20th March 2015

• Almost half of 8 year olds have obvious dental decay, according to new stats
• Welsh Health Minister speech on prudent healthcare at RCS emergency surgery event
• Major review of orthopaedic surgery finds signfiicant variations in care and practice
• Acute hospitals must look outside their own walls to realise five year vision, says King's Fund
• Austerity to continue but no mention of NHS in Chancellor's budget

Almost half of 8 year olds have obvious dental decay, according to new stats

The Health and Social Care Information Centre has published the latest Child Dental Health Survey, providing statistical information on the dental health of children up to the age of 15 in England, Wales, and Northern Ireland. This is the fifth iteration of the decennial publication, with the survey itself having taken place in 2013.

Although the results show improvements in the prevalence and severity of tooth decay, the data indicates that nearly half (46%) of 15 year olds and a third (34%) of 12 year olds have obvious decay of their permanent teeth. This compares to figures of 56% of 15 year olds and 43% of 12 year olds from the last survey in 2003.

For younger children, 31% of 5 year olds and 46% of 8 year olds have obvious decay in their primary teeth.

The survey also revealed that more than a third of 12 year olds (35%) and just over a quarter of 15 year olds (28%) felt embarrassed smiling or laughing because of the appearance of their teeth. Moreover, 58% of 12 year olds reported that their daily life had been affected by problems with their teeth in the past three months.

The statistics back-up the findings of a recent report from the Faculty of Dental Surgery at the Royal College of Surgeons which examined the issue of children’s oral health. That report, available here, highlighted the prevalence and impact of dental decay among children and made a number of recommendations aimed at improving oral health.

Commenting on the publication of the survey Professor Nigel Hunt, Dean of the FDS, said:

"As the survey shows, oral health can have a negative impact on a child's day to day life, including eating, smiling or speaking. We need to take action to prevent children from suffering loss of confidence at such a young age.

"It is encouraging to see an improvement in rates of tooth decay amongst children aged between 12 - 15 years old. However this survey shows nearly half of 8 year olds had obvious decay showing more work needs to be done, particularly as this is a nearly entirely preventable disease.”

Welsh Health Minister speech on prudent healthcare at RCS emergency surgery event

This week the Welsh Health Minister, Professor Mark Drakeford AM, gave the keynote address at a RCS conference on the future of emergency surgery. Speaking at the one day event in Cardiff, Professor Drakeford highlighted that prudent healthcare in Wales was part of a growing international movement of ‘choosing wisely’ and that surgeons’ time should be freed to enable them to make best use of their skills. He also outlined that surgeons should be part of a collaborative decision making process with patients. The Chief Executive and Director General of NHS Wales , Dr Andrew Goodall, also participated in a panel session on emergency surgery reconfiguration in Wales, where he highlighted that local clinical voices should participate in service reconfiguration debates. The event was attended by over 100 surgeons and trainees from across Wales.

Major review of orthopaedic surgery finds significant variations in care and practice

The British Orthopaedic Association has published the findings of a national pilot project assessing the quality of practice and outcomes in orthopaedic surgery across England.

Getting it Right First Time (GIRFT) assessed care in 144 acute trusts, finding significant variations in care in those hospitals assessed. This included variance in clinical costs and readmission rates, waiting times, and deep wound infections, which ranged from 0.2% to 5% of patients in the units visited. Moreover the project also found that the proportion of patients requiring further surgery due to complications was as high as 7% in some hospitals and as low as 0% in others. The report also highlights differences in the types of devices used and procedures selected for some operations.

The review finds that 23.7% of surgeons performing hip replacements and 16.1% of surgeons performing knee replacements at centres assessed by the pilot team undertook ten or fewer operations per year. This is despite well-established evidence indicating that higher activity volumes are linked with better outcomes.

The GIRFT project demonstrated opportunities to improve care and efficiency and provided each trust visited with guidance on its own practice.

Commenting on the report, Miss Clare Marx, President of the RCS, said:

“This important study will help surgical teams to understand their own figures and work to reduce variation for orthopaedic procedures such as knee and hip surgery.”

Acute hospitals must look outside their own walls to realise five year vision, says King’s Fund

Acute hospitals must seek to develop strong links with community and primary care organisations and avoid developing a ‘fortress mentality’ if the outcomes identified in the NHS Five Year Forward View are to be realised, according to a new report from the King’s Fund.

The report, which draws on learning from five case study sites in England, argues that acute hospitals must play a bigger role in community healthcare, including in prevention and public health, while there is also a need for greater collaboration between neighbouring hospitals to develop innovative new service models for patients. A more parochial outlook, as a means of safeguarding individual organisations against service and financial pressures, would be unhelpful, according to the report, and severely limit the potential benefits of integrating care in the NHS.

The report makes a number of recommendations, including advocating new regulatory models and payment systems to better promote the functioning of the whole system, rather than individual parts, as well as calling for the creation of a transformation fund to cover the costs of enabling transition to new ways of working.

The full report is available here.

Austerity to continue but no mention of NHS in Chancellors budget

George Osborne delivered his final Budget of the Parliament this week, setting out a number of proposals on tax and public spending with just 49 days to go until the General Election.

The Chancellor promised a continuation of his plans for fiscal consolidation, announcing that a further £30bn would need to be saved from public spending by 2017/18.

There were no key announcements on NHS spending however, funding of which is ring-fenced, although Mr Osborne did outline a £1.25bn increase for mental health spending and financial assistance for blood bikes and helicopter ambulance services.