Gathering evidence with digital tools - Yorkshire and Humber

Hull and Wakefield have used PHE’s online SHAPE tool to work out how best to invest money in dental services. SHAPE has allowed officials to map where practices are against areas of high deprivation as a proxy for poor oral health.


Overall access to NHS dentistry continues to increase. But problems still persist. During 2016/17, 60 per cent of children aged 0 to two years did not access services in Wakefield and Hull. Access figures are better for slightly older children, with about one fifth of three to five year olds not accessing the care that they need to enjoy good oral health.

In more deprived areas, where oral health tends to be poorer, lower proportions of children access primary care dental services. In Wakefield and Hull over a third of five year olds experience tooth decay. This is significantly higher than the England and regional averages.

The solution

To help tackle inequalities in children’s oral health, NHS England has launched a new national pilot called Starting Well. It is targeted on the 13 areas with highest rates of tooth decay in young children. Two of these are Wakefield and Hull.

The programme has two levels and involves working with existing practices. The first level sees dental teams adopting a preventive approach to the care that they provide and involves accepting new child patients, having an oral health champion, team training and audit.

Level two includes all that plus a commitment to work with communities and the children’s workforce such as health visitors and children centre staff, to reach out to families to encourage access to services by young children.

In Wakefield and Hull working groups were set up, including representatives from the local authority, PHE and NHS England, in spring 2017 to explore how best to tackle the issue. The decision was taken to use PHE’s SHAPE tool to identify the areas where need was greatest.

SHAPE (strategic health asset planning and evaluation) is an online platform that supports the planning of services by mapping physical assets and national datasets across a health economy.

Using SHAPE, the working group was able to create a heat map showing where dental practices were located, the areas of highest deprivation – which was used as a proxy for tooth decay – and the 15-minute walking radius from the practice. Knowledge of public transport links and soft intelligence were then considered.

Sally Eapen Simon, PHE’s Yorkshire and Humber consultant in dental public health, says: “We wanted to help stakeholders have a shared understanding of need and think about where investment might be made to address inequalities in access. Already we can see there are areas of high deprivation where access to services by families with young children is more of a challenge.

“Improving access to services for children, with a focus on reaching out to those who have not engaged with services previously, provides the opportunity for regular examinations, prevention interventions and evidence based advice to optimise children’s oral health.”

Lessons learned

Dr Eapen Simon says: “Deprivation is considered a good proxy risk factor for oral health. Unfortunately, we did not have tooth decay data at ward level in the either area. Local authorities commission oral health surveys and the potential to use larger sample sizes would have provided us with data at a ward level. In this way, we could have potentially mapped the tooth decay and additional data using the SHAPE tool.”

She also says with more time and funding, they could have gone into even more detail.

“We could have looked at the location of children’s centres and nurseries, for example, to give us an idea of where children and families were in local communities.

“A collaborative approach between partners and making best use of local intelligence is key to help us address oral health inequalities and improve oral health in children locally.”

How is the approach being sustained?

The pilot has now been launched and tenders have gone out to local dental practices inviting them to apply to take part in Starting Well. Following an evaluation process, which will include sense checking information with the SHAPE tool, the practices taking part should be identified by the end of the year with a view to them starting the work in early 2018. The programme will then last two years.

By using SHAPE in this way, PHE associate director Barbara Coyle says it has prompted ideas about other ways it could be developed and deployed.

“The tool has great value in supporting the re-design of existing services or developing new ones to meet the needs of local people. This way of intelligence gathering could be of real use in supporting the wider healthcare commissioning agenda.

“The work in Wakefield and Hull has stimulated us to develop a specific component in SHAPE which will focus on dental care and will bring together data on dental activity and outcomes with demographic data and travel time analysis.”