Monthly column for providers and professionals working in adult social care from Andrea Sutcliffe CBE, Chief Inspector of Adult Social Care.

Good oral health is a critical aspect of good overall health and wellbeing. This is true for all of us, but especially for people living in vulnerable circumstances or unable for whatever reason to manage their oral hygiene without assistance.

Although many residents of care homes are supported to maintain good oral health, there is evidence to show that some services struggle to provide the support people need. The consequences can be devastating. The gruesome pictures of blackened, infected teeth CQC’s Senior National Professional Dental Advisor showed me recently were awful and I can just imagine the impact this has on people in pain or embarrassed about the way they look. I was also shocked by some of the other consequences he explained as mouth infections can spread and cause, for example, respiratory problems like pneumonia and other cardiovascular problems.

Oral health is important to get right, but it poses challenges for people working in adult social care services. For example, more people are keeping their own teeth longer which presents different challenges. Residents of care homes may have difficulty brushing their teeth due to poor manual dexterity, limited mobility, vision problems and cognitive difficulties. Long-term conditions such as Parkinson’s disease and dementia can make it harder to hold and use a toothbrush, and go for dental treatment. There are challenges for staff too who may not have the time and understanding to support people appropriately particularly if this is not seen as a high priority in the service or they face resistance from the person they are trying to assist.

Oral health is important to get right, but it poses challenges for people working in adult social care services.

When CQC inspects services and asks whether they are effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence. This of course includes oral care. Despite this, we are concerned that there has not been enough focus on oral health (for example, it is not specifically mentioned in the Key Lines of Enquiry). In our role of encouraging services to improve we want to look at this in more depth to identify and share good practice as well as to understand the challenges and what can be done to improve this important aspect of care.

This is a really important piece of work and one that I am sure people living in care homes and their families as well as providers and staff will welcome.

I am therefore very grateful to my dental colleagues in the Primary Medical Services team who will be conducting a thematic review to gather information and produce a national report on the quality of oral health in care homes at present. Our dental colleagues will attend inspections to ask some additional questions and speak to staff and those who use services. We will also be looking at whether care homes are following the NICE guidance on oral health in care homes and if not, what the reason for this is.

This is a really important piece of work and one that I am sure people living in care homes and their families as well as providers and staff will welcome. I hope that by shining a spotlight on this issue we can really help to make a difference. We will make sure that further information is shared with you as the review progresses.

As the summer is coming to a close I wanted to mention a couple of exciting things coming up in autumn. Firstly, our State of Care 2017/18 report will be publishing in October. You can sign up for updates on the publication of State of Care 2017/18. Before that, CQC will be exhibiting at Health and Care Innovation Expo 2018 on 5–6 September in Manchester. In recent years Expo has been a good opportunity to explore cross-sector working between health and social care and share innovative practice and other developments. I enjoy this event every time I attend and I look forward to seeing new faces as well as those familiar next week.

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