Technical Notes 2021, Issue 177 - Care Inspectorate: Supporting Better Oral Health in Care Homes

1. Following the Scottish Dental Action Plan (2005), the Caring for Smiles programme was developed and established to support Care Homes in Scotland with the Oral Health needs of Care Home residents. The aims of the programme include the provision of training for Care Home staff by NHS teams to improve the understanding of the complex oral health needs of Care Home residents and to support the maintenance of oral health through

• Risk assessment
• Care plans
• Daily care, and
• Referral to a dentist if required

2. The training provided takes the form of accredited and non-accredited training. The former was more commonly used earlier in the Caring for Smiles programme and has historically formed the greater part of training to Care Home staff in NHSGG&C. More recently an accredited training programme, in partnership with NHS Education Scotland (NES) has been offered. This takes the form of Foundation (SCQF Level 5) and Intermediate Training (SCQF Level 6). This has enabled recognition of these qualifications alongside other qualifications relevant to health & social care and Post Registration Training and Learning.
    
3. The Board’s Caring for Smiles team provide support to Care Homes and regular monitoring of activity in relation to training. This is reported both nationally and through the Oral Health Directorate and is included in the activity reports provided to HSCPs. Concerns with Care Homes in relation to Caring for Smiles activity or a lack of engagement with the programme are reported to HSCPs and can assist in the identification of wider concerns in Care Home settings.
    
4. The Care Inspectorate has recognised the importance of good oral health as part of good general health and wellbeing and have been involved in partnership working in the development of resources. The Care Inspectorate has recently published a quality illustration: Supporting Better Oral Health in Care Homes.
5. This quality illustration has been produced by the Care Inspectorate to:

• Highlight good practice in Oral Care for care services and staff
• Help care services and staff/inspectors to identify indicators where a care service’s practice could be better and support them to improve
• Support care providers to better understand and implement good quality oral care.

6. The Care Inspectorate also state this quality illustration does not replace the need for training of Care Home staff and highlight the availability of the accredited training for Caring for Smiles (older people, including Care Home residents) and also Open Wide (adults with additional care needs living in the community).
    
7. The quality illustration provides examples of what good practice looks like and links to support actions and resources to assist Care Homes and inspectors in how to improve mouth care for residents.
    
8. This quality illustration is a welcome resource and will be a vehicle to help re-establish the training delivery element of Caring for Smiles as the Oral Health Improvement Team continue to re-mobilise following the COVID-19 pandemic.

The Impact of the COVID-19 Pandemic on Caring for Smiles

9. The COVID-19 pandemic had a profound impact on the ability for Caring for Smiles Teams to delivery training to Care Home staff and monitor activity. It has not been possible to deliver face-to-face training or to undertake monitoring visits with Care Homes. In addition, Oral Health Improvement staff have been re-deployed as part of the pandemic response.
    
10. Wherever possible support has been provided to Care Homes through telephone consultations and the use of online platforms to deliver training. Caring for Smiles newsletters and updates have been circulated to Care Homes. It is expected the use of alternative ways of delivering training will continue beyond the pandemic to supplement more traditional means as the Oral Health Improvement Team re-establish links with Care Homes. The Care Inspectorate quality illustration will provide a platform to support this.

Roadmap for Recovery for Caring for Smiles

11. Work is underway within the Oral Health Improvement Team to gather information on the current status of Caring for Smiles in Care Homes across NHSGG&C. The team are engaging via surveys and telephone consultation to gather data. This data will facilitate planning and prioritisation of Caring for Smiles training, with the Care Inspectorate quality illustration acting as a driver to facilitate engagement with Care Homes.
     
12. The HSCPs will be provided updates to training and monitoring progress within Care Homes through the established reporting channels. Where concerns are identified with Care Homes, notification and engagement with HSCPs will take place to determine what supportive actions are required.