Download Oral Health for all Northlanders - Northland District Health Board

Oral Health for all
Northlanders
Oranga Mangai mo Te Tai Tokerau
A Strategy for Oral Health in Northland
Adopted by the Board March 2007
Table of Contents
1
2
3
4
Executive Summary ...................................................................................................................... 1
Why we need an Oral Health Strategy ......................................................................................... 2
Background and Scope of Strategy .............................................................................................. 3
Oral Health Services in New Zealand .......................................................................................... 5
4.1 Service coverage ................................................................................................................. 5
4.2 Health Practitioners Competence Assurance Act 2003 ...................................................... 5
4.3 Publicly funded work in private practice ............................................................................ 6
4.4 Maori Child Oral Health Services Review (MCOH) .......................................................... 6
4.5 School Dental Services Facilities Review .......................................................................... 6
4.6 Future directions ................................................................................................................. 7
5 Oral Health Services in Northland ............................................................................................... 8
5.1 Types of oral health provider .............................................................................................. 8
5.2 The ‘Lifecourse’ approach .................................................................................................. 8
6 Needs analysis ............................................................................................................................ 10
6.1 Early childhood (preschoolers and their mums) ............................................................... 10
6.2 School Aged Children ....................................................................................................... 12
6.3 Adolescents ....................................................................................................................... 16
6.4 Adults ................................................................................................................................ 18
7 Secondary Services ..................................................................................................................... 22
8 Oral Health Promotion ............................................................................................................... 23
8.1 Importance of oral health promotion ................................................................................ 23
8.2 Water Fluoridation ............................................................................................................ 23
8.3 Fluoridation in non-reticulated areas ................................................................................ 24
9 Summary of findings from the Situation Analysis ..................................................................... 25
10 Goals ........................................................................................................................................... 27
10.1 Promote Oral Health ......................................................................................................... 27
10.2 Develop publicly funded dental services and facilities that best meet the needs of
Northlanders ...................................................................................................................... 28
10.3 Increase, develop and support the oral health workforce .................................................. 29
10.4 Ensure a quality service .................................................................................................... 29
11 Implementation Plan ................................................................................................................... 31
Appendix 1 Acknowledgements ................................................................................................... 33
Appendix 2 Maori Child Oral Health Services Review Recommendations ................................. 34
Appendix 3 Recommendations from SDS review ........................................................................ 36
Appendix 4 Private Provider Survey Results ............................................................................... 39
Glossary ............................................................................................................................................. 43
References ......................................................................................................................................... 47
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Figures
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Lifecourse approach, service roadblocks, access issues and Northland providers ......... 9
Northland populations by age, 2001 Census and projected for 2006 and 2016 ............ 10
Excerpt from Well-Child Handbook ............................................................................. 11
Location of rural clinics, Northland DHB School Dental Service, October 2006 ........ 13
Number of dental therapists, actual and estimated shortage ......................................... 14
Dentists providing of adult oral health services in Northland, October 2006 ............... 20
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1
Executive Summary
The Strategy for Oral Health in Northland has been written to identify the goals that will
support the achievement of the vision:
Oral Health for all Northlanders
Oranga Mangai mo Te Tai Tokerau
Within this vision of oral health for all Northlanders, the aim of this strategy is to reduce
and eliminate oral health inequalities by achieving four goals:
1
To promote oral health
2
To develop publicly funded oral health services and facilities that best meet the needs
of Northlanders
3
To increase, develop and support the oral health workforce
4
To ensure a quality service.
The Northland Oral Health Planning Group prepared this strategy during a period of review
by the Ministry of Health, to which Northland contributed, and which culminated in the
Ministry publishing, in August 2006, a new strategic vision for oral health in New Zealand
“Good Oral Health for All, for Life”. This strategy has been written in the context of the
vision and to support the achievement of NDHB’s District Strategic Plan 2005-2010 and
provides the strategic direction for one of the five strategic priorities, oral health, with a focus
on one of the four priority population groups, children and youth.
Northland experiences some of the highest dental disease rates in New Zealand. There are
inequalities of both oral health status and access to oral health services, particularly for Maori
and Pacific people and those living in rural areas and with lower socioeconomic status. None
of Northland’s water supplies are fluoridated.
To achieve equity of access and oral health outcomes this strategy advocates for an integrated
and seamless Northland-wide oral health service, delivered by a mix of providers. This will
mainly be achieved by means of oral health teams, consisting of dental therapists and dental
assistants, with the support of dentists, working out of community based fixed and mobile
facilities. A dental therapist to patient ratio of 1:600 is recommended in order to address the
high level of disease among children and youth in the district.
Alongside the focus on reconfiguration and reorientation of oral health services in Northland,
this strategy places an emphasis on expanding oral health promotion activities and using a
variety of approaches to prevent dental decay and gum disease.
This document contains a description of current service provision and analyses need based on
different populations: pre-schoolers and their mums; school aged children; adolescents;
adults. It also looks at secondary services and health promotion.
A brief implementation plan is included to identify initial actions that need to be taken to
work towards achievement of the goals.
Northland Oral Health Strategy, Feb 2007
Page 1 of 47
2
Why we need an Oral Health Strategy
Oral health is important: when you have good oral health, you will generally feel good and
look good. When you have poor oral health you are likely to experience oral infections,
recurrent episodes of pain, general discomfort, eating difficulties and poorer general health
and well-being. A mouth that doesn’t look good, due to rotten or missing teeth, can seriously
affect your ability to interact socially with friends, peers and work colleagues and can
adversely affect educational success and employment opportunities.
There is a close link between oral health and general health. The same ‘lifestyle’ risk factors
(eg, poor nutrition and diet, smoking, alcohol and a lack of physical activity) that contribute to
poor oral health will also increase susceptibility to other chronic diseases such as
cardiovascular disease, renal disease, diabetes and obesity.
Northland experiences some of the highest dental disease rates in New Zealand. There are
also known inequalities in both oral health status and access to oral health services,
particularly for Maori and Pacific people and those living in rural and lower socioeconomic
areas. One of the principle aims of this strategy, and the objectives and actions that flow from
it, is to reduce these inequalities wherever possible. This strategy for improving oral health
for all Northlanders will also try to reduce the levels of oral disease currently existing, while
seeing an increasing number of Northlanders exhibit functional, pain-free and socially
aesthetic dentitions.
Northland District Health Board and the New Zealand Ministry of Health have made oral
health one of their key health priorities.
The ‘Lifecourse’ approach
The recent launch of the New Zealand strategic vision for oral health Good Oral Health for
Life, for All, has provided the vision and framework on which Northland’s Oral Health
Strategy could be developed and realised. The focus of this vision is initially on the younger
members of our population (0-17 year group). This supports the sound and evidence-based
concept of a ‘lifecourse approach’ to improving health outcomes. This concept is particularly
helpful in a limited resource environment such as public health services, where the focus
should be on achieving more favourable health outcomes as early as possible in a person’s
life.
The NDHB oral health strategy supports, in principle, this ‘lifecourse’ approach to the
planning and investment in oral health promotion and treatment services. However through
the process of investing in oral health facilities and workforce for our youngest members of
society, it is recognised that there will be opportunities for improving oral health outcomes
and access for other special needs groups such as the elderly, the medically compromised and
low-income adults.
Working together
There is a wide range of providers working in oral health, including private, community,
Maori and NDHB. There are also proactive Primary Health Organisations and other agencies,
both from the government and non-government sectors, all wanting to see a healthier
Northland. There are therefore many opportunities to improve oral health through working
together and it is hoped this strategy will play a part in achieving ‘Oral Health for All
Northlanders’, as well as improve the general health of individuals.
Northland Oral Health Strategy, Feb 2007
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3
Background and Scope of Strategy
Oral health is considered one of the strategic priorities for the health of New Zealanders as a
whole, Maori and Pacific health, and specifically for Northland. This understanding of the
importance of oral health has been developed and underpinned by the following national
strategy documents and papers:
New Zealand Health Strategy
Maori Health Strategy
Child Health Strategy
DHB Toolkit: Improve Oral Health, 2004
Achieving Health for All People: A
Framework for Public Health Action for the
NZ Health Strategy
Primary Health Care Strategy
Improving Child Oral Health and Reducing
Child Oral Health Inequalities
In early 2004 the Northland Oral Health Planning Group (NOHPG) 1 , was brought together
with the purpose of developing a Northland Oral Health Strategy for the next 3 to 5 years.
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The NOHPG was set up under the auspices of the NDHB’s planning and funding
responsibilities, and reported, via the Service Development and Funding (SD&F) team to the
General Manager SD&F. The group’s advice and conclusions formed the basis of the oral
health component of the District Strategic Plan.
The NOHPG in 2004 was initially charged with investigating and detailing the oral health
needs and service gaps of the population of Northland and to provide recommendations and
actions for better outcomes from, and improved access to, oral health services across
Northland. The focus was intended to be on oral health as a primary care issue, rather than at
secondary and tertiary levels. More specifically however, the NOHPG was asked to develop
a Northland Oral Health Strategy document that would:
1
2
3
4
5
6
Carry out a baseline needs analysis.
Investigate options for the delivery of comprehensive, needs based, Northland wide
oral health services and make recommendations to the GM SD&F for inclusion in
NDHB planning.
Undertake a desk top workforce and current services stocktake.
Consider workforce recruitment and retention issues.
Consider the future of the School Dental Service (SDS) and recommend a response to
any planning requests from the National project to the GM SD&F.
Consider findings from the SDS Facilities Review and other Ministry of Health
documents and reviews.
A final draft of the strategy was delivered to the GM SD&F in April 2005. However from
this date until June 2006 there was a delay in moving the strategy forward due to
developments and specific requests for information from the Ministry of Health. This was in
preparation for the launch of a new national strategic vision for oral health by the Ministry of
Health in August 2006.
From the NDHB perspective this meant preparing and sending off further documents related
to Northland’s current oral health facilities and assets and a proposed service plan for an
integrated 0-17 oral health service in June 2005. No further work was therefore done on the
Northland oral health strategy until after the official launch of the national strategic oral
1
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Refer Appendix 1 for group membership
Northland Oral Health Strategy, Feb 2007
Page 3 of 47
health vision Good Oral Health for All, for Life. This Ministry of Health document lays out a
clear vision and direction for future public oral health services. It also provides a robust
framework on which strategic and operational oral health service development should occur.
In the light of the above developments and directives from the Ministry of Health, the
Northland Oral Health Planning Group reconvened in August 2006. This was to further
progress the Northland Oral Health strategy, with a special focus on embracing the new
national oral health vision. This resulted in the Northland Oral Health Strategy in its present
form. It, like the national oral health strategic vision, continues to support and promote a
more integrated and seamless approach to delivering primary public oral health services.
Northland Oral Health Strategy, Feb 2007
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4
Oral Health Services in New Zealand
4.1
Service coverage
In New Zealand, the focus of publicly funded oral health is on children and adolescents. The
intent is that all people up to the age of 18 have the opportunity to receive free oral health care
through public dental services. After that age, the general expectation is that adults should
take responsibility for their own oral health in the private setting, although public oral health
services are available to special needs groups and low-income adults.
‘Essential’ care and ‘relief of pain’ dental treatment is therefore offered to low income adults
in some areas, and specialist hospital level care is offered to all New Zealanders as required.
Work and Income also contracts oral health providers to provide some limited emergency
dental services to low-income adults. However there are a number of issues, which the MoH,
DHBs and oral health providers are grappling with, including:
• inequalities in oral health outcomes and access, based on ethnicity, rurality, and
socioeconomic levels
• a shortage of private dental services in rural areas
• withdrawal of private providers from public contracts in some areas, leaving gaps in
service provision
• groups of children, adolescents and adults not receiving oral health care, due to significant
barriers to access
• all oral health providers facing workforce shortages, non-compliant facilities, and lack of
appropriate service models to meet demand
On the positive side, many areas in New Zealand now have fluoridated water, which has
improved dental decay rates; unfortunately Northland has no fluoride in its water and so does
not benefit from this important public dental health measure.
4.2
Health Practitioners Competence Assurance Act 2003
In September 2004 the Health Practitioners Competence Assurance Act 2003 came into
effect. All oral health practitioners now work under this act. There are general and additional
dental therapist scopes of practice for children, adolescents and adults. This means that dental
therapists now have the opportunity to extend basic primary dental care to adolescents and
adults.
Dental therapists are now independent health practitioners; provided they meet registration
requirements, they can work independently of public health providers. They can therefore
work in public or private practice, but are required to have a professional mentoring
relationship with a dentist of their choice. This professional relationship is probably closer
than that which used to be with the Principal Dental Officer of the NDHB, so there is greater
opportunity for information sharing and coordination of comprehensive clinical care.
Northland Oral Health Strategy, Feb 2007
Page 5 of 47
4.3
Publicly funded work in private practice
Publicly funded contracts offered by the DHB to private providers are as follows:
• school children (0-12 years) Special Dental Benefits (Section 88); known as SDB, this is
for complex cases beyond the scope of practice or experience of a dental therapist
• adolescents (13-17 years) General Dental Benefits Contract (Section 88), known as GDB;
this contract was phased out in 2005 and replaced with the Oral Health Services
Agreement (OHSA), which is the adolescent-specific portion of the combined dental
agreement contract
• combined SDB and adolescents (13-17 years) Oral Health Services Agreement (OHSA),
which started in January 2006.
4.4
Maori Child Oral Health Services Review (MCOH)
In 2004 the Ministry of Health commissioned a review of Maori Child Oral Health Services.
The aim of the MCOH review was to obtain information about the types of services being
delivered, the capacity and capability needs of the services and to identify preferred models of
Maori child oral health services. The recommendations of this review are closely aligned to
the objectives of this strategy. One key recommendation is that:
A coordinated approach to the delivery of oral health services to Maori is crucial and the
relationship between DHBs, Maori providers, School Dental Service and dentists must be
focused on addressing inequalities in Maori child oral health.
A summary of the MCOH recommendations is provided in Appendix 2.
4.5
School Dental Services Facilities Review
In 2004 the Ministry of Health required DHBs to survey School Dental Service (SDS)
facilities using the stocktake tool developed by the School Dental Services Technical
Advisory Group (SDSTAG). Using this information each DHB was to develop a service
model that met the needs of its child population most effectively then and in the future. The
focus was to be on reducing child oral health inequalities.
NDHB reported on:
• inequalities
• a service reconfiguration plan
• consultation feedback
• an indication of the proposed implementation outcomes for inclusion in NDHB’s District
Annual Plan for 2005/2006.
It was found that none of the current fixed SDS clinics met the recommended standards, and
the majority of equipment had exceeded its expected lifespan. A possible service model
configuration was developed (see Appendix 3), but this was devised prior to the Ministry of
Health releasing its national strategic vision for oral health.
Northland Oral Health Strategy, Feb 2007
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4.6
Future directions
In August 2005 the Minister of Health released a statement of the future direction for child
and adolescent oral health services, to have these features:
• community based dental services with strong links to schools, Maori oral health providers
and primary care providers
• a seamless 0-17 year old structure, which has the ability to extend to whanau/ adults
• delivery through a mix of fixed and mobile facilities that are suitable for modern dentistry
• a focus on prevention and very early intervention
• an appropriate and skilled workforce
• nationally consistent dental data.
This was followed a year later in August 2006 by the Ministry of Health’s launch of a new
strategic vision for oral health in New Zealand entitled Good Oral Health for All, for Life,
with the following seven key action areas:
• reorientation of child and adolescent public oral health services
• reduce inequalities in oral health outcomes
• promote oral health
• build the oral health workforce
• build links with primary care
• develop oral health policy
• research, monitoring and evaluation.
This new national strategic vision for oral health further supports the vision and objectives of
what could be a Northland-wide integrated, seamless, community-based public primary care
oral health service. This concept had already been mooted by the NOHPG which had already
explored this vision in its draft oral health strategy of 2005. This final document has built
upon and reflects this shared vision.
Northland Oral Health Strategy, Feb 2007
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5
Oral Health Services in Northland
5.1
Types of oral health provider
There are two main types of oral health provider in Northland:
Private providers run as independent businesses. There are 23 private oral health
providers in Northland (excluding orthodontics and denture management) who employ
38 dentists. As of September 2006 only 13 dental practices held contracts for
adolescent services, 3 of which also held a contract to provide SDB services. All
providers are paid on a fee for services basis. Some providers will only provide
adolescent services to the children of their registered adult clients.
Community and Maori providers generally have a responsibility for a specific
population, community or group, and are funded by a combination of capitation
funding and fee-for-service depending on their workforce capacity and the type of
services they offer. These oral health providers tend to take the service to the areas of
highest need, and invariably deliver services at or close to where patients live or go to
school. The community and Maori oral health providers in Northland are Hokianga
Health, Hauora Whanui (Ngati Hine Health Trust) and NDHB Public Dental Service.
NDHB Public Dental Service also provides the secondary dental care service mainly
out of Whangarei Hospital. Increasingly, the focus is moving to adolescent and lowincome adult groups because of the high level of need identified, but limited financial
and human resources mean that only some of the gaps in service to these high need
groups are addressed.
5.2
The ‘Lifecourse’ approach
According to ‘lifecourse’ theories, factors that help or hinder oral health accumulate over
time. People are exposed to numerous different factors which can influence oral health at
individual, behavioural, socioeconomic, or environmental levels.
While the influences of oral health can be felt into old age, there are some critical periods
over the lifetime when either beneficial or hindering factors can have the most impact. These
are the early years of life, when habits are being formed, and following the eruption of
primary, permanent and wisdom teeth, before the enamel hardens.
It is also important to ensure adequate education of adolescents because they are the adults
and parents of the future. The current oral health system recognises the importance of oral
health in childhood and adolescence, but there should be more priority placed on oral health
through adulthood and into old age as well.
This strategy therefore recommends the adoption of a ‘lifecourse’ approach to managing and
resourcing present and future public oral health promotion and treatment services in
Northland. Hence, the above age groups have been identified in the assessment of the current
oral health needs and services in the next chapter.
Figure 1 provides a high-level pictorial representation of the services available by age group,
and the related access and tracking issues.
Northland Oral Health Strategy, Feb 2007
Page 8 of 47
Figure 1
Lifecourse approach, service roadblocks 2 , access issues and Northland providers
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Age
0-5
Roadblocks
Key access issues
Identification
and
enrolment
5-12
13-15
Transfer to OHSA scheme
16-17
65+
Transfer to private care
Leave school
Awareness
of service
18-64
Reduced
income
Limited
income
Adolescent attitudes
Mobility
Cost
Parental
attitudes
Awareness of service
Compatibility with family
Attendance on acute pain rather than regular
checkups
Service availability and disability access (location, hours, staffing, etc.)
Northland providers
Private
SDB
9
9
OHSA
Privately funded
Community, Maori
Hauora Whanui
9
9
9
9
9
9
9
9
Under SDS
9
Under SDS
9
9
9
Private
9
Private
9
9
9
9
9
9
9
9
9
Low income
9
Low income
9
9
9
9
9
Hokianga Health
NDHB
9
9
Community
SDB
9
SDB
9
Secondary
9
9
School Dental Service
Adolescent
2
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Under the current siloed approach there are various roadblocks that contribute to the discontinuity of
services. The transfer of children from the School Dental Service to OHSA, or of adolescents from OHSA to
private practice, both contribute to client loss from oral health services. A seamless service would remove
some of these roadblocks, thus improving continuity of care.
Northland Oral Health Strategy, Feb 2007
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6
Needs analysis
This strategy divides the population into four age-related groups (preschool 0-4 years, school
aged 5-12 years, adolescent 13-17 years, and adult 18 years and over) based on the
chronological splits that have historically existed in the way services have been provided.
Figure 2 provides summary demographic information for these age groups for 3 different
years.
Figure 2
Northland populations by age, Census 2001 and 2006 and projected for 2016
Age group
Year
2001
Census
2006
Census
2016 projected
(2001-base)
0-4
10,476
10,272
8,950
5-12
19,718
19,333
16,980
13-17
10,508
11,516
10,298
18 and over
99,401
107,355
119,532
140,103
148,470
155,760
All ages
2001-base projections suggest that the numbers of 0-17 year olds will decrease over time
(from 41,022 in 2006 to 36,228 in 2016). However, because the Maori population’s growth
rate is higher than non-Maori, the proportion of Maori in the younger population will increase
(from 37% of the child population in 2001 to 41% in 2016). Maori children have higher oral
health needs, so it is unlikely that overall oral health needs in children will decrease much in
the short term at least.
While the needs of children and youth will receive first priority, the data in Figure 2 indicate
that the number of adults will be growing significantly over the next decade. Needs of adults,
particularly of those aged over 65, the age group that will show the biggest percentage
growth, will become increasingly important over time.
6.1
Early childhood (preschoolers and their mums)
6.1.1
Population
The 2006 Census counted 10,272 preschoolers in Northland. In 2006 the SDS had 5,198
preschool children enrolled in their service, 51% of the estimated preschool population.
During 2005/06 the SDS had completed 3,587 treatments of preschoolers.
6.1.2
Need
In an analysis of the hospital events with an oral health related primary diagnosis for the
period 2000/05, preschoolers made up 41% of the events while making up only 7% of the
population. In 2005/06, 291 pre-schoolers received SDB treatments through NDHB.
Research identifies the following as indicators of oral health risk for children:
• fluoride availability
• socioeconomic status
Northland Oral Health Strategy, Feb 2007
Page 10 of 47
•
•
•
•
•
maternal education (food, behaviour, attendance)
maternal oral health (hereditary, behaviour, anxiety)
ethnicity
locality
disability status.
Increasingly throughout New Zealand there are oral health initiatives being targeted at
pregnant mothers, adolescents and mothers of young children. There are two key factors in
targeting mothers:
• oral health disease in pregnant mothers can affect the health and oral health of their babies
and children
• mothers are the predominant providers and teachers of young children.
6.1.3
Services
The School Dental Service is primarily responsible for the enrolment and primary treatment
of preschoolers. Discussion of the SDS is provided in section 6.2. Oral health in preschoolers is also the responsibility of other health providers and professionals such as:
• well-child providers
• GPs and PHOs
• midwives
• Maori health providers.
Figure 3
Excerpt from Well-Child Handbook
Recommended procedure:
Provide care in a culturally appropriate manner
Assess family/whanau need for information and support
Provide relevant information and anticipatory guidance to parents/caregivers to
promote oral health care
Identify barriers to access, including historical barriers
Check the teeth for abnormalities when they have erupted
Facilitate referral of the infant to the dental therapist from 12 months of age
Document findings and health gains identified including in the Well ChildTamariki Ora Health Book
Use appropriate referral pathway.
Educational preparation needs to include:
Oral hygiene
Age-appropriate nutrition
Normal and abnormal teeth and mouths
Appropriate use of feeding bottle.
Hauora Whanui is the only provider with a contract that focuses on pregnant mothers and
mothers of young children. However, the contract is only to provide dental examinations and
clean teeth. Any other requirements have to be referred to a dentist, which could be a barrier
to accessing necessary care.
Northland Oral Health Strategy, Feb 2007
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6.1.4
Summary of Issues
Enrolment and treatment of preschoolers requires attention from of all health providers.
There is an opportunity to increase the focus of well-child providers on oral health promotion
and enrolling preschoolers in SDS.
There is an opportunity to include oral health messages and basic oral examinations at the
standard health checks for pregnant mothers and mothers with preschool children.
All of the issues identified in section 6.2 relating to school children are relevant to
preschoolers.
Further work needs to be done on considering the options of full, community based services
that could cater to all age groups.
Appropriateness of service is extremely important for this group because it sets them up for
involvement in the service throughout life.
6.2
School Aged Children
6.2.1
Population
According to the June 2006 school rolls there were 19,744 school children (aged 5-12, or year
1-8) in Northland. In 2006 the SDS had 17,917 school children enrolled in their service, so
91% of all school children were enrolled.
During 2005/06 the School Dental Service (SDS) had 25,140 attendances. 11,622 children
completed their course of treatment, 3,587 of whom were preschoolers, and 8,035 were
school children. The actual number of treatments by SDS was 67,073 for both pre-school and
school-age children.
6.2.2
Need
A national comparison in 2004 found Northland DHB out of all the DHBs had the worst
caries-free figure at 33% and the worst 5 year age DMFT (decayed missing and filled
permanent teeth) at 4.11. The average DMFT for the whole of New Zealand was 2.11, and
2.56 for non-fluoridated areas. The New Zealand average caries-free rate was 52% total and
45% for non-fluoridated areas.
31% of Northland hospital events over the last 5 years with an oral-health-related primary
diagnosis were school children, though they are only 18% of the Northland population.
Maori and Pacific children are disadvantaged compared with the rest of the population: only
14% of Maori and 25% of Pacific 5-year-olds were caries-free in 2005, compared with 48%
of other ethnicities. In addition, the percentages for Maori and Pacific children have been
trending down over the last few years.
6.2.3
Services
Figure 4 shows the extensive coverage achieved by the School Dental Service. This structure
helps the service gain access to schoolchildren, but its capital-intensive nature, with many
school-based clinics scattered throughout Northland, makes it expensive to maintain.
Northland Oral Health Strategy, Feb 2007
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Figure 4
Location of rural clinics, Northland DHB School Dental Service, October 2006
Northland Oral Health Strategy, Feb 2007
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The NDHB Public Dental Service presently has responsibility for offering oral health
treatment services for children up to the age of 12 years. Dental therapists, supported by
assistants, provide basic preventive and restorative care. If children require more complex
treatment they are referred to private dental practitioners contracted under special dental
benefits (SDB), or community dentists working within the NDHB Public Dental Service.
Hauora Whanui provides some care for children in their local Kura Kaupapa Maori schools
on behalf of NDHB Public Dental Service. Their numbers are included in the analysis of the
SDS.
In the SDS review a decision tree (Appendix 3) was developed to weight schools for need
based on DMFT figures and school deciles. This suggested a shortage of 13.5 therapist
teams, much more than the 4.5 dental therapist/assistant teams suggested by the commonly
used national ratio of 1:1,100. Due to the shortage of therapists not all children are being seen
12-monthly. Particular gaps are in the Mid North and Far North regions. Figure 5 shows
actual numbers of therapists and the results of applying the two different needs assessment
tools by area within Northland.
Figure 5
Number of dental therapists, actual and estimated shortage
Number of dental
therapists 2004
(FTEs)
Estimated total
based on 1:1,000
Estimated total
based on NOHPG
needs analysis
Far North
4.5
4.0
5.5
Whangaroa
1.0
1.0
1.0
Hokianga
1.0
1.0
1.75
BOI
2.0
6.0
7.0
Urban Whangarei
8.0
10.0
13.25
Rural Whangarei
4.0
4.0
4.0
Kaipara
3.0
3.0
4.5
23.5
28.0
37.0
Total Northland
There is a shortage of private dentists who will accept SDB referrals. Three dental practices
hold contracts for SDB services. Anecdotally, it is understood that it is difficult to find
dentists who will take private paying children. NDHB provides a dentist based with their
north team to do SDB work.
NDHB Public Dental Service community dentists now do most of the more complex work
referred on by dental therapists. This is done in the dental suite at Whangarei Hospital, in the
SDS school clinics throughout the region and the surgical bus. In 2005/06, 1,162 children
were treated under the SDB scheme, 209 of whom were treated in the surgical bus.
Northland Oral Health Strategy, Feb 2007
Page 14 of 47
The recent SDS review identified the following issues relating to school-aged service
provision:
Access
Parents sometimes don’t know when the mobile unit will be in their
schools (they are told, but sometimes don’t remember).
If the fixed clinic is closed, parents sometimes don’t think about going
anywhere else.
Children from some smaller schools have to travel to other schools for
care.
Mobile units do not visit any early childhood centres, doctors’
practices or marae.
Some schools are difficult to take services to, especially in getting
access for mobiles.
Service barriers
Lack of therapists means that children don’t get seen often enough and
problems compound.
The service has been run in the same way for many years and it may be
difficult to change from the national structure.
The service has reduced over time, and there isn’t a full-time therapist
in each clinic anymore.
Does the funding formula reflect the high needs in Northland?
Socioeconomic
barriers
Economic fluctuations mean people move from Northland to Auckland
to find work.
Transport.
Education on prevention.
Mothers’ perceptions of need for oral health.
Cost of toothpaste etc.
Transience
Don’t attend appointments.
Difficulty keeping track of children.
Difficulty getting consent for treatment.
Children move in and out of Northland, particularly to South
Auckland.
Cultural barriers
Only a small number of therapists and assistants are Maori.
Must respect concept of tapu of the body.
6.2.4
Summary of Issues
The SDS does not have the human and financial resource capacity to meet the high oral health
needs of all children in Northland.
Not all private providers will take on private paying child patients.
There is a shortage of dentists to be SDB providers of child and adolescent dental care.
Northland Oral Health Strategy, Feb 2007
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6.3
Adolescents
6.3.1
Population
MoH describes the adolescent population for oral health as being those aged between 13 and
17 inclusive (that is, up to but not including the eighteenth birthday). The 2006 Census
recorded 11,516 people aged between 13 and 17 years inclusive in Northland.
During 2003/04 5,588 (49% 3 ) had completed treatments, leaving a gap of 5,712 (51%)
adolescents with either no treatment, partial treatment, or paying for their care privately. The
MoH aims for 85% coverage.
TP
PT
Since 2003/04 the number of private dental providers signed up to adolescent dental contracts
within Northland has decreased from 23 to 13. Of the 13 private providers remaining, only
one is located outside of Whangarei. This has meant an ever-decreasing level of accessible
oral health services for adolescents living in rural areas; this group, because of the difficulty it
has in accessing services and its ethnicity and deprivation, is our most needy. Adolescent
service contracts are increasingly seen as being unattractive to private dental providers, and
evidence to date has shown that once providers exit from this contract they are unlikely to resign.
6.3.2
Need
There is very little information collected on the needs of adolescents. The 12-year-old DMFT
rate is 2.6. However, there is concern that this number doesn’t represent the true picture due
to some areas, especially those with higher needs, not having any access to services. This is
reflected in figures which show that the areas with highest DMFT rates are the more rural,
high-deprivation areas that include Whangaroa (3.8), Hokianga (3.2) and Bay of Islands (3.1).
The Far North has a 12-year-old DMFT rate of 1.9, which seems low and is probably not
accurate.
Maori adolescents have poorer oral health than their European counterparts. In 2002, the
DMFT score for Maori was 2.9, compared to 1.5 for European/other 4 . 2004 data suggests the
Maori figure has worsened slightly to 3.0 5 . The picture is the same for 12-year-olds: in 2005,
41% of non-Maori/non-Pacific were caries-free, but only 24% of Maori and 10% of Pacific
children were caries-free. The caries-free percentage for this age group has generally
decreased over the last few years 6 .
TP
TP
TP
PT
PT
PT
Oral health planning must take account of the projected increase in the number of Maori
children and adolescents in Northland. By 2016 the percentage of Maori in the 0-24 age
group will increase to 41% of the child and youth population, from 37% in 2001. Overall, the
0-24 population is projected to decrease by 8.3% between 2006 and 2016, a numerical drop of
4,320.
3
TP
PT
4
TP
PT
5
TP
PT
6
TP
PT
Based on the 2001-based projection that estimated the population of 13-17yr olds to be 11,300.
Paediatric Society Report to NDHB, 2005.
Community Dental Service, NDHB.
NDHB data from School Dental Service for 1994-2005.
Northland Oral Health Strategy, Feb 2007
Page 16 of 47
6.3.3
Services
When adolescents go to secondary school they should be offered the opportunity to enrol with
a public adolescent provider to continue to receive free care until they turn 18. Many
adolescents however haven’t been receiving treatment so public sector providers have
recently undertaken access and service initiatives to try and fill the gap. The service coverage
across Northland is however sporadic at best and non-existent at worst.
NDHB’s Public Dental Service runs two mobile dental units dedicated to adolescent care.
Adolescent South covers Whangarei and Kaipara and Adolescent North covers Whangaroa,
Taipa and Kaitaia.
As part of the strategy development, a questionnaire was sent to all private providers in
Northland. Full results are provided in Appendix 4; some key points:
• some dentists limit their adolescent numbers to children of existing patients
• more than 50% of private dentists planned to exit the service within the next 3 years
• the key areas identified for DHB support were improving the handover from SDS and
promotion of the adolescent service
• there were many reasons for not holding a contract; all said it was uneconomic,
bureaucratic, and clinically restrictive; other comments were about non-attendance of
children, and issues with policies
Of particular concern was that three private providers, covering a total of 945 completions,
indicated in the survey that they intended to continue providing the service for less than a
year. One of those who offered a service 2003/04 (170 completions) had already withdrawn.
Hokianga Health, which works out of the SDS clinics at various schools, holds the contract to
provide adolescent care in their region.
Hauora Whanui is contracted to provide adolescent care within the high schools in Kawakawa
and Kaikohe. They have a mobile unit which can be taken on to school grounds.
6.3.4
Summary of Issues
There is very little information on the current oral health levels of adolescents.
About half the estimated number of adolescents received completed treatments in 2003/04.
Private providers are unhappy with the current contracting arrangements. Many are
considering withdrawing, or have already withdrawn from offering the adolescent service.
Given that they historically provided most of the service, it is important to address this issue.
The areas of highest need, based on ethnicity and socioeconomic level, tend to have the
lowest private provider coverage.
Services need to be specifically targeted to the needs and expectations of adolescents.
Northland Oral Health Strategy, Feb 2007
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6.4
Adults
6.4.1
Population
The 2006 Census counted 107,355 Northland residents aged 18 years and over.
6.4.2
Need
There is no information available on the level of need of adults. The majority of care is
provided in a private setting and getting detailed information is difficult.
Traditionally the focus of the Ministry of Health has been on children and adolescents. Most
adults are expected to access private services, but many barriers, particularly financial, exist
to gaining access to these services. As a result, certain groups have not been accessing oral
health care. There is no information on the number of adults not receiving care, but it is
believed to be quite high.
Maori made up 56% of all hospital events, compared with their 30% share of the total
Northland population.
Based on ethnicity and socioeconomic level, all areas within Northland have quite large highneed populations. However, there are only services for low-income adults in Whangarei (by
NDHB), Hokianga (by Hokianga Health) and Kawakawa (by Haoura Whanui). Work and
Income treatments are discussed below.
Based on the lifecourse approach it would make sense to focus on young adults. Catching
decay early and developing good habits will provide a basis for improved oral health
throughout adulthood. This group of the population are also future parents of children so it is
important that they have the knowledge required to educate their children about oral health. It
is possible that young adults find it harder to access care due to the financial impact of
activities such as undertaking education, having children, and setting up first homes.
Older adults, because of the combined effects of age and accumulation of chronic diseases,
are another target group. They also suffer increased barriers to accessing care due to factors
such as the financial impact of reducing paid work, mobility and medical problems. There
are no oral health services targeted at older adults, other than those with multiple morbidities
who can access a limited service at Whangarei Hospital. There were a projected 21,930
people aged 65 or over in 2006.
As already mentioned, the focus for public funding of oral health is mainly on children and
adolescents. There is very limited NDHB funding for special needs groups and low-income
adult care. Available services for adults fall into five areas:
Private
For the majority of adults, services are through private providers on a user
pays basis.
Relief of
pain
There is a relief of pain service for low-income adults offered through
NDHB’s Community Dental Service, though it runs only in Whangarei. The
service’s 2 dentist FTEs also provide other public dental services for children
and special needs groups. In 2003/04 they had 1,327 low income completions
funded by NDHB and 1,429 completions funded by Work and Income. In
2005/06, 1,675 Community Service Card patients were treated. Hauora
Northland Oral Health Strategy, Feb 2007
Page 18 of 47
Whanui also provides Work and Income-funded services for low income
adults.
Hokianga
Health
Hokianga Health is contracted to provide primary care oral health services for
low income adults in their region, however they extend the service to all
registered patients.
Work and
Income
Work and Income contracts providers to undertake care for beneficiaries.
They will pay up to $300 a year per client for emergency dental treatment.
This usually amounts to at least $500,000 a year, with services going to more
than 2000 clients. They also provide advance loans on benefits for at least 800
people to access further emergency treatment beyond the $300 threshold. All
funding is for emergency dental treatment only and generally does not render a
patient dentally fit.
Secondary
services
Secondary care level services are offered through the hospital oral health
service. Adults made up 21% of the hospital events between 2000 and 2005.
Further discussion on secondary care services is provided in section 7.
Risk factors for oral health are often the same as those for many other health and social issues.
There are opportunities to work more closely with organisations such as Work and Income,
ACC, local councils and PHOs to try and make a difference in the overall health and living
conditions of high need adults.
6.4.3
Services
Figure 6 shows that dentists tend to concentrate in the more urbanised areas, especially
Whangarei.
Northland Oral Health Strategy, Feb 2007
Page 19 of 47
Figure 6
Dentists providing of adult oral health services in Northland, October 2006
Northland Oral Health Strategy, Feb 2007
Page 20 of 47
6.4.4
Summary of Issues
Public funding for adult services is extremely limited. Given that there is an emphasis on
providing care for the 0-17 year age group adult oral health at present is not seen as a priority
for the MoH for the foreseeable future.
There is a lack of information regarding oral health needs of adults.
Oral health services for low income adults are limited.
Work and Income provides funding for oral health services, but only for low-income earners
needing emergency care.
People aged over 65 years have increasing oral health needs, but there is no monitoring of
need, or targeted services.
Many of the risk factors for oral health are the same as for other health and social issues.
Northland Oral Health Strategy, Feb 2007
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7
Secondary Services
Hospital-based dental services are available to the whole of the population in Northland.
MoH’s service specifications for hospital dentistry indicate that as a minimum all regions
should provide the following:
• dental services which are an essential part of inpatient hospital medical or surgical
treatment
• dental services that require hospital admission, such as services requiring general
anaesthetic
• general and specialist dental services for persons needing special care because of medical
conditions or disabilities
• general and specialist dental services for persons with severe dental conditions which
cannot be treated appropriately in private dental practice.
The current hospital dental service in Northland is at an embryonic stage and relatively small,
and is staffed by one hospital dental specialist, one day a week. There is a partial on-call
service for out-of-hours emergencies. Occasionally there are visiting specialists in
oral/maxillo-facial surgery and orthodontics. A recently opened hospital dental suite may
allow for further development and enhancement of the existing service in the years to come.
Any patients requiring more specialist advice and treatment are referred to the Auckland
Regional Oral Health Service, which is the tertiary facility responsible for Northland patients.
Some general dentistry that requires a hospital admission, especially for children and
adolescents who require a general anaesthetic (GA), is carried out by one of the community
dentists employed by NDHB’s Public Dental Service. Most of these GA sessions take place
at Whangarei Hospital and a few patients will be seen and treated at Kaitaia Hospital as of
February 2007. Increasingly efficient and effective use is being made of the Mobile Surgical
Bus that provides a GA facility for medically fit child and adolescent patients who require
general dental treatment in the more rural locations of Kaikohe and Dargaville. This facility
now treats 50% of the total number of dental treatments (approx. 250) completed under GA
each year.
The Community Dental Service’s main role is to provide a primary dental care service to:
• eligible low-income adults requiring emergency treatment
• children and adolescents who require advice, assessment or treatment beyond the scope of
practice or experience of a dental therapist (under SDB, OHSA and ACC contracts).
The main base for these activities is now at the hospital dental suite in Whangarei. This
provides opportunities for community dentists to see and treat some patients who might be
considered to lie within the definitions of the hospital dental service specification document.
There are therefore some overlaps between primary and secondary care when treatment is
carried out within a hospital setting; these might include:
• patients requiring basic or general dental care who are medically compromised
• patients who require basic or general dental care under general anaesthesia or sedation.
There were 566 inpatient hospital attendances in 2003/04; 270 were technically classed as
hospital events, meaning that they were admitted for longer than 3 hours and had a primary
diagnosis that was oral health related. An analysis of the 1,016 hospital events over a 5 year
was undertaken and findings are discussed in relevant sections of this document.
Northland Oral Health Strategy, Feb 2007
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8
Oral Health Promotion
8.1
Importance of oral health promotion
Oral health promotion is one of the key issues for strategic planning. The only way to
improve oral health disease levels in Northland is to shift our focus from treatment to
prevention. There are 1.4 FTE oral health promoters employed by Northland DHB; 0.8 FTE
has a focus on fluoridation advocacy Northland-wide, and the other 0.6 FTE covers general
oral health promotion.
Hokianga Health undertakes oral health promotion as part of their other health initiatives, but
they are not funded specifically for oral health promotion. Hauora Whanui has 1.6 FTE
working in oral health promotion who are predominantly involved in the brush-in
programmes in local schools. There has been no review of the effects of the brush-in
programmes, though anecdotally they are believed to make a difference.
Te Hauora O Te Hiku O Te Ika (a Far North iwi provider) also provides some oral health
education as part of their well-child services.
Many risk factors for oral health are consistent with those for key chronic diseases that PHOs
are addressing. There is an opportunity to work with the PHOs and introduce an oral health
component into their education initiatives. It is understood that Te Tai Tokerau PHO is
already encouraging GPs to look in their patients’ mouths when they come in for general care
and Manaia PHO is also introducing oral health promotion in the practices. NDHB therefore
has an opportunity to ensure that oral health is a priority within the regional plan for PHOs.
8.2
Water Fluoridation
Northland is one of the few regions in New Zealand that has no fluoridation in any of its
reticulated water supplies. Water fluoridation is a well proven public health measure that
reduces tooth decay rates especially for those who are in the lower socioeconomic groups.
Northland DHB employs a fluoride advocate, whose task is to work with the three district
councils (Whangarei, Far North and Kaipara) and their communities to encourage discussion
and implementation of fluoridation into water supplies.
MoH subsidises up to 100% of the costs of setting up water fluoridation so cost is not an
argument against it. The councils are required to develop Long Term Council Community
Plans (LTCCPs) within which they must detail how they are adding to the health and
wellbeing of their communities. Fluoridation would be a measurable factor to be introduced
into such plans, which is one of the main tasks of the fluoride advocate.
It is estimated that 20,356 children (77%) in Northland attend schools with reticulated water.
Fluoridated water would reduce dental decay rates by 40-60% in children and by 10-20% in
adults. Based on the SDS decision analysis tree there is a weighted need of 28 therapist/
assistant teams for Northland. Research suggests that if water fluoridation were introduced,
over time the level of need for dental therapists and assistants would drop by 40-60%.
However, it is unlikely there will be any significant reduction in the primary dental care
workload of dental therapists for some time, as the re-establishment of an annual examination
for all children in the SDS would need to be achieved first. This could take some time (10
years plus at least) even in the favourable environment of water fluoridation. The future
workforce predictions of needing another 12 to 13 therapist teams would therefore stand true
for at least the next decade.
Northland Oral Health Strategy, Feb 2007
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There is a need for all health workers to raise the profile of oral health, and in particular the
benefits of fluoridation, so that communities have the information they need to make
informed decisions and hopefully lobby councils for water fluoridation.
The Far North District Council decided in July 2006 to introduce fluoridated water into two
towns in the Mid North and Far North, namely Kaikohe and Kaitaia. This would allow over
10,000 people to access fluoridated water supplies from early 2007. It is an encouraging step
in the right direction but extending fluoridation to other parts of Northland may be difficult
because of strong and vocal opposition from a small minority within the community.
8.3
Fluoridation in non-reticulated areas
While water fluoridation is the most effective way of improving oral health, there are large
areas of Northland that are not on reticulated water supplies. The next best way to expose
people to fluoride is through regular and daily use of standard strength toothpaste of 1000ppm
of fluoride. There is also the option of promoting the benefit to families of making up
drinking water themselves to optimal levels of fluoridation (by dissolving two 0.5mg fluoride
tablets in 1 litre of water).
Northland Oral Health Strategy, Feb 2007
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9
Summary of findings from the Situation
Analysis
Oral health need:
The oral health status of 5- and 12-year-olds is worsening.
85% of Northland’s child and youth population live in areas with the lowest 5 deciles (the
NZ figure is 56%).
There are significant inequalities for Maori and Pacific children and youth.
The number of Maori children and youth is projected to rise over the next 10 years.
There is inadequate information available about the oral health of adolescents and adults.
Early childhood:
Enrolment and treatment of preschoolers requires attention from all health providers.
There is an opportunity to increase the focus of well-child providers on oral health
promotion and enrolling preschoolers in SDS.
There is an opportunity to include oral health messages and basic oral examinations at the
standard health checks for pregnant mothers and mothers with preschool children.
All of the issues relating to school children are relevant to preschoolers.
Further work needs to be done on considering the options of full, community-based
services that could cater to all age groups.
Appropriateness of service is extremely important for this group because it sets them up for
involvement in services throughout life.
School-aged children:
The SDS does not have the human and financial resource capacity to meet the high oral
health needs of all children in Northland.
Not all private providers will take on private paying child patients.
There is a shortage of dentists to be SDB providers of child and adolescent dental care.
Adolescents:
There is very little information on the current oral health levels of adolescents.
About half the estimated number of adolescents received completed treatments in
2003/04.
Private providers are unhappy with the current contracting arrangements. Many are
considering withdrawing, or have already withdrawn from offering the adolescent service.
Given that they historically provided most of the service, it is important to address this
issue.
The areas of highest need, based on ethnicity and socioeconomic level, tend to have the
lowest private provider coverage.
Services need to be specifically targeted to the needs and expectations of adolescents.
Northland Oral Health Strategy, Feb 2007
Page 25 of 47
Adults:
Public funding for adult services is extremely limited. Given that there is an emphasis on
providing care for the 0-17 year age group, adult oral health at present is not seen as a
priority for the MoH for the foreseeable future.
There is a lack of information regarding oral health needs of adults.
Oral health services for low income adults are limited.
Work and Income provides funding for oral health services, but only for low-income
earners needing emergency care.
People aged over 65 years have increasing oral health needs, but there is no monitoring of
need, or targeted services.
Many of the risk factors for oral health are the same as for other health and social issues.
Local services around Northland:
They vary by locality, particularly among private providers with contracts to look after
adolescents and adults.
Hokianga Health and the Ngati Hine Health Trust both have contracts to provide some
services.
Whangarei people have access to the community dental services based at the hospital.
Secondary services:
There is a small hospital dental service based in Whangarei and Kaitaia hospitals but the
mobile surgical bus is also used.
Oral health promotion:
Contracts for promotion are with NDHB (includes fluoridation advocacy), Hokianga
Health, Hauora Whanui and Te Hauora o te Hiku o te Ika; other providers such as Plunket
carry out oral health promotion.
There is potential to introduce oral health in to PHO initiatives.
There is no fluoridation of water systems in Northland, though trials are to be introduced in
Kaitaia and Kaikohe.
Northland Oral Health Strategy, Feb 2007
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10
Goals
Within the vision of oral health for all Northlanders, the aim of this strategy is to reduce and
eliminate oral health inequalities by achieving four goals:
1 To promote oral health.
2 To develop publicly funded oral health services and facilities that best meet the needs of
Northlanders.
3 To increase, develop and support the oral health workforce.
4 To ensure a quality service.
Inequalities in oral health exist, both in oral health outcomes and access to services. These
inequalities tend to be based on ethnicity (Maori and Pacific people are generally more
disadvantaged), rurality, and socioeconomic factors. This strategy, through a combination of
oral health promotion, preventive strategies and the reconfiguration and reorientation of
Northland’s public oral health services, aims to address these inequalities.
Public oral health services could look very different in the years to come, with a number of
different models of service delivery operating across the region. However all public oral
health services in Northland will have common threads regarding:
• maintaining and improving oral health outcomes
• providing equitable access to treatment and promotion services
• meeting the needs of our local community, in the context of ‘Oral Health for all
Northlanders’.
In order to maintain equity of access and oral health outcomes, this oral health strategy
advocates for the building of an integrated and seamless Northland-wide public oral health
service. This will mainly be achieved by means of oral health teams (consisting of dental
therapists, dentists, dental assistants etc) working primarily out of community-based fixed and
mobile facilities.
Dental therapists and assistants will continue to visit areas of Northland that are outlying,
rural and of greater socioeconomic deprivation, to support equity of access to basic oral health
care for children and adolescents. However in the more urban and highly populated areas
there may be slightly different and more complex service models, with a particular focus on
encouraging private dental practitioners to be part of the local public oral health team
wherever possible.
10.1
Promote Oral Health
There is now recognition within society that ‘health is everybody’s business’, and that
intersectoral collaboration between health agencies, national and local government, nongovernment agencies and community groups is essential for the promotion of healthy
lifestyles for all.
Maintaining and improving oral health can only occur if there is a shift of focus and resources
(or additional resources are allocated) away from treating oral disease to pursuing health
promotion activities and other interventions that might prevent disease.
Northland Oral Health Strategy, Feb 2007
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Most dental decay and gum disease is preventable, but to make any inroads into reducing the
oral disease burdens of our community there must be an oral health promotion strategy that
addresses the complexity of oral health issues and is sustainable over several decades. There
should be a special focus on families with preschool children to reduce disease levels or more
preferably prevent disease altogether. Oral health and general health promotion should occur
at every level and strata of our society and include a variety of approaches and interventions
at a whole population, community, Whanau and individual level.
The promotion of oral health in Northland will therefore mainly be delivered within this
‘intersectoral’ context, so that most oral health promotion will occur outside oral health
services per se, by other agencies and health professionals. That aside, there will still be the
need for specifically targeted oral health promotion and education activities by oral health
personnel, as well the ongoing advocacy of specific oral health population and community
based strategies like the fluoridation of reticulated water supplies and school toothbrushing
programmes.
A Northland-wide oral health promotion plan will be drawn up which will be delivered and
supported by an increased number of oral health promotion personnel. A Northland-wide oral
health promotion coordinator would oversee this work to ensure that consistency of messages
and approach is being maintained across the region.
10.2
Develop publicly funded dental services and facilities that
best meet the needs of Northlanders
This strategy advocates for the development of an integrated and seamless Northland-wide
primary public oral health service that allows for equitable access and oral health outcomes.
There will be a particular focus on child and adolescent services to ensure continuity of care
can be offered to all patients from birth through to adulthood. In some areas of very high
need, there will be also the opportunity to offer additional services to low-income and special
needs adults, and some of these services will have a strong ‘Whanau Ora’ approach to
delivering oral health care.
Therefore the models of service delivery may differ from community to community
throughout Northland, but one principle will remain: the ability to deliver comprehensive
primary dental care through oral health teams, consisting of a skill-mix of dental professionals
(dental therapists, dentists, hygienists etc) at or close to where patients live, work or go to
school.
This strategy supports the delivery of oral health services throughout Northland to be mainly
delivered by way of a simple ‘hub’ and ‘spoke’ model. The ‘hubs’ will consist of modern
multi-chair fixed facilities that will:
• provide a facility where oral health teams work together to provide quality comprehensive
oral health care to all eligible patients (the hubs)
• provide a base from which outlying treatment services (the spokes) can be planned and
implemented
• provide an administrative and team base for all oral health personnel working within the
local vicinity.
Northland Oral Health Strategy, Feb 2007
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The number and types of spokes will look different for each hub. However they will consist
of mobile dental facilities in more rural and sparsely populated areas, and a mixture of mobile
and fixed facilities in some higher need and/or more highly populated areas.
Each oral health provider will work in collaboration and cooperation with other providers to
ensure and enhance the building of an integrated and seamless service throughout Northland.
All oral health providers will establish close relational and referral links with their
neighbouring areas and with Northland’s secondary dental care services to promote a
seamless primary-secondary care interface.
10.3
Increase, develop and support the oral health workforce
The public oral health workforce is changing. While dental therapists will remain the
backbone of the public oral health workforce, there clearly is a need for dentists and other oral
health personnel such as hygienists and dental technicians to be involved, in order to deliver a
comprehensive primary oral health care service.
There is a nationwide shortage of dental therapists and a problem attracting oral health
personnel to work in the more rural and inaccessible parts of Northland. The high disease
levels presently being experienced in Northland indicate that public dental services in
Northland should have a much higher therapist/patient ratio than the national average.
Therefore more dental therapist teams will be required to support this new vision. There is
also a shortage of dentists across the region, with a decreasing number of dentists showing
interest in providing publicly funded dentistry.
This strategy therefore requires the implementation of a variety of workforce initiatives that
will attract high quality oral health professionals to live and work in Northland. Providing a
professionally supportive workplace that means oral health professionals want to stay
underpins this approach. Particular emphasis will be placed on increasing the numbers of
Maori and Pacific health professionals who are presently under-represented in the clinical
workforce.
10.4
Ensure a quality service
The future publicly funded oral health service of Northland will maintain and continually
improve the quality of its clinical care and services. Northland’s oral health providers and
promoters will embrace the concept of ‘clinical governance’, a quality framework within
which clinical excellence can flourish. Clinical governance involves every facet of an
organisation that works effectively to ensure that its structures, processes and strategic and
operational decision-making fully support the delivery of appropriate, accessible and
evidence-based clinical care.
Quality should encompass all aspects of the planning and delivery of oral health care: what
we do; how we do it; where we do it; when we do it; why we do it. There will be a special
focus on the provision of oral health services that are accessible, appropriate, patient-focused,
evidence-based and treatment that has a predictable and successful outcome. There will be a
need to develop standardised quality measures and monitoring processes for all oral health
providers across Northland.
Northland Oral Health Strategy, Feb 2007
Page 29 of 47
As part of the clinical governance quality framework appropriate research and surveys will be
encouraged and carried out within, across and throughout Northland’s public oral health
service. This will promote quality clinical care and confirm that it is being delivered.
In addition, appropriate monitoring of clinical care outcomes and patient’s/parent’s opinions
of the public oral health service will continue to be sought and recorded. Some new
indicators of oral health status will be added to enhance the information available for needs
analysis and ongoing monitoring of treatment and service outcomes.
Northland Oral Health Strategy, Feb 2007
Page 30 of 47
11
Implementation Plan
Within the vision of “Oral health for all Northlanders”, the aim of this strategy is to reduce
and eliminate oral health inequalities by working towards a set of four goals. This section
identifies the key actions to be taken for each of the goals. The priority action, at the time of
writing, is to prepare and submit business cases to the Ministry of Health (goal 2.2); this will
require work to be completed on the service configuration and team model (2.1) and
preparation of a workforce plan (3.1). After this work is completed, the other actions can be
prioritised and addressed.
Goal 1
Promote oral health
Key Action
Measure
Agencies
1.1 Prepare an oral health promotion plan
Plan in place with focus
on pre-schoolers and
appropriate strategies for
Maori
NDHB
MAPOs
PHOs
1.2 Appoint an oral health promotion coordinator
Appointment made
NDHB
1.3 Continue fluoridation advocacy
campaign
All 3 District Councils
fluoridate their water
supplies.
NDHB
MAPOs
TAs
Solutions taken up to add
fluoride to non-reticulated
supplies.
Goal 2
Develop publicly funded oral health services and facilities that best
meet the needs of Northlanders
Key Action
Measure
Agencies
2.1 Establish a Northland-wide service
configuration for 0-17 year olds, using
“hubs and spokes” and an oral health
team approach adapted to the needs and
characteristics of each area.
Seamless and integrated
configuration developed
for 0-17 year olds, with a
whanau ora approach
where appropriate.
2.2 Prepare and submit business cases to
MoH.
Submitted business cases
are successful
NDHB
MAPOs
PHOs
Private
dentists
PCOs
NGOs
NDHB
MAPOs
Goal 3
Increase, develop and support the oral health workforce
Key Action
3.1 Prepare workforce plan, with a focus on
developing the Maori workforce
Northland Oral Health Strategy, Feb 2007
Measure
Agencies
Plan completed and
available for use in
business cases
NDHB
MAPOs
PHOs
Private
Page 31 of 47
Numbers of Northlanders
in training increases
dentists
PCOs
NGOs
NDHB
MAPOs
Measure
Agencies
4.1 Implement clinical governance quality
framework
Seminars and training
held on clinical
governance standards;
framework in place, in
use and monitored.
4.2 Develop standardised quality measures
and monitoring processes
Oral health outcomes and
disease status indicators
agreed and monitored
4.3 Carry out research
Research committee in
place to overview,
encourage and support
research
NDHB
MAPOs
PHOs
Private
dentists
PCOs
NGOs
NDHB
MAPOs
PHOs
Private
dentists
PCOs
NGOs
NDHB
MAPOs
PHOs
Private
dentists
PCOs
NGOs
3.2 Provide scholarships
Goal 4
Ensure a quality service
Key Action
Northland Oral Health Strategy, Feb 2007
Page 32 of 47
Appendix 1 Acknowledgements
This report has been made possible by the generous contributions of time and expertise by the
Northland Oral Health Planning Group by:
NDHB Service Development and Funding team representatives
Te Tai Tokerau MAPO representative
Northern DHB Support Agency representative(s)
Oral Health Advisor, Northland District Health Board
Hauora Whanui Oral Health Service (Ngati Hine Health) representatives
Chief Executive, Hokianga Health Primary Health Organisation (who also provided a
communication link with PHO Managers group)
NDHB Public Dental Service representatives
New Zealand Dental Association (NZDA) Northland Branch representative
New Zealand Dental Therapist Association (NZDTA), Northland Branch representative
Peer reviewers of the April 2005 draft:
John Dalton, Dental Officer, Waitemata DHB
Sue Dashfield, Programme Manager Primary Care, Counties Manukau DHB
Callum Durwood, Paediatric Dentist, Auckland DHB
Pauline Koopu, Advisor Clinical Services Improvement, Ministry of Health
Northland Oral Health Strategy, Feb 2007
Page 33 of 47
Appendix 2 Maori Child Oral Health Services
Review 7 Recommendations
TP
PT
1
Maori providers should have flexible oral health service contracts that are funded
appropriately to ensure that they can provide necessary services to Maori by adopting a
whanau ora approach. More urgently, Maori providers who are providing services
outside of their contracts should be reimbursed for the additional services.
2
DHBs should consider capitation funding for Maori provider child oral health contracts so
that service can be delivered in the most effective manner.
3
Maori providers recommend increasing the number of oral health community clinics that
are based on the successful service at Te Taiwhenua o Heretaunga. Such a service adopts
whanau ora as its kaupapa and has proven to reduce the barriers to Maori receiving oral
health treatment and therefore reducing inequalities in Maori oral health.
4
Mobile services are considered an essential part of the ideal community service model
and funding for this should be prioritised by the Ministry of Health and DHBs in building
the capacity of capability of Maori providers.
5
A coordinated approach to the delivery of oral health services to Maori is crucial and the
relationship between DHBs, Maori providers, SDS and dentists must be focused on
addressing inequalities in Maori child oral health. Coordination plans should be
developed that ensures a partnership approach is adopted and the key role of the Maori
provider recognised in providing the two key components of any Maori oral health
service, being enrolment and attendance. Many other Maori providers are available to
offer these services through their tamariki ora nurses and therefore the successful models
can be easily duplicated.
6
The Te Taiwhenua o Heretaunga oranga niho service should be developed further into a
centre-of-excellence for Maori oral health service. This service would then act as a
development site for new initiatives seeking successful approaches and outcomes to
improve the status of Maori oral health.
7
The Ministry of Health and DHBs with predominantly urban populations should identify
Maori providers who can adapt the community model into a successful urban service to
ensure that the goal of improving child oral health and reducing child oral health
inequalities is achieved.
8
Maori providers should have capital equipment funding made available to them and
repairs and maintenance components included in their contracts. Maori providers are not
private practices and therefore more like the DHB provider arms than mainstream private
practices. DHB contracts should be amended to reflect this as the lack f operational
equipment means that oral health service can not be delivered.
9
Measures of performance are required to determine the effectiveness of the Maori child
oral health services and to demonstrate how these services are improving Maori child oral
health. A consistent framework that allows the components influenced by Maori
providers should be used to accurately assess the effectiveness of these services.
10 Maori providers should be encouraged to develop their own oral health workforce
through their relationships with training establishments and the development of further
treatment services where Maori can gain important community experience and attraction
to the oral health professions.
7
TP
PT
Mauri Ora Associates. (2004). Review of Maori Child Oral Health Services, New Zealand Ministry of Health
Northland Oral Health Strategy, Feb 2007
Page 34 of 47
11 Te Ao Marama should be supported by the Ministry of Health and DHBs and be
recognised as an important thread that brings together the Maori oral health workforce.
12 Further assessment of the wider oral health system should be undertaken to determine
how organisational and systemic issues affecting Maori oral health providers can be
improved.
Northland Oral Health Strategy, Feb 2007
Page 35 of 47
Appendix 3 Recommendations from SDS review
The SDS Review required the DHB to undertake a stock-take of current facilities and then
make recommendations regarding an optimum service configuration for the future. In order
to decide what type of service would best suit each school we developed a decision
framework. The 3-stage process was as follows:
1 Assign a risk/need rating for each school based on DMFT or decile, depending on what
information was available
School Risk Rating
New Entrant DMFT
<2
2-4
>4
Unknown
Low
Med
High
Form 2 DMFT
<2
2-4
>4
Unknown
Low
Med
High
School Decile
1-2
3-4
5 - 10
High
Med
Low
2 Weight the school roll to reflect the level of risk/need. The weighting is to reflect the fact
that children with high levels of risk or need require more contact with the therapists.
Roll weighting based on risk:
• high risk = x2
• medium risk = x1.5
• low risk = x1
3 Recommend type of clinic based on the weighted roll size.
Northland Oral Health Strategy, Feb 2007
Page 36 of 47
Assigning Clinic Type
Weighted Roll
< 90
90-500, and/or low risk
> 500, and medium or high risk
Mobile clinic
Fixed Clinic
Difficult
Site
Access
Easy
Site
Access
Single
Mobile
Double
Mobile
< 750
Case by case basis
considering isolation,
size, need and social
demographics
Options:
• Own transport to nearby clinic
• DHB transport
• Mobile clinic visiting
Renovate
Existing
Static
need/
numbers
Growing
need/
numbers
Single
Fixed
Clinic
Double
Fixed
Clinic
> 750
Building
from
Scratch
Double
Fixed
Clinic
The findings from the decision tree were then summarised into an optimum service
configuration.
Northland Oral Health Strategy, Feb 2007
Page 37 of 47
Double
Fixed
Clinic
Below is a summary of the recommended optimum configuration for SDS, compared with the
current configuration:
Recommended
Actual SDS roll (2003)
26,496
Weighted roll (based on
need/risk)
40,953
Current
Gap
Therapist/assistant teams
required (based on
weighted 1100 children
per team)
37
23.4
13.6
Fixed clinics
23
63
-40
Schools to receive mobile
service
88
55
33
Double mobile units
required
9.5
0.5 (could be 1)
8.5
Schools needing
consideration (roll <90)
32
32
The resources that would be required to bring the current service up to the optimum are:
Capital costs:
One-off operating costs:
Ongoing operational costs
14 sets of operational
equipment
13.6 therapist/assistant
teams
upgrade IT patient
management systems (mix
of capital and operating)
equipment replacement
and maintenance
replace 12 clinics
refurbish 11 clinics
8.5 double mobile units
truck to move mobile
units
replace 46 chairs
8.6 FTEs of oral health
promoters
maintenance and diesel etc
for truck and trailers
27 xrays and processors
other equipment (see
estimates)
If the SDS service structure was retained as is, the SDS review identified a total estimated
cost of:
• $8,803,100 to bridge the gap between the current service and the optimum configuration
• an ongoing additional cost of $1,362,600 per year (excluding IT needs).
Northland Oral Health Strategy, Feb 2007
Page 38 of 47
Appendix 4 Private Provider Survey Results
Summary
The questionnaire was sent to 16 contracted providers (covering 26 dentists) and 7 noncontracted providers (11 dentists). 9 contracted (56%) and 4 non-contracted (57%)
questionnaires were returned.
Of the 9 contracted providers who responded:
4 limit their adolescent numbers to children of existing patients.
3 intend to offer the service for less than 1 year; 2 for 1-3 years; and only 3 for more than 3
years (one didn’t answer).
All except one said the service was uneconomic; 6 said it was bureaucratic; 5 didn’t like
the clinical restrictions.
8 provided adult care under Work and Income contracts.
The key areas identified for DHB support were improving the handover from SDS and
promotion of the adolescent service.
Most do not have an electronic patient management system, though most would be
interested in contributing to a regional data collection.
Of the 4 non-contracted providers who responded:
1 sent a blank questionnaire back.
1 was interested in entering into a contract and 1 was undecided.
There were many reasons for not holding a contract. All said it was uneconomic,
bureaucratic, and clinically restrictive. Other comments were about cultural correctness,
racially biased documents, and the unreliability of children.
All 3 provided services to low income adults under Work and Income contracts.
2 were interested in attending an evening to learn more about the OHSA contract.
Contracted Providers Questionnaire
9 Responses Received
Do you currently treat any adolescents (Form 3-18 th birthday) as completely private patients i.e. NOT
under the adolescent oral health contracts?
P
P
Yes. How many private adolescent patients would you treat regularly? 3
Exact Number if known: ______________________
Otherwise, estimated:
1 – 50 2
51 - 100
101 - 500
501 -1000
Over 1001
No/Not Sure 5
Northland Oral Health Strategy, Feb 2007
Not answered
1
Page 39 of 47
Do you accept Special Dental Benefit patients on referral from the School Dental Services?
Yes
3
No
6
Please state the number of adolescent patients currently enrolled with your practice under your contract.
Exact Number if known: ______________________
Otherwise, estimated:
0 – 50 1
51 – 100
2
101 – 500
2
501 – 1000
2 (based on actual claims there is only one provider in this category)
More than 1000
Not Sure
2
Do you limit the number of Adolescents patients you have registered with your practice?
No
Yes, because
5
Adolescent enrolments are limited to children of existing patients
4
Patient numbers are at full capacity (books are full) 1
Adolescent numbers were getting too many to be financially viable to my practice
1
Other reasons, please state
1 The fees paid under the DB system are totally inadequate to
cover the cost of treatment and have been for years. The practice has these patients at a loss!
What is the ideal number of adolescents you would like to enrol and treat?
Less than you currently have and to what number? _________________
The same as you currently have 5
More than you currently have and to what number? _________________
No ideal
None 2
Not answered 1
How long do you intend to continue providing services under the adolescent contract?
Less than 1 year
1 – 3 years
3
2
3 years and longer
Not answered
1
3
If you were to consider resigning your contract it would be because of:
Uneconomic for your practice
8
The bureaucracy associated with the contract and the payment systems
Clinical restrictions
6
5
Other – please specify 1
The contracts are unrealistic and there should be more consultation personally with the contractors so we
can have a mutually satisfying relationship and contract.
Do you currently charge any patients under the adolescent contract for any of the following:
Northland Oral Health Strategy, Feb 2007
Page 40 of 47
Repairs to accidentally damaged teeth that are eligible for ACC funding
Non-Amalgam filling to posterior teeth (greater than one surface)
Orthodontics
3 (if not fully covered)
5
7
Oral Surgery (for wisdom teeth removal)
Root Canal Treatments
No
Other – please specify 2 Sedation, Antibiotics
1
Do you provide diagnostic screening/examination services or treatments for adolescents off site from your
base surgery?
No
8
Yes, Please list establishments where these services are provided and provide details of level of
examination or treatment provided.
1 - Ruakaka
Do you currently provide dental care for any adults (over 18 years) under Work and Income contracts?
Yes, if so, approximately how many per year? ________________
4=Y (no number), 1=20, 1=156, 2=200
No
1
Please outline below the type of DHB support you would see as most useful:
An improvement in hand-over of Form 2 children from the school dental service?
Promotion of the availability of the free adolescent oral care?
3
3
Assistance with follow up when patients do not keep appointments?
1
Other, please specify 4
Support in consistency in brief given to software company – constant updates
A realistic contract with realistic fees
Improve SDS, provide a better remunerated, less restrictive package for adolescents
When a DHB dentist is in the area they should be the first referral base for SDB patients
Not answered
2
Do you have a PMS (patient management system) in your practice? Yes 3, No 4, Not understood 1, Not
answered 1
If so, what kind?
Software of Excellence, Exact Dental, Not answered
If not, are you considering getting a PMS system? Yes 1, No 2, Not understood 1, Not answered 1, would
like further information 1
Would you be open to contributing information about patients treated under public contracts into a
regional data collection? Yes 4, No 1, Not answered 3, Depends on cost and staff time 1
Northland Oral Health Strategy, Feb 2007
Page 41 of 47
Non-Contracted Providers Questionnaire
4 responses received – one with no answers so that is not included in the summary
Do you at some stage in the future wish to hold a contract with a DHB for the provision of dental care to
adolescents?
Yes, I do wish to hold a contract
Undecided 1
1
No, I do not wish to hold a contract
1
You do not hold a contract with a DHB for the provision of dental care to adolescents for the following
reason(s):
Uneconomic for my practice 3
The bureaucracy and paperwork associated with the payment systems
3
The new Oral Health Services Agreement (Contract) is too complex and difficult to decipher 2
Clinical Restrictions on materials and techniques I can use
3
Other, please specify 3
Cultural correctness is beyond what is needed to provide quality care
Unreliability of children in this area
Contract is a racially biased document, dealing with people you can’t trust
Do you currently provide dental care for any adolescents (aged from 13 to 18) as private patients?
Yes, if so, approximately how many? ___________________________
6-12, 100-200, 200
No
Do you currently provide dental care for any adults (over 18 years) under Work and Income contracts?
Yes, if so, approximately how many per year? ____________________________
Yes, 11, 100
No
Would you be interested in attending an information evening to learn more about the new Oral Health
Services Agreement (Adolescent contract)?
Yes
2
No
1 No-one from the Government of Health department have ever in my 30 years
practising, kept their word.
Northland Oral Health Strategy, Feb 2007
Page 42 of 47
Glossary
Terms in italics have their own entry.
Term
ACC
caries, dental caries
chronic
Combined Dental
Agreement (CDA)
completion
Explanation
Accident Compensation Corporation.
The disease that causes decay to teeth and results in ‘holes’ which
require filling.
Used to describe an illness, disease or disability of long duration, and
which has developed slowly. Chronic conditions are usually permanent
or incurable, so that management to minimise discomfort and cost of
services is important. (See also acute).
A combination of OHSA and SDB.
DC
In oral health services, the stage at which all the needs identified during
an intitial assessment have been met, which may take more than one
visit.
District council.
decile
See deprivation.
dental therapist
A health worker trained to provide care in primary and intermediate
school settings, under the supervision of a dentist. Dental therapists
work for DHBs and used to be called ‘dental nurses’.
Describing those with high, often multiple, needs (often used loosely to
mean ‘poor’, though income is only one of the factors considered). The
most widely quoted source of data on deprivation is the NZ Deprivation
(NZDep) scale which analyses 5-yearly Census data to describe
deprived populations. Once ‘deprivation index’ scores are calculated
across the whole of New Zealand, the data is divided into deciles, 10
population groups of equal number. (These deciles are calculated
differently, and use a different scale to the school deciles used by the
education system.)
District Health Board.
deprivation, deprived
DHB
diabetes
District Annual Plan
(DAP)
DMFT
epidemiology
ethnicity
A complex condition in which the body is unable to control the amount
of glucose (sugar) in the blood, either because there is not enough of the
hormone insulin or it does not work effectively. Uncontrolled diabetes
can lead to metabolic disturbances that increase the risk of long term
complications and affect a number of the body’s systems. 90% of
diabetes is type 2, acquired as a consequence of unhealthy lifestyle, and
is usually related to excess weight gain; onset is gradual. About 10% of
diabetes is type 1, a result of the pancreas malfunctioning whose cause
lies in viral infection and a breakdown in the body’s autoimmune
systems (not lifestyle); onset is usually rapid and can be life-threatening
(see ketoacidosis).
Northland DHB’s statement of its intentions for the coming year. (See
also District Strategic Plan.)
Decayed, missing, filled teeth. The number of teeth in a mouth that have
been damaged, lost or repaired.
A population science concerned with the distribution and determinants
of health- and disease-related states in human populations.
A measure of cultural affiliation defined by Statistics New Zealand as a
social group whose members share a common origin, claim a common
Northland Oral Health Strategy, Feb 2007
Page 43 of 47
Term
FTE
GDB
HealthPac
Healthy Eating, Healthy
Action (HEHA)
Explanation
sense of distinctive history and destiny, possess one or more dimensions
of collective individuality and feel a sense of unique collective
solidarity.
Full-time equivalent
General Dental Benefit, the subsidy formerly paid to private dentists to
treat adolescents, overtaken now by OHSA..
Part of the Ministry of Health which processes all payments of public
sector health funding, as well as being the central site for health sector
contracts.
A Ministry of Health-driven strategy which aims to identify, promote,
and coordinate programmes for healthy nutrition and appropriate physical
activity at national, regional, community and iwi levels.
Hospitalisation
inequality
The process of attending hospital as a patient. It includes 3 main types:
inpatient, a patient who stays at least one night in hospital
outpatient, a person who is seen in a non-inpatient setting, or ‘clinic’, by
a specialist after referral from a GP
daypatient, a patient who undergoes an operation or other procedure in
hospital and able to return home without staying overnight.
The term ‘hospitalisation’ is often used loosely to mean one or any
combination of the 3 types.
See reducing inequalities.
inpatient
See hospitalisation.
life-course, life-course
continuum, life-course
approach
Another name for a model of disease progression developed by Leading
for Outcomes. It maps the flow of chronic disease from early risk
through to advanced symptoms, complications and death. One of the
aims is to get health services to think about how they could work
together better to keep people towards the ‘left-hand’ end of the
continuum.
A provider of health services which is run by Maori for Maori (as
distinct from a ‘mainstream’ provider who deals with Maori clients or
patients).
A Maori co-funder organisation, Northland DHB’s funding and planning
partner (the name persists from the days when they were called ‘ Ma ori
p urchasing o rganisations’). NDHB deals with 2: Te Tai Tokerau
MAPO (whose responsibilities for Maori correspond with the DHB’s
responsibilities for the population bounded by the Whangarei and Far
North territorial local authority areas) and Tihi Ora MAPO (whose
responsibilities for Maori coincide with the DHB’s responsibilities for
the Kaipara district).
Relating to the jaws and face, particularly with reference to specialised
surgery of this area.
Ministry of Health.
Maori provider
MAPO
U
U
maxillofacial
MoH
NDHB
U
U
U
U
Northland District Health Board, which has 2 parts, NDHB Funder and
NDHB Provider. The NDHB Funder is that part of NDHB that has been
legislated to carry out the funding function for health services in
Northland. The funder assesses needs, sets priorities for services,
allocates funds, lets contracts to providers, and monitors performance.
The NDHB Provider is that part of NDHB that provides health services
(as distinct from the NDHB Funder). The majority of the Provider
Service’s funding goes on Secondary care services. In the strategy
Northland Oral Health Strategy, Feb 2007
Page 44 of 47
Term
NOHPG
Explanation
documents, ‘NDHB’ refers to the whole organisation with involvement
as relevant in each case from the funder or from the provider arm.
Northland Intersectoral Forum, which comprises representatives from
councils and government organisations throughout Northland.
Northland Oral Health Planning Group
NZDA
New Zealand Dental Association.
obese, overweight
Degrees of excess weight, as defined by the Body Mass Index (BMI).
Overweight = BMI 25-29 for Europeans, 26-31 for Maori and Pacific.
Obese = BMI 30+ for Europeans, 32+ for Maori and Pacific.
(Acceptable figures differ across ethnic groups because of variations in
bodily composition and how this relates to risk of developing health
problems such as heart disease and diabetes).
Oral health.
NIF
OH
OHSA
orthodontics
outcome
patient management
system
PDO
primary health care
Primary Health
Organisation (PHO)
reducing inequalities
risk factor
Oral Health Services Agreement, the contract private dentists may
choose to sign to provide free services to adolescents. See also
Combined Dental Agreement (CDA).
The use of devices to move teeth or adjust underlying bone.
The result of an action. As distinct from an output, which is a measure
of an activity rather than the result it has. An operation to mend a
broken leg is an output, while the return to full function of the leg is the
outcome. In a bigger picture sense, a focus on outcomes aims to analyse
how effectively health services are provided and how well they work
together.
A system for managing data about all the people to whom an
organisation provides services.
Principal Dental Officer.
Health services provided in the community which people can access
themselves. The most well known are those provided by general
practitioners, though they also include pharmacy services, private
physiotherapists and, increasingly, nurse practitioners. (See also
secondary services, tertiary services).
A group of providers of primary health care services whose
responsibility is to look after the people who enrol with them (those who
are ‘on the register’). PHOs include GPs as well as a whole range of
primary health care providers and practitioners (Maori and community
health service providers, nurses, pharmacists, dietitians, community
workers, and many others). As well as providing traditional primary
health care services, PHOs must improve access to services for those
with higher needs (such as Maori or those with chronic health
conditions), have a focus on preventing ill health (rather than waiting till
they are visited by sick people) and improve the way services work
together.
Inequalities in the health status of populations exist by socioeconomic
status, ethnicity, gender, age and geographical areas. The reducing
inequalities approach is about recognising these and proactively
planning, funding and delivering services to reduce these differentials.
A factor, which may be biological (such as a genetic predisposition) or
associated with behaviour (such as smoking), that increases the
likelihood of a disease developing.
Northland Oral Health Strategy, Feb 2007
Page 45 of 47
Term
SDB
SDF
SDS
specialist
Whanau Ora
Explanation
Special Dental Benefit. When dental therapists in the School Dental
Service are unable to treat children aged 0-12 (either because their oral
health needs are outside their scope of practice or they have special
needs arising from, for example, a disability) they are referred to a
dentist (either public or private) for treatment. Funding paid under the
SDB enables dentists to provide this service. See also Combined Dental
Agreement (CDA)
Service Development and Funding, the planning and funding team
within the NDHB Funder.
School Dental Service, part of Northland DHB.
A physician or surgeon, usually based in a hospital, who has undertaken
extra training on top of the normal medical degree to specialise in a
particular type of service or disease. Also called a consultant.
A Ministry of Health-driven process aimed at supporting healthy Maori
families which emanates from He Korowai Oranga. It aims to identify
and extend whanau strengths and build them into initiatives throughout
the health sector.
Northland Oral Health Strategy, Feb 2007
Page 46 of 47
References
1
Good Oral Health for All, for Life: A New Strategic Vision for Oral Health in New
Zealand. Ministry Of Health, Wellington, Aug 2006.
2
New Zealand Health Strategy. Ministry Of Health, Wellington, Dec 2000.
3
Maori Health Strategy. Ministry of Health, Wellington, Nov 2002.
4
Child Health Strategy. Ministry of Health, Wellington, June 1998.
5
DHB Toolkit: Improve Oral Health. Ministry of Health, Wellington, Jan 2004.
6
Achieving Health for All People: A Framework for Public Health Action for the New
Zealand Health Strategy. Ministry of Health, Wellington, Oct 2003.
7
Primary Health Care Strategy. Ministry of Health, Wellington, Feb 2001.
8
Improving Child Oral Health and Reducing Child Health Inequalities. Public Health
Advisory Committee, May 2003.
9
NDHB Strategic Asset Management Plan, Child and Adolescent Oral Health. NDHB,
June 2005.
10 NDHB Child and Adolescent Oral Health Service Plan for Northland. NDHB, June
2005.
11 Maori Child Oral Health Service Review. Ministry Of Health, Wellington, 2004.
12 NDHB School Dental Services Review Report. NDHB, June 2004.
13 Health is Everybody’s Business: Working together for Health and Wellbeing. Public
Health Advisory Committee, June 2006.
Northland Oral Health Strategy, Feb 2007
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