Based on findings from 100 care homes, the CQC found that 52 per cent did not even have an oral health plan for residents and 47 per cent of staff never receiving training specific to dental care. 73 per cent of care plans only partly covered or did not cover oral health at all, with homes specialising in dementia less likely to do so.
The CQC reports that one of the main challenges in providing access to NHS services was lack of domiciliary care provision. Freedom of Information requests by the BDA suggest levels of commissioning are low and falling, equivalent to providing coverage to under 1.3 per cent of the population whose activity is significantly limited by disability or ill health.
The BDA has backed CQC calls for swift implementation of NICE guidelines among care home providers, and for comprehensive training for staff. The BDA has stressed that appropriate commissioning, underpinned by robust needs assessment is now key to ensure all those most in need of NHS care can receive it, in the right place and at the right time. In light of the CQC findings this would need to cover mainstream, urgent and domiciliary care.
NHS services have been struggling to meet the demand of an ageing population who are keeping their teeth longer, and often have complex medical histories. While some local initiatives such as the innovative Residential Oral Care Sheffield (ROCS) scheme have delivered comprehensive dental coverage for adults in care homes, the BDA has expressed concern over the postcode lottery of provision and the horrific cases that have emerged from the sector.
The NHS Long Term plan has committed government to adopt an 'ageing well' model but has offered scant detail on the place of oral health.
Charlotte Waite, chair of the BDA's England Community Dental Services Committee said, “This welcome report shines a light on services that are failing some of the most vulnerable in our society.
“There are residents left unable to eat, drink and communicate, as an underfunded and overstretched NHS struggles to provide the care they need.
“We require nothing short of a revolution in the approach to dentistry in residential homes. Oral health can no longer remain the missing piece when it comes to care planning and budgets.”
Mili Doshi, consultant in special care dentistry, and resident of the British Society of Gerodontology, said, “Sadly this report shows that supporting people with mouth care isn’t considered an essential part of personal care but as an optional extra.
“It’s a toxic mix. Admission assessments rarely include oral health, staff lack adequate training, and dedicated services are thin on the ground.
“There is a growing evidence base of the links between oral health and general health including respiratory infections, which carry a high mortality risk.”