Service Considerations

Deborah White

Outline

• Dental Attendance

• Service use

• Treatments received

• Relationship with dental practice

Reason for dental attendance

Regular attendance amongst men and women

Attendance by country and SHA

0102030405060708090

100

EnglandW

ales

N Ireland

N East

N West

Yorks

E Mids

W M

idsE Eng

London

SE Coast

S Central

S West

Regular Occasional With trouble Never been

* *

Regular attendance and SEC

• 66% - managerial and professional

• 62% - intermediate

• 55% - routine and manual

Trends in regular attendance

0

10

20

30

40

50

60

70

80

1978 1988 1998 2009

%

England Wales N Ireland

Frequency of visiting the dentist• At least every 6 months?• At least once a year?• At least once every two

years?• Less frequently than every

two years?• Only when having trouble

with teeth and/or dentures?

• Half of dentate adults reported attending every 6 months – Variation between countries (highest in Wales)– Variation between Socio-economic classification

• Majority of dentate adults (77%) attended within two years– Consistency between countries– Variation between Socio-economic classification

Change in frequency of attendance

Service use

Use of NHS dental care

0102030405060708090

All 16-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

%

Age

NHS or Private

0102030405060708090

100

EnglandW

ales

N Ireland

N East

N West

Yorks &

Humber

E Mids

W M

idsE Eng

London

SE Coast

S Central

S West

All NHS Private

NHS

0102030405060708090

EnglandW

ales

N Ireland

N East

N West

Yorks

E Mids

W M

idsE Eng

London

SE Coast

S Central

S West

Free NHS Paid for NHS

Why did people choose NHS?

0 10 20 30 40 50 60 70

Affordability

Location

Dentist only sees NHS patients

Reputation / Recommendation

Better quality of care

Lack of availabiltiy of private dentists

Shorter waiting times

More types of treatment available

No reason

%

Why did people choose Private?

0 5 10 15 20 25 30 35 40 45

NHS dentist has gone private

unable to find an NHS dentist

better quality of care

better reputation

Location

shorter waiting times

more treatments available

affordability

insurance provided by employer / job

no reason

%

What would encourage people to go to NHS

• Availability – 38%• Quality of care – 17%• Convenient location – 13%• Affordability – 11%• Recommendation – 8%• Increased treatment range – 7%• Nothing – 21%

Reasons for not going in last 2 years

No need to go to the dentist / nothing wrong 40I can’t find an NHS dentist / dentist gone private 25I’m afraid of going 23I can’t afford the NHS charges 20Keep forgetting / haven’t got round to it 18I’ve had a bad experience 1I don’t see the point 15I haven’t got time to go 9It’s difficult to get to / from the dentist 6I’m too embarrassed to go 5

%

Dental treatment

Dental treatment received

0102030405060708090

100

16-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Age

%

> 1 visit1 visit

Types of treatment

0 20 40 60 80 100

Check-up

S&P

Advice

X-ray

Filling

Hygienist

Extraction

Impressions

%

Treatment differences by SEC

0102030405060708090

100

Check-up S&P Advice Hygienist Extractions

Managerial & Professional Intermediate Routine & Manual

Treatment 1998 & 2009 - England

0

10

20

30

40

50

60

70

S&P Filling X-ray extraction crown abscesstreated

denturefitted

denturerepair

19982009

Cost of treatment• Range of costs reported

– 13% paid more than £100– Varied between age groups:

• 19% of 55-64• 3% of 16-24

• Minority reported pre-payment plan or dental insurance scheme– 12% overall– Varied between age groups:

• 18% of 55-64• 5% of 16-24

– Varied between countries:• 18% in Wales• 12% in England• 9% in Northern Ireland

Value for money

Very good / Good

Fair Poor / Very poor

All 65% 21% 12%

England 65% 22% 12%

Wales 74% 16% 9%

N Ireland 65% 18% 17%

16-24 56% 23% 18%

75-84 73% 16% 10%

Relationship with dental practice

• People had mainly been to the same practice before – 89%

• Two thirds had been at the practice for at least five years

• Slightly less in younger age groups and less in London than other SHAs in England

Percentage rating good or very good

0 20 40 60 80 100

Length of time waiting forroutine appointment

Length of time waiting for anurgent appointment

Availability of evening /weekend apointments

Transport facilities & access

Convenience of dentalpractice location

Standard & quality of care

Explanation of NHS charges

Reputation of dentists

Conclusions

• High proportion of people attending the dentist within the maximum recommended recall interval.

• Socio-economic differences in reason for attendance and recall interval.

• Variation by Strategic Health Authority• The NHS remains the major provider of dental

care in all age groups and in almost all parts of the three countries.

Adult Dental Health Survey 2009

The NHS Information Centre commissioned the survey, with funding provided by the Department of Health in England, the Welsh Assembly Government and the Department for Social Services and Public Safety in Northern Ireland.

The Office for National Statistics (ONS) was the lead contractor working in partnership with the National Centre for Social Research, the Northern Ireland Statistic & Research Agency, and a team of academics from the Universities of Birmingham, Cardiff, Dundee, Newcastle and University College London