Covid 19 Dental Scheme
1. Introduction
Ordinary dental services were suspended in Jersey during 2020 in response to the risk that Covid-19 would be transmitted when dental procedures were undertaken. During this time only the most urgent treatment was delivered in the dental department of the General Hospital. As a result, children could not access dental appointments for routine care or the delivery of preventative treatments such as fluoride varnish.
Services have since been resumed with younger children (aged 0 to 11, prior to starting secondary school) receiving treatment free of charge in the General Hospital Dental Department and children of secondary school age cared for by private dentists (meeting their own costs).
However, there are concerns that there is a hidden spike of dental decay developing among children in Jersey and that low-income families will be disproportionately affected.
Public Health Jersey note that poor oral health can affect a child’s ability to sleep, eat, speak, play and socialise with other children and that impacts are also seen educationally when children miss school because of dental pain or to go to the dentist for treatment. These negative consequences are observed more frequently in lower income groups where UK analysis has shown that dental disease is more prevalent among socially and economically deprived communities.
These communities will have been impacted more severely by the disruption caused by Covid-19 and the cost of accessing services will make it difficult for poorer families to catch up with the care they missed. The General Dental Council (UK) warn that:
The impact of COVID-19 on oral health is likely to be more severely felt by those who were already more likely to have poorer health outcomes raising concerns about the creation and exacerbation of oral health inequalities in the UK if not addressed.
Dental disease is treatable and preventable; simple treatments, such as fillings and preventative treatments like fluoride varnish application and fissure sealants, can be delivered by community dentists and reduce the growing burden of dental disease among children in low-income families at high risk of developing dental decay.
This scheme supports the Council of Ministers commitment in the Common Strategic Policy (CSP) 2018-2022 to ‘Putting Children First’ and Government Plan commitments to improving access to primary care, with a particular focus on financially vulnerable people.
2. Overview of the Covid 19 Dental Scheme
Considering the risk of a spike in dental disease among children in low-income families, the Minister for Social Security will bring forward a scheme which targets extra support in a one-off scheme to make children dentally fit. The Minster is seeking to target secondary school age children (who are not provided for by the hospital service) who are members of Income Support Households, numbering just under 1,000 children.
A benefit allocation of £350 will be made for each child to make them dentally fit and to pay for preventative treatments. The child or their parent/guardian can use this allocation with the dentist of their choice. Funding may be reclaimed if used inappropriately.
The allocation cannot be transferred to another person or used for other purposes. This is a non-statutory scheme and as such the decision made by CLS acting on the Minister's behalf is final and there is no appeals process. The Minister at her discretion may amend the scheme.
The scheme does not commit to funding on-going care for this group, noting that:
- There is a likely spike of dental disease because of the unique suspension of normal services in 2020 in response to Covid-19
- The imminent creation of an island wide Oral Health Strategy will consider on going access to dental care for all age groups
The Minister is grateful for the contributions offered by Public Health Jersey, The General Hospital Dental Department and the Jersey Dental Association in the development of the Covid 19 Dental Scheme.
2. Scheme Design
2.1 The scheme is similar in design to Pension Plus benefit, where each eligible person is awarded an allocation to pay for the dental care they need. In the case of the Covid 19 Dental Scheme, an allocation of £350 has been made per child and in cases where the allocation is not sufficient to meet care costs, families can apply for a top-up grant.
2.2 The scheme will be open to children of secondary school age who are recorded as being members of Income Support Households (meaning they are part of an open claim) on 1 December 2021, prior to launch.
2.3 Parents/Guardians will receive notification of their child’s eligibility by letter. The letter will be in two parts;
- A letter which can be used as proof of eligibility and retained by the dentist providing treatment.
- An insert which describes the scheme, including roles, responsibilities and data use. This part should be retained by the parent/guardian for reference.
- Parents/guardians who wish to take part in the scheme will arrange to visit their dentist, taking with them the proof of eligibility.
- The dentist, according to their normal process and in line with best practice, professional judgement and ethics, and in keeping with General Dental Council requirements, will create a care plan where the treatment required and the cost of this treatment is recorded and shared with the parent/guardian. If the cost of the treatment plan exceeds the benefit allocation the parent will be able to apply for a top-up grant.
- The dentist will undertake the treatment or course of treatments and submit itemised invoices to Customer and Local Services on behalf of the benefit recipient.
- The invoice must identify the benefit recipient so that Customer and Local Services can confirm eligibility and oversee the balance of the benefit allocation.
- The invoice must be itemised to ensure that the allocation is used only to fund treatments covered by the scope of the scheme. (See below.)
- When all treatments have been completed and the child has been made dentally fit the account in respect of the child will be closed and any unspent allocations returned to CLS budgets.
- All courses of treatment must be completed by 30 June 2022, at which point the scheme will be closed, but the Minister at her discretion may extend the date of final closure as wider circumstance may require.
- To offer insight into the dental health of low-income children, CLS will collate anonymised data on the performance of the scheme. This information will be shared with Health and Community Services and Public Health to support their development and implementation of the Oral Health Strategy and joint strategic needs assessment. Analysis of anonymised data will include
- Uptake and the numbers/ages of children who receive treatment
- The extent of dental disease
- The type and volume of treatment provided
3. Treatment provided under the Scheme
The Covid 19 Dental scheme aims to make the eligible cohort of children dentally fit and provide preventative treatments (fluoride varnish and fissure sealant) which reduce the future incidence of dental disease. Public Health Jersey support the deployment of this scheme and endorse it as being needed and worthwhile.
Children on the scheme can expect to access the following, but only where appropriate and necessary
- Dental check up
- Bite wing x-ray
- Scale and polish
- Two courses of fluoride varnish (the second course will be accompanied with a further check-up)
- Fissure Sealant
- Remedial treatments including filings and extractions
The scheme will not fund cosmetic/whitening treatment, implants, orthodontic treatment, bridges or letters of referral. No charges will be made to the scheme for missed appointments however dentists may levy a charge to parent/guardians according to their usual policy.
4. Evaluation
The performance of the scheme will be evaluated, considering the number of eligible children who access care, the type and number of treatments provided, cost, customer experience and feedback from practitioners.
5. Cost and Resources
The Covid 19 Children’s Dental scheme will be resourced with officers from Customer and Local Services, Health and Community Services, and Strategic Policy, Planning and Performance and with support from dental practitioners.
The extent of dental disease among eligible children is not known. Current projections suggest that the majority of children may receive the preventative treatment they require for sums between £120 to £180 but that 40% of children will require remedial work. Analysis suggests a budget of £240,000 will be required to deliver this investment in children’s oral health depending on the level of latent dental disease. This will be funded from Customer and Local Services.
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