Dental Informatics
Programme Newsletter

November 2009

Introduction

Welcome to Newsletter no. 2 of the ISD Dental Informatics Programme (DIP). We hope you find this update and news items interesting and informative. Please contact Stephen Goold at stephen.goold@nhs.net for more information on any topic raised here or to let us know what you think. You can see we like our acronyms - we’ve tried hard to reduce the technical language and jargon, but let us know if this is not the case.

The Big Chart

Newsletter no. 2’s Big Chart shows the level of children and adults registered with an NHS dentist between September 2008 and June 2009.

Graph showing the level of children and adults registered with an NHS dentist between September 2008 and June 2009

Nearly 82% of children and 63% of adults were registered with an NHS dentist at 30 June 2009, up from 80% and 61% respectively at 31 March, and the year to June saw increases of 7.5% and 15.4%.

These data were released as part of the October 2009 ISD National Statistics release, and the work was a major part of the 80+ information requests processed by the ISD Dental Information Team between August and October 2009.

For more news, see Review of dental registrations data below.

Strategic Objectives

First, a reminder of the Dental Informatics Programme’s strategic objectives, along with some progress updates ....

Deliver SHIS-Dental (Scottish Health Information System – Dental), the dental data warehouse and stakeholder access portal for Area and Special NHS Boards / Scottish Government Health Directorates / Practitioners, and support the linkage of key dental datasets.

There are currently several major change requests being actioned by colleagues in ISD IT. The first of these significant changes, once implemented, will populate the dental warehouse (now known as the dental “mart”) with General Registrar Office (GRO) deaths data, enabling us to remove the details of deceased patients from our dental registrations analyses; the second concerns comprehensive population geographies, and will permit patient-based analyses to be carried out at the level of any standard or ad hoc geographies (including Community Health Partnership level).

Support delivery of Childsmile – the national oral health improvement programme – including children’s NHS dental service redesign.

The dental mart is being substantially developed to accommodate all the individual patient-based Childsmile data to be held within ISD for evaluation of the Childsmile programme and production of linked patient and practice data outputs. The Dental Informatics Programme has also sponsored colleagues in NISG (National Information Systems Group) to lead on planning the development of eDental systems for dental services in Scotland under the National eHealth Programme. The scope of the review includes IT requirements for the Community and Salaried Dental Services, the National Dental Inspection Programme, Childsmile, and the Hospital Dental Service. The review will report by Summer 2010 and we will be engaging with a wide range of our stakeholder on this.

Develop and enhance quality of dental health data across agreed datasets: National Dental Inspection Programme, Scottish Health Survey dental module, Primary care data.

Data from the 2008 and 2009 National Dental Inspection Programme, now hosted in their entirety in the secure environment of NHS National Services Scotland and ISD, are currently being cleaned prior to analysis and publication of outputs in the 2009 NDIP Report, as we report below. It’s expected that data for previous years will be added to the dental mart in due course, thereby enabling further historical analyses to be carried out.

Develop and enhance quality of dental service data across agreed datasets: workforce, training, quality, new Statement of Dental Remuneration, General Dental Service, Community and Salaried Dental Service, Hospital Dental Service.

Among many developments, a proposal has been recommended for inclusion in the 2010/11 suite of HEAT targets currently being commented on by NHS Boards; this will be an incremental target of at least 60% of 3- and 4-year-olds in each SIMD quintile to have fluoride varnishing twice a year by March 2013. Performance will be monitored by ISD in two different ways: via Childsmile Practice GP17 forms and via the Childsmile Nursery databases managed by HIC (Health Informatics Centre in the University of Dundee).

NDIP 2009: data cleansing and analysis; NDIP 2010: examiners' calibration

Image of Alex McMahon

Alex McMahon (alex.mcmahon@nhs.net), epidemiologist from the Community Oral Health (COH) Section, University of Glasgow Dental School, is collaborating with colleagues in ISD on analyses of the 2009 National Dental Inspection Programme (NDIP) data.

We have begun the process of cleaning and analysing the c.12,000 Detailed inspection Primary 7 records and close to 100,000 Basic inspection (Primary 1 and primary 7) records that will be aggregated and published in the NDIP 2009 report due for publication by early 2010.

Alex will be assisted by Stephen Watson (stephenwatson@nhs.net), ISD Dental Information Analyst, who took a very active part in the NDIP Examiners' Training and Calibration Exercise held in Edinburgh between 2 and 6 November.

Stephen witnessed first hand frontline NHS dental services and assisted in the collection and analysis of data from the training and calibration of NDIP examiners. He attended a local primary school on one of the two calibration days to observe schoolchildren being inspected by the dentists undergoing calibration, and then assisted in the complex collection, export and analysis of data to determine agreement and ensure consistency of examiners.

Childsmile

childsmile logo ISD continues to support the monitoring and evaluation of the Childsmile programme. The NHS National Services Scotland (NSS) Privacy Advisory Committee (PAC) has approved the record-linkage of the Childsmile databases to key evaluation outcome measures:

oral health outcomes via NDIP data
general health outcomes via BMI (body mass index) data from school health systems
dental service outcomes via registration and treatment data from the GDS
health service outcomes via data on hospital admissions for dental extractions

The Childsmile Central Evaluation Research Team (CERT) at the University of Glasgow Dental School led by Dr. Wendy Gnich are currently reviewing the evaluation strategy and developing a logic model structure. These ISD record-linkage projects will be key to assessing the impact of the programme.

PSD and ISD continue to support the processing of Childsmile practice GP17 forms, which both provide a valuable source of monitoring information and support the processing of Childsmile payments. The early problems, which saw 80% of forms being returned to practitioners, have reduced dramatically to under 5% rejection. More detailed information on these processes is available from Lynn Brewster ( lynn.brewster@nhs.net), one of the Childsmile Programme Managers.

Overview of dental data mart progress

As part of the dental mart Conforming/Refresh Strategy, analysts led by Steven Williamson (steven.williamson@nhs.net) are comparing the non-conformed universe (BO6) to the conformed universe (BOXI):

to ensure the data match between both universes, and where there are differences that these are deemed acceptable (tolerable)
to run standard reports in both universes and compare results
to compare outputs from the refresh strategy between non-conformed and conformed universes

Data up to August 2009 held in the dental data mart show there were minor differences still to be corrected, but it is expected that, come the refreshes to the dental data mart with September data, there will be acceptable matches, with any differences agreed and documented.

CHI-seeding of the dental data mart has started, and testing shows it is currently producing a very encouraging 80%+ hit rate. Expectations are that the process to add CHI to the monthly data load will be in place by the end of November 2009. Once this has been completed, analysis and corrective action will be carried out to assign “missing” CHI numbers to patient records.

Scottish Dental Practice Board Annual Report

The Scottish Dental Practice Board (SDPB) published its 2008/09 Annual Report at the end of September. Each year, ISD's Dental Information Team makes a valuable contribution to the work of the Board - one of ISD's key customers - by collating and analysing important data on, and providing interpretation of, NHS general dental services (GDS) activity in the last 12 months. This essential support service is greatly appreciated by the SDPB and is characterised by strong collaborative working across ISD and PSD.

The key messages of the Board's 2008/09 report stemming from ISD-provided interpretation are these:

the level of population registered with an NHS dentist was 80% for children and 61% for adults, up from 77% and 57% respectively in 2008
total spend on NHS GDS (non-salaried) dental care was almost £220 million, an increase of over 10% from the previous year
the average cost to the NHS GDS (non-salaried) of treating a child increased from £58 to £62 during 2008/09; and an adult from £42 to £43
The number of tooth extractions carried out by NHS GDS dentists increased by nearly 4% to 485,698 in 2009; there were also increases in the number of fillings (4%), root fillings (7%) and crowns (5%) provided
the number of principal non-salaried dentists working in the GDS increased by 5% to 2,204 at 31st March 2009
in 2008/09, 92% of post-treatment referrals that resulted in examinations received a satisfactory treatment grading from the Scottish Dental Reference Service

One particular feature of this year's report, which will be re-visited in more depth in future, is description of the effects of deprivation on the provision of NHS general dental services across Scotland.

The full electronic version of the report can be viewed at SDPB Annual Report 2008/09, while an executive summary is available at SDPB Executive Summary 2008/09. Board Secretary Anne Ferguson can be contacted at anne.ferguson3@nhs.net.

Annual digest of NHS dental statistics

Also on ISD’s horizon is an annual digest of dental statistics taking in data from the full range of oral health, NHS dental services - general, community and hospital - and dental health informatics. It’s intended that this publication will complement the extensive information presented in the SDPB Annual Report with data and interpretation that will be of use and interest to an even wider range of stakeholders in dentistry. ISD will be delighted to hear from you if you have a view on what could be included in this digest. Please send your ideas to Stephen Goold at stephen.goold@nhs.net.

Action Plan Monitoring Report enhancements

From early 2010, ISD intends to publish under National Statistics the 6-monthly Dental Action Plan monitoring reports it currently produces informally for NHS boards and the Chief Dental Officer. These detailed reports monitor national and NHS board performance against key targets set out in the Action Plan, which was published in 2005. These key targets apply to measures of:

oral health improvement (e.g. level of decay experience in children)
dental workforce (e.g. achieving 1 dentist per 1,750 population)
service provision (e.g. increasing the levels of people registered with an NHS dentist)
quality of services (e.g. the level of dental practices conforming to practice inspection criteria)

If you'd like to know more, please speak to Cathy Johnston at c.johnston2@nhs.net, ISD Dental Information Team Analyst.

Scottish Health Survey 2008

The Dental Health chapter of the Scottish Health Survey 2008, published at the end of September 2009, has provided another interesting insight into the state of Scottish adults’ dental health (adults here are those aged 16+).

Among other things, it found that

88% of adults in 2008 had all or some of their own natural teeth (this is just below the 2010 target – see the Dental Action Plan – for 90% of adults to have some of their own teeth)
women are more likely than men to attend for regular dental check-up
the 2010 Dental Action Plan target for 65% of adults aged 55 to 74 to have some of their own teeth has already been exceeded (81% of men and 75% of women - 78% overall - had some natural teeth)
the age-standardised prevalence of toothache showed no clear pattern in relation to socio-economic group, equivalised income or area deprivation
however, having no natural teeth was significantly associated with socio-demographic factors
(for example, 5% of men in the least deprived areas had no teeth compared with 13% in the
most deprived areas; for women this was 8% and 20%)
35% of men and 31% of women thought they would need dental treatment if they were to visit a dentist tomorrow

ISD will shortly be applying for access to this valuable dataset to commence analysis and interpretation for the benefit of our many routine and ad hoc customers.

Review of Dental Workforce

The Scottish Government has asked the Chief Dental Officer, in conjunction with Workforce Planning Unit colleagues, NHS Education for Scotland and other relevant key stakeholders, to carry out a review of the dental workforce in Scotland by December 2010.

The purpose of this review is to provide a clear picture of the skills mix of all dental professionals currently providing dental care to the public in Scotland. This includes Dentists and Dental Care Professionals (Dental Nurses, Clinical Dental Technicians, Dental Technicians, Hygienists, Orthodontic Therapists, and Dental Therapists) in the Hospital, General and Salaried Dental Services and Academic sector across Scotland. Although the review will consider all services it will focus mainly on Primary Care, as this is the area where the majority of treatment is provided.

This work is vital to ensure that we have the right number of people, in the right place, doing the right job.

The last full dental workforce review of this nature was completed in September 2000 . Since then, NHS Education for Scotland and NHS National Services Scotland have collaborated on the Dental Workforce Project to produce four review documents culminating in their most recent report.

Dental Informatics Group (DIG)

The DIG, the Dental Informatics Programme’s steering group, held its latest quarterly meeting at Gyle Square on 10 September. Minutes, papers and actions arising will soon be available on the new combined DIP / Dental Core website (see below).

Review of dental registrations data

One of the matters highlighted at DIG (see above) is ISD’s plans for the publication of dental registration data. Our current plans are to publish under National Statistics with a revised timetable. With these revisions we will be providing enhancements to the meaningfulness and up-to-dateness of dental registrations data:

ISD will ensure patients’ registration status is as up to date as is meaningful and possible
when an extract is taken, and the National Statistics timetable will be amended to reflect these enhancements
registrations data will be published using true numerators (i.e. based on registered patients’ postcodes, rather than postcodes of practices where patients are registered) and
denominators (i.e. based, as is done at present, on population of the geography in question)
ISD will prepare provisional data on “participation” in NHS general dental services for the DIG’s scrutiny as an alternative measure to registration
the meaningfulness of patient postcode analysis, mentioned above, will be enhanced with
analysis of any appropriate geography, below or above NHS board

This timetable will come into effect during 2010/11.

Visitors from Ministry of Health, Malaysia

Image of Mayalsian Ministry of Health Logo

On 23 October, ISD hosted visitors from the Oral Health Division, Ministry of Health Malaysia, based in that country’s capital, Kuala Lumpur. Drs. Salmiah Bustanuddin and Savithri Vengadasalam were in Scotland on a short attachment as guests of NHS Education Scotland.

A series of ISD workforce and dental presentations was organised for our visitors, whose interests are mainly in the fields of children’s dental health and the workforce required to support such services.

Much of Salmiah and Savithri’s time was spent visiting NES colleagues in outreach centres across Scotland, so ISD was very pleased to have the opportunity of sharing our knowledge of dental and workforce information with such interested colleagues. There was no doubting the collective benefits Malaysian and Scottish participants derived.

Web pages

Dedicated web pages presenting ISD’s Dental Informatics Programme and Core Dental Information pages combined are in development and will be available shortly.