In 2019 the Care Quality Commission undertook a report into oral health in care homes. In March 2023 they produced a follow up report. This was an issue identified by the CQC back in 2016 when they reported that the oral health of those in care settings was routinely overlooked as they pointed out in their report: The State of Health Care and Adult Social Care in England 2016/17.
The dental care of older adults, particularly those in residential care settings has long been a major issue highlighted by the LDC Confederation and its members. We have raised this issue at LDC Conference on several occasions and made it clear to the Mayor of London in response to both his Inequalities Strategy and Food Strategy that the oral health of older adults must be addressed urgently. We welcome the CQC’s interest in this matter and their recommendations.
The latest CQC report made several recommendations building on their original report that need to be acted on:
- Oral health surveys for those in care homes to assess need;
- Raised awareness of:
- The need for an oral health assessment on entry to a care home
- Clarity on charges
- Mandatory oral health component on the Care Certificate;
- Updated guidance:
- For dentists providing domiciliary care
- For care home staff
- Improved collaboration facilitated by commissioners:
- To promote cross-sector integration between care home and dental professionals
- Funding to provide improved services
- Dentists to have access to summary care records;
- Automatic exemption from patient charges when someone enters a care setting;
We further welcome CQC’s commitments and challenges that it sets itself to:
- Keep raising this issue with the care homes it regulates;
- Reviewing how it will use its new powers to regulate Integrate Care Boards to assess what actions they are taking in this area.
While the LDC Confederation welcomes these recommendations we would like more detail. According to the Office of National Statistics in 2020 there were 4,865,591 adults aged over 75 in England. The issue of maintaining older adult oral health is only going to become more pronounced. Independent living is becoming more and more important. So, while those in residential care settings must have their care addressed this must not be at the expense of those who are not supported in their care. The same principles apply. The CQC’s recommendations are a great starting point for LDCs to have conversations at the local level. To work with partners to ensure that resources are applied in a meaningful way.
The move to Integrated Care Boards represents an opportunity to drive these changes and support joined up working. We will be working with partners to:
- Ensure that all those who are registered as requiring domiciliary care by a GP or social services are automatically linked into oral health domiciliary services;
- On entry to a care home, when the patient is at their most mobile, that they have an oral health assessment and care plan with a dentist;
- More joined up care so that those patients with dementia, Parkinson’s, engaged in stroke rehabilitation and other conditions that directly affect the ability to self care are known to dental services and their access to those services actively supported;
- The most pressing issue remains dental charges.
All of these proposals will require clear co-working and a commitment to finding resources as well as ensuring that dental practices are not penalised for supporting the best interests of the most vulnerable. The LDC Confederation will work to ensure that proposals are workable and sustainable.
The full CQC report is available on the CQC website.