Oral health training for care homes

EdgeWorks™ ‘Oral Health for Care’ eLearning is designed to help our clients meet their obligation to provide regular oral health training for all care staff. The course has been developed to meet the recommendations of Care Quality Commission review: ‘Smiling Matters’ that was published in June 2019 and will now form part of their regular monitoring and inspection of care homes. CQC will be looking for evidence of staff training and Skills for Care has also added Oral Health training to its list of Statutory and Mandatory training.

The great news for all our clients who already have access to our learning platform, Care Academy, access to the eLearning training can be purchased for just £5 per person – which represents incredible value. It is also included in our “enhanced” refresher package to ensure you remain on top of your obligations and can evidence your service is effective, responsive, and safe. If you are a new client and want to access this eLearning, just get in touch and we’ll get you set up with an account so you can access this great course.

Background

Care Quality Commission review ‘Smiling Matters’ (June 2019) found variable levels of support available to residents of care homes across the country, with almost 1 in 5 homes confirming they never assess people’s oral health on admission. Additionally, some three years following the publication of the NICE oral health guideline (NG48) and the associated assessment toolkit, almost 40% of care managers were not aware of it and only 28% had actually read the document. Furthermore, almost 50% of care homes included in the review confirmed that staff do not receive any specific training in Oral Health – which is quite alarming!  Sadly, this means that for many people their ability to eat, speak, and socialise was significantly compromised.

Although there were some good examples of joined-up practice between care homes and dental practices, this was very patchy and people’s dental care was not routinely recorded in care plans and records. As a direct consequence, many people were not able to access routine NHS dental care often leading to further complications.

Conclusions and recommendations

CQC recommendations are as follows:

1. People who use services, their families, and carers need to be made more aware of the importance of oral care
   • We recommend that a multi-agency group, including care providers, is convened to significantly raise awareness among people living in care homes and their families and carers of the importance of day-to-day dental hygiene and routine check-ups. This should focus on encouraging people to look after their own teeth and challenge care providers to support them with this as part of their care package.
2. Care home services need to make awareness and implementation of the NICE guideline ‘Oral health for adults in care homes’ a priority
   • We recommend that care home providers should:
     • Make the NICE guideline (NG48) the primary standard for planning, documenting, and delivering oral care.
     • Make day-to-day dental hygiene of equal priority to other personal care tasks.
     • Assess people’s oral health and their ongoing day-to-day dental hygiene needs when they enter the home, showing whether people are exempt from NHS charges.
     • Routinely check the state of people’s oral health when they lose weight if it is not explained through ill-health or other ongoing conditions. This should be carried out by a qualified dental professional and should include an assessment of the fit of dentures.
     • Establish an ‘oral health champion’ within their portfolio of staff roles and responsibilities.
3. Care home staff need better training in oral care
   • We recommend that local social care commissioners (both clinical commissioning groups and local authorities) introduce the need for oral health training as part of their assessment frameworks.
   • We recommend that Skills for Care, Health Education England, and Skills for Health introduce a mandatory oral health component in the next iteration of the Care Certificate qualification to include the impact of poor oral health on general health and associated diseases.
4. The dental profession needs improved guidance on how to treat people in care homes
   • We recommend that all dental providers make sure they are clear about their NHS and private charges and make every effort to assist care homes in making applications for exemption from charges.
   • We recommend that Health Education England updates and re-issues guidance for the training of dental professionals on how to provide care within care homes, particularly in relation to people with complex conditions and cognitive impairment, the frequency of routine examinations for those living in care homes, and the most appropriate setting and dental care professional to deliver routine and urgent treatment.
5. Dental provision and commissioning needs to improve to meet the needs of people in care homes
   • We recommend that NHS England and local commissioners:
     • Work with the care home sector to avoid lengthy waiting times for appointments and treatment and provide emergency appointment times.
     • Work with GP practices and other primary care contractors to signpost people to local dental
       provision.
     • Provide adequate capacity to provide routine and emergency treatment to people in care homes.
   • We recommend that NHS England works with other bodies, such as Public Health England and Healthwatch to develop accessible information for the public and care home staff to signpost them to routine and emergency NHS dental care in their area.
   • We recommend that NHS England reviews how domiciliary dental care is provided to the care home sector – targeting it to those who would benefit it the most.
   • We recommend that NHS England considers a more local and responsive approach to dental commissioning, given the inclusion of oral health in care homes within the NHS Long Term Plan.
   • We recommend that commissioners should recognise the opportunities for a more diversified
     workforce – for example, make available hygienists, therapists, and dental nurses to provide services for people living in care homes.
   • We recommend that NHS England explores how the developing primary care networks and local dental networks can work with NHS dental services to develop services that meet the needs of vulnerable groups and address health inequalities for those living in care homes.
6. NICE guideline NG48 needs to be used more in regulatory and commissioning assessments
   • We recommend that local social care contractual monitoring and quality frameworks include awareness and implementation of NG48 as part of their assessment of the overall quality of care.
   • We recommend that CQC reviews and clarifies how oral health care should be part of their
     monitoring and inspection of care homes.
   • We recommend that the Regulation of Dental Services Programme Board, chaired by CQC, continues to work collaboratively towards a shared view of quality in relation to the awareness of the NICE guideline, oral health training, and commissioning of services.

To find out more about our oral health eLearning course please visit our course portfolio page.

Please feel free to get in touch if you would like to discuss access to any of our eLearning training courses or require any further information – we’re always happy to chat!