960&chk=07GL5R 2) The Dental Practice Board - offers a broad range of statistical information for policy makers, managers, academics and practitioners covering all aspects of NHS dentistry, including manpower, dental treatments, registrations and fees paid. Information is available by Strategic Health Authority, Primary Care Trust (Local Health Board for Wales) and Postal Area. In addition to individual data there are summary reports, analysis of trends and background articles, all of which are downloadable from the web site.
  9. 9. 3) NICE is the independent organization responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health. On 1 April 2005 NICE joined with the Health Development Agency to become the new National Institute for Health and Clinical Excellence (also to be known as NICE). 4) Journal of the British Dental Association. This contains some interesting articles on NHS dentistry from the perspective of the practitioner.