South Yorkshire and Bassetlaw Oral Health Needs Assessment 2015

South Yorkshire and Bassetlaw oral health needs assessment 2015 This document details the oral health of the people of South Yorkshire and Bassetlaw and describes the services currently commissioned to meet those needs. It identifies key issues that should be addressed in future oral health and dental commissioning strategies. 1 South Yorkshire and Bassetlaw Oral Health Needs Assessment About Public Health England Public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Public Health England Wellington House 133-155 Waterloo Road London SE1 8UG Tel: 020 7654 8000 www.gov.uk/phe Twitter: @PHE_uk Facebook: www.facebook.com/PublicHealthEngland For queries relating to this document, please contact: [email protected] © Crown copyright 2015 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v3.0. To view this licence, visit OGL or email [email protected]. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Any enquiries regarding this publication should be sent to [email protected]. Published September 2015 PHE publications gateway number: 2015317 This document is available in other formats on request. Please call 0782 5105728 or email: [email protected] 2 South Yorkshire and Bassetlaw Oral Health Needs Assessment Contents Executive summary 4 Chapter 1. Introduction 12 Chapter 2. Context for oral health needs assessment 22 Chapter 3. Population and demographic variations 26 Chapter 4. Determinants and impacts of oral health 43 Chapter 5. Epidemiology of oral diseases 54 Chapter 6. Oral healthcare services 86 Chapter 7. Dental public health services 117 Chapter 8. Patient and public engagement 129 Chapter 9. Next steps 136 References 137 3 South Yorkshire and Bassetlaw Oral Health Needs Assessment Executive summary Introduction Despite improvements in oral health in England over the last forty years, many people continue to experience the pain and discomfort associated with oral diseases, which are largely preventable. There are socio-demographic variations in the distribution and severity of oral diseases with vulnerable groups experiencing significant oral health problems. This oral health needs assessment describes the oral health of people living in South Yorkshire and Bassetlaw and the services currently commissioned to meet those needs. It identifies the key issues that should be addressed in future oral health improvement and dental commissioning strategies to improve oral health and reduce oral health inequalities in the area. Population and demographics South Yorkshire is densely populated and has a mainly White population. Bassetlaw is a rural local authority area with an older age profile. The residents of South Yorkshire and Bassetlaw are relatively deprived when compared with the national population, with the people of Doncaster and Sheffield experiencing greater levels of deprivation and child poverty. Men and women in all the local authority areas of South Yorkshire and Bassetlaw have lower levels of life expectancy than the England average. The population of Barnsley and Sheffield increased in 2012 and this trend is predicted to continue, which will have an impact on service planning and provision. Lifestyle choices such as unhealthy eating, poor oral hygiene and tobacco and alcohol use impact on oral and general health. People across South Yorkshire are less likely to have a healthy diet when compared with England. A greater proportion of the residents in Bassetlaw are at higher risk from excessive alcohol consumption. Residents in Barnsley, Doncaster and Rotherham are more likely to smoke relative to the England average. Determinants and impacts of oral health Poor oral health results in social and financial impacts both for the individual and society as a whole. A large spectrum of factors have been identified as influencing oral health including economic and social policy and individual health behaviours. However, focusing solely on individual behaviour change has only short term 4 South Yorkshire and Bassetlaw Oral Health Needs Assessment benefits for oral and general health. It is therefore essential to focus on the wider determinants of health and partnership delivery to achieve sustainable improvements. Epidemiology of oral diseases There has been a significant decline in tooth decay and improvements in oral health over the past 40 years. However, a substantial proportion of the population experiences high levels of oral disease. The prevalence and severity of tooth decay in three-year-olds in South Yorkshire in 2013 was similar to the England average. Five and 12-year-old schoolchildren in South Yorkshire were more likely to have tooth decay and have more decayed teeth than nationally. Children in the more deprived areas of South Yorkshire experienced greater levels of tooth decay. Five- year-olds in Barnsley and 12-year-olds in Barnsley and Doncaster were less likely to have a filling placed in their decayed teeth when compared with schoolchildren in the other local authority areas. In 2009 men from socially deprived backgrounds were more likely to experience higher levels of tooth decay and gum diseases, but less likely to visit a dentist. Adults in Doncaster were more likely to report poorer oral health and perceive a greater need for treatment. People in Yorkshire and The Humber were more likely to wear a denture than people nationally. The incidence of mouth cancer in Barnsley has increased and there has also been a recent increase in Bassetlaw. There is limited information describing the oral health needs of vulnerable groups in South Yorkshire and Bassetlaw. Sheffield has a higher prevalence of adults and children with learning disabilities. People with learning disabilities are more likely to have poorer oral health. Children with learning disabilities are more likely to have their teeth extracted than filled and have poorer gum health. Approximately one quarter of the population experiences some kind of mental health problem in any one year however there is no local information on the oral health needs of this group. Sheffield City Council has prioritised the needs of people with mental health problems although local commissioning arrangements may not consider access to dental services for this vulnerable group. 5 South Yorkshire and Bassetlaw Oral Health Needs Assessment The Roma Slovak population is increasing in Rotherham and Sheffield and this group is likely to have difficulty accessing oral healthcare services. Severely obese people may be at higher risk of oral disease. There are currently no dental services for severely obese people in South Yorkshire and Bassetlaw. The closest service provider is Leeds Salaried Dental Service. Looked after children are likely to have greater oral health needs. Doncaster and Rotherham have a significantly greater proportion of children in care than Sheffield and Barnsley. Sheffield has the lowest proportion of children in care in the area, however, a significantly lower proportion of these children have their teeth checked by a dentist when compared with England. Oral healthcare services Most dental services in South Yorkshire and Bassetlaw are primary care services provided by general dental practitioners. The availability of services is variable across local authority areas and does not reflect need or access to care. Access to care is better than nationally across all local authority areas. Limited data was available on the provision of unplanned care as well as services provided by the community dental services. There are inconsistencies in service provision for vulnerable groups including access to domiciliary care, general anaesthetic services, sedation services and anxiety management services. There is inconsistent provision of primary care specialist oral surgery services across the area, with differences in tariffs across providers. There is adequate provision of orthodontic services. However, there are inconsistencies in UOA rates and some non-specialist provision. Most hospital activity is provided on an outpatient basis. The highest spend is on oral surgery day cases and most activity is outpatient oral surgery. There are a significant number of non-elective oral surgery inpatient cases. Local data on tariffs and quality assurance programmes for hospital services was not available. Dental public health services From April 2013, oral health improvement became the responsibility of local authorities. A range of universal and targeted oral health improvement programmes are implemented by local authorities in South Yorkshire with some, sufficient or 6 South Yorkshire and Bassetlaw Oral Health Needs Assessment strong evidence of effectiveness for most of them. Most oral health improvement programmes are directed towards children. Patient and public engagement The overall experience of people using primary care dental services in South Yorkshire and Bassetlaw is positive. Parents and carers tend to report adequate access to dental services. The main reported barriers to accessing NHS dental services include dentists not taking on patients, costs, lack of time

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