Reports
Dentistry and the impact of COVID-19
Since the outbreak of COVID-19, Healthwatch England has seen a significant increase in the number of people telling them about the problems they face when trying to get an NHS dentist appointment, suggesting the impact the pandemic has had on dentistry has been particularly acute. We take a look at the key issues people have raised with Healthwatch England.
What did people tell Healthwatch?
Between July and September 2020, HWE heard from 1,313 people about their experiences of dentistry, compared to just 238 people in the previous three months. Their stories show that often they were unable to get the care they needed, leaving them in pain and at risk of serious long-term oral health issues:
- Access to dental care - the pandemic has made it difficult for most people to access both routine and emergency dental services, with many feeling unsure about when they would next see a dentist or leaving others to travel long distances to get care.
- No routine care - although dental practices have now reopened, people are still unable to get an appointment for check-ups, hygienist appointments or fillings.
- Limited NHS appointments - people have reported struggling to access NHS dentistry because practices are either not taking on new NHS patients or have no available NHS appointments.
- Treatment still on hold - in some cases, dentists have not been able to continue treatment started before lockdown, meaning people have been left in pain and with unresolved issues, like a broken tooth.
- Access to emergency treatment - people have told HWE they can’t get through to their dentist when they need urgent care or are unable to access treatment if they do not meet the criteria for it.
- Affordability - HWE evidence suggests practices are prioritising private patients over NHS ones or are only offering non-urgent treatment if they pay privately.
- Lack of information - inaccurate information from the NHS 111, NHS Choices and dental practice websites can leave people frustrated and confused.
- Confusion about registration - a dental practice cannot de-register someone, but often people who have had a long gap since their last appointment are told they have been, when really what the dental practice means is that there are no available NHS appointments.
- COVID-19 measures - while practices did adapt once they reopened, not all of them understood how COVID-19 measures would impact some groups of people or didn’t follow all the measures needed to make people feel safe.
4% of people also told HWE about positive experiences of dental care, praising staff who were helpful, kind and considerate and highlighting that clear and regular information from dental practices made them feel reassured.
Between July and September 2020, over 38,082 people shared their experiences of using health and social care with Healthwatch. This article is a summary of the key issues that the public are telling us about, including:
- Access to NHS dental care
- The support provided in care homes
- Getting COVID-19 tests
The consequences of not getting treatment
People who struggled to access dental treatment during the COVID-19 pandemic, told us they experienced inconvenience, anxiety, worsening problems requiring further treatment, or worse. Victoria and Samantha share the impact poor dental care has had on them and their loved ones.
'Living my worst nightmare'
After needing emergency dental care, Victoria has struggled to get follow up treatment and has been unable to register her son at a dentist, unless she pays privately.
She tells us about the impact this has had on her.
“None of the dentists I have seen seem at all interested in trying to find out why my teeth are crumbling, despite having to have a total of four removed over such a short space of time. In desperation, I have spoken to my GP about the situation who instantly is concerned that during pregnancy, I have developed a deficiency of some sort. He is running blood tests to try and get to the bottom of the problem. I feel like my GP has helped me more and been kinder and more considerate than any of the dentists I have seen in the last few months. I feel that if the dentists had done this sooner, then I may not have needed so much treatment.
"I am extremely concerned that I cannot access any care for my son. The NHS website stresses the importance of preventative care when it comes to children’s teeth – and getting used to the dentist at a young age is a big part of this. Yet, my son is being denied care because I cannot afford to go private.
"The stress and worry about my son together with the pain, anguish and difficulties in securing my own treatment have left a big impact on my life. Due to having so many teeth removed, I don’t like my mouth now. I have no confidence in the way I look and am dreading people wanting photos at Christmas to celebrate my son’s first Christmas.
"Before COVID-19 I was frightened about the dentist; now the thought of trying to book appointments fills me with anxiety, the lack of care means I am needing more and more treatment causing extra stress, and my son being denied care means I am living my worst nightmare.”
'No one would help us'
When Samantha’s husband developed a problem with his tooth earlier this year, they found it impossible to access dental care in Northamptonshire.
“I called up every local dentist in the area trying to book him an appointment to be seen as an NHS patient but was unable to find help anywhere. Those that did answer said they were not seeing NHS patients, or that they were prioritising private patients. Several dentists offered me the treatment as a private patient stating that they would need either a deposit or payment upfront, but no one would help my husband as an NHS patient.
"His pain got worse, his face became swollen, he had a raging temperature, continually sweating, getting no sleep at night and a large pocket of pus developed in his mouth. His bone started to ache, and he would get rocketing pain. I continued to try and get him access to dental care for fear the infection would spread around his body, but even when I described his symptoms to the surgeries – no one would help us."
Eventually, after six weeks of agony, she managed to get her husband a short 10-minute emergency appointment. In his emergency appointment, Samantha’s husband was told that he had a bad infection and would need a root canal to resolve the issue.
“He was told to go away and register with a dentist to get a root canal done but given a prescription for a short course of antibiotics to clear up the worst of the infection in the meantime. He still has to be very careful around the tooth and still has no idea when he will receive treatment.”
What needs to change?
Looking at the issues people raised with us highlights four essential areas for improvement:
- Clearer information - NHS England and dentists need to provide more accurate and up-to-date information for patients.
- Patient registration - NHS England and dentists need to be clear that people don't register with a dentist in the same way as with a GP surgery. There is no guarantee of treatment at the same practice as a result.
- Access to care - The Government must make more resources available to dentists to help reduce the backlog caused by the pandemic.
- Affordability - The Government and the NHS should review the cost of NHS treatment, as many people struggle to pay the NHS charge, particularly as many people have less money as a result of the pandemic.
Responding to the report, Healthwatch England Chair, Sir Robert Francis QC said:
“Even before the pandemic, people were telling us about problems in accessing NHS dental appointments but since the start of the summer these reports have hugely increased.
“If we don’t improve access to NHS dental care, not only do people risk facing far greater dental problems in the future but it also puts pressure on overstretched hospitals and GPs. Untreated dental problems can lead to pain, infection and the risk of long-term harm, which is comparable with other medical conditions.
“Health and care services are working hard to deal with the pandemic, but we believe the Government and the NHS should give more attention to resolving both long-standing and COVID-related issues in dentistry.”
590 people's stories of leaving hospital during COVID-19
Healthwatch England's new report with the British Red Cross looks at how well the new hospital discharge policy is working for patients, carers and healthcare professionals.
In March 2020, the Government introduced a new hospital discharge policy to help the NHS free up beds by getting people out of hospital quickly. This meant anyone who may need out-of-hospital support to help them recover would now have their needs assessed after being discharged, rather than in hospital.
We wanted to find out how the new policy was affecting people's experience of leaving hospital. Together with the British Red Cross, we spoke to over 500 patients and carers and conducted 47 in-depth interviews with health and care professionals involved in the hospital discharge process.
What did people tell us?
- 82% of respondents did not receive a follow-up visit and assessment at home and almost one in five of these reported an unmet care needs.
- Some people felt their discharge was rushed, with around one in five (19%) feeling unprepared to leave hospital.
- Over a third (35%) of people were not given a contact who they could get in touch with for further advice after discharge, despite this being part of the guidance.
- Overall patients and families were very positive about healthcare staff, praising their efforts during such a difficult time.
- Around a third (30%) of people faced an issue with delayed COVID-19 test results, potentially putting family and carers at risk, or in a care home, other residents and staff.
Downloads
If you need this information in a different format, please email enquiries@healthwatch.co.uk or call 03000 68 3000
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CQC reports on findings of Covid-19 in-patient survey
But those diagnosed with coronavirus had poorer experiences than those without the virus - particularly in relation to:
- discharge from hospital and
- knowing what would happen next with their care.
The results also reveal some concerns that certain groups found some aspects of their hospital stay more difficult, such as:
- people with dementia or Alzheimer’s
- those with a mental health condition.
The survey captured the views of more than 10,000 adults who were discharged from hospital during April and May 2020. The CQC carried it out to gather feedback to help services and local systems plan for and improve future coronavirus care.
The sample of patients surveyed included people admitted with confirmed or suspected coronavirus. It also included those admitted for unrelated reasons.
The survey asked people to give their opinions on the care they received, including:
- quality of information and interaction with staff
- how well they were able to communicate with family and friends
- the cleanliness of the hospital environment
- their discharge arrangements.
The results reveal some notable trends, including:
Feeling safe from risk
Most patients (83%) said they felt safe from the risk of catching coronavirus in hospital:
- those diagnosed while in hospital felt least safe (68%)
- compared with those who did not receive a coronavirus diagnosis (84%).
Confidence and trust in staff
Over 8 in ten people surveyed (83%) said they ‘always’ had confidence and trust in the staff treating them:
- 77% said they were involved ‘a great deal’ or ‘a fair amount’ in the decisions made about their treatment
- 70% felt they ‘always’ received enough emotional support from staff during their stay.
Overall experiences
Patients with a coronavirus diagnosis reported poorer experiences than people who did not have the virus. Particularly in relation to discharge and accessing support after leaving hospital.
You can read the full CQC report here
The doctor will zoom you now
A recent survey for the British Medical Association showed that 95% of GPs are now offering remote consultations and 88% want to see greater use of them continue in the future.
Whilst people previously told us that they welcome the idea of the NHS making better use of new technology to help make care more convenient, people’s experiences of telephone, video, and email consultations to date have been more mixed.
For some, they are working well, and many previously sceptical individuals have been converted following a positive experience. For others, these types of appointments have introduced new barriers to care.
So how can we make sure that this revolution in the way care is delivered works for everyone?
What makes a virtual appointment good?
Last week we published the findings of some rapid research conducted in partnership with Traverse, National Voices, and PPL. Involving people who have had a virtual consultation during the pandemic, this report provides useful insights for NHS services and individual clinicians.
Key findings and recommendations
Arranging a virtual consultation
- Feeling safe and comfortable
It’s important for people to feel safe, comfortable and that they have a confidential space in which to talk about their medical concerns.
Most of those we spoke to hadn’t received any information in advance about how the appointment would work or what they could do to help. It would be useful for patients to be alerted to this fact beforehand so that they can prepare for their appointment. - Making the benefits known
Secondly, to realise the benefits of people not having to travel to appointments, patients need a reasonable time window for their appointment. Where people are not given this, it leads to increased frustration, with missed calls or unexpected delays creating anxiety. - Getting the format right
Most of those we spoke to had telephone consultations, but a significant number felt that video would have been better.
We also heard examples where people’s level of digital literacy had not been assessed before the appointment. There were also examples discussed where people felt remote consultations would never be appropriate, such as delivering bad news following a diagnosis.
During the appointment itself
- Giving people the time they need
Whichever form of remote consultation is used, people were clear that it must not mean a compromise on the quality of the interaction. Appointments must not feel rushed, patients need to feel listened to and clinicians must have all the information they need to hand.
Test, learn and improve
- Seek feedback
As with any significant change it is important to seek feedback and to learn from what works and what needs improvement. Yet most participants in our research reported that they weren’t asked for feedback about their remote consultation experience.When we asked them for suggestions, they identified many ways in which remote consultations could be made better. For example, enabling sessions to be recorded and played back later so people can confirm they have understood, or introducing closed captioning to help those with hearing loss.
Overall, one of the biggest learnings was around quality. While some people in the health and care system may see remote consultations as a way of delivering care more efficiently, it is clear that any impact on quality will likely see a significant drop-off in people willing to access care in this way.
Getting the most out of the virtual health and care experience
Using people's experiences, we have created top tips for both patients, health and care professionals on how to get the most out of digital consultations.
GP Patient Survey - See how your GP practice is doing
See how others feel about your GP Practice or research a new one. Visit GP Patient here and enter your Practice.
Patient-Led Assessments of the Care Environment (PLACE)
Healthwatch Bracknell Forest was invited to participate in a number of this year assessments.
"Good environments matter. Every NHS patient should be cared for with compassion and dignity in a clean, safe environment. Where standards fall short, they should be able to draw it to the attention of managers and hold the service to account. PLACE assessments will provide motivation for improvement by providing a clear message, directly from patients, about how the environment or services might be enhanced." NHS England.
Healthwatch Bracknell Forest Reports
