The Health Overview and Scrutiny Committee met on Wednesday, 8 January 2025, to discuss access to dental services and the progress made in addressing outcomes from a Care Quality Commission inspection. The committee also reviewed its work programme.

Update on Dental Services Access

The committee received an update on the challenges and progress in improving access to NHS dental services across Herefordshire and Worcestershire. Charmaine Hawker, Director of Delegated Commissioning for NHS Herefordshire and Worcestershire Integrated Care Board (HWICB), explained that the commissioning of dental services transferred to ICBs in April 2023, inheriting a service that had been in decline for over a decade. Key issues identified include the outdated National Dental Contract, which has not been revised since 2006 and does not adequately remunerate practices for complex cases, and workforce shortages.

The HWICB has developed a Local Dental Recovery Plan (LDRP) which aims to reinvest £5 million over two years. A significant change from April 2025 will allow commissioners to rebase underperforming contracts, releasing funding for reinvestment. The plan includes increasing the Unit of Dental Activity (UDA) rate to £31 from April 2025 and establishing a Dental Training Centre for overseas graduates.

During the discussion, members highlighted the importance of prevention, particularly for children, and enquired about outreach in nursery and school settings. It was confirmed that prevention in schools falls under the remit of the County Council's Public Health Team. An Oral Health Needs Assessment has identified health inequalities, with commissioning plans targeting areas of highest dental need. The council has written to the government requesting water fluoridation for the whole of Worcestershire.

Members expressed concern about residents struggling to access NHS dentists, and the committee agreed to ask the HWICB to increase the promotion of the Dental Access Centre in Worcester City, which handles emergency dental services. It was noted that 48 wards across Herefordshire and Worcestershire have been identified as high priority for dental services, with 37 of these in Worcestershire.

Simon Adams, Managing Director of Healthwatch Worcestershire, commented that residents continue to report problems with NHS dental access, and suggested that improved communication could help. He acknowledged the efforts made by the HWICB to enhance provision locally, particularly within the constraints of the national contract. The committee requested an update in 12 months and agreed to ask the HWICB to increase the promotion of dental services, especially the Dental Access Centre. Councillors also agreed to urge the Director and Cabinet Member with Responsibility for Health and Wellbeing to continue lobbying the government for water fluoridation across Worcestershire.

Update on Progress to Address Outcomes of Care Quality Commission Inspection of Herefordshire and Worcestershire Health and Care NHS Trust

Scott Parker, Director of Improvement at Herefordshire and Worcestershire Health and Care NHS Trust, provided an update on the progress made in addressing the concerns raised by the Care Quality Commission (CQC) following their Well Led Inspection. The CQC identified 35 'Must Do' actions and several themes, including issues with culture, racism, risk management, governance, and mandatory training.

The Trust has developed an Improvement Plan with six key workstreams: Culture and Equality, Diversity and Inclusion; Systems, Process and Structures; Regulatory Compliance; Communication, Strategy/Planning and Patient/Carer Engagement; Risk Management; and Corporate and Administrative Services. As of December 2024, 85 out of 132 actions in the Improvement Plan are complete, with 47 ongoing.

Members raised concerns about the launch of programmes and workstreams that they felt should have already been in place. It was clarified that these schemes had been reset to provide a baseline for consistency and monitoring. Assurance was given that the Trust has identified necessary changes and has a framework for management and leadership. The associated costs of the work were discussed, with the Trust stating that no patient care had been compromised.

The committee welcomed the focus on continuous training and the emphasis on equality, diversity, and inclusion. Members expressed a desire for future reports to detail how actions would directly affect patients. The Trust acknowledged this and stated that embedding changes could take three to five years. The Chairman thanked the Director and invited an update in six months.

Work Programme

The committee considered its Work Programme for 2024/25 and made no amendments. The programme outlines the key issues the committee intends to scrutinise throughout the year, including updates on mitigating winter pressures, ambulance services, adult mental health services, and routine immunisations.