western nsw local health district oral health service plan and repo… · oral diseases are among...

Western NSW Local Health District

Adapted from the artwork of Jasmine Sarin

ORAL HEALTH SERVICE PLAN2017-2020

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WesternNSWLocalHealthDistrictacknowledgesthetraditionalcustodiansofthelandsacrossourregion.WeacknowledgethatweliveandworkonAboriginallands.WepayourrespectstoElderspastandpresentandtoallAboriginalpeople.

WESTERN NSW LOCAL HEALTH DISTRICT ORAL HEALTH SERVICE PLAN 2017-2020 Plan endorsed by the Western NSW Local Health District Board on 7 February 2018 Aboriginal Health Impact Statement endorsed 27 September 2017

This work is copyright. It may be reproduced in whole or part for study or training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the Western NSW Local Health District. © Western NSW Local Health District 2018

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CONTENTS EXECUTIVE SUMMARY ..................................................................................................................................................................................................................................5 UNDERSTANDING ORAL HEALTH ...................................................................................................................................................................................................................6

The significance of poor oral health ..................................................................................................................................................................................................................................... 6 The oral health of Aboriginal people and communities ......................................................................................................................................................................................................... 7 Oral health in the Western NSW LHD ................................................................................................................................................................................................................................... 8

THE WESTERN NSW LHD ORAL HEALTH SERVICE ...........................................................................................................................................................................................9 Demand for and delivery of services .................................................................................................................................................................................................................................. 10 Clinical quality indicators ................................................................................................................................................................................................................................................... 11

PLANNING FOR THE FUTURE ....................................................................................................................................................................................................................... 12 The Western NSW LHD Strategic Plan 2016-2020 ............................................................................................................................................................................................................... 12 Oral Health 2020: A Strategic Framework for Dental Health in NSW.................................................................................................................................................................................... 13 Consultation and reflections to sharpen our focus .............................................................................................................................................................................................................. 14 What we will do ................................................................................................................................................................................................................................................................ 15

THE PLAN .................................................................................................................................................................................................................................................... 16 Plan at a glance ................................................................................................................................................................................................................................................................. 16 Principle 1: Invest more where it is needed the most ......................................................................................................................................................................................................... 17 Principle 2: Build the capacity of our team to achieve our goals effectively and efficiently ................................................................................................................................................... 18

Goal 1: Plan and promote our services to more effectively reach our priority populations ......................................................................................................................... 19 What the evidence tells us ................................................................................................................................................................................................................................................. 19 What we will do ................................................................................................................................................................................................................................................................ 20

Goal 2: Design and deliver our services with uncompromising standards of care ........................................................................................................................................ 25 What the evidence tells us ................................................................................................................................................................................................................................................. 25 What we will do ................................................................................................................................................................................................................................................................ 26

Goal 3: Invest in prevention and preventive care to improve oral health across our communities .............................................................................................................. 35 What the evidence tells us ................................................................................................................................................................................................................................................. 35 What we will do ................................................................................................................................................................................................................................................................ 36

REFERENCES ................................................................................................................................................................................................................................................ 42

EXECUTIVE SUMMARY

Good oral health is essential to our health and wellbeing, and oral disease including dental caries (tooth decay), periodontal disease (gum disease) and oral cancers are among the most common and costly health problems experienced by Australians. The most common clinical consequences of oral disease are infection and tooth loss. Oral disease can be associated with pain and has broader implications, affecting a person’s ability to chew and swallow, thus affecting their overall nutrition and potentially contributing to a range of other health issues. Oral disease can disrupt speech, sleep and productivity, erode self-esteem, psychological and social wellbeing, and have a detrimental impact upon relationships and quality of life.

The Western NSW Local Health District (LHD) provides public oral health services across our District to people who live in the Western NSW LHD, have a valid Medicare card, and are either a child (under 18 years of age) or hold one of the following Centrelink concession cards: Centrelink Health Care card, Centrelink Pensioner Concession card or Commonwealth Seniors Health card. This is a total potential eligible population of 145,150 people (54% of the people living in our District) including 66,546 children and 78,604 adults.

This document describes our plan for oral health service delivery over the coming three years July 2017 to June 2020. In alignment with our Western NSW LHD Strategic Plan 2016-2020, we are committed to achieving outcomes for healthier rural people and thriving communities. Oral Health 2020: A Strategic Framework for Dental Health in NSW highlights the importance of improving access to oral health services, reducing the inequities experienced by some groups within our communities, and increasing investments in prevention. The latter is a particular focus of our planning for the future. We must strike a balance between meeting

immediate clinical demands and investing more in proactive, preventive strategies to reduce those demands in the future.

The development of this plan has drawn from evidence and the strategic directions outlined in national, state and local planning documents. To build upon this, a consultation process was undertaken with our team, service partners and local stakeholders including consumer representatives. We are a strong team. We proudly acknowledge our achievements made in relation to proactive interventions such as the Early Childhood Oral Health Program (ECOH) and 10-minute assessments to triage and plan oral health care. The Priority Oral Health Program (POHP) for fairness and patient flow, a successful voucher system to expand service options for our patients, and building strong partnerships are other important priorities that we will continue to focus on, such as those with Aboriginal Community Controlled Health Organisations, local Health Councils and Aboriginal Working Parties.

We also recognise the work that lies ahead, including more focus on older people, particularly those who require support for daily living, more investments in evidence-based, coordinated prevention, better awareness in the community of service availability/eligibility, better access for people in remote areas, services closer to home, more specifically-targeted strategies for disadvantaged groups, ensuring that our single point of contact centre is working effectively, and extending fluoridation of reticulated water supplies.

The Western NSW LHD Oral Health Service will: 1. Plan and promote our services to more effectively reach our priority

populations 2. Design and deliver our services with uncompromising standards of care 3. Invest in prevention and preventive care to improve oral health across

our communities.

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UNDERSTANDING ORAL HEALTH

The significance of poor oral health

Oral diseases are among the most common and costly health problems experienced by Australians1. Oral disease includes dental caries (tooth decay), periodontal disease (gum disease) and oral cancers, and oral health can also be impacted by injury. Poor oral health has a significant impact not only on individuals, but on the health system and society1. As described in Healthy Mouths Healthy Lives, Australia’s National Oral Health Plan 2015-2024, the broader impacts of poor oral health can include:

• Disturbance to a person’s ability to chew and swallow, thus affecting their overall nutrition2-4.

• Disruptions to speech, sleep and productivity, erosion of self-esteem, psychological and social wellbeing, and impacts upon relationships and general quality of life5, 6.

• Restricted participation at school, the workplace and home, resulting in loss of school or work hours7. On a societal level, this results in the loss of millions of work days each year8.

• Association with possible increased risk of other diseases such as heart and lung infections, stroke, aspiration pneumonia, low birth weight and premature birth, although causality has yet to be proved. For those with diabetes, gum disease can affect the control of blood sugar and increase the risk of diabetic complications. Gum disease is also associated with rheumatoid arthritis1.

• Delays in receiving treatment often leads to serious infection, pain and poorer long-term health outcomes as well as increased presentation to general practitioners, emergency departments and hospital admissions1.

Image acknowledgement: Victorian Department of Health9

http://www.coaghealthcouncil.gov.au/Portals/0/Australia%27s%20National%20Oral%20Health%20Plan%202015-2024_uploaded%20170216.pdf

http://www.coaghealthcouncil.gov.au/Portals/0/Australia%27s%20National%20Oral%20Health%20Plan%202015-2024_uploaded%20170216.pdf

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The oral health of Aboriginal people and communities

Western NSW Local Health District (LHD) is home to over 30,700 Aboriginal people, representing 11.1% of our District’s total population10. Achieving meaningful gains in Aboriginal health is accordingly recognised as a top priority for action in Western NSW LHD, with a focus on achieving a measurable improvement in Aboriginal health and better access to culturally respectful services10. This need is very clear in oral health. Aboriginal people experience significantly more oral disease than other Australians11-13.

• Aboriginal children typically have more than twice the caries experience and a greater proportion of untreated caries than other Australian children11. This is evident for both deciduous (child or milk teeth) and permanent (adult) teeth13.

• Aboriginal adults have more missing teeth than other Australian adults11, 13, twice the number of decayed teeth12, 13 and three times the number of decayed surfaces12, 13. Aboriginal adults also experience higher rates of periodontal disease which has flow-on complications for people with diabetes, which is also more prevalent in Aboriginal adults13.

• Aboriginal people are less likely to access and utilise preventive dental care14. • Aboriginal people are more likely to experience injury14.

Addressing these issues is a high priority for our services. The underlying factors are complex: living in a remote area, living in small communities without fluoridated water and being socioeconomically disadvantaged are all predictors of poor oral health11. Aboriginal people are strongly represented in all these groups, and the compounding increased risk is apparent. Access to and uptake of services also remain substantial barriers to Aboriginal oral health11, 13, 15. Aboriginal people experience generally poorer health in many ways16, 17 and the complexity of managing co-morbidities can also make it challenging to manage other aspects of one’s health, such as oral health.

Our efforts will be directed by the needs of our local communities, with consultation and engagement to be at the heart of our approach. If the way that we deliver services now is not effective for Aboriginal people and communities, then we must and will consider different approaches. This journey will be undertaken in close partnership with Aboriginal Community Controlled Health Organisations, local Health Councils and Aboriginal Community Working Parties. We will also be guided by key strategic documents including The NSW Aboriginal Oral Health Plan 2014-202015 and Achieving oral health equity for Aboriginal communities in NSW, a position paper produced by the Aboriginal Health and Medical Research Council13. Both highlight key principles for action that are familiar across Aboriginal health, including self-determination, taking a holistic perspective and paying greater attention to the social determinants of health. These concepts have influenced and are embedded in this plan, along with two key priorities for improving Aboriginal oral health:

« We will make greater investments in prevention, particularly in the formative years of childhood. « We will improve access to and encourage better uptake of culturally safe services.

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Oral health in the Western NSW LHD

18-21

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THE WESTERN NSW LHD ORAL HEALTH SERVICE

Unlike other health services, public oral health services are not covered by the principle of universal access. To ensure available resources are used efficiently, NSW Health limits access to these services to those populations at higher risk of dental disease or who are less able to afford dental care through private providers22. Specifically, to use public oral health services provided in Western NSW LHD you must live in Western NSW LHD, have a valid Medicare card, and must either be a child (under 18 years of age) or hold one of the following Centrelink concession cards: Centrelink Health Care card, Centrelink Pensioner Concession card or Commonwealth Seniors Health card.

The Western NSW LHD Oral Health Service provides a range of free dental services to eligible patients. Most are provided in our dental clinics but sometimes patients can access services through a local private dentist with a ‘dental voucher’. Our Dental Contact Centre provides a single point of contact for our services, including initial inquiries and appointment management.

Services are delivered through various means as shown in the map (left) including in partnership with Aboriginal Community Controlled Health Organisations, the Royal Flying Doctor Service and Charles Sturt University.

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Demand for and delivery of services

NSW Centre for Oral Health Strategy analyses of population estimates and Centrelink eligibility data undertaken in 2013 suggest that 145,150 people or 54% of the total Western NSW LHD population are eligible for public oral health services. This includes 66,546 children and 78,604 adults23.

In the 12 months to June 2017 our Dental Contact Centre took 61,923 phone calls which were a mix of patients seeking access to care, general enquiries, appointment changes, new appointments made, private providers, and dental clinic staff. These calls resulted in 22,167 triages (initial telephone based assessments) being conducted for oral health care. We delivered 39,386 appointments to adults and children at our dental clinics. An additional 35,425 appointments were delivered through other dental clinics, paid for through the dental vouchers system.

Data from the last 5 years are shown below, indicating heavy traffic through the Dental Contact Centre, ongoing demand for triage and clinic appointments, and a substantial increase of the use of vouchers to manage patient demand and flow.

For the purposes of reporting to the NSW Ministry of Health, overall clinical activity is reported in terms of Dental Weighted Activity Units (DWAUs) which is a weighted data system that factors in the complexity of services delivered. Since the reporting system was introduced in 2013, we have met all targets.

57,33067,879 66,896 70,033 61,923

020000400006000080000

12/13 13/14 14/15 15/16 16/17

Contact Centre Calls handled

24,191 24,851 22,817 24,218 22,167

0

10000

20000

30000

12/13 13/14 14/15 15/16 16/17

Triages conducted

39,319 36,665 35,684 37,634 39,386

010000200003000040000

12/13 13/14 14/15 15/16 16/17

Dental Clinic appts

15,259

26,45821,909

34,121 35,425

010000200003000040000

12/13 13/14 14/15 15/16 16/17

Other dental clinic appts - vouchers

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Clinical quality indicators

The Western NSW LHD Oral Health Service has three key clinical quality indicators. We are currently exceeding our performance targets on all three.

Definition: Number of attendances for complication within 7 Days of routine extraction, during the time period under study24.

These data reflect a stable continuum of outcomes for patients following an extraction. Clinicians have adopted the ideals of Antimicrobial Stewardship across the District since 2015, resulting in a significant decrease in prescriptions without a corresponding increase in unscheduled or scheduled returns. As well as meeting our clinical KPI, these local results are also below the 2015 national rate average of 1.8%24.

Definition: Retreatment of same tooth following restorative treatment within 6 months (1 to 183 days) from the initial treatment. Retreatment refers to any treatment provided to the same tooth or for the same condition within the study period and includes repeat of the same treatment, eg. replacement of an amalgam and/or further treatment of the same tooth, eg. replacement of a restoration with a new restoration, extraction of a restored tooth24.

We have reviewed many of our clinical processes to decrease the retreatment of a tooth restored within the preceding 6 months. Particular effort was applied to diagnosis and consideration of the prognosis of a tooth prior to placing a restoration, and to rigid application of manufacturer’s instructions regarding the use of dental materials. Consequently we are meeting our clinical KPI and are well below the 2015 national rate of 7.1%24.

Definition: Number of same denture type (full or partial) remade within 12 months following initial denture issue24.

The large majority of dentures constructed within the District is by private practitioners under the Oral Health Fee for Serviced Scheme (OHFFSS). Vouchers improve access to care closer to home, particularly in remote areas. Occasionally dentures do not meet patient’s expectations, and sometimes the dentures do not perform as well as they should. In these cases, staff work with the private provider requesting a refund of voucher before commencing reconstruction of the patient’s dentures. This process of continuous performance review contributes to the low remake rate for dentures. As well as meeting our local clinical KPI, we are performing well against the national benchmark which has been below 3% since 200924.

1.24% 1.24% 1.10% 1.08%

3% 3%2% 2%

0%2%4%6%8%

2013-14 2014-15 2015-16 2016-17

Return following simple extraction

Western NSW LHD actual KPI target (to be less than)

5.74%4.13% 3.88%

2.72%

6% 6%5% 5%

0%2%4%6%8%

2013-14 2014-15 2015-16 2016-17

Retreatment following restorative treatment


1.49% 0.60% 0.71% 0.54%

3% 3%2% 2%

0%

2%

4%

6%

2013-14 2014-15 2015-16 2016-17

Denture remakes


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PLANNING FOR THE FUTURE

The Western NSW LHD Strategic Plan 2016-2020

The Western NSW LHD Strategic Plan 2016-2020 outlines our purpose (why we are here), our focus areas (what we will deliver by 2020) and our enablers (how we will make this possible)10. Our District goal of healthier rural people and thriving communities will be achieved by a focus on four key areas of activity as shown below right. These key areas have informed the development of this service plan.

Healthier rural people – thriving communities

WHY

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PLALA

OUR PURPOSE

Adapted from the artwork of Jasmine Sarin

STRATEGIC PLAN 2016 - 2020

Western NSW Local Health District

Healthier rural people – thriving communities

WHY

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OUR PURPOSE

Living Well Together

HEALTHIER RURAL PEOPLE – THRIVING COMMUNITIES

Aboriginal health Chronic

and complex

care

Maternal and child

healthMental

health and substance

abuse

Older persons

care

PRIORITY HEALTH AREAS

OUR VALUES - COLLABORATION, OPENNESS, RESPECT, EMPOWERMENT

WHAT

HOW

LWT

WE WILL ACHIEVE

WE WILL MAKE THIS POSSIBLE

WHYWE ARE HERE

• High performing teams • Enabling technology and systems• Innovation and research• Productive partnerships• Contemporary infrastructure• Financial sustainability• Effective communication

LIVING WELL TOGETHER

IMPROVED HEALTH AND WELLBEING OF RURAL

PEOPLE

MEANINGFUL GAINS IN

ABORIGINAL HEALTH

WORLD CLASS RURAL HEALTH CARE

ONE HEALTH SERVICE

ACROSS MANY PLACES

FOR

PE

OP

LE A

ND

C

OM

MU

NIT

IES

FOR

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WO

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https://wnswlhd.health.nsw.gov.au/Downloads/Publications%20and%20Reports/WNSWLHD_StrategicPlan_FINAL_21.11.16_LORES.pdf

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

Strategic priorities for the delivery of public oral health services across NSW are outlined in Oral Health 2020: A Strategic Framework for Dental Health in NSW11. This describes three key goals which have also informed the development of this plan.

Improving the dental visiting pattern across the whole population remains a challenge for the dental system in NSW. A significant proportion of the NSW population does not access dental services regularly, and this is most notable amongst those in our communities who experience disadvantage11, 15, 19, 20. Ensuring access to public oral health services is a challenge, particularly in rural and remote areas11, 15.

Certain groups within our communities require additional focus to ensure disparities in oral health status are reduced11, 15, 18. Aboriginal and Torres Strait Islander people, older people, adults and children with special needs, early childhood (notably children in out-of-home care) and those in rural/remote communities where access to services is limited are identified as priority populations in Oral Health 2020.

The growing demand for individual treatment will need to be balanced with funding for preventive strategies. Prevention strategies such as the fluoridation of water, health promotion and disease prevention form the third key goal of Oral Health 2020. This is required to reduce the burden of poor oral health on our communities and on our health system, and again with a strong focus on priority populations who experience this burden the most11, 15.

http://www.health.nsw.gov.au/oralhealth/Publications/oral-health-2020.pdf

http://www.health.nsw.gov.au/oralhealth/Publications/oral-health-2020.pdf

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Consultation and reflections to sharpen our focus

Our LHD Strategic Plan and Oral Health 2020 provide a clear strategic path for our oral health services in Western NSW LHD. To build upon this, a consultation process was undertaken with our team, service partners and local stakeholders including consumer representatives. The following themes emerged as key priorities to shape this plan.

What we are doing well and will build upon • Proactive interventions such as the Early Childhood Oral Health

Program (ECOH)25 • 10 minute assessments to better triage and plan oral health care • Priority Oral Health Program (POHP)26 for fairness and patient flow • Voucher system including for dentures • Partnerships, such as those with Aboriginal Community Controlled

Health Organisations, local Health Councils and Aboriginal Community Working Parties

• We are a strong team

What we must and will do better • More focus on older people, particularly those who require support

for daily living • More investments in evidence-based, coordinated prevention • Better awareness in the community of service availability/eligibility • Better access for people in remote areas: services closer to home • More specifically-targeted strategies for disadvantaged groups • Ensuring our single point of contact centre is working effectively • Extending fluoridation of reticulated water supplies

What will make us a strong, quality service Important concepts from our LHD Strategic Plan will guide our work.

Other important influences include but are not limited to:

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Western NSW Local Health District | Strategic Plan 2016 – 202014 15

Workforce

Recruitment and retention of a skilled workforce is difficult, particularly in small rural and

remote communities. Maintaining workforce capability and agility to meet rapidly changing

models of care and technology is problematic. We must continue to investigate and

adopt new ways of working that make better use of the available workforce and match

capabilities with the health needs of local communities.

Financial sustainability

Ensuring that health services make a difference to

the health of communities, are of high quality, and

deliver value for public money will be at the heart

of every consideration. The Triple Aim Framework

(a decision making framework that simultaneously

aims to improve patient experience, improve

population health and reduce the cost of health

care)24 will continue to provide the basis for a

balanced approach to health system planning

and decision making.

Our opportunities

While we continue to face significant challenges,

the current environment also presents us with

opportunities.

We have led and participated in a range of reform initiatives over the last three years.

The Integrated Care Strategy is expanding with the commencement of the Wave Two

demonstrator sites. Roll out of telehealth infrastructure and implementation of telehealth

models of care is improving the integration of care provided across our region and

facilitating access to specialist services closer to home. We can share the learnings and

sustain the successes from these initiatives.

We maintain our commitment to improving the health of Aboriginal people, with

a renewed focus on making a meaningful difference. This will be supported by the

development of partnerships with Aboriginal people and organisations which are

built on trust and common goals.

Our challenges

Meeting the needs of our community

Western NSW communities rightfully have high expectations regarding the scope and quality of the

services they receive. Providing services equitably across a geographically sparse population requires

innovation, a willingness to embrace change and new ways of working.

As a major provider of health services in the west of NSW, we are committed to improving access to

services, by providing services that people trust and feel safe using. This is particularly important for

the many vulnerable groups within our communities.

A focus on developing and sustaining services across the whole of the region, including providing

care as close to home as possible will assist in meeting the needs of communities. Reducing the

number of people leaving the region for care will also alleviate some of the social and financial

pressures associated with travel and time away from home.

Our population

of the NSW population4

live in Western NSW LHD

(277,353)3.6%

246,494 km2

(30,786)people11.1%

WESTERN NSW LHD

Orange

Bathurst

Mudgee

Parkes

Forbes

Cowra

Dubbo

increased prevalence of chronic disease including dementia, with fewer carersand an greater need for health and social services.

OLDER POPULATION

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years

(NSW

med

ian ag

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s

than

15years

% 31%landmassof NSW

Western NSW LHD

covers

2.9%in NSWe

Mudgeeeee

o

Win NSW

People living in the more sparsely populated north western and remote

areas of our region are often socioeconomically

disadvantaged, have poorer health, and have

di�culty accessing health services. 60%

live here

Approx

pred

icted p

opulation g

rowth

to 2031

10which is low

er than the anticipated

5.5%

pop

ulation grow

th for NSW

overall (24.5%

) 4

Population growth is uneven across

our region. Growth is expected in the southern and eastern parts of the

region but there will be a decline in the

north and west.are Aboriginal4

are Aboriginal4

Impr

oved

qua

lity,

saf

ety

& ex

perie

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of c

are

Improved health & equity

for all populationsIND

IVID

UAL PO

PULATION

SYSTEMBest value for public

health system resources

QUALITYIMPROVEMENT

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Western NSW Local Health District | Strategic Plan 2016 – 202030 31

HOWHOW WE WILL MAKE THIS POSSIBLE

Enabling technology and systems

WHAT WILL WE DO? We will become Australia’s first digital health region through implementing ehealth solutions.

How will we do it?

Implement the eHealth Strategy

Design a digital health strategy to become Australia’s first Digital Health Region across health providers

Ensure our Information and Communication Technology (ICT) services become more customer focussed

Innovation and research

WHAT WILL WE DO? We will increase our capacity and capability to contribute to and lead innovation and research aligned our priorities.

How will we do it?

Implement the Research Strategy, with a strong focus on collaborating with research partners and prioritising future research activities

Support the Greater Western Human Research Ethics Committee to meet the performance requirements for health and medical research including clinical trials

In partnership with the Agency for Clinical Innovation, develop an innovation strategy

High performing teams

WHAT WILL WE DO?We will foster employee engagement, culture and diversity in order to enhance the capability and performance of all employees in our organisation.

How will we do it?

Implement the actions within the priority areas of our Workforce Plan

Establish an Organisational Development Unit

Develop the Workforce Culture Strategy - ‘Working Well Together’

Build a safety culture

Strengthen our clinician engagement strategy

Improve contractual arrangements for the appointment of clinicians

Partner with education providers to build the capacity and capability of the workforce

Improve the engagement of and support for volunteers

Implement a carer support strategy

HO

W W

E W

ILL MA

KE

TH

IS P

OSS

IBLE

Achieving success in our four focus areas is dependent upon:

Enabling technology and systems

Innovation and research

Contemporary infrastructure

High performing teams

Productive partnerships

Financial sustainability

Effective communication

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What we will do

Drawing upon all these important elements, the following describes the priorities of this plan, including three goals.

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THE PLAN

Plan at a glance

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Principle 1: Invest more where it is needed the most

All things being equal, health services might be delivered on a simple, one-size-fits-all basis. An equal, fair share for all. But all things are not equal. There are clear differences in health and wellbeing across the whole social gradient of our communities – and not just in one small group that experiences the most extreme disadvantage27, 28. Disadvantaged people typically use preventive health services less often, have more health risks, get sick more often and more severely, and die younger29, 30. Addressing the inequities that exist across our own local communities is a strong priority of our LHD Strategic Plan10. We have clear evidence that people who experience disadvantage:

• Are less likely to have visited a dentist in the last 12 months11, 19 • Are less likely to be free of dental caries at ages 5-6 and 11-1218 • Are more likely to be hospitalised for oral health treatment21

Inequities in oral health are universally acknowledged as a priority for action by both national1 and state11 strategic oral health plans, as well as specialist oral health plans addressing the needs of populations such as Aboriginal people in NSW15. The Western NSW LHD Oral Health Service will enact this by investing more where it is needed the most. NSW Health policy already limits access to our services to those who are at high risk or who are less able to afford private dental care22. We will meet these obligations but extend that principle further, to plan and deliver services in a more proactive way. We recognise that the people who are hardest to reach are often the very ones we need to reach the most – and that this frequently requires specifically tailored strategies and specific investments to be made31-33.

Our priority populations are people eligible for our services who are:

• Aboriginal • Pregnant women • Vulnerable families and children • Older people, particularly those who require

support for daily living • People who live in remote areas • People with chronic and complex conditions

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Principle 2: Build the capacity of our team to achieve our goals effectively and efficiently

Whilst this plan describes what we will do, in order to maximise the likelihood of achieving our goals it is equally important that we consider how to do that. We will implement the plan with a focus on building the capacity of our team to achieve our goals effectively and efficiently.

A Framework for Building Capacity to Improve Health34 provides a structured approach to this. It poses practical planning questions, recognising that each must be answered within the relevant context and will most likely require a different mix of strategies. So whether it is to improve policy compliance, better meet the needs of Aboriginal people or introduce routine preventive care in our clinical services, we will ask:

• What organisational development is needed, such as changes to the structures, systems, policies, procedures or practices?

• What workforce development would help to ensure that our people have the abilities and commitment to achieve this?

• What resources should be allocated – including but not limited to people, infrastructure, administrative support, planning tools, access to information, best practice guidelines or direct service funding?

• How will working in partnerships within and beyond our services help us to achieve our goals, and how will we foster more effective partnerships to do so?

• What leadership will drive our teams to meet these goals? This is not limited to management roles but also includes the project champions and natural leaders within our teams and partnerships.

These questions have informed the development of the specific actions in this plan and will continue to inform our process as we implement it.

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Goal 1: Plan and promote our services to more effectively reach our priority populations

What the evidence tells us

A significant proportion of the NSW population does not access dental services regularly11. It is concerning that the total percentage of people living in our LHD that have visited any dental health professional in the last 12 months is lower than the NSW average, and contrary to state trends, has dropped over the last decade.

Western NSW LHD has large numbers of people eligible for our public oral health services. NSW Centre for Oral Health Strategy analyses of population estimates and Centrelink eligibility data undertaken in 2013 suggest that 145,150 people or 54% of the total Western NSW LHD population are eligible for public oral health services. This includes 66,546 children and 78,604 adults23. Demand frequently outstrips supply, particularly for adults, and a significant concern is our ability to target those valuable service resources to reach the people who need it the most.

Consultation with our team, service partners and local stakeholders including consumer representatives indicated that there are also significant and growing challenges around meeting the needs of older people, particularly those who require support for daily living.

Finally, the consultation also revealed issues regarding poor public awareness of service availability and eligibility as per NSW Policy22. Many of those who might benefit the most from our services are not aware of them or how to access them. This was also recognised as a priority for attention in this first goal, which primarily deals with service planning and promotion. The second goal will go on to discuss service delivery.

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What we will do

Goal Objectives Key themes Signals of success

Goal 1: Plan and promote our services to more effectively reach our priority populations

1.1 Gather the necessary evidence to determine the actual and desirable reach of our services, to plan and promote them more effectively.

1.2 Plan our services to more proactively address equity issues and improve access for priority populations, including a strong focus on providing care as close to home as possible.

1.3 Ensure that service planning considers the needs of a changing population.

1.4 Design and deliver direct-to-public promotional activities that raise awareness of service availability and eligibility across our communities, with a focus on priority populations.

1.5 Design and deliver cross-collaboration promotional activities to raise awareness of service availability and eligibility amongst relevant LHD teams/partners/local organisations who have access to our priority populations.

1.6 Ensure that our Dental Contact Centre is working effectively for those who need it most.

Proactive planning and promotion for more equitable reach and service access

We will develop indicators to track:

1A Evidence of better engagement and involvement of consumers and partners

1B Evidence of increased service use by priority populations

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Implementation Detail

Goal 1. Plan and promote our services to more effectively reach our priority populations

Objectives Actions Lead Timeframe

2017-18 2018-19 2019-20

1.1. Gather the necessary evidence to determine the actual and desirable reach of our services, to plan and promote them more effectively.

1.1.1. Undertake a deep data dive to better understand the demands for and gaps in service access and delivery across the LHD, with consideration of the following:

• Who is eligible for our services • Where they live • Who accesses our services and who does not • Service delivery mechanisms (eg clinic, outreach, telehealth)

We will look for differences by priority populations, location and service type in order to better understand and address inequities and access issues.

Director

1.1.2. Supplement the epidemiological work with local consultation and engagement of key stakeholders, service partners, potential referrers and consumers, particularly in reference to access and equity issues. The same scope of inquiry described in 1.1.1 will apply to this process.

Director

1.1.3. Deliver relevant communication and professional development to our workforce to build a better understanding across the whole team of the evidence and consumer input, and what impact these will have on service design and delivery.

Director

1.1.4. Where this process identifies gaps or weaknesses in current data collection and/or data quality, we will make appropriate recommendations for improvement.

Director

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2017-18 2018-19 2019-20

1.2. Plan our services to more proactively address equity issues and improve access for priority populations, including a strong focus on providing care as close to home as possible.

1.2.1. Develop service delivery strategies to specifically explore and/or expand upon:

• Outreach and mobile service delivery

• Service delivery to older people living in residential aged care and who require support for daily living

• Service delivery in shared spaces

Oral Health Managers

1.2.2. Ensure that these actions respond appropriately to issues identified in 1.1 with a focus on better meeting the needs of priority populations of people eligible for our services who are:

• Aboriginal • Pregnant women • Vulnerable families and children • Older people, particularly those who require support for

daily living • People who live in remote areas • People with chronic and complex conditions


1.3. Ensure that service planning considers the needs of a changing population.

1.3.1. Use population projections from multiple, relevant sources to identify future shifts in service demands.

Director

1.3.2. Explore recruitment strategies to prepare for future service focus.

Director

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2017-18 2018-19 2019-20

1.4. Design and deliver direct-to-public promotional activities that raise awareness of service availability and eligibility across our communities, with a focus on priority populations.

1.4.1. Liaise with key stakeholders, service partners, potential referrers and consumers to develop appropriate promotional strategies to specifically target our priority populations, notably exploring the different issues of people eligible for our services who are:



Lead Oral Health Therapist

1.4.2. Build/foster partnerships including but not limited to Aboriginal services and organisations, social care NGOs and other organisations that work with the vulnerable people listed as our priority populations.

Director

1.4.3. Explore promotional strategies including but not limited to:

• Paid advertising • Unpaid promotions such as local media • Tying in with local events (with due consideration of cost-

benefit) • Social media strategies.


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2017-18 2018-19 2019-20

1.5. Design and deliver cross-collaboration promotional activities to raise awareness of service availability and eligibility amongst relevant LHD teams/partners/local organisations who have access to our priority populations.

1.5.1. Liaise with relevant partners including Aboriginal services and organisations, early childhood professionals, aged care services and residential aged care facilities, Out of Home Care services, midwives, integrated care teams and other organisations to develop appropriate strategies to whereby they promote oral services on our behalf to priority populations, notably exploring the different issues of people eligible for our services who are:




1.5.2. Monitor the number of referrals made to our services from other organisations as a means of tracking the impact and influence of the cross-collaboration promotion described above, and providing directions for future action.

Manager Patient Flow

1.6. Ensure that our Dental Contact Centre is working effectively for those who need it most.

1.6.1. Analyse service data and conduct relevant local consultation with stakeholders and consumers to determine whether the Dental Contact Centre is meeting the needs of all priority groups.


1.6.2. Address any identified gaps through service improvement strategies.


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Goal 2: Design and deliver our services with uncompromising standards of care


Both the Australian1 and NSW11 strategic plans for oral health provide clear directions for best practice oral health care. The national foundation areas include oral health promotion (as explored in our Goal 3), service access (as explored in our Goals 1 and 2), systems alignment and integration, safety and quality, workforce development and research and evaluation. Safety and quality are reinforced by the National Safety and Quality Health Services (NSQHS) Standards35. In the oral health service context, service governance, partnering with consumers, preventing and controlling healthcare associated infections, and medication safety are paramount, as well as patient identification and procedure matching, and clinical handover. Our service has achieved accreditation and will work towards maintaining and improving our standards of care.

These national foundations are enhanced at the state level by Policy Directives and Clinical Practice Guidelines that provide more specific directions relating to a range of service issues36. These are enhanced locally by our LHD commitment to uncompromising standards of care10, 37.

Within this second goal that focuses on service delivery, we will design and deliver our services in a proactive and evidence-based way, using data as well as feedback from our consumers and partners to drive service improvements towards the world class rural health care that our LHD Strategic Plan aspires to: that which offers person-centred care and positive experiences, in a workplace that is culturally and clinically safe, with pride in our work, and shared and continuous learning to improve what we do10.

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What we will do


Goal 2: Design and deliver our services with uncompromising standards of care

2.1 Consult and collaborate more effectively with consumers and with other LHD teams, partners and local organisations who have access to our priority populations to determine priorities for service improvement.

2.2 Use data more proactively, systematically and effectively to drive service improvement.

2.3 Ensure a culture of patient safety and transparent accountability. 2.4 Design and deliver person-centred care. 2.5 Attract, develop and retain quality personnel. 2.6 Build the capacity of all our services and teams to achieve accreditation

according to the National Safety and Quality Health Service Standards. 2.7 Build the capacity of all our services and teams to ensure compliance with

NSW Health policies and guidelines. 2.8 Achieve the KPIs and clinical benchmarks set by our LHD. 2.9 Improve timeframes for the delivery of services with a focus on fairness

and efficiency. 2.10 Optimise strategies to meet service revenue targets. 2.11 Develop and implement strategies to ensure that existing clinical

equipment continues to support appropriate and effective clinical service delivery.

2.12 Develop and implement strategies to support mobile care for those in residential aged care.

2.13 Address the functional requirements and build capacity for the Mudgee Community Dental Clinic.

2.14 Build on existing outreach service infrastructure to better serve rural and remote populations.

2.15 Work toward establishment of a Community Dental Clinic in Cowra.

Clinical service quality, safety and infrastructure


2A Feedback from our patients and partners

2B Achievement of service KPIs

2C Achievement of accreditation

2D Improved policy compliance service data

2E Service performance measures demonstrating improvements related to issues such as timeliness and revenue

2F Analysis of all relevant indicators by priority population to ensure that inequities are being addressed

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Goal 2. Design and deliver our services with uncompromising standards of care.


2017-18 2018-19 2019-20

2.1. Consult and collaborate more effectively with consumers and with other LHD teams, partners and local organisations who have access to our priority populations to determine priorities for service improvement.

2.1.1. Increase participation and engagement through a more collaborative, proactive process including Aboriginal Community Controlled Health Organisations, local Health Councils and Aboriginal Community Working Parties.


2.1.2. Ensure that these voices are genuinely heard and understood, demonstrating and documenting how this has occurred, who was involved and what was established.


2.1.3. Demonstrate that consumer input has influenced service design and delivery.


2.1.4. Ensure that there is a feedback loop to reflect back to these contributors regarding what has happened, how that is progressing, and seek their ongoing input to future service delivery. Continue the loop.


2.2. Use data more proactively, systematically and effectively to drive service improvement.

2.2.1. Develop practical and relevant indicators to describe and analyse delivery of this plan.

Director

2.2.2. Analyse all indicators to identify any inequities in the way that services are delivered to priority population groups.

Director

2.2.3. Follow the “plan, do, study, act” process described in the Western NSW LHD Our Health District Living Quality and Safety38, asking: What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement?


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2017-18 2018-19 2019-20

2.3. Ensure a culture of patient safety and transparent accountability.

2.3.1. Include focus on the following, as per the Western NSW LHD Our Health District Living Quality and Safety38:

• Promote a workplace culture in which it is easy to do the right thing, which is honest, transparent and accountable

• Maximise accountability using relevant clinical supervision tools

• Investigate clinical incidents systematically and transparently

• Ensure that our systems for reporting and feedback are robust and encourage proactive reporting of adverse events

• Recognise and address human factors in patient safety. • Ensure that individual and team management systems are

in place to monitor, reflect on and improve these issues regularly.

Clinical Director

2.4. Design and deliver person-centred care.

2.4.1. Include focus on the following, as per the Western NSW LHD Our Health District Living Quality and Safety38:

• Seeing and treating patients and carers as partners in negotiating care

• Effective management of complaints and compliments for improvement

• Open disclosure • Health literacy • Culturally appropriate care • Compassionate care • Effectively measuring patient feedback.

• Ensure that individual and team management systems are in place to monitor, reflect on and improve these issues regularly.

Clinical Director

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2017-18 2018-19 2019-20

2.5. Attract, develop and retain quality personnel.

2.5.1. Implement effective recruitment strategies, including:

• Proactivity in all areas of the recruitment process to minimise the duration of the recruitment process

• Creation of training opportunities to “grow” the local workforce, such as Dental Assisting traineeships

• Exploration of opportunities to increase Aboriginal participation in our workforce, such as identified traineeships and targeted employment opportunities.


2.5.2. Build staff capacity through:

• Professional development opportunities that build the capacity of staff to deliver this plan

• Effective supervision and mentoring of new staff • Formal and informal opportunities to build the leadership

capacity of identified staff in our teams.


2.5.3. Work with education providers to provide opportunities for final year students to experience positive placement in rural public dental clinics.

Director

2.5.4. Use the full scope of team skills across services, including:

• Utilising the full scope of practice for oral health therapists and dental therapists

• Fully utilise dental assistants trained in oral health promotion

• Developing capacity of all clinicians to work in outreach settings.

Clinical Director

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2017-18 2018-19 2019-20 • Fostering a positive workplace culture that values working

as part of a team, offers varied and challenging professional experiences and uses the full potential of personnel.

2.6. Build the capacity of all our services and teams to achieve accreditation according to the National Safety and Quality Health Service Standards.

2.6.1. Further develop local leadership in individual clinics to plan for and meet the requirements of the National Safety and Quality Health Service Standards (NSQHS).


2.6.2. Build skills across the entire workforce in understanding the requirements of the NSQHS and how they embed quality and safety within service delivery.


2.6.3. Improve staff capacity in community engagement for patient feedback (eg through patient rounding) and in facilitating consumer participation in planning and evaluation of our services. Explore similar strategies where appropriate in relevant partner services/organisations.


2.6.4. Actively recruit consumer/community representatives and provide training in the operation of our oral health services so that they may be constructive participants and partners in service planning and evaluation, as per NSQHS Standard 2 Partnering with Consumers35.

Director

2.6.5. Undertake a gap analysis of existing reprocessing standards against the new requirements of AS/NZS 4187:2014 Reprocessing of reusable medical devices in health service organisations39 and develop an action plan based on this.

Lead Dental Assistant

2.6.6. Review audit systems to develop a suite of specific tools that can comprise an Oral Health Standards Evaluation Program.

Clinical Director

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2017-18 2018-19 2019-20

2.6.7. Further embed principles of Antimicrobial Stewardship into the Oral Health Service.

Clinical Director

2.7. Build the capacity of all our services and teams to ensure compliance with NSW Health policies and guidelines.

2.7.1. Ensure compliance with relevant NSW policies and guidelines, with particular attention to those underpinning patient priorities of access to general and specialist services, patient eligibility, and mechanisms to deliver services through the private and not for profit sectors (eg Oral Health Fee for Service Scheme).

Director

2.7.2. Develop/improve service monitoring systems including data collection and management oversight to maintain a better ongoing record of clinical compliance with all policies and guidelines.

Clinical Director

2.7.3. Move to an electronic oral health record that can be seen by all clinicians across the district, to improve compliance and provide better insights to clinical service delivery.


2.8. Achieve the KPIs and clinical benchmarks set by our LHD.

2.8.1. Maintain investment in strategies to achieve the following KPIs (at the time of writing):

• Clinical activity – measured as Dental Weighted Activity Units (DWAUs)

• Dentures remade within 12 months <2% (NB this is Western NSW LHD target – the NSW Ministry of Health target is <3%)

• Teeth re-treated within 6 months <5% (NB this is Western NSW LHD target – the NSW Ministry of Health target is <6%)

• Unplanned return following tooth extraction <2%

Clinical Director

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2017-18 2018-19 2019-20

2.8.2. Ensure that service monitoring systems include data collection and management oversight, and that data are interrogated down to clinic/individual clinician level where appropriate.

Director

2.9. Improve timeframes for the delivery of services with a focus on fairness and efficiency.

2.9.1. Explore service improvements that could accommodate flexibility around appointment times, particularly for patients who travel to appointments.



2.9.2. Build upon already-successful initiatives that encourage greater participation by private sector dentists and other organisations in the treatment of public patients, to reduce waiting times.


2.10. Optimise strategies to meet service revenue targets.

2.10.1. Undertake regular scans for new opportunities for funded projects that fit with the LHD’s model of service delivery (eg new graduate programs and university-based research programs).

Director

2.10.2. Ensure compliance with PD2017_027: Eligibility of Persons for Public Oral Health Care in NSW22 and ensure that parents and carers understand the importance of consenting to bulk billing, so as to maximise revenue for the LHD.


2.11. Develop and implement strategies to ensure that existing clinical equipment continues to support

2.11.1. Develop a plan for preventive maintenance of all dental equipment to ensure this continues when LHD Biomedical Engineering is unable to meet the needs of the Oral Health Service.

LHD Corporate Services and Clinical Support

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2017-18 2018-19 2019-20 appropriate and effective clinical service delivery.

2.11.2. Work with LHD Corporate Services and Clinical Support to ensure all existing dental equipment >$10,000 is included in forward plans for timely replacement and upgrade, including both through the LHD directly and through Spotless where the public private partnership is in place.


2.11.3. Ensure that all equipment that greater than 15 years old as at June 2017 is replaced by 30 June 2019.


2.12. Develop and implement strategies to support mobile care for those in residential aged care.

2.12.1. Work with LHD Corporate Services and Clinical Support to procure new portable dental equipment to support all adult dental clinics to be able to provide outreach mobile dental care in residential aged care facilities.


2.13. Address the functional requirements and build capacity for the Mudgee Community Dental Clinic.

2.13.1. Participate in Product User Group and planning processes for Mudgee Health Service to develop a schedule of accommodation and room requirements based on a five chair dental clinic.

Director

2.14. Build on existing outreach service infrastructure to better serve rural and remote populations.

2.14.1. Continue to work with Health Infrastructure and participate in Product User Group planning to ensure that the Cobar Health Service redevelopment meets the needs of visiting oral health service practitioners.

Director

2.14.2. Establish dental equipment at Oberon Health Service to ensure continuity of the existing public dental service for children, and to improve access to care for adults.

Oral Health Manager

2.14.3. Contribute to planning for Lightning Ridge Community Health to create better clinical spaces to support the provision of

Director

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2017-18 2018-19 2019-20 dental services locally by not-for-profit partner organisations (eg Royal Flying Doctor Service) including increased capacity for students to work under supervision.

2.14.4. Ensure that the Oral Health Service is considered in planning of all new facilities and redevelopments that are proposed within the LHD.

LHD Planning

2.15. Work toward establishment of a Community Dental Clinic in Cowra.

2.15.1. Explore solutions to establish a Community Dental Clinic in Cowra to replace the existing Child Dental Clinic located within a school, and add adult dental services, all in a more appropriate location.

Director

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Goal 3: Invest in prevention and preventive care to improve oral health across our communities


Expanding our investments in prevention is vital to reduce service demand in the long-term1,

7, 15. But with limited resources, it is equally vital that such investments only be made in evidence-based strategies.

Fluoridation of drinking water is effective at reducing levels of tooth decay among children40 and is supported by health policy1, 11, 15. Whilst it is not always feasible (eg in communities of less than 500 people), the unfluoridated water supply in a number of our larger communities remains an issue of ongoing concern and debate.

Lifestyle interventions include those aimed at reducing the consumption of sweetened drinks7, 9. There is also increasing attention to other risk factors including alcohol, nutrition, weight and smoking cessation9, 11, 41, 42. The common ground with broader population health initiatives such childhood obesity and chronic disease prevention presents an opportunity for us to work in partnership with other teams (such as LHD health promotion) for more effective reach and positive health outcomes for our local communities11.

Early interventions such as the Early Childhood Oral Health Program are evidence-based43, supported by health policy25, 44 and demonstrate the potential for oral health promotion to be delivered in other settings.

There is also good evidence supporting proactive and systematic oral health preventive care at the chairside. Pit and fissure sealants45 and fluoride varnishing46 are best-practice preventive clinical care9, 41, 47 that are supported by evidence-based chairside oral hygiene instruction and brief health promotion interventions 9, 41, 48.

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What we will do


Goal 3: Invest in prevention and preventive care to improve oral health across our communities

3.1 Deliver and support primary prevention strategies at the community level to improve oral health.

3.2 Advocate for and support the delivery of proactive prevention and oral health promotion strategies by relevant LHD teams/partners/local organisations who have access to our priority populations.

3.3 Build the capacity of all our oral health services and teams to systematically embed proactive prevention and health promotion strategies into routine clinical practice.

Increasing investments in evidence-based oral health promotion at the primary prevention (community) and clinical levels


3A Evidence of appropriate investments made in primary prevention

3B Evidence of oral health promotion being delivered by other services and teams

3C Service performance measures demonstrating improved routine delivery of preventive care by our own services

3D Analysis of all relevant indicators by priority population to ensure that inequities are being addressed

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Goal 3. Invest in prevention and preventive care to improve oral health across our communities.


2017-18 2018-19 2019-20

3.1. Deliver and support primary prevention strategies at the community level to improve oral health.

3.1.1. Review all of our current primary prevention investments against evidence for best practice (eg9, 49) and determine what to retain, what to disinvest in and what new investments to make.

In alignment with Oral Health 2020, our primary prevention investments should focus on:

• Continuing to encourage and work with Local Governments of unfluoridated communities to introduce fluoride to the water supply

• Recommending the consumption of tap water instead of bottled water or sweetened drinks

• An integrated risk factor approach to oral health promotion that capitalises on key initiatives such as Make Healthy Normal and the Healthy Children Initiative (notably in relation to relevant recommendations regarding nutrition)

• Providing support to and capitalising on other health promotion campaigns, programs and services that include common messages around alcohol, smoking and nutrition

• Ensuring that oral health promotion is appropriately tailored to the context and needs of our priority populations.

Lead Oral Health Therapist Director is lead for actions related to water fluoridation

3.1.2. Involve our staff in the review and planning process, and provide professional development to build their capacity to understand why disinvestments are recommended in some instances, and to develop and deliver future evidence-based health promotion actions


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2017-18 2018-19 2019-20

3.1.3. Build a strong and mutually beneficial partnership with the Western NSW LHD Health Promotion team to:

• Improve alignment of actions and messages related to common themes, such as drinking tap water and reducing the consumption of sweetened drinks

• Identify opportunities to support each other’s work, particularly in relation to children such as the Healthy Children Initiative.


3.1.4. Ensure that primary prevention actions are embedded into our service reporting systems to monitor our activities over time and ensure that an appropriate proportion of investment is retained in the face of competing clinical demands.


3.1.5. Ensure that existing communication resources and those developed in the future to communicate with patients:

• Reflect evidence for best practice9 • Are developed in consultation with our consumers • Are written in plain English and appropriate for people with

low literacy • Are culturally appropriate and sensitive • Employ relevant health communication and health literacy

principles • Include messaging consistent with other oral health

communication, such as that produced by the NSW Centre for Oral Health Strategy

• Are consistent with our LHD communication standards.


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2017-18 2018-19 2019-20

3.2. Advocate for and support the delivery of proactive prevention and oral health promotion strategies by relevant LHD teams/partners/local organisations who have access to our priority populations.

3.2.1. Support implementation of the Early Childhood Oral Health Program (ECOH) as per NSW Health policy PD2013_037 Early Childhood Oral Health (ECOH) Program: The Role of Public Oral Health Services25 and clinical practice guidelines GL2014_020 Early Childhood Oral Heath Guidelines for Child Health Professionals44. Explore strategies to build the capacity within the relevant services to deliver the program effectively and efficiently, including consideration of:

• Ensuring that protocols are embedded appropriate into service structure

• Nominating champions within each service to drive the implementation

• Providing professional development as required • Providing support, mentoring and advice as required • Putting appropriate data collection and reporting in place to

monitor implementation quality and sustainability


3.2.2. Implement relevant and effective early intervention strategies promoting good oral health and associated healthy lifestyles (eg nutrition) in other settings and programs, including:

• Out-of-home care programs • Prenatal/midwifery services • Chronic care programs, such as the Chronic Disease

Management Program “Connecting Care” • Working with Aboriginal Health Workers in LHD and

Aboriginal Community Controlled Health Organisations to develop capacity to provide patients with oral health education and appropriate referrals.


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2017-18 2018-19 2019-20

3.2.3. Provide access to oral health promotion learnings and resources through distribution via the Centre for Oral Health Strategy and NSW Oral Health Promotion Network.


3.2.4. Ensure that all integrated oral health promotion strategies are appropriately tailored to the context and needs of our priority populations.


3.3. Build the capacity of all our oral health services and teams to systematically embed proactive prevention and health promotion strategies into routine clinical practice.

3.3.1. Take a proactive and systematic approach to the delivery of evidence-based preventive clinical care (eg 9, 41, 47) including but not limited to pit and fissure sealants (as per NSW Health policy PD2013_02547) and fluoride varnishing.

Clinical Director

3.3.2. Make greater investments in proactive and systematic chairside oral hygiene instruction, with a focus on:

• Utilising the whole team more effectively • Using evidence-based messages and care models9, 41, 48 • Maximising attention, comprehension, persuasion and

capacity to adopt the recommended behaviours50 • Tailoring strategies to the needs of priority populations


3.3.3. Undertake a proactive and systematic approach to brief chairside health promotion interventions that:

A) Routinely and systematically identify risks such as smoking (as per PD2015_030 Smoking cessation brief intervention at the chairside: the role of public oral health/dental services51) and poor nutrition (notably the consumption of sweetened drinks)

B) Provide at-risk patients with evidence-based brief advice (eg52) and referral to relevant preventive care services such

Clinical Director

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2017-18 2018-19 2019-20 as the Quitline, Get Healthy Information and Coaching Service and Go4Fun.

We will build the capacity of services and staff to systematically and routinely deliver the actions described above by:

• Developing protocols that are systematic and routine • Providing infrastructure and resources to support this • Training staff in evidence-based techniques such as

motivational interviewing • Monitoring service delivery, including analyses by priority

population to ensure it is being delivered equitably.

3.3.4. Provide clear guidance for external providers outlining the key information and strategies expected when claiming payment for oral hygiene instruction and fluoride application items.

Clinical Director

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REFERENCES

1. Council of Australian Governments. Healthy mouths, healthy lives: Australia's National Oral Health Plan 2015-2024. Adelaide: South Australian Dental Service; 2015.

2. Sheiham A. Dental caries affects body weight, growth and quality of life in pre-school children. Br Dent J. 2006 Nov 25;201(10):625-6.

3. Duijster D, Sheiham A, Hobdell MH, Itchon G, Monse B. Associations between oral health-related impacts and rate of weight gain after extraction of pulpally involved teeth in underweight preschool Filipino children. BMC public health. 2013 Jun 03;13:533.

4. Abanto J, Carvalho TS, Mendes FM, Wanderley MT, Bonecker M, Raggio DP. Impact of oral diseases and disorders on oral health-related quality of life of preschool children. Community dentistry and oral epidemiology. 2011 Apr;39(2):105-14.

5. Kramer PF, Feldens CA, Ferreira SH, Bervian J, Rodrigues PH, Peres MA. Exploring the impact of oral diseases and disorders on quality of life of preschool children. Community dentistry and oral epidemiology. 2013 Aug;41(4):327-35.

6. Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NH. Tooth loss and oral health-related quality of life: a systematic review and meta-analysis. Health Qual Life Outcomes. 2010 Nov 05;8:126.

7. Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 2005 Sep;83(9):661-9.

8. Leeder S, Russell L. Dental and oral health policy issue paper. Sydney: The Menzies Centre for Health Policy; 2007.

9. Prevention and Population Health Branch - Victorian Department of Health. Evidence-based oral health promotion resource. Melbourne: Government of Victoria; 2011.

10. Western NSW Local Health District. Western NSW LHD Strategic Plan 2016-2020. Western NSW Local Health District; 2016.

11. Centre for Oral Health Strategy NSW. Oral Health 2020: A Strategic Framework for Dental Health in NSW. North Sydney: NSW Ministry of Health; 2013.

12. Slade GD, Spencer AJ, Roberts-Thomson KF. Australia’s dental generations: the national survey of adult oral heatlh 2004-06. Canberra: Australian Institute of Health and Welfare; 2007.

13. Aboriginal Health & Medical Research Council. AHMRC Oral Health Position Paper: Achieving oral health equity for Aboriginal communities in NSW. Sydney: AHMRC; 2016.

14. Centre for Epidemiology and Evidence. The health of Aboriginal people of NSW: Report of the Chief Health Officer. Sydney: NSW Ministry of Health; 2012.

15. Centre for Oral Health Strategy NSW. New South Wales Aboriginal Oral Health Plan 2014-2020. Sydney: NSW Ministry of Health; 2014.

16. NSW Ministry of Health. NSW Aboriginal Health Plan 2013-2023. North Sydney: NSW Ministry of Health; 2012.

17. Australian Institute of Health and Welfare. The health and welfare of Australia's Aboriginal and Torres Strait Islander people: an overview 2011. Cat. no. IHW 42 Canberra: AIHW; 2011.

18. Centre for Epidemiology and Evidence. HealthStats NSW: Dental status of children. 2017 [cited 8/3/17]; Available from: http://www.healthstats.nsw.gov.au/Indicator/ora_denkid_cat/ora_denkid_caries

19. Centre for Epidemiology and Evidence. HealthStats NSW: Visits to a dentist by children. 2017 [cited 8/3/17]; Available from: http://www.healthstats.nsw.gov.au/Indicator/ora_visitskid_age/ora_visitskid_ses_trend

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WESTERN NSW LOCAL HEALTH DISTRICT

29 Hawthorn Street DUBBO NSW 2830

PO Box 4061 DUBBO NSW 2830

Phone: +61 2 6809 8600 Fax: +61 2 6841 2225

www.wnswlhd.health.nsw.gov.au

western nsw local health district oral health service plan and repo… · oral diseases are among...

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