Suffolk & North East Essex Integrated Care System

Oral health and eye health

WHY this is important for people in Suffolk and North East Essex

The best oral and eye health throughout life is essential if everyone in Suffolk and North East Essex is to start well, live well and age well.

As an Integrated Care System we will ensure that:
  • Children, adults and older people can prevent oral and eye health problems
  • Children, adults and older people have access to high quality oral and eye health services

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In 2017, the Health Foundation and Nuffield Trust published a summary of data on people’s levels of satisfaction with community-based services:
  • In England in 2009, 97% of patients felt they were treated with respect and dignity, 93% had confidence and trust in their dentist, and 91% felt their treatment was explained in an understandable way.
  • In data published in 2015, the percentage of parents that had difficulty finding an NHS dentist for their child was substantially higher among those with children eligible for free school meals (18%) than those whose children were ineligible (11%)
    For further information see www.nuffieldtrust.org.uk
LTA - Oral Health Additional Pic
Public Health England highlights:
  • Just under a quarter of 5 year olds have tooth decay.
  • 77% of 5 year old children in England are now free of obvious tooth decay, significant regional inequalities remain, with children from the most deprived areas having more than twice the level of decay than those from the least deprived.
  • Almost 9 out of 10 hospital tooth extractions among children aged 0 to 5 years are due to preventable tooth decay and tooth extraction is still the most common hospital procedure in 6 to 10 year olds
  • Tooth decay can cause problems with eating, sleeping, communication and socialising, and results in at least 60,000 days being missed from school during the year for hospital extractions alone.

For further information see https://www.gov.uk/government/publications/child-oral-health-applying-all-our-health

The General Optical Council’s Public Perceptions Survey 2016 found:
  • GPs remain the first port of call for people with eye health problems with 40% of respondents saying that they would go to a GP first if they woke up tomorrow with an eye problem. Only 22% said that they would go to an optician first and 14% said they would go to a pharmacist first.
  • Overall confidence and satisfaction levels with opticians remain high. 89% of respondents were confident that they would receive a high standard of care from an optician.
    For further information see www.optical.org

The RNIB’s ‘The State of the Nation Eye Health 2016 highlighted:

More than two million people in the UK live with sight loss that is severe enough to have a significant impact on their daily lives, such as not being able to drive.

For more information see www.rnib.org.uk

HOW we plan to make a difference 

    1.1 Children and young people, adults and older people are supported to prevent oral and eye health problems. We will enable this by:

  • The Starting Well Core Initiative supporting dentists to see more children from a young age to form good oral health habits, preventing tooth decay. Children and their families need the right advice and support to maintain good oral health and create positive habits for life. Education involves an integrated approach between parents, early year’s provision, schools, social care and communities to help with strategies such as supervised brushing, and preventing worsening of dental disease.
  • Children’s and adults’ social care supporting good oral and eye health in children and young people. Poor oral and eye health is one indicator of potential parental or carer neglect. Social care and oral and eye health providers should work in an integrated way to share any safeguarding concerns and support the people and families they work with.
  • Awareness campaigns to promote good oral health, linked to wider public health campaigns such as healthy eating and reduced sugar intake, alcohol and smoking, and including information on risks of oral cancers. Improving awareness helps prevent future oral health problems. Information should accessible in a range of formats, and adaptable to be age appropriate. Dental Care Professional Champions can play a key role in awareness raising about good oral health within the community. Community pharmacies are also involved in these. The new pharmacy contract requires pharmacies to be promoting sugar reduction, providing awareness campaigns on these topics and in supporting self-care and as part of minor illness management (eye care).
  • Improving people’s access to sugar-free medications to help reduce the risk of tooth decay.
  • Supporting people to self-care their oral health. Individualised patient assessment and prescriptive patient care pathways cover four domains: caries, periodontal disease, soft tissues and tooth surface loss. A self-care plan is agreed with the person based on their levels of risk in these areas.
  • Improving screening and monitoring people with Type 2 diabetes for periodontitis, and diabetes related eye conditions, together with early access to treatment. Type 2 diabetes is a risk factor for periodontitis; and people with periodontitis have relatively higher levels of HbA1c, so may be more likely to develop non-diabetic hyperglycaemia and type 2 diabetes. People with diabetes also need support in preventing diabetic retinopathy, and in accessing treatment.
  • Exploring the potential benefits of water fluoridation as a measure to reduce the prevalence and severity of dental caries, and to reduce dental health inequalities.

    2.1 Children and young people, adults and older people with additional or complex needs, are diagnosed with oral and eye health problems early.

  • Staff will work with vulnerable children, adults and older people ensure they have prompt and full access to primary care oral and eye health services. Earlier diagnosis of oral and eye health problems enables earlier treatment and prevents more invasive treatment later on. Tailored advice should also be given to the person and their carers about how to maintain good oral and eye health.

    2.2 Children and young people, adults and older people access oral and eye health care when they need it. We will enable this by:

  • Primary and secondary care oral and eye health providers having sufficient capacity and a range of expertise to meet people’s needs in a timely way. Community-based and secondary care services need to meet the challenge of increasing levels and complexity of local demand and work in an integrated fashion. Expertise is particularly important for people with complex needs, and people with dementia, physical or learning disabilities that impact on their ability to self-care.
  • More oral and eye health services provided to residential schools and residential care homes, so that everyone living in an institutional setting has equality of access to oral and eye health services in accordance with NICE guidance. We will enable this through the provision of domiciliary optometrists providing care in the home for those who are unable to attend other services.
  • People will receive more eye care services within the community via their local optician. We are extending the contracts of optometrists to provide more care through enhanced service contracts. Glaucoma patients will be monitored routinely by one of these trained optometrist for their all their tests, only returning to hospital if their condition deteriorates and becomes more complex.

    2.3 People have equality of access to oral and eye health services.

  • We will identify areas and communities with lower rates of access to services, and ensure sufficient capacity and range of services. Population health approaches can support the system to eliminate unwarranted variation.

    2.4 People have oral and eye health services that are integrated and based on best practice.

  • Primary Care Networks will support dentists and optometrists to develop services and be full partners in integrated care in our local neighbourhoods. Primary Care Network support is key to reducing variation in access to services and so health inequalities, and to promoting integrated working.
  • Optical and dental health pathways between primary and secondary care will work in a joined-up way. Improving care pathways between primary and secondary care will enable more integrated care and help provide a better patient experience.
  • Follow-up care and non-surgical treatment more services are being developed to be provided through community services and with local opticians which means that patients will receive their care closer to home with less hospital appointments. Consultants will be able to review tests carried out by local opticians in the hospital and advise on which service the patients should next be treated. This will be supported by all care records being shared across these services, so patient care can be tracked in all settings
  • Age-related macular degeneration (AMD) - approximately 475,000 people
  • Cataracts - approximately 380,000 people
  • Glaucoma - approximately 145,000 people
  • Diabetic retinopathy - approximately 95,000 people

By 2030, we estimate more than 2.7 million people in the UK will be living with sight loss. This growth will be primarily driven by an ageing population.

We will know we are making a difference because we will see:

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