Dental Health: Older People

Steve Brine Excerpts

Wednesday 27th February 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

I realise that a debate on older people’s dental health is merely of passing interest to you, Mr Deputy Speaker, as you are many years from it being of direct interest, but I hope you enjoy my response.

I congratulate my good friend, my hon. Friend the Member for South West Bedfordshire (Andrew Selous), on securing time for this debate and on setting out his case so clearly. I will do my best to answer his points in the time available. As he knows, I will write to him on anything I do not answer.

Oral health has improved significantly over the 40 years that I have been alive. At the start of the NHS—it is worth noting this incredible statistic—40% of the population had no natural teeth. The figure is now—answers on a postcard—6%. These massive improvements are to be celebrated but, of course, with improvements come new challenges.

As we are all aware, older people—we categorise those aged over 65 as older people for the purpose of this conversation—make up an increasingly large proportion of the population. By 2032, we project there will be 13.5 million people aged 65 and over in our country. Older people are retaining far more teeth, often heavily filled, than previous generations. As people age, so do their fillings and all the other bits of their bodies, and ongoing restorative work is needed.

Many older people live independently and are in full charge of their oral health, as are working-age adults, but we recognise that frail older people—those with additional needs, often living in care homes or supported to remain at home, as my hon. Friend set out—can face real barriers to accessing the appropriate care and support they need to maintain good oral and dental health.

My hon. Friend set out some of the reasons why good oral health is an essential part of active ageing. We know that poor oral health can affect an individual’s ability to eat, which can lead to an acute episode and an encounter with the tertiary sector, or even to speak and socialise. Obviously, poor oral health hits their confidence and then it spirals. For older adults who are frail, good oral health is particularly important to maintaining hydration and the ability to eat comfortably and easily, which helps them to stay healthy and independent for as long as possible, and even to stay well in a care home setting.

As we set out in our 2017 manifesto, we are committed to improving the nation’s oral health, from children right the way through to older people. The NHS long-term plan, published last month, set out our plans specifically to ensure that individuals in care homes are supported to have good oral health. My hon. Friend raised that point.

The long-term plan national implementation framework, due to be published later this spring, and the national implementation plan, due to be published this autumn, will provide further information on how the LTP will be implemented, but I will now turn to the five specific issues raised by my hon. Friend.

[Andrew Selous]

The Royal College of Surgeons obviously raised concerns about people who use domiciliary care agencies. While there is still time, will it be possible for the NHS long-term plan to address that issue, too, so that we look after all older people whatever type of care they receive, not just those in care homes?

[Steve Brine]

I will touch on that, but I take my hon. Friend’s point. I will make sure it is flagged up in writing as a note from me, the Minister, to the relevant officials as a response to this debate.

In 2016, the National Institute for Health and Care Excellence published its “Oral health in care homes” report, which was an important piece of work. As we know, it set out a number of recommendations for care homes to help maintain and improve oral health and ensure timely access to dental treatment for their residents. In dental health, as in every other part of health, prevention is better than cure.

I completely agree that we expect care homes to follow NICE guidance and NICE recommendations in this area, as in every other. Alongside the importance of appropriately trained staff, my hon. Friend makes an important point about the role regulators can play in this area.

The Care Quality Commission is responsible for this area, as it is for many other areas of policy, and it is currently looking in depth at oral health for older people in residential care settings, and much needed that is, too. So last autumn, the CQC’s dental inspection teams joined adult social care inspectors on visits to about 100 care homes to gain a better understanding of the oral health care support for residents. I know that the CQC intends to publish the findings later this year. I have asked to be kept updated on the progress of this work and to have early sight of its findings. I will update the House and my hon. Friend in particular on this, given his interest and the fact he is a member of the Health and Social Care Committee. I will make sure the rest of the Committee are aware of this as well.

We should also recognise and highlight the ongoing work of NHS England and Public Health England, which I sponsor within my portfolio, to improve the oral health of vulnerable older people. As is referred to in the long-term plan, NHS England considers oral health for older people, particularly those in care homes who may be vulnerable, an important issue. I have asked also to be kept updated on progress as NHS England takes forward action on this and other areas highlighted in the plan.

Public Health England has published “Commissioning better oral health for vulnerable older people”—a snappy title—which is designed to support commissioners of services to improve the oral health of vulnerable older adults so that they can lead a healthy, long and meaningful life outside the acute sector. My hon. Friend highlighted the Mouth Care Matters programme, which, as he says, is a local training initiative from Health Education England offering support and training in oral healthcare for the elderly and for hospital staff looking after patients who may need help with mouth care. I know the programme has been very successful locally in Kent, Surrey and Sussex. Decisions on whether to extend the training more widely are for HEE, but I would hope the success of the programme to date means that HEE is able to take it forward to new areas in the longer term, including to his county. I cannot give the nationwide answer that he asked for in his speech, but I suggest that the early signs are positive.

On access to dental services currently, NHS England is legally responsible for commissioning services to meet local identified need, and that includes the commissioning of domiciliary care services, where appropriate. However, it is important to say that where residents can, the care home and the local NHS work together, often very successfully, to ensure that dental services are provided in the most appropriate setting for those residents, whether that is within the care home itself or in a dental practice, or provided by the community dental service. Often people in care home settings will enjoy the trip out to the dentist; it is part of their socialisation and their routine, and we should not overlook that.

I note my hon. Friend’s concerns about the availability of oral health data, particularly for the older age groups. I agree that the adult dental health survey is an important tool for understanding oral health changes over time. I can reassure him that although there is not yet a date set for the next survey, no decision has been taken to discontinue this important source of information. I take this debate as a bit of a nudge to ask more questions about this. If my hon. Friend looks at my track record, for example, on the cancer patient experience survey, which I was clear was an important tool to give me information about cancer patients’ experience, he will see that I place value on such patient health surveys. In the shorter term, I agree that the regularly published NHS dental statistics on numbers of people seeing an NHS dentist could provide more helpful information by analysing the data by age. I am going to ask my officials to work with NHS England and NHS Digital to pursue this further, and I will ensure that my hon. Friend is kept informed on that point.

My hon. Friend made a point about the social care Green Paper, which remains very much a priority but is not yet in reach. The Green Paper will cover a range of issues that are common to all adults with care and support needs, and will bring forward proposals to ensure that we have a social care system in which people know that the care they receive will help them to maintain their independence and wellbeing, and that we have a social care system that we can be proud of. We will publish the document shortly, and it will set out proposals to reform the adult care system. I take the points made by my hon. Friend about the importance of including dental and oral health in the Green Paper. I will make sure that a copy of this remarks is sent to the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage).

In the remaining few minutes, I wish to touch on the prevention Green Paper. We set out our prevention strategy last year, and it is one of the Secretary of State’s three priorities. We are now in the process of developing the prevention Green Paper, which is an exciting piece of work with which to be involved. It will be called “Prevention is better than cure” and will do exactly what it says on the tin. I will engage with key dental stakeholders—including the British Dental Association, Mr Deputy Speaker, so there is no need to tweet me—in the coming weeks. I look forward to those engagements.

In conclusion, although I am disappointed not to have heard from the hon. Member for Strangford (Jim Shannon) during my speech, I know he has already intervened, and I am pleased that we have had the opportunity to discuss these issues. I think this is the first time I have responded to an Adjournment debate on this subject, and I have responded to quite a few. I hope I have been able to demonstrate the Government’s commitment to improving oral health. Of course there is more to do, and that commitment absolutely includes work on the oral health of older people in care homes, as set out in the long-term plan, and in domiciliary care settings. Our plans to engage in the coming weeks with key dental stakeholders on the development of the prevention Green Paper are honest and sincerely meant. I will continue to watch the work of the CQC and the outputs of its report with interest, and I will follow up on the dental survey so that we have the key data we need to improve services for the people we are here for—our constituents.

Question put and agreed to.