May 13

100 Patients… Making A Point

On May 5th, 6 months after launch, the Real Junk Tooth Project supported by Dentaid reached its first 100 patients - sufficient to provide relevant insights to the situation.

And here it is.

​Summary of audit of patients attending Dentaid Dewsbury Real Junk Tooth Project

​Dec 2015-May 2016.


Introduction

The UK Homeless face major barriers in accessing dental services, even though they are more likely to experience oral health problems. A study involving 853 people experiencing homelessness identified 98% had experienced dental decay.

According to Cole et al (2011) decayed and missing teeth can psychologically influence and exacerbate depression within the homeless community. Government statistics from 2014 showed; the percentage of rough sleepers across England has risen by 14% from 2013. A study conducted in Eastman Dental hospital in London (2013) identified the difficulty for homeless people accessing dental services. Over 50% reported that NHS dentistry was ‘hard to find’ and ‘accessing it was difficult.’

The Real Junk Food Project Dewsbury

​The Dentaid Dewsbury/Real Junk Tooth Project (RJTP) pilot was set up in response to requests from the The Real Junk Food Project Dewsbury (TRJFPD) to treat those attending who were unable to eat free food because of dental pain.

The intention had originally been to treat those using the TRJFPD who were migrants or unable to officially access NHS dental services. 

Very soon, and following on from reading the Healthwatch report into dental access for Dewsbury , The need was identified to treat those unable to access NHS dentistry despite being entitled to this service.

​The dental practice involved was volunteered by Nick O Donovan for use by the charity Dentaid and staffed by volunteers mainly from the DFT postgraduate course, both FDs and trainers.

These FDs experienced working with a charity, gained experience of treating a different cohort of patients, emergency dentistry, extractions experience and taking part in this pilot seeing innovation working (HEE QA initiative).

image of Dewsbury dental staff

Paul Burr of TRJFP Dewsbury, nurse Katie Labourn and dentist Nick O'Donovan at the Dewsbury Dental Centre

The Dean gave permission for the DFT involvement and they were supported by DFT Trainers, experienced dentists or oral surgeons in order to provide a safe clinical environment. FDs were responsible for contacting and gaining approval from their indemnity society and Dentaid managed and checked DBS certification.

​All attendees were asked a series of voluntary questions regarding access as well as the normal dental records mandatory for all patients e.g. medical history and treatment completed; the results for the first 100 patients are available in the audit summary that you can download here.

Download a .pdf version here

​Payment was on a pay as you feel voluntary basis.

Summary of data and comments

1.  49% of those attending were currently smokers; this is in contrast to the 19% of adults in England (4.) who are smokers. Numbers have been dropping following campaigns and advertising cuts, warnings, social pressure. This is actually higher than figures for England in the 1950s and indicates a ‘group or section of society where improvements in health and life expectancy are not keeping pace with the rest of the population’.

​2..23% had visited a dentist within the last 5 months but were still experiencing dental problems.

​3.  59% had tried to access NHS dental services but were unable to do so. Some had been waiting for years and had resorted to taking painkillers up to 5 times daily. Some patients thought they were on waiting lists for nhs services and were expecting to be told when they reached the top of the list; this generally never happened and they were left waiting with no information.

​4.  Twice as many male patients attended compared to female patients.

​5. Around a quarter of those seen had mental health and/or addiction problems.

6. The general impression was that patients did not disclose all information for fear of not receiving treatment but this is not definitive evidence.

7. ​The number of patients who had either accessed 111 emergency services and received incomplete advice, or poorly communicated treatment, or tried to access dental treatment at an inappropriate site (A+E, GP) made up nearly a quarter (24%) of all those seen. The cost attached to this, both for the service and the patient, is significant.

Patients accessing 111 services because they couldn’t obtain NHS dental treatment were being treated with a pulp extirpation and dressing (at a cost to the patient of the nhs charge of £51.30 in some cases and £18.80 depending on the site accessed) then being advised to find a dentist to get further treatment. This was poorly communicated to the patient concerning the cost and need for further treatment.

The patients were attending the emergency service because they are unable to access regular dental services at all; the dressing was then lost within days or weeks and the patient was no better off. The cost of the service for 111 plus the patient charges could be better spent paying for considered and patient centred treatment.

8. Some patients on low income were unable to pay the NHS charges some were too frightened of the costs.

9. ​6% of those attending were children (none of them migrants and were all entitled to free nhs treatment) who were losing permanent molars in the mixed dentition. The cost for later orthodontic treatment to correct this is not insignificant plus the pain, suffering and loss of educational time associated with dental decay.

10.  98% of patients attending gave details of a GP where they said they were registered. It was noted that some GP addresses were not near the address given for residence. This was due to some patients just working or living in the area temporarily.

​11.  Distance travelled. 70% of those attending travelled less than 2 miles. Only 5% travelled more than 4 miles. Currently the only emergency dental service accessed through 111 is either in WF1 or HD1 which are both 10 miles from Dewsbury and not easily accessible for this population group as these figures indicate.

12.  ​This pilot has confirmed and has added understanding to the findings of the Healthwatch Kirklees report Why can’t I find an NHS dentist in Kirklees? 2014

image of data chart

Dewsbury West has the lowest number of UDAs commissioned per population in the region and the highest attendance at Dentaid /RJTP . WF13 accounted for 53% of those attending as the pilot was positioned in the most appropriate place where the current access is poor.

​13.  Accuracy of given information: The postcodes for patients was discussed with one attendee at RJFP. In the case of the homeless, this was usually a friends postcode of the flat where they lived in the stairwell, or the postcode used for claiming benefits but they didn’t actually live there. The postcode was however considered to be close enough to be an indication of the distance travelled. It was also noted that the medical history declared was probably not complete possibly due to fear of not receiving treatment.

​14.  Access to this patient group has traditionally been difficult but running this clinic in association with the The Real Junk Food Project Dewsbury has targeted this group effectively.

​15.  The Real Junk Food Project Dewsbury also makes healthy food accessible which works in collaboration with dental health and medical health. Over 3 months in Dewsbury TRJFPD have intercepted 10 tonnes of food, fed 6820 people, provided 14000 meals. Multiprofessional working has shown to be very effective in this respect. Partnership working with TRJFPD alongside Connect Housing, Lifeline, ‘On Track’, churches and other groups has been the key to effective targeting and treatment of high need patients.

​16.  General Dental Practitioners working in an area with very low UDA commissioning will not select these patient types due to the lack of profitability for their business when they have such a choice of patient demand. Practices which are overloaded with high needs patients worry they may run the risk of bankruptcy or resorting to inappropriate activity.

17.  Discussions with Healthwatch and the Health and Wellbeing Board show that access is an issue which has not been addressed despite evidence over several years by Healthwatch.

18.  This pilot has gained further understanding of patient experience and has developed a model to provide care which is appropriate.

19. To date this project has received no support from the NHS for provision of these services.

In summary

​The results of this pilot show a link between the data collected for poor access and the Index of Deprivation. The UDAs commissioned in the region are worst in the areas of maximum deprivation when it should ideally be the opposite if the NHS Constitution is to be upheld.

Index of Deprivation 2015 Dewsbury West Ward

Index of Deprivation 2015, Dewsbury East Ward

Index of Deprivation 2015, Dewsbury East Ward

The population for Dewsbury West is slightly higher than Dewsbury East yet the UDAs commissioned are 6500 UDAs for Dewsbury West compared to 41,453 UDAs for Dewsbury East (over 6 times more).

The NHS aims to provide a comprehensive service, available to all (Department of Health NHS Constitution for England updated Oct 2015).

Highlighted are extracts from the constitution showing the areas where the charity Dentaid/RJTP is able to work alongside NHS England in developing appropriate access for this group of patients that currently are ‘falling through the cracks’ of NHS dental provision in Kirklees :-

It is available to all irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status. The service is designed to improve, prevent, diagnose and treat both physical and mental health problems with equal regard. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.


It provides high quality care that is safe, effective and focused on patient experience;


It should support individuals to promote and manage their own health. NHS services must reflect, and should be coordinated around and tailored to, the needs and preferences of patients, their families and their carers.


The NHS works across organisational boundaries


It works in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is an integrated system of organisations and services bound together by the principles and values reflected in the Constitution. The NHS is committed to working jointly with other local authority services, other public sector organisations and a wide range of private and voluntary sector organisations to provide and deliver improvements in health and wellbeing.


It is committed to providing the most effective, fair and sustainable use of finite resources. Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves.

The NHS is accountable to the public, communities and patients that it serves


Key to this project is the extensive links between charities and other organisations who have access to the population that find it difficult to reach dental care. Linking together and having a charity providing the treatment has broken down barriers for this population; concerns regarding costs of treatment or language difficulties or judgments of situation have been removed.

The provision of emergency treatment for 100 patients at 1.2 UDAs (suggested rate £30/UDA for a high need population) over 22 weeks equates to £ 136 per 2hr session. Many emergency services are historically allocated band 2 for pulp extirpation and extractions which would put the cost per session at only £346 per 2hr session.

A suitably funded model of working that links The Real Junk Food Project Dewsbury (or similar feeding programme) with Dentaid and postgraduate teaching and training has been shown to work with regard to access for the target patient base and provision of appropriate treatments in a cost effective way using the finite resources which are available.

The NHS working with, and funding this model, would move dentistry nearer to the NHS constitution recommendations.

References

  1. Healthwatch Kirklees . ‘Why can’t I find an NHS dentist in Kirklees? 2014’

  2. Department of Health NHS Constitution for England updated Oct 2015

  3. ASH Nov 2015 Facts at a Glance

  4. Dept Health statistics on smoking http://www.hscic.gov.uk/catalogue/PUB17526/stat-smok-eng-2015-rep.pdf

  5. http://godewsbury.uk/2016/02/27/reason-for-concern-in-dewsbury/

  6. Freeman , R. Beaton , L. Rodriguez , A. (2015). Scottish Oral Health Improvement Homelessness Programme: Smile4life. University of Dundee. Accessed October 2015: http://dentistry.dundee.ac.uk/scottish-oral-health-improvement-homelessness-programme-smile4life

  7. Coles, E., Chan, K., Collins, J., Humphris, G.M., Richards, D., & Williams, B., Freeman, R. (2011). Decayed and missing teeth and oral health-related factors: predicting depression in homeless people. Journal of Psychosomatic Research, 71: 108-112. Accessed October 2015: http://www.sciencedirect.com/science/article/pii/S0022399911000067

  8. Howard D. (2014). Rough Sleeping Statistics England - autumn 2014 Official Statistics. Department for Communities and Local Government, 3. Accessed October 2015: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/407030/Rough_Sleeping_Statistics_England_-_Autumn_2014.pdf

  9. University College London. (2013). New study discovers homeless dental problems. University college London hospitals. Accessed October 2015: http://www.uclh.nhs.uk/News/Pages/Newstudydiscovershomelessdental problems.aspx

  10. Collins, J., & Freeman, R. (2007). Homeless in North and West Belfast: an oral health needs assessment. British Dental Journal. Accessed October 2015: http://www.nature.com/bdj/journal/v202/n12/abs/bdj.2007.473.html

Thank you to everyone who has worked hard to make this project happen.

Paul Burr from The Real Junk Food Project Dewsbury; Sue Baker HEEYH; Linzi Maybin LDFTyr2 for the rota organisation; Andy Evans and Jill Harding at Dentaid; Bruce Bird VIPromotions; Nick O Donovan for the use of his surgery, equipment and materials free of charge; Ian Wilson for support and encouragement; dentists, foundation dentists, nurses and receptionists from Yorkshire and Humber for your dedication to patient care; our works experience volunteers; Linda Holmes manager at Sensory World for giving us a base from which to operate.

Sue Baker

May 2016

Dec 17

It’s Not Just Dentists…

It's not just dentists that are needed to make The Real Junk Tooth emergency dental service work.

As the weekly clinic pilot project settles down credit is due to those supporters who also stand and serve - and sterilise the instruments and keep the records and all the other things necessary to keep good order. 

So credit is due to: ​Paula Thornhill, receptionist, Bethany O'Donovan, scrub nurse, Andy Evans of Dentaid who helped make all this happen and to Usman Majid, volunteer dentist.

This is what community action actually looks like.  People who make things happen.

Paula Thornhill

Bethany O'Donovan

Andy Evans

Usman Masjid

logo for Radio Leeds interview about The Real Junk Tooth Project
Dec 05

Launch Day For Dewsbury Emergency Dental Surgery

Launch day for The Real Junk Tooth Project on 3rd December met or exceeded everyone's expectations and even made a spot on BBC Radio  Leeds local news show.

Click the link to listen to the spot on Jonny l'Anson's news programme.  Move the slider along to listen from 2:07:55 to 2:16:00.

With live Interviews with patients, one of whom had not visited a dentist for 20 years and another who had been unable to find an NHS dentist available in Dewsbury since moving here 4 years ago, the first patients seemed to confirm that the emergency service was reaching the right target audience.

There were also contributions from the volunteer dentists providing their services for free, Dentaid who are supporting the project and from Paul Burr who made the connection that users of The Real Junk Food Project who are in food insecurity probably don't have an income that enables them to pay for normal dental services - and ended up with dental pain as a result.

Advice to patients about how to access further treatment available through the NHS was made available as a follow up while feedback was obtained from patients about how the limited emergency treatment matched their expectations.

The service is planned to continue for 3 months in the pilot project in Dewsbury before the results are reviewed to see how it may need to be adapted and may be rolled out to other locations.

Nov 13

Wagons Are Rolling At the Real Junk Tooth Project

The Real Junk Tooth Project wagon is beginning to roll even before the first open surgery takes place.

With the first dentist to volunteer from outside the Dewsbury pilot project group already checking in and a donation page set up and beginning to collect donations.

In addition, press coverage in the Yorkshire Post is getting the message out that things are really beginning to happen.

image of Dewsbury dental staff
Nov 01

Innovative Dental Service Sparked By Junk Food Project

The Real Junk Food Project Dewsbury is working with international charity Dentaid to develop ‘The Real Junk Tooth Project’.

This the first of this model in the country and Dewsbury is the pilot area!

The idea for The Real Junk Tooth Project was sparked by the concept behind The Real Junk Food Project that uses food intercepted from many locations including cafes and supermarkets that are obliged to discard perfectly edible food due to various regulations.  This food is normally wasted but The Real Junk food project works with the food retailers and intercepts the food and feeds it particularly to those in need in the local community. In Dewsbury the project is supported by businesses such as Morrisons, Co-op and Nandos.

Paul Burr, organiser of the Dewsbury project, noticed that the Real Junk Food customers often had many other problems including difficulty due to various barriers in accessing routine NHS dental care.

noun_146588_cc“Watching a hungry person struggle to eat because they are in pain with a long term dental problem was something that switched me on to this particular issue.  Because of the work we do in the local community we were able to connect up the various people and with some innovative thinking by local dentists.  We are really excited about making this new project happen.”

“There are already over 140 Real Junk Food cafes operating across the UK and they are all likely to have customers with similar problems.  So the potential that the volunteers already supporting the cafes can talk to their local dentists and quickly generate a community response in other locations could help this service model to spread very quickly.”

The Real Junk Tooth Project

image of Dewsbury dental staff

Paul Burr of The Real Junk Food Project, nurse Katie Labourn and dentist Nick O’Donovan at the Dewsbury Dental Centre

Dentists in Dewsbury concerned for the welfare of vulnerable people are volunteering their time to help members of their local community who have difficulty accessing dentistry.

This is especially valuable in the run up to Christmas and takes some pressure away from NHS services. Healthwatch Kirklees have identified Dewsbury as being an area with particular dental access problems.

This innovative idea originated with Dewsbury dentists who were aware of the work to The Real Junk Food Project in the area.  The idea is being piloted in one practice in Dewsbury starting 3rd Dec 2015 for several hours on Thursday evenings.  There are 2 surgeries at the practice which will be used and it will be a turn up on the night between 6 and 7pm no appointment system.

Staffed by volunteer dentists and surgery staff, it will provide extractions and pain relief only; it will not provide normal NHS dental services.  The pilot which is supported by the dental charity, Dentaid, will operate from Dewsbury Dental Centre, 15, Halifax Rd, Dewsbury.

The Dewsbury project is really a step into the unknown as a working pilot model that will enable us to determine if this model intended solely to improve the quality of life by providing pain relief can work effectively.

We are keeping it very simple.  There is no appointment system but we will be monitoring uptake of these service in order to measure the demand.

Pay As You Feel

We have taken the ‘pay as you feel‘ concept from The Real Junk Food Project so that even those with no or very limited income need pay nothing yet still escape the debilitating effect of dental pain.

We would like those who can do so to contribute a minimum of £10 to cover disposable items and anaesthetic.

We are hoping that people with an income but simply unable to gain normal access to dental services will pay a normal fee to contribute to this project to help members who are struggling in their own community.