How tackling health inequalities in Suffolk and north east Essex is the first step to make NHS dental care available to all
Ed Garratt OBE, Chief Executive of NHS Suffolk and North East Essex Integrated Care Board (SNEE ICB), explains how health inequalities are front and centre of his dental commissioning strategy and how this has led to innovative new partnerships and contracts.
When SNEE ICB took over the commissioning of NHS dental services in April 2023, we had a vision to make routine and urgent NHS dental care available to everyone in our population who either wants it or needs it.
At the time, 31% of our population had unsuccessfully tried to get an appointment in the last 2 years, 9% more in comparison to the rest of England, including almost half of our children in care.
NHS Digital dental statistics show that Suffolk and north east Essex is classed as an ‘under-served’ area in terms of dental workforce. Establishing recruitment and retention packages to improve workforce availability in such areas is necessary to meet current NHS dentistry demand. We are working on this alongside the packages announced in the NHS England dental recovery plan. NHS England’s Workforce Education and Training team is working closely with the ICB, the universities of Essex and Suffolk and professional dentists to create a workforce plan to address the gaps in service.
In February, the University of Suffolk welcomed the first students on its bachelor of science dental hygiene and dental therapy course. Graduates will be able to carry out many of the routine tasks performed by dentists, freeing up the latter to concentrate on more complex treatments.
Another flagship part of our workforce strategy to tackle inequity is our commissioning of the University of Suffolk Dental CIC to support training placements in Ipswich for dental hygienists and therapists.
The University of Suffolk Dental CIC was also successful in gaining a new NHS contract which sees dental care professionals receiving NHS patients in its purpose-built surgery units on Ipswich waterfront. Patients are referred via NHS 111 with the service soon to take referrals from health and social care organisations.
The following groups are prioritised:
- patients requiring urgent and emergency care
- homeless people
- transient populations including immigrants
- people with learning disabilities and people on the autism spectrum
- children in care and care leavers
- those awaiting any NHS procedure that requires oral health problems to be stabilised
- people in care homes, nursing homes and children’s homes
- patients at high dental risk
- dementia patients
- sex workers
Once fully operational, 18,000 hours of NHS-only dental appointments will be provided every year. This model of direct provision of NHS dentistry alongside training and education is one of the first of its kind in the country.
A mobile dental clinic will be established to target areas of greatest need thanks to another new contract with community dental services. It will provide assessment, prevention and treatment for Suffolk’s most vulnerable children and young people such as those with learning disabilities or those living in care. The clinic will work directly with organisations who are already supporting children and young people and will take patients on a referral basis. This service is funded by the ICB and managed by Suffolk County Council’s Public Health and Communities team.
As part of the NHS dental recovery plan, the ICB has also allocated £700,000 to spend on another mobile dental surgery which will serve deprived coastal and rural areas.
15 additional services have been commissioned allowing more NHS appointments to be made in the evenings, weekends and bank holidays. The providers in these schemes are contracted to prioritise the same disadvantaged groups as the University of Suffolk Dental CIC. The ICB is also running a pilot in Sudbury to prioritise armed forces families due to the inequities they face, particularly the frequency with which they move to different areas.
We have reviewed all our dental contracts which fall below the ICB’s payments average and set a minimum payment rate to ensure those services providing NHS care continue to do so. We have subsequently looked at areas of high deprivation in Suffolk and north east Essex and will be trialling a localised payment rate in Clacton-on-Sea where there are significant health inequalities.
We know that the impacts of poor oral health disproportionally affect the most vulnerable and socially disadvantaged individuals and groups in society. They might not know how to take care of their oral health and they might be unable to afford toothpaste regularly. Oral health problems can negatively affect a person’s confidence, their mental health and their employment and promotion prospects. It can also cause them to need time off work, impacting their finances.
Our vision is one we are determined to realise, but we recognise that this will take time, effort and imagination. What is extremely encouraging is the enthusiasm and drive we have generated with our partners and providers to embed equity in NHS dental access and I feel both excited and humbled to be a part of it.
Dr Ed Garratt OBE DL
Ed is Chief Executive of the NHS Suffolk and North East Essex Integrated Care Board and has led the integrated care system since 2019. He is a Visiting Professor of Integrated Care at the University of Suffolk and an Honorary Professor at the University of Essex in the Institute of Public Health and Wellbeing. He is a Deputy Lieutenant of Suffolk. In 2023 he was awarded an OBE in The King’s first Birthday Honours List for services to the integrated care system.
Ed has worked in the system for over a decade, including leading through the pandemic. He was Chief Executive of the NHS Ipswich and East Suffolk, North East Essex and West Suffolk clinical commissioning groups (CCGs), gaining ‘outstanding’ ratings in all 3 CCGs, before they were closed in 2022. Previously he was Deputy Director of Commissioning and Head of Communications and Engagement at NHS East of England.
Ed supports various regional responsibilities such as chairing the East of England Mental Health Board and commissioning the East of England Ambulance Trust. He also sponsors the Essex Anchor Institutions’ Network and the Care Tech campus being developed at the University of Essex.
He has worked on major national policy by supporting the development of the NHS Constitution (2009) and the Government’s NHS White Paper (2021).
Ed has a published doctorate in English Literature from the University of Cambridge and a first-class degree in History from the University of Sussex.