Snippets of Steele and toothpaste

I was recently interviewed for a regional television programme. Commenting on activity data, the journalist said: “Surely, the reduction in treatments is an indication that the new system is not working?’ I pointed out that what we wanted to see was a system which encouraged both patients and dentists to work towards improving oral health and, thereby, reduce the need for intervention.

Recently published data on the oral health of five year olds showed an encouraging increase in the number of children free from decay at that age.  

This will eventually feed through as a reduction in the need to intervene – although it is also, to some degree, offset by the increasingly dentate nature of our older population.

When we published Delivering Better Oral Health in September 2007, I am not sure we realised how influential it would become in introducing a focus on prevention and also its impact on some pretty basic issues.

Following publication of the document, the major toothpaste manufacturing companies changed the formulation of their child-targeted toothpastes to include fluoride levels that can be shown to be effective in reducing tooth decay, raising concentration of fluoride from 440ppm to 1000ppm. This, in itself, should reduce levels of tooth decay in children in the years to come.

We are also starting to see a significant rise in the prescribing of high-concentration fluoride toothpastes, and a wider use of fluoride varnishes.

This focus on improving health is consistent with the recommendations of the Steele review, which is now moving into its implementation phase.

Professor Jimmy Steele has agreed to remain closely involved with the process, and has joined the main board responsible for overseeing implementation.  

We have established work streams with continuing stakeholder involvement to make sure we make progress on all the issues raised in the review – particularly developing clinical pathways, quality standards, and testing these in contract pilots.

For many years dentists, remuneration has been directly related solely to activity and we need to move towards a situation where remuneration relates not only to activity but also to health outcomes for the patient and the patient’s ability to access services.

For some time, a group of stakeholders has been working with the Department of Health in developing indicators of quality for a new preventive-orientated service.  

The new access template, which has been made available to PCTs for the first time includes key performance indicators (KPIs) and we will be looking to see how closely they affect the quality of services being provided.

The lessons from this will feed in to the overarching programme of implementing the Steele report.

There is much going on already around the country in terms of innovative development in services, and we will be looking to incorporate some of these developments in the Steele work and evaluation.

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