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NHS "dental deserts" persist in rural and deprived communities – LGA analysis

NEW analysis by the Local Government Association reveals a growing number of "dental deserts" across the country with more deprived or rural local authority areas having fewer NHS dentists than those in more affluent urban areas.

The LGA, which represents over 350 Councils in England and Wales, is calling on the Government to address shortages in NHS dentists urgently or risk more people requiring costly emergency dental treatment further down the line.

As we face increased rates of inflation and the cost of living crisis bites, Councils and their local directors of public health are warning some people may have to go without important dental work as they look to cut down on spending.

Analysis of data, collected by the Care Quality Commission (CQC) and published as a rate per 1,000 residents, on the LGA's data platform, LG Inform, shows that:-

No local authority area in the country has more than 1 dentist per 1000 of the population who provides NHS treatment.

Rural and more deprived areas are more likely to have shortages in NHS dentists than their counterparts, with the top 10 Council areas for shortages mainly having higher than average levels of deprivation or higher than average proportion of residents in rural areas.

There are wide variations in the availability of NHS dentists, with the City of Westminster having over 6 times the number of NHS dentists per 1000 of population compared with Ashfield, the area with the lowest number in the country.

Previous research by Public Health England shows that children in deprived communities have poorer oral health than those living in more affluent communities. For example, across Local Authorities in England there is huge variation ranging from 7% to 51% of 5 year olds having experience of tooth decay.

To tackle the growing shortage of NHS dentists, Councils have urged the Government to reform the dental contract and ensure the £762 million clawback taken by the Treasury over the last 10 years from dental practices who miss contractual targets is reinvested into subsidised dental treatments.

Dentists are commissioned by NHS England to provide treatment although it is the responsibility of Councils to run programmes to promote good oral health and prevent problems, particularly among children.

However Councils' public health grant, which provides funding for this service as well as sexual health services, School health visitors, substance misuse support , has been reduced by 24% in real terms per capita since 2015/16, equivalent to a total reduction of £1 billion.

Councils are calling on the Government to commit to long term public health funding increases so Councils can provide important early interventions to take pressure away from NHS dentists.

Cllr David Fothergill, Chairman of the LGA's Community Wellbeing Board said:- "This stark new analysis shows a shortage in affordable dental treatments for communities all over the country. In particular, it is concerning that it is rural areas as well as those living with the highest levels of deprivation that are more likely to miss out on NHS dental provision. As we continue to feel the effect of the cost of living crisis, a lack of NHS dentists could risk people choosing to forgo routine dental treatments or even resort to DIY dentistry, risking more costly emergency dental treatments being needed further down the line. The Government should reform the contract it has with dental surgeries as well as develop a workforce strategy to ensure we can have affordable dental treatments for communities across the country. Councils also need a real terms increase in their public health grant so they can provide vital oral health improvement programmes to prevent longer term health problems."

The British Dental Association has long warned that the current crisis in NHS dentistry is having a disproportionate impact on high needs patients, in already underserved communities.

British Dental Association Chair Eddie Crouch said:- "The Government must be more ambitious in its plans to reform NHS dentistry. To save this service we need real commitment; root and branch reform and adequate funding. A broken contract is forcing dentists out of the NHS every day it remains in force. Tinkering at the margins will do nothing to help the patients who need us most."

Are you able to find an NHS Dentist in your area?  Please do let us know by emailing our Newsroom at:- News24@SouthportReporter.Com. Don't forget to tell along with letting us know if you can or can't locate an NHS Dentist, both your area and let us know if you have had to go private or go to another area; and if so how far away from you...

Time to act

CARE England, the largest and most diverse representative body for independent providers of adult social care in England, has this week written to the Secretary of State for Business, Energy and Industrial Strategy to call for care providers to be categorised as:- 'vulnerable' in the upcoming 3 month review of the Energy Bill Relief Scheme, ensuring they continue to receive support for surging energy costs beyond the current 31 March 2023 deadline.

Professor Martin Green OBE, Chief Executive of Care England, says:- "The extreme vulnerability of the care sector in the wake of energy price rises is indisputable and plain for all to see. The Government must recognise the sector as such and do so immediately. Not only are care providers integral to the lives of some of society's most vulnerable, but they play a crucial role in alleviating pressure on the NHS by offering a secure and cost effective route for Hospital discharges. Even with the support outlined in the Energy Bill Relief Scheme, the financial pressures facing providers are largely unsustainable, as they continue to face a 3 to 4 fold increase on August 2021 energy prices. The ongoing crisis has come against a backdrop of wider, deep-rooted financial difficulties, such as those relating to workforce pressures and decades of chronic underfunding by Government. To withdraw the current measures of support in 6 months would be an immense oversight by the Government."

Care England's open letter to the Rt Hon Jacob Rees Mogg, the newly appointed Secretary of State for Business, Energy and Industrial Strategy (BEIS), highlights that although the Government's Energy Bill Relief Scheme will provide much needed reassurance to care services across the country in the short term, more substantial Government support is needed to protect against increased costs.

The Government's announcement of their relief scheme was caveated by the statement that only sectors considered:- 'vulnerable' at the 3 month review of the scheme will continue to benefit from Government support. While that term is yet to be defined, care providers are not currently considered as such and are facing the withdrawal of Government support. There is no indication that wholesale energy prices will substantially lower between now and 1 April 2023.

Care England's call to action details the following asks to BEIS:-

The adult social care sector must be recognised as:- 'vulnerable' in the upcoming 3 month Energy Bill Relief Scheme review.

Zero rate VAT for the care sector.

Security deposits and risk premiums need to be underwritten by energy providers benefitting from wholesale rates.

£400 energy bill discount applied to those in receipt of care.

National voltage regulation.

Cease unnecessary burning of coal.

Assess the 1 price energy pricing system.

Waive penalty charges.

Support package for alternative energy sources.

Martin Green continues:- "The vulnerability of the adult social care sector is not in doubt. The current relief scheme is simply papering over the cracks of deeper-rooted issues. It is incumbent upon the new Government to finally deliver a long term strategy to secure the financial sustainability of the sector, using the extension of current measures as a 1st step in a series of much-needed reforms. Until this commitment is made, Care England is recommending that all care providers, who are currently on a variable rate, consider signing up to new contracts if they wish to be protected by the cap up to 31 March 2023. In the last 48hrs, leaks in the Nord Stream gas supply to mainland Europe have had a further impact on energy prices in England and caused energy providers to remove offers from the market which could put smaller care providers at risk of variable rate increase exposure beyond the current cap protection available under the relief scheme, if not reinstated. This serves as a reminder of the dangers currently facing the sector and the necessity of swift Government action to ensure continued support beyond the current deadline."

North West children at risk of avoidable serious illness due to missing vital routine vaccinations

UK Health Security Agency (UKHSA) North West is warning parents and guardians of the serious health risks from children missing routine immunisations as new data shows vaccination coverage for young children fell last year for virtually all programmes

Parents and guardians are being urged to ensure their children are up to date with all their routine childhood immunisations including polio and measles, mumps and rubella (MMR) vaccinations.

Vaccination rates have fallen over several years and additional disruption caused by the Covid19 Pandemic, beginning in March 2020, is likely to have caused some of the decreases in Vaccine coverage seen in 2020 to 2021 and 2021 to 2022 compared to earlier years.

The latest vaccination statistics from the UKHSA and NHS Digital for children up to 5 years of age in the UK (COVER programme) shows coverage decreased for 13 out of the 14 routine vaccination programmes measured in 2021 to 2022.

In the North West only 90.3% of children had completed their 1st dose of the MMR Vaccine by the time they were 2 years old, which is a decrease from 91% in the previous year. The rate has been steadily decreasing from 94.9% in 2012.

Coverage for the 2nd dose of MMR by age 5 years, within 2021 to 2022 time frame was at 87.1%.

Coverage for the 1st dose of MMR at 24 months was less than 90% in 5 (out of 23) North West upper tier Local Authorities with only 1 above 95%.

It is important vaccination coverage is recovered as soon as possible to levels recommended by The World Health Organization of 95% for all childhood immunisation programmes to help prevent the spread of avoidable serious; and sometimes deadly; diseases such as measles and polio.

Since the introduction of the measles Vaccine in 1968 it is estimated that 20 million measles cases and 4,500 deaths have been prevented in the UK.

Measles is highly contagious so even a small decline in MMR uptake can lead to a rise in cases. Since international travel has resumed closer to pre-Pandemic levels, it is more likely that measles will be brought in from countries that have higher levels of the disease and cause outbreaks.

Measles can lead to complications such as ear infections, pneumonia, and inflammation of the brain which require Hospitalisation and on rare occasions can lead to long term disability or death.

The NHS is running a MMR catch up campaign so some parents may be contacted directly.

Dr Merav Kliner, Deputy Director at UKHSA North West, said:- "Measles is highly contagious and can be dangerous, and it is extremely worrying that we are seeing levels of uptake of the MMR Vaccine falling among young children. I would urge parents to check that all children are up to date with their Vaccines, and if not to get them booked in as soon as possible to make sure they have maximum protection against what can be terrible diseases. Childhood Vaccines also boost population immunity levels, helping prevent outbreaks, so by taking up all vaccinations for our children, we play our part in keeping these diseases confined to the past."

Tricia Spedding, Head of Public Health at NHS England North West, said:- "It's important parents make sure their children are protected against measles, mumps and rubella with the 1st and second dose. It can easily spread between unvaccinated children and potentially be very serious for them. The MMR Vaccine is safe and effective for your child, and will protect them, their friends and the wider community from these unpleasant but preventable diseases. If your child hasn't been vaccinated yet, or is not up to date with their vaccinations, please contact your GP to book an appointment as soon as possible."

Anyone who is unsure if their child is up to date with all their routine vaccinations should check their child's Red Book (personal child health record) in the 1st instance. If you are still not sure, or if you need to bring your child up to date with their Vaccines, contact your GP practice to check and book an appointment.

To find out more about childhood vaccinations, please visit the NHS website.

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