Agenda item

To receive an update from representatives from King's College Hospital NHS Foundation Trust on the Community Dental Service provided by the Trust in the Borough.

The Director of Operations for King’s College Hospital NHS Foundation Trust, Chloe Cox introduced the item by apologising to the Sub-Committee for the Trust not having consulted with the Sub-Committee prior to the closure of the Community Dental Service at the Parkway Health Centre in New Addington and before patients were notified.  It was confirmed that the Trust had learnt from the process and it was not anticipated that a similar error would be made again.

During the introduction it was confirmed that the Trust had been providing Community Dental Services in 17 Community Health Centres across 9 London boroughs since 2016/17. As part of the operation of this service the estate was continually reviewed to ensure that the facilities kept up with best practice and in light of continuing financial pressures that they were as efficient as possible.

The decision to close the service located at the Parkway Health Centre was based on a number of factors including a utilisation rate of 50% against a Service average of 62%. There was also concern about the adequacy of the facilities at the centre, particularly the ability to meet decontamination standards and limitations upon the types of dental services that could be provided. The majority of the patients used the service on a short term referral basis, with only a small number of patients with longer term needs. With all these factors taken into account, the Trust concluded that it would be possible to offer patients higher quality services from other locations.

The Consultant in Special Care Dentistry and Head of Department for Community Special Care Dentistry, Doctor Rob Hale, provided Members with further background information on the Community Dental Service provided by the Trust, highlighting that the service was commissioned by NHS England and had a contract value of £8m per year.

When the Special Care Dentistry service was introduced by NHS England in 2017, it defined special care in the broadest sense, including patients with physical, mental health and learning difficulties.  As well as the service provided from Community Health Centres, the Trust also operated a mobile dental service that could be used to treat patients at home and services in schools and care homes. Over 35,000 appointments had been delivered by the Service in the past year, with 1,110 of these provided at the Parkway Health Centre.

Looking forward, any patient who had attending the Parkway Health Centre in the past two years would continue to have full access to the service. Patients would also benefit from the higher standard of the other sites, equipment and better access to treatment options. Patient transport would be available to take eligible patients to and from appointments and home visits would continue to be provided five days per week.

Following the introduction, the members of the Sub-Committee were provided with the opportunity to question the representatives from King’s College, with the threshold for eligibility for home visits and the types of services that could be provided queried. In response, it was confirmed that the patients who were eligible for home visits were normally elderly residents or people, who for a variety of reasons, were unable to leave their homes. As patients tended to be referred to the service from other providers, such as GPs or standard dental practitioners, eligibility was normally based on information provided in the referral, but a further assessment would be made via a home visit.  The treatment provided in a home visit was limited to routine inspections, simple restorative care and simple extractions. For more complex work, the patient would need to be transported to a surgery.

In response to a question about the increasing cost of dental care, it was highlighted that the charges were set nationally and based on three banding levels, which took into account the level of treatment provided. It was possible to obtain an exemption certificate to not have to pay the charge, but it was acknowledged that these could be difficult to obtain, which was as issue the Trust worked to address nationally.

It was questioned whether Croydon had been treated the same as the other boroughs? It was confirmed that there was no suggestion that Croydon residents had been treated differently, a service was also being closed in Lewisham and there had been similar issues with the consultation on this decision.  It was highlighted that the Trust had raised a concern with NHS England around the specific needs of people in Croydon and had requested that further work was undertaken to gain a greater understanding of the health needs in the area.

It was questioned whether alternative options to the closure had been considered during the review process. It was confirmed that there had been a number of suggestions arising from the review, but it had been decided to focus upon those sites at which the Trust would struggle to comply with decontamination and infection control standards, which included the Parkway Health Centre. It was advised that the starting point for the decision was from a clinical perspective rather than financial.

As it had been noted that 250 letters had been sent to the people who had been a patient of the service in the past two years to inform them of the change, it was questioned what the level of response to this letter had been. It was advised that a large proportion of the patients written to would have been short term patients and no longer using the service, but a final letter informing the patients of the change could be sent.

As it was highlighted that the demographics for New Addington were in the lowest quartile, the Sub-Committee expressed serious concern about removal of the service and questioned what could be done to continue to provide a service. It was advised that existing services could still be accessed within the borough or outside of the borough if it was more convenient for the patient. The Trust would be engaging with long term patients to assess their needs and develop a plan for continued services. It was highlighted that in the longer term the Trust was keen to explore options for co-locating at the new leisure centre facility that was due to be built in New Addington.

It was questioned whether there would be a rental saving from delivering the service from Eldridge Road facility given that it was of a higher standard than the Parkway Health Centre. It was confirmed that there was not a rental charge for the Eldridge Road facility as the space was provided by NHS England.

Although it was acknowledged that there had been an error made with the lack of consultation throughout the process, the Sub-Committee as a whole registered serious concern and disappointment that they were only being consulted after the decision to discontinue the Community Dental Service at the Parkway Health Centre. As such it was questioned how the decision had been made. In response it was confirmed that the decision had been reached through an internal consultation process which had taken into account the utilisation of the service and the condition of the premises.

In response to a question about whether an equalities impact assessment had been undertaken as part of the process, it was confirmed that there had not been an assessment as all the centres had patients of a similar level of need.  In light of this and given that the Parkway Health Centre was based in one of the most deprived parts of Croydon, it was questioned whether the correct background work had been undertaken to enable a proper assessment of the service.

Given the concerns of the Sub-Committee about what was considered a substantial change to the service provision, it was suggested that consideration should be given to possibly writing to the Secretary of State to highlight these concerns, but it was agreed that opportunities for a local resolution would be explored in the first instance.

Conclusions

In forming its recommendations, the Sub-Committee reached the following conclusions:

1. The Sub-Committee had serious concerns about the removal of the service from one of the most deprived areas of the borough and would like to see the return of the service in the future.
2. The Sub-Committee were deeply concerned that the Trust had not given any consideration to consulting either the Scrutiny Committee at the local authority in the borough effected or most importantly the patients who use the service.
3. The Sub-Committee were also deeply concerned that no equalities impact assessment had been undertaken as part of the process.
4. The Sub-Committee felt that there was a lack of understanding of the needs of Croydon.
5. In light of the lack of consultation, it was concluded that there were grounds to raise the closure of the Service with the Secretary of State if a local resolution could not be found.
6. It was agreed that colleagues at Lewisham Council would be contacted to find out if they were notified of the potential closure of the Service in their borough and to establish what action they were taking.

Recommendation

The Sub Committee RESOLVED to leave it in the hands of the Chairman and Vice-Chairman in conjunction with Democratic Service, to write a letter to King’s College Hospital NHS Foundation Trust to:-

1.  Express the extreme disappointment of the Sub-Committee at the closure of the Community Dental Service at the Parkway Health Centre in New Addington.

2.  Express the concern of the Sub-Committee that the proper consultation process for making a substantial service change had not been followed.

3. Express the concern of the Sub-Committee that no assessment of the equalities needs of the local community had been undertaken as part of the process, which was particularly concerning given that New Addington was an area effected by deprivation.

4. Recommend that the Trust reconsider their decision to close the Community Dental Service at the Parkway Health Centre in New Addington.

5.