Leading change

A healthcare support worker at the Black Country Partnership NHS Foundation Trust introduced a mobile dentistry unit into an inpatient ward for older people with mental health needs. This has improved the experience of patients and staff as well as improving outcomes and the use of resources.

Where to look

The Five Year Forward View for Mental Health (2016) highlights the importance of an integrated mental and physical health approach to care, with physical and mental health being interrelated. People with severe and prolonged mental illness are at risk of dying on average 15 to 20 years earlier which represents one of the greatest health inequalities in England. A lack of access to physical healthcare for people with mental health problems is common with serious consequences.

The National Institute for Clinical Excellence (NICE, 2014) highlight the importance of good oral health for general health and wellbeing. Poor oral health can affect someone’s ability to eat, speak, smile and socialise normally. Oral health problems include gum (periodontal) disease, tooth decay, tooth loss and oral cancers. Many of the risk factors – diet, oral hygiene, smoking, alcohol, stress and trauma – are the same as for many chronic conditions, such as cancer, diabetes and heart disease. As a result, interventions that aim to tackle these risk factors should be considered within all care settings.

Penn Hospital in Wolverhampton provide an inpatient ward where 24-hour care and support is provided to older people with mental health needs such as dementia, depression, and anxiety. A healthcare support worker observed community dentistry services working well within the local community and identified unwarranted variation within the hospital setting. Access to such services wasn’t easily accessible. The support worker identified the need to ensure holistic services were provided to all service users with mental health conditions and that an inpatient dentistry service would be beneficial to patients on the inpatient ward, supporting them with their physical health as well as their mental health.

What to change

Whilst reviewing current practice, the support worker and inpatient team identified that support for oral hygiene and dentistry wasn’t standardised. If inpatients were struggling with tooth pain, they would be referred to the dental team. This required considerable travel to the other side of the city, which as well as being onerous for patients, meant staff taking time away from the wards to escort them.

Having observed a community dental team, who offered quarterly in-reach into the dementia pathway team, the healthcare support worker wanted to see if that could be expanded and implemented into the elderly metal health inpatient ward.

How to change

The healthcare support worker discussed the idea of an in-reach service with the ward manager, highlighting the need for optimal access to services and resources as well as ensuring parity of care across services. The ward manager agreed there was a clinical need and advised on processes for implementing the change, such as organising meetings with senior management. The healthcare support worker also engaged with all staff on the ward to discuss the idea and seek their feedback.

Following approval by the senior team, the healthcare support worker worked closely with community teams to establish a mobile dental service on the inpatient ward.

Adding value

Better outcomes – Patients can now obtain dental healthcare and treatment on the ward without needing to travel. This has also meant patients who would not ordinarily access services in the community are now supported to access high quality dentistry care as part of their inpatient stay. The service provides education and support to promote good oral hygiene as well as treatment for common complaints and referral onwards for more extensive care. By taking a whole person approach to care, inpatients are provided with the opportunity to improve their physical health as well as their mental health.

Better experience – Positive patient and staff feedback has been received. The approach to support oral care as part of the service has been welcomed.

Better use of resources – There has been a reduction in the need for patients to travel off site to access dentist services. This has had a positive impact on staff time on ward. Oral healthcare on the ward has also meant information is readily available for patients and staff to support a collaborative, patient-centred approach. The in-reach service has reduced duplication and released staff time to spend more time with patients.

Challenges and lessons learnt for implementation

Speak to other people about ideas for change. Identifying a team of people who are passionate about the same things and identifying what leaders can do to implement that change is important.

A key learning point from the programme has been that everybody can be a leader and lead on change.

For more information contact

Tony Longbone
Nursing Assistant
Derbyshire Healthcare NHS Foundation Trust
tony.longbone@nhs.net