Oral Health 2020: A Strategic Framework for Dental Health in NSW

Transcription

1 Oral Health 2020: A Strategic Framework for Detal Health i NSW

2 NSW MINISTRY OF HEALTH 73 Miller Street NORTH SYDNEY NSW 2060 Tel. (02) Fax. (02) TTY. (02) Produced by: Cetre for Oral Health Strategy NSW This work is copyright. It may be reproduced i whole or i part for study or traiig purposes subject to the iclusio of a ackowledgemet of the source. It may ot be reproduced for commercial usage or sale. Reproductio for purposes other tha those idicated above requires writte permissio from the NSW Miistry of Health. NSW Miistry of Health 2013 SHPN (CEE) ISBN Further copies of this documet ca be dowloaded from the NSW Health website February 2013

3 Cotets Itroductio... 2 Delivery of Oral Health Services i NSW...2 Plaig Cotext...3 The Challeges Ahead...3 The Oral Health of the NSW Populatio...4 Goals... 7 Goal 1: Improve Access to Oral Health Services i NSW...7 Goal 2: Reduce Disparities i the Oral Health Status of People i NSW...8 Goal 3: Improve the Oral Health of the NSW Populatio through Primary Prevetio...9 Priority Populatios Early Childhood...10 Childre ad Adults with Special Needs...10 Aborigial ad Torres Strait Islader People...11 Older People...11 Rural ad Remote Commuities...11 Actio Framework Primary Prevetio...12 Workforce...15 Professioal Educatio...17 Data, Research ad Evaluatio...19 Moitorig Progress Refereces Oral Health 2020: A Strategic Framework for Detal Health i NSW NSW Health PAGE 1

4 Itroductio Oral Health 2020: A Strategic Framework for Detal Health i NSW (the Framework) sets the platform for oral health actio i NSW ito the ext decade. It provides a overview of the oral health status of the populatio, outlies the goals for oral health services, describes target groups that require focussed efforts, ad outlies the high level actios that will be pursued to improve the oral health of the populatio. The Framework will support the NSW Miistry of Health ad Local Health Districts (LHDs) to pla ad deliver priority programs tailored to the health eeds of the populatio at both a state ad local level. It also ackowledges the sigificat role the Agecy for Cliical Iovatio (ACI), the Cliical Excellece Commissio (CEC), the Health Educatio ad Traiig Istitute (HETI), ad NSW Kids ad Families will have i cotributig to improved oral health i NSW. Delivery of Oral Health Services i NSW Detal services, ulike other health services, are ot covered by the priciple of uiversal access. I the Australia health care system, Medicare ad the etitlemet that all Australias have to the medical ad pharmaceutical beefits it provides are a well recogised stregth. Public detal services, however, are largely oly provided to the youg ad the disadvataged, with o Commowealth scheme similar to Medicare that provides access to all. I NSW, public detal services are provided to childre * ad eligible adults, with the majority of detal services beig fuded o a private basis. For adults, this eligibility meas they have oe or more of the followig cards: Commowealth Seiors Health Card, Health Card, or Pesioer Cocessio Card. NSW Health does ot charge a co-paymet for oral health services. The Commowealth Govermet plays a role i the fudig of detal services, however, the NSW Govermet is resposible for deliverig the major public program for childre ad eligible adults. The rage of oral health services provided through the NSW public health system broadly icludes detal services to childre ad eligible adults accordig to criteria that prioritise emergecy situatios: those i most eed ad at highest risk of disease; detal educatio ad oral health promotio services. Operatioally i NSW these services are delivered by each of the Local Health Districts (LHDs). The services are delivered i detal cliics based i commuity health cetres, hospitals ad schools ad iclude geeral detistry such as examiatios, filligs, ad detures. Cotracted services are also provided via the Oral Health Fee for Service Scheme (OHFFSS), which eables public oral health services to provide care through a private practitioer usig a voucher system. I rural LHDs, cliics may be located i hospitals, schools, commuity health facilities, or mobile detal cliics. I some commuities a private surgery may be reted to provide public sector oral health services. I metropolita areas, cliics are maily located i commuity health cetres, or o school or hospital grouds. Eightee Aborigial Medical Services also provide detal services fuded by NSW Health. The Westmead Cetre for Oral Health, the Childre s Hospital at Westmead ad the Sydey Detal Hospital provide geeral ad specialist oral health services i their cliics ad through outreach programs i rural public detal cliics. The specialist services iclude paediatric detistry, oral surgery, edodotics, prosthodotics, special eeds detistry, oral medicie ad oral pathology, orthodotics, ad periodotics. * This excludes access to geeral aaesthetics, for which there is eligibility criteria for childre. PAGE 2 NSW Health Oral Health 2020: A Strategic Framework for Detal Health i NSW

5 Plaig Cotext There are a rage of state ad atioal oral health programs, fudig iitiatives, reviews, ad reports that have iflueced this Framework. This icludes iput from the NSW Miisterial Taskforce o Detal Health, the report of the Natioal Advisory Coucil o Detal Health established by the Commowealth Govermet i 2011, ad recetly aouced Commowealth oral health iitiatives 1 (icludig the Child Detal Beefits Schedule, Natioal Partership Agreemets, ad a Flexible Grats Program). Workig with both the Commowealth Govermet ad private sector to provide ehaced oral health services will be a key requiremet ito the future. There have also bee sigificat reforms across the NSW Health system that have iflueced this Framework: i particular, implemetatio of the Natioal Health Reform Agreemet. Uder the ew goverace arragemets, LHDs have clear resposibility ad accoutability for goverig health service delivery for their local district. These resposibilities ad the fudig required to deliver services to address local eed are beig articulated i a Service Agreemet egotiated betwee the Miistry of Health, as purchaser ad system maager/regulator, ad the LHDs as providers of health services. The Agecy for Cliical Iovatio (ACI) ad the Health Educatio ad Traiig Istitute (HETI) will have a ehaced rage of resposibilities ad accoutabilities. The Cliical Excellece Commissio (CEC) ad the Bureau of Health Iformatio (BHI) are also takig o a expaded portfolio of resposibilities but largely withi their curret roles. Further, the statutory health corporatio, NSW Kids ad Families has bee established to champio the health iterests of childre ad youg people whether they are at home, i the commuity or i or out of hospital. This icludes health services for babies, childre, adolescets, mothers, parets ad families. These agecies are kow as the "pillars. The Cetre for Oral Health Strategy (COHS) NSW, which is part of the Populatio ad Public Health Divisio withi the Miistry, will eed to esure that there are strog likages ad parterships with the Commowealth, the private sector, the pillars (especially the ACI, HETI ad NSW Kids ad Families) as well as LHDs, ad the Aborigial Health ad Medical Research Coucil (AH&MRC). The Challeges Ahead Some of the challeges facig oral health services over the ext 10 years iclude: Populatio growth: I 2026, the NSW populatio is projected to reach eight millio; with Sydey remaiig the domiat populatio cetre i NSW. Most growth i Sydey will occur to the west ad south west of the city. The populatio of most local govermet areas alog the NSW coast is expected to icrease, while the populatio of most ilad areas of NSW is expected to declie. 2 These chagig demographic patters will ifluece the demad for services ad will eed to be cosidered i plaig the locatio ad type of services provided. Workforce: The majority of oral health services are provided by the private sector, with a relatively small proportio of the oral health workforce withi the public sector. Attractig ad retaiig a skilled workforce, particularly i rural ad remote areas ad i specialist disciplies, is a ogoig ad sigificat challege. Ageig of the populatio: I 2026, 20% of the populatio will be people aged 65 years ad older, compared to 13.1% i The prevalece of edetulism has decreased i older Australias, ad accordigly, a rage of chroic degeerative detal disorders is ow emergig (such as tooth wear, erosio, cuspal fractures, pulp ifectio, ad root fracture). The cosequeces of icreased tooth retetio i older adults, combied with a icreased proportio of cliets i this age group with complex medical eeds, meas ew skills will be required by detists to maage these age-related disorders as well as a icreased demad for more geeral, periodotic, ad prosthodotic detal care. Oral Health 2020: A Strategic Framework for Detal Health i NSW NSW Health PAGE 3

6 Icreasig demad for oral health services: This is partly due to the ageig populatio, but also to chagig public expectatios, icreasig services per visit required, ad a greater depedece o the public sector as the umber of private sector detists i rural commuities declies. The impact of techology o access: New iformatio ad commuicatio techologies offer the potetial to improve cosumer access to health iformatio ad services, as well as boostig operatig efficiecy this will require timely ivestmet. Uequal gais i oral health status: There is a persistet gap betwee the most ad least disadvataged: for example healthcare cardholders, Aborigial ad Torres Strait Isladers, ad people livig i rural ad remote commuities. Focussed efforts will be required to esure targeted service provisio to those who are most i eed. Balace betwee populatio prevetio ad idividual treatmet services: The cost of providig treatmet cotiues to grow as does the demad for public detal services. This demad for idividual treatmet will eed to be balaced with the eed to fud health promotio ad disease prevetio iitiatives. Opportuities to itegrate oral health withi existig health promotio programs i early childhood ad chroic disease maagemet eed further exploratio. Fudig of oral health services: Services are fuded by idividuals, the Commowealth Govermet, private health isurace, ad by State ad Territory Govermets i their provisio of services to the eligible populatio. The detal iitiatives of the Commowealth, ad chages to Private Health Isurace rebates will alter the ature of fudig ad affect the use of public ad private detal services. The Oral Health of the NSW Populatio Oral health is cosidered itegral to geeral health, with poor oral health likely to exist whe geeral health is poor ad vice versa. 3 Oral health refers to the stadard of health of the oral ad related tissues that eable a idividual to eat, speak ad socialise without active disease, discomfort or embarrassmet. While oral diseases are commo, they are largely prevetable through populatio-level itervetios (icludig water fluoridatio), ad idividual practices such as persoal oral hygiee ad regular prevetive detal care. A key idicator of the oral health status of a populatio is the detal caries experiece. I the primary detitio, this is recorded as the umber of primary teeth that are decayed (d), missig (m) due to detal caries, or filled (f) because of detal caries. Permaet caries experiece (DMFT) is recorded as the umber of permaet teeth that are either decayed (D), missig (M) because of detal caries, or filled (F) because of detal caries. Collectig robust data o the oral health of a populatio requires a survey methodology that icludes detal examiatios, ad it is this complexity that limits the frequecy of data collectios. The most recet survey of child detal health i NSW was coducted i It utilised robust samplig methodology ad stadardised detal examiatios ad data collectio to estimate the oral health status of childre. The ext Child Oral Health Survey is beig coducted i For adults, the most recet data is provided by The Natioal Survey of Adult Oral Health Key results from both surveys are provided below. PAGE 4 NSW Health Oral Health 2020: A Strategic Framework for Detal Health i NSW

7 Table 1: Oral Health Problems i NSW Childre (2007) Idicator of oral health Mea dmft for 5 6 year olds 1.53 Mea DMFT for year olds 0.74 Percetage of 5 6 year olds with active or treated decay i their primary teeth Percetage of year olds with active or treated decay i their permaet teeth Source: NSW Health Child Detal Health Survey Figure 1: dmft/dmft i childre by Local Health District (2007) dmft/dmft 5-6 years Local Health District years dmft/dmft 1.2 Sydey South Wester Sydey South Easter Sydey Illawarra Shoalhave Wester Sydey Nepea Blue Moutais Norther Sydey Cetral Coast Huter New Eglad Norther NSW Mid North Coast Souther NSW Murrumbidgee Wester NSW NSW Mea umber of teeth Mea umber of teeth Source: NSW Child Detal Health Survey Oral Health 2020: A Strategic Framework for Detal Health i NSW NSW Health PAGE 5

8 Table 2: Oral health problems i NSW ad Australia Adults ( ) Idicator of oral health NSW Australia Percetage of adults with complete tooth loss Percetage of adults with fewer tha 21 atural teeth Percetage of detate adults who wear detures Percetage of adults with utreated coroal decay Average umber of teeth per perso missig due to pathology Average umber of decayed, missig or filled teeth per perso Percetage of adults with more tha 4 mm periodotal pocket depth Source: Sivaeswara S. The oral health of adults i NSW, I additio to these surveys, the NSW Health Survey Program captures self-reported iformatio from adults aged 16 years ad above. The followig figure idicates that less tha 60% of adults visit a detist regularly. Data from the survey also idicates that most visited private detal practitioers (86.8%), however, just over half of the populatio has private health isurace for detal expeses (51.2%). 6 Figure 2: Time sice last detal visit, adults aged 16 years ad over, NSW, Males Less tha 12 moths ago 1 to less tha 2 years ago 2 to less tha 5 years ago 5 to less tha 10 years ago 10 years ago or more Never Females Per cet Per cet Source: Cetre for Epidemiology ad Research Report o Adult Health from the New South Wales Populatio Health Survey. Sydey: NSW Departmet of Health, PAGE 6 NSW Health Oral Health 2020: A Strategic Framework for Detal Health i NSW

9 Goals The goals of Oral Health 2020: A Strategic Framework for Detal Health i NSW are to: 1. Improve access to oral health services i NSW. 2. Reduce disparities i the oral health status of people i NSW. 3. Improve the oral health of the NSW populatio through primary prevetio. Goal 1: Improve Access to Oral Health Services i NSW As described previously, a sigificat proportio of the NSW populatio does ot access detal services regularly, ad whe they do, they geerally access private services. This accords with the service provisio model, i that the NSW public detal system provides services to childre ad eligible adults (geerally the most disadvataged members of the populatio) with the majority of detal services beig fuded o a private basis. The rate of cliets visitig detal professioals varies cosiderably betwee the most ad least disadvataged i the populatio. A sigificatly higher proportio of adults i the first or least disadvataged quitile (68.6%), ad a sigificatly lower proportio of adults i the fifth or most disadvataged quitile (53.5%) visited a detal professioal less tha 12 moths ago, compared with the overall adult populatio. Figure 3 illustrates the disparities i oral health i childre by socioecoomic status. Figure 3: Mea umber of dmft/dmft i childre by socioecoomic status dmft/dmft years Socioecoomic status 1st Quitile least disadvataged years dmft/dmft d Quitile rd Quitile th Quitile th Quitile most disadvataged NSW Mea umber of teeth Mea umber of teeth Source: NSW Child Detal Health Survey Oral Health 2020: A Strategic Framework for Detal Health i NSW NSW Health PAGE 7

10 It has bee recogised atioally that this disparity i access is evidece of the eed to improve the way i which the detal system services the populatio. Natioally the system has bee described as a episodic, problemorieted primary health approach with little comprehesive treatmet ad cotiuity of care. 7 Improvig the detal visitig patter for all of the populatio, particularly the most disadvataged, remais a challege for the detal system i NSW. Goal 2: Reduce Disparities i the Oral Health Status of People i NSW Implemetatio of activities to achieve both Goals 1 ad 3, such as water fluoridatio, populatio prevetio through itegrated health promotio, ad improved access to detal services for the etire populatio, will lead to improved oral health status of the populatio. However, there are subpopulatios withi the commuity that will eed additioal focus to esure disparities i oral health status are reduced. Aborigial ad Torres Strait Islader people, older people, adults ad childre with special eeds, childre i out-of-home care, ad those i rural/remote commuities where access to services is limited, are priority groups i NSW (see Figure 4, which illustrates childre s oral health status by remoteess). These subpopulatios form the Priority Populatios for this Framework. Figure 4: Mea umber of dmft/dmft i childre by remoteess dmft/dmft 5-6 years Remoteess category years dmft/dmft 1.3 Major cities Ier regioal Outer regioal Remote ad very remote NSW Mea umber of teeth Mea umber of teeth Source: NSW Child Detal Health Survey PAGE 8 NSW Health Oral Health 2020: A Strategic Framework for Detal Health i NSW

11 Goal 3: Improve the Oral Health of the NSW Populatio through Primary Prevetio Whole of populatio or uiversal iitiatives are cetred o icreased access to water fluoridatio, health promotio, ad disease prevetio. These iitiatives address the social determiats of oral disease ad share commo risk factors with other chroic diseases. A itegrated risk factor approach recogises that chroic diseases ad coditios such as overweight ad obesity, heart disease, stroke, cacer, diabetes, ad oral disease share commo risk factors. Key risk factors iclude poor diet, smokig, ad alcohol use. The key cocept of the itegrated risk factor approach is that by directig actio o these commo risks ad their uderlyig social determiats, improvemets to a rage of chroic diseases (oral disease beig oe) will occur more efficietly ad effectively. I the comig decade, NSW Health will cotiue to pursue a fluoridated water supply for the populatio ad itegrate oral health promotio withi other health promotio activities i areas such as healthy eatig, prevetio of overweight ad obesity, ad smokig reductio programs. NSW Health will also idetify opportuities for oral health promotio to be icluded withi other health care programs, such as chroic care iitiatives for older adults, ad early childhood programs (icludig home visitig). NSW Kids ad Families will be a key parter, as will other parts of NSW Health with resposibility for health promotio. Broad target expectatios for oral health by the year 2020 have bee developed: Target 1. A reductio i the percetage of people across all age groups who are edetulous (meaig complete loss of all atural teeth) have ay decayed teeth have periodotitis (a serious gum ifectio that damages the soft tissue ad boe). Target 2. A icrease i the percetage of people across all age groups who have te or more occludig pairs of teeth (meaig the way upper ad lower teeth fit together durig bitig ad chewig). These broad targets have bee developed because they represet key idicators of oral health i a populatio. Oral Health is fudametal to overall health, wellbeig ad quality of life eablig people to eat, speak, ad socialise without pai, discomfort, or embarrassmet. People who have completely lost their atural teeth (that is, they are edetulous), either through ijury or severe detal disease, for example, may experiece a reduced quality of life or daily fuctioig. Hece it is importat that edetulism across the populatio is reduced. Reducig the umber of decayed teeth ad the prevalece of periodotitis i people will also cotribute to improved oral ad geeral health across the populatio. It is importat for people to maitai as may of their teeth as possible, hece the target of icreasig people with te or more occludig pairs of teeth. Oral Health 2020: A Strategic Framework for Detal Health i NSW NSW Health PAGE 9

12 Priority Populatios Early Childhood I NSW, 40% of childre aged 5 6 years have utreated or have experieced detal disease. This is sigificatly higher i certai populatios, icludig Aborigial childre (2.5 times higher), childre from a lower socioecoomic backgroud (refer to Figure 3), childre livig i remote/very remote areas (up to 6 times higher), ad for childre of mothers bor i o-eglish speakig coutries. 4 Early Childhood Caries (ECC) is a detal decay disease that crosses all socioecoomic boudaries with high prevalece ad a sigificat health burde i Australia ad globally, eve though it is prevetable. It is a ifectious disease that is modified by diet. ECC has sigificat cosequeces, 8 ad hece childre are a key priority populatio for this Framework. The Early Childhood Oral Health (ECOH) Program is a commuity-based, early itervetio program, built o the priciples of itegrated service delivery. It focuses o effective parterships betwee families, oral health professioals, ad geeral child health professioals to achieve optimal oral health for ifats ad youg childre. A example of itegratig oral ad geeral health is the NSW Persoal Health Record (Blue Book) that is provided to parets ad child health professioals. It icludes iformatio about prevetio of detal disease ad a oral health check as part of all child health checks from six moths of age. Itegrated primary prevetio activities that improve childre s diets, ad the ECOH early itervetio program, are the mai actios to improve the oral health of childre i NSW. Esurig good oral health for childre i out-ofhome care i particular will also be a focus. Childre ad Adults with Special Needs People with special eeds are people with a itellectual or physical disability, or medical or psychiatric coditios, which icreases their risk of oral health problems or icreases the complexity of oral health care. 3 People with special eeds ca require a rage of differet levels of detal care from geeral detistry through to highly traied specialist detal services. While a sigificat umber of people with special eeds ca be quite satisfactorily ad safely treated withi the existig maistream public detal services, barriers to access eed to be a key cosideratio. Such barriers may be reduced by targeted oral health promotio activities, traiig for oral health staff i the specific additioal eeds of people with special eeds, ad parterships with other health ad service providers. PAGE 10 NSW Health Oral Health 2020: A Strategic Framework for Detal Health i NSW

13 Aborigial ad Torres Strait Islader People Compared to the overall Australia populatio of similar age, Aborigial ad Torres Strait Islader people experiece sigificatly more oral disease. Amog Aborigial ad Torres Strait Islader peoples: childre geerally have more tha twice the caries experiece ad a greater proportio of utreated caries adults have more missig teeth childre ad adults have worse periodotal health, with poor periodotal health evidet i youger populatios. 3 Actios withi this Framework to improve the oral health of Aborigial ad Torres Strait Islader people will eed to be based o the key Aborigial health priciples 9 icludig: Whole-of-life view of health Workig i parterships Cultural competecy Older People As described earlier, the NSW populatio is ageig, ad with the reductio i edetulism, a rage of chroic detal disorders is ow emergig. Eve though edetulism is decliig i metropolita areas, complete ad sigificat tooth loss remais high amog both youger ad older populatios i rural areas, ad there is still strog demad for full detures. Further, there are strog idicators that detal caries ad periodotal diseases are more prevalet ad more severe for residets i aged care facilities. The Better Oral Health i Residetial Care Program i Nursig Homes was established i respose to this. The Program is fuded by the Australia Govermet Departmet of Health ad Ageig uder the program Ecouragig Best Practice i Residetial Aged Care. 10 The cosequeces of icreased tooth retetio i older adults meas ew skills will be required by detists to maage these age-related disorders as well as a icreased demad for more geeral, periodotic, ad prosthodotic detal care. Rural ad Remote Commuities Across Australia, people livig i rural ad remote areas geerally have worse health tha those livig i cities. 11 People livig i rural commuities experiece geographic isolatio, problems with access to care, affordability of home health care resources (e.g. toothbrush ad fluoride toothpaste), affordability ad availability of fresh ad healthy food, shortage of health care providers ad health services, socioecoomic disparities, greater exposure to ijury, lower road quality ad lack of trasport, small sparsely distributed populatios, ad higher Idigeous health eed. Delivery of quality health services depeds o havig adequate umbers of skilled staff workig where they are eeded. Addressig the curret shortfall i the supply of oral health professioals must be a key priority. Oral Health 2020: A Strategic Framework for Detal Health i NSW NSW Health PAGE 11

14 Actio Framework The followig diagram summarises the Actio Framework required to deliver the Goals of Oral Health Actios will spa from whole-of-populatio primary prevetio, through to service provisio for eligible adults ad childre i primary care settigs, to the tertiary services provided i the two detal hospitals ad other settigs. Eablig actios will also occur i workforce, research ad educatio. Tertiary Services Primary Care Services for the Eligible Populatio Whole of Populatio Primary Prevetio Workforce Research Educatio Primary Prevetio Water Fluoridatio Fluoridatio of public water supplies is the sigle most effective public health measure for reducig detal caries across the populatio, with its most proouced effects amog those who are disadvataged ad most at risk. 12 Lifetime exposure to fluoridatio is associated with caries experiece reductio i both the primary ad the permaet detitio compared with o-exposed childre. 13 Sice 2004 NSW Health, i cojuctio with the LHDs, Local Coucils, ad Water Supply Authorities, has bee proactive i developig strategies to promote water fluoridatio to rural commuities i NSW to reduce iequalities i oral health. A comprehesive ad multi-discipliary approach is take i educatig ad cosultig commuities ad stakeholders about the beefits of water fluoridatio. This proactive approach to water fluoridatio has resulted i 20 Coucils implemetig fluoridatio. Populatio coverage of water fluoridatio has icreased from approximately 90% i 2004 to approximately 96% i I some small commuities, however, it is ot feasible to fluoridate the water supply, due to the ature of the water supply utility, hece alterative approaches are pursued. PAGE 12 NSW Health Oral Health 2020: A Strategic Framework for Detal Health i NSW

15 Fluoridatio Actios Resposibility Parters Cotiue to ecourage ad work with Local Govermets of ufluoridated commuities to itroduce fluoride to the local water supply. Idetify ad implemet the most appropriate strategy to provide fluoride to commuities where water fluoridatio is ot feasible, especially Aborigial Commuities. Where cliically appropriate, esure fluoride applicatios for all high risk idividuals attedig public detal services. COHS, LHDs COHS, LHDs LHDs Local Govermets Uiversities Itegrated Health Promotio As described earlier, itegrated approaches to health promotio recogise that chroic diseases ad coditios such as overweight ad obesity, heart disease, stroke, cacer, diabetes, ad oral disease share commo risk factors. Key risk factors iclude diet, smokig, ad alcohol use. I the comig decade, NSW Health will cotiue to itegrate oral health promotio withi other health promotio activities. Over the ext te years, oral health promotio will be able to capitalise o the broader health promotio ageda, particularly withi existig early childhood programs ad implemetatio of the Natioal Partership Agreemet o Prevetive Health, which icludes the Healthy Childre Iitiative. Strategies withi the Iitiative will provide the platform for oral health to boost some key commo messages, such as choosig water as a drik, promotig breastfeedig, ad reducig cosumptio of sugary driks ad food. Oral Health Promotio Actios Resposibility Parters Implemet a itegrated risk factor approach to oral health promotio that capitalises o key iitiatives such as the Healthy Childre Iitiative. Provide support to other health promotio campaigs that iclude commo messages aroud alcohol, smokig, water cosumptio ad reductio of itake of sugary driks ad food. Promote oral health promotio programs, resources ad literature through the Natioal Oral Health Promotio Clearig House. Idetify opportuities to support the commo risk factor messages beig itegrated ito the educatioal curriculum for studets ad relevat educatio/health professioals. Cotiue to support parets/carers to implemet good oral health practices with their childre through early childhood oral health programs. Esure itegrated oral health promotio programs are appropriately tailored to those with special eeds, Aborigial ad Torres Strait Islader People, rural commuities, ad older people. Itegrate oral health promotio withi existig early childhood ad outof-home care programs i partership with NSW Kids ad Families. LHDs, Miistry, Office of Prevetive Health LHDs, Miistry, Office of Prevetive Health LHDs, Miistry, Office of Prevetive Health Miistry COHS, LHDs LHDs, Miistry, Office of Prevetive Health LHDs, Miistry, Office of Prevetive Health, NSW Kids & Families Uiversities Departmet of Educatio ad Commuities Child health professioals NSW Kids & Families Peak orgaisatios, NGOs Oral Health 2020: A Strategic Framework for Detal Health i NSW NSW Health PAGE 13

16 Primary ad Tertiary Service Delivery I NSW, all childre, ad oly those adults that meet the eligibility criteria, are able to access public oral health services. For adults, this eligibility meas they have oe or more of the followig cards: Commowealth Seiors Health Card, Health Card or Pesioer Cocessio Card. NSW Health does ot charge a co-paymet for oral health services. Each year betwee 2.6 ad 2.8 millio weighted occasios of service are provided. The services are provided via approximately 183 public sector detal cliics with a combied total of approximately 750 detal chairs (May 2012). Eightee Aborigial Medical Services also provide oral health services, fuded by the NSW Miistry of Health. The most efficiet public sector cliics have four or more detal chairs: this level of service capacity allows for ecoomies of scale, improves staff security, ad provides studet cliical placemets. Ito the future, while cliics with lesser capacity (e.g. two-chairs) will still be required, these will be liked to Hub cliics (i.e. those with four or more chairs). Sigle chair surgeries will also still be required i small commuities where there are special eeds for visitig services. The optimum use of all detal resources i each Local Health District ad across NSW requires collaboratio betwee the public sector, the private sector, ad Aborigial Medical Services, with arragemets egotiated to suit local circumstaces i the Local Health Districts. Hub ad Spoke cofiguratios will be established to ehace local service delivery. Through this model, higher capability sites (Hubs) provide services ad support to smaller sites with lower capability (Spokes). This model icreases the ability of smaller services to provide improved access to a broader rage of services, particularly i rural ad remote areas where the efficiet provisio of services is challeged by workforce ad physical capacity. The fuctios of the Hubs would iclude: A cocetratio of specialised expertise i providig services to groups such as people with special eeds, older people, refugees, ad homeless people. Outreach services to the Spokes. Educatio ad traiig opportuities for staff from the Spokes. I rural commuities, a Hub may be a cocetratio of geeral cliicias (detists ad oral health therapists) who ca provide outreach services to smaller commuities. Regioal ad Rural Oral Health Cetres will be created as Hubs to lik prevetio ad oral health promotio, access to services, oral health workforce icetives, ad specialist care. A Aborigial Oral Health Hub ad Spoke program has bee established, ad will serve as a model for future Hub ad Spoke arragemets. It cosists of a dedicated two chair oral health surgery at Sydey Detal Hospital staffed by a Aborigial oral health coordiator, four detists, Aborigial detal assistats ad traiees, ad a Aborigial receptioist. The detists rotate through rural Aborigial Medical Services cliics that do ot have a detist as well as seeig Aborigial cliets referred to the Sydey Detal Hospital cliic. Beyod improvig service capacity ad delivery of geeral detal services across NSW, the specialty ad statewide services largely provided through the two detal hospitals warrat review ad formal cliical service plaig. A Oral Health Specialty ad Tertiary Cliical Services Pla is beig developed. This excludes access to geeral aaesthetics, for which there is eligibility criteria for childre. Each appoitmet visit is weighted by the actual umber ad comparative value of the treatmet items provided to arrive at the total weighted occasios of service. PAGE 14 NSW Health Oral Health 2020: A Strategic Framework for Detal Health i NSW

17 Primary ad Tertiary Service Delivery Actios Resposibility Parters Develop ad implemet a Oral Health Specialty ad Tertiary Cliical Services Pla that cosiders specialist services, postgraduate traiig ad research. Idetify ad address iadequacies i existig models of care ad icorporate a evidece-based prevetive ad therapeutic approach to service provisio, icludig timely oral assessmets ad provisio of idividual oral health care. Further develop ad refie outreach iitiatives ad Hub ad Spoke models, through collaboratio withi ad beyod the health system, particularly with the private sector. Develop ad implemet iitiatives that ecourage greater participatio by private sector detists ad other orgaisatios i the treatmet of public cliets. Establish targeted models of care for idetified groups that ecourage cliet-cetric service provisio ad prevetio, ad itegratio with other health care ad commuity services. Cosider opportuities to pilot programs whereby detal teams with the appropriate skills provide services to older people i a variety of locatios, such as aged care facilities, detal cliics ad the home. Cosider opportuities for oral disease to be icluded i other chroic care programs, such as the Coectig Care Program. Develop ad implemet a Aborigial Health Services Pla to improve coordiatio of services. This will eed to esure that oral health services are culturally appropriate ad create easy access ad appropriate pathways for Aborigial ad Torres Strait Islader people. COHS, LHDs COHS, LHDs, ACI COHS, ADA, LHDs, COHS, LHDs, COHS, LHDs, ACI, COHS, LHDs, COHS, ACI, LHDs COHS, LHDs ADA ADA, AMSs AMSs ADA, AMSs ADA, AMSs, NGOs ADA, AMSs, NGOs, Aged Care Sector AH&MRC, AMSs Workforce The majority of oral health services are provided by the private sector (87%), with a relatively small proportio of all detists i NSW withi the public sector. Detal Board of Australia data idicates that less tha seve per cet of detists i NSW work i the public sector. Other professios employed i oral health services iclude Aborigial ad Multicultural health workers, urses, dieticias, radiographers, admiistrative/ clerical staff ad health service maagers. The optimum skill mix ad distributio of the oral health workforce requires creatig icetives for both the public ad private sector, addressig issues of scope of practice, ad ecouragig detists i particular to relocate to rural areas. The May 2012 Federal Budget icluded iitiatives to ecourage detists to relocate to regioal, rural ad remote areas. To develop the public sector oral health workforce, the followig key areas are crucial: 1. Recruitmet to the public sector workforce 2. Retetio of the public sector workforce 3. Skill mix ad skill sets of the public sector workforce 4. Distributio of the public sector workforce 5. Use of the o-detal workforce. The implemetatio of the Miistry s Health Professioals Workforce Pla as it relates to oral health will require cosideratio of each of the five areas above. Workforce developmet activities will eed to be developed i partership with key stakeholders such as Health Workforce Australia ad the private detal sector. Iovative approaches to partership with the private detal sector will require exploratio. The Detal Board of Australia data for NSW (2012) show that there are 4706 registered detists (icludig specialists) i NSW. NSW Govermet data (2011) idicates that there are approximately 289 detists (icludig specialists) i the public sector. The figures should be iterpreted cautiously as the Detal Board data will iclude those ot actively practisig, ad there are differet timeframes for the Detal Board data ad the public sector data. Oral Health 2020: A Strategic Framework for Detal Health i NSW NSW Health PAGE 15

18 Workforce Developmet Actios Resposibility Parters Collaborate with the Commowealth Govermet ad the private sector to ecourage the relocatio of detists to regioal, rural ad remote areas. Establish additioal detal ad oral health therapist positios, supported with appropriate ifrastructure to provide appropriate services to a wider sectio of the eligible populatio. Expad the role of detal hygieists ad oral health therapists, particularly i the area of providig oral health services to older people i residetial aged care ad oral health promotio i commuity cliics. Review ad improve NSW Health iitiatives for the recruitmet ad retetio of public sector oral health staff i rural commuities. Ecourage o-detal health professioals to udertake appropriate oral health traiig courses to better meet the oral health eeds of their cliets. Improve the distributio ad skill mix of the public sector oral health workforce, takig ito accout the high oral health eeds of groups such as Aborigial people, people i rural commuities, older people, people with special eeds, refugees, ad childre i out-of-home care. Work with the educatio providers to ecourage more Aborigial studets udertakig study that leads to acceptace ito oral health careers of their choice. Icrease the proportio of Aborigial ad Torres Strait Islader people i the public sector oral health workforce by implemetig strategies to attract ad retai Aborigial people to the workforce. Ecourage detal ad oral health graduates to take up positios i rural LHDs. Esure that seior oral health staff i rural cetres are retaied by offerig opportuities to udertake advaced cliical traiig, research ad teachig. COHS, Workforce Developmet ad Iovatio Brach, LHDs COHS, LHDs COHS COHS, Workforce Developmet ad Iovatio Brach COHS, Workforce Developmet ad Iovatio Brach COHS, Workforce Developmet ad Iovatio Brach, LHDs COHS, Workforce Developmet ad Iovatio Brach, Workforce Developmet ad Iovatio Brach COHS, LHDs, COHS, LHDs, HETI ADA ADA PAGE 16 NSW Health Oral Health 2020: A Strategic Framework for Detal Health i NSW

19 Professioal Educatio Graduate Year Programs A rage of educatio ad traiig programs are i place for the career developmet of ew detal graduates withi LHDs, ad the Commowealth Govermet is also committig fudig to graduate year programs for detists ad oral health therapists. 1 NSW Health will eed to work closely with the Commowealth i the implemetatio of their programs to esure the beefits are maximised ad are complemetary to existig programs withi NSW. Studet Placemets The NSW public oral health system plays a importat role i supportig the educatio ad traiig of detal ad oral health studets, by providig placemets i public cliics. The cliical educatio of studets takes place over the course of the academic year. CliCoect 16 a web-based applicatio developed by the Miistry of Health is the mechaism used by uiversities i seekig cliical placemets for detal ad oral health studets ad by LHDs i providig them. Icreasig public sector service capacity by, establishig graduate year programs, alog with existig studet placemets i NSW, will require LHDs to balace service provisio agaist educatio ad traiig, especially i the use of seior detal ad oral health staff, ad detal chairs. Cotiuig Professioal Developmet Cotiuig professioal developmet (CPD) is the systematic maiteace, improvemet, ad broadeig of kowledge ad skills, ad the developmet of persoal qualities ad values ecessary for the coduct of professioal duties throughout a perso s workig life. A compulsory CPD program was established by the Detal Board of Australia i July 2010 to esure professioal members maitai professioal competece; update their existig kowledge ad skills; ad attai ew or additioal kowledge ad skills. Give this compulsory requiremet, LHDs eed to esure that staff developmet ad educatio programs are eligible for CPD poits. The role of the HETI i the cosolidatio of detal cliical teachig ad educatio coordiatio will eed to be cosidered. Educatio ad Traiig of the No-Detal Workforce As described earlier, oral health is part of geeral health, ad hece the broad health workforce eeds to be up-skilled with regard to basic oral health care where appropriate. The Commuity Services ad Health Idustry Skills Coucil (CSHISC) project Developmet of Oral Health Competecies for the Commuity Services ad Health Workforce, 17 led to the developmet of seve TAFE-based modules. These are aimed at Aborigial ad Torres Strait Islader workers, urses, aged care workers, childcare workers, ad others i similar roles, i recogitio that they already provide some basic oral health care to their cliets ad, with appropriate traiig, could be more effective. The Commowealth Govermet also has programs to trai aged care workers i esurig residets daily oral hygiee is maitaied. Some oral health educatio ad traiig is provided to health ad commuity practitioers by oral health staff but o a more iformal basis. Depedet o Commowealth fudig iitiatives. Oral Health 2020: A Strategic Framework for Detal Health i NSW NSW Health PAGE 17

20 Professioal Educatio Actios Resposibility Parters Develop ad implemet a cosistet approach across NSW to the recruitmet ad professioal developmet of ew detal graduates. Collaborate with the Commowealth ad other stakeholders i the implemetatio of graduate year programs. Facilitate the CliCoect scheme i NSW to esure appropriate opportuities for cliical placemets. Ecourage uiversities to adopt the model that the detal team becomes the basis for traiig of oral health practitioers i NSW. Collaborate with HETI, the ADA (NSW), uiversities ad other educatio providers i the developmet of a suite of educatio courses appropriate to the public sector that meet CPD requiremets. Support the professioal developmet of oral health professioals from rural ad regioal cetres i oral health care for people with chroic coditios ad special eeds. Ecourage o-detal professioals to udertake relevat modules i oral health. Provide ursig, medical ad allied health persoel with iformatio, kowledge ad skills to esure the recogitio of oral health as a itegral compoet of geeral health. Develop oral health educatio programs for carers ad other health professioals that ecourage prevetio, early idetificatio ad referral. Advocate for educatioal opportuities to build the capacity of Aborigial health workers. Ecourage staff who work with older people i Nursig Homes to udertake the Better Oral Health i Residetial Care Program. COHS, LHDs, Workforce Developmet ad Iovatio Brach COHS, LHDs, HETI, Workforce Developmet ad Iovatio Brach Workforce Developmet ad Iovatio Brach COHS COHS, HETI, HETI, HETI HETI HETI COHS COHS, LHDs ADA, Uiversities, Health Workforce Australia ADA ADA Idustry Skills Coucil ADA, Uiversities, TAFE AH&MRC, AMSs NGOs, Aged Care Sector, Departmet of Health ad Ageig PAGE 18 NSW Health Oral Health 2020: A Strategic Framework for Detal Health i NSW

21 Data, Research ad Evaluatio Populatio oral health ad detal health services research, ogoig moitorig of service quality ad efficiecy data, ad evaluatio of existig programs, are all required to build a evidece base o the chagig oral health status of the populatio (icludig sub-populatio groups), ad to describe access to, ad beefit from, detal services ad programs. Data, research ad evaluatio efforts ito the future will eed to focus o: 1. Service data to esure ehacemets i the reportig of detal health services quality ad performace 2. Oral Health Services Research to idetify ew models of care ad opportuities to icrease effectiveess ad efficiecy withi service delivery 3. Program Evaluatio to provide iformatio o the efficiecy ad effectiveess of ew ad existig programs, icludig health promotio ad Aborigial health iitiatives 4. Oral Health Epidemiology to describe the oral health status of the populatio. It is recogised that NSW Health will eed to work i partership with may stakeholders, such as Uiversities ad the ACI, to ecourage ad facilitate improved data collectio ad reportig, ad evaluatio ad research i the required program areas. Data, Research ad Evaluatio Actios Resposibility Parters Idetify potetial collaborators ad fudig opportuities to support the data collectio ad evaluatio research priorities. Commuicate ad dissemiate performace data ad research ad evaluatio fidigs so they ca be used by o-govermet orgaisatios, detal professioals ad policy makers. Esure that evaluatios ad research cocerig Aborigial ad Torres Strait Islader people is based o the key Aborigial health priciples ad actio-orieted leadig to improved oral health. Ecourage research ad evaluatio ito the oral health ad detal service eeds of priority populatio groups. COHS, Cetre for Epidemiology & Evidece COHS, Cetre for Epidemiology & Evidece COHS, Cetre for Epidemiology & Evidece COHS, Cetre for Epidemiology & Evidece ADA AH&MRC, AMSs AH&MRC Oral Health 2020: A Strategic Framework for Detal Health i NSW NSW Health PAGE 19

22 Moitorig Progress Overall the progress of this Framework will be measured by determiig whether its Goals have bee achieved: improved access, reduced disparities, ad improved oral health. The overarchig performace idicators iclude: 1. A reductio i the percetage of people across all age groups who: are edetulous have ay decayed teeth have periodotitis. 2. A icrease i the percetage of people across all age groups who: have te or more occludig pairs of teeth. 3. Esure cliically appropriate ad quality services by maitaiig low levels of: re-treatmet followig restorative treatmet deture remake. These idicators will be measured usig oral health surveys that iclude a detal examiatio, i cojuctio with routie moitorig of the health status of the populatio through self-report surveys. Oral health data plays a importat role i the efficiet maagemet of services ad therefore i achievig better oral health outcomes for the commuity. It is importat that all LHDs have access to timely ad appropriate iformatio o cliical safety, performace, ad productivity. The Iformatio System for Oral Health (ISOH) was implemeted i , ad ecompasses the Priority Oral Health Program (POHP) triage system that prioritises cliets for cliical care. This system assists oral health services i NSW i: 1. adherig to NSW Health prioritisatio policies 2. maagig waitig lists 3. providig useful de-idetified data o utilisatio rates ad types of treatmet provided. The ISOH ad its associated applicatios will cotiue to be developed ad ehaced. PAGE 20 NSW Health Oral Health 2020: A Strategic Framework for Detal Health i NSW

23 Key Performace Idicators (KPI) are curretly collected through ISOH ad used to moitor efficiecy of the delivery of public detal services. These iclude but are ot restricted to Weighted Occasios of Service (WOOS), cliical hours ad waitig times. Revised systems ad aalytical processes are beig itroduced to keep abreast of chagig accoutability requiremets ad electroic data capture. Referral pathways ad processes cotiue to be developed ad implemeted as liks betwee oral health ad geeral health are cosolidated. Icluded i this latter group are the itroductio of the electroic oral health record ad digital imagig. Beyod routiely collected idicators, program evaluatios for key iitiatives will also provide iformatio about how successful programs have bee, ad idetify opportuities to improve program rollout. Oral Health 2020: A Strategic Framework for Detal Health i NSW NSW Health PAGE 21

24 Refereces 1. Commowealth of Australia. Budget Paper No. 2, Budget Measures Caberra: Commowealth of Australia, Garde F, Moore H, Jorm L. The curret ad future health status of the New South Wales populatio (summary report). Sydey: NSW Departmet of Health, Australia Health Miisters Advisory Coucil, Steerig Committee for Natioal Plaig for Oral Health. Oral health of Australias: atioal plaig for oral health improvemet: fial report. Adelaide: South Australia Departmet of Huma Services, Cetre for Oral Health Strategy NSW. The New South Wales Child Detal Health Survey Sydey: NSW Departmet of Health, Available at (accessed 19/07/2012). 5. Sivaeswara S. The oral health of adults i NSW, NSW Public Health Bulleti 2009; 20 (3 4): Available at (accessed 19/07/2012). 6. NSW Departmet of Health, Cetre for Epidemiology ad Research Report o Adult Health from the New South Wales Populatio Health Survey. Sydey: NSW Departmet of Health, Available at 7. Slade G, Specer A, Roberts-Thomso K. Australia's detal geeratios: the Natioal Survey of Adult Oral Health Caberra: Australia Istitute of Health ad Welfare, 2007: Douglass J, Douglass A, Silk H. A practical guide to ifat oral health. America Family Physicia. 2004; 70: NSW Departmet of Health. Aborigial Health Impact Statemet ad Guidelies. Policy Directive PD2007_082. Sydey: NSW Departmet of Health, Commowealth Departmet of Health ad Ageig. Better Oral Health i Residetial Care Traiig Project. Available at (accessed 18/07/2012). 11. Australia Istitute of Health ad Welfare Detal Statistics ad Research Uit. Geographic variatio i oral health ad use of detal services i the Australia populatio : Research Report 41. Adelaide: AIHW Detal Statistics ad Research Uit, Available at files/rr41_geographic.pdf (accessed 19/07/2012). 12. Acheso D. Idepedet iquiry ito iequalities i health. Lodo: Statioery Office, PAGE 22 NSW HEAlth Oral Health 2020: A Strategic Framework for Detal Health i NSW