The Health and Adult Services - Executive Member & Corporate Director Meeting of North Yorkshire Council was scheduled to convene on Wednesday, 27 August 2025. The meeting's agenda included a discussion on the Director of Public Health's decision regarding the Oral Health Improvement Service. The aim was to seek approval to procure an oral health promotion service.

Oral Health Improvement Service

The Director of Public Health, in consultation with Councillor Michael Harrison, Executive Member for Health and Adult Services, was asked to consider a proposal to procure an Oral Health Promotion service. The service would maintain support to targeted Early Years Settings participating in Supervised Toothbrushing Programmes (STB) and provide a virtual workforce development offer to North Yorkshire Council's Children and Young People and Health and Adult Services.

The report pack stated that the proposal was to procure an oral health promotion service from April 2026 for 5 years (3+1+1) with a total budget of £225,000 (£45,000 per year).

The two core elements of the Oral Health Promotion Service were listed as:

• Improving the oral health of North Yorkshire's under 5 population through a daily supervised toothbrushing (STB) programme in areas of greatest need, maintaining the existing level of provision to targeted Early Years Settings and Special Schools.
• A virtual workforce development programme to those in adult and children's services supporting vulnerable population groups, ensuring the workforce has the confidence and skills to deliver evidence based oral health promotion advice and support in their day-to-day roles.

The intended service outcomes included:

• Supporting delivery against the public health outcomes framework indicator Tooth decay in five-year-old children.
• Reducing inequalities in oral health, with a priority focus on children and young people supported by NYC's children and family services, children living in deprived areas, children attending NY Special Schools, older people, vulnerable adults and health inclusion groups.
• Embedding evidence based oral health practice within workforces and settings in North Yorkshire.

The report pack noted that it was proposed that North Yorkshire Council continue to jointly commission this service with City of York Council (CYC), with North Yorkshire Council as the lead commissioner.

Background

Local authorities have a statutory requirement to provide or commission oral health promotion programmes to improve the health of people in their area, as set out in The NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations 2012.

The report pack cited the National Institute for Health and Care Excellence (NICE) public health guideline (PH55) Oral health: local authorities and partners, which recommends supervised toothbrushing schemes for nurseries and primary schools in areas where children are at high risk of poor oral health. Supervised toothbrushing schemes also support the NHS Core20PLUS5, an approach to reducing health inequalities for children and young people, of which oral health is one of the clinical priorities for children.

The report pack stated that in March 2025, the Department for Health and Social Care (DHSC) announced a financial uplift for oral health, targeted at stabilising and expanding current provision to improve outcomes and reduce inequalities in 5-year-old tooth decay. The policy is to ensure that all 3 to 5-year-olds living in the 20% most deprived areas are brushing daily.

The report pack referred to the Child of the North Report An evidence-based plan for improving children's oral health with and through education settings which documents the impact that poor oral health can have on children and young people's education and learning.

The report pack stated that the costs of treating tooth decay in children and young people are substantial, including costs of primary care and specialist treatment. Hospital admissions for tooth decay-related extractions in 0- to 19-year-olds alone cost the NHS over £40 million in the 2022-23 financial year.

The report pack cited the 2023-24 survey of 5-year-olds in England, Oral health survey of 5 year old schoolchildren 2024, which found that the national prevalence of children with enamel and/or dentinal decay was 26.9%. Children living in the most deprived areas of the country were more than twice as likely to have experienced dentinal decay (32.2%) as those living in the least deprived areas (13.6%).

In North Yorkshire the highest proportion of hospital admissions for tooth extraction is the 5-9 year old age group (414.3 per 100,000 children, HES data 2023-24). In England, dental caries remains the most common reason for all hospital admissions in this age group.

Additional DHSC STB Funding

The report pack stated that subsequent multi-year funding for STB from DHSC is subject to this year's Spending Review. It is not known at present whether North Yorkshire Council will continue to receive an allocation for this from April 2026.

Humber & North Yorkshire Integrated Care Board (HNYICB) Prevention, Access and Treatment (PAT)

The service will also be expected to engage in collaborative working with additional prevention programmes, such as the Humber & North Yorkshire Integrated Care Board (HNYICB) PAT, where this may encourage uptake of supervised toothbrushing or develop appropriate pathways to improve access to prevention and care.

PAT offers Supervised Toothbrushing in Primary Schools alongside fluoride varnish and onward dental care for children where dental treatment is identified. 64 North Yorkshire Primary Schools are currently participating in the PAT programme. This programme is funded by the NHS through NHS contract variations with participating NHS general dental practices.

Policy Implications

The proposal aligns with several strategic priorities:

• DfE's Giving Every Child the Best Start in Life strategy (2025).
• NHS Core20PLUS5 framework reducing hospital admissions for dental extractions.
• DHSC financial uplift to Public Health grants for STB (March 2025).
• NICE PH55 guidelines (2016), NICE NG48 promoting good oral health for adults in care homes (2016), CQC Smiling Matters update (2025), NDEP Survey 2024-25 Oral Health in Care Homes.

Alternative Options Considered

The report pack stated that Health Education England's eLearning for health platform (eLfh) includes a number of oral health online learning modules which are free to access once an account is created.

Financial Implications

The report pack stated that supervised toothbrushing programmes are effective in reducing the prevalence and inequalities in tooth decay and are cost effective. For every £1 spent on supervised toothbrushing programmes, there is an estimated return on investment of £3.06 over a 5-year period.

Recommendation

The report pack stated that the recommendation was to request approval from the Director of Public Health, in consultation with the Executive Member for Health and Adult Services, to proceed with the procurement of an Oral Health promotion service for 5 years (3+1+1).