2. “Improving dental services for homeless people” Summary of findings from the exploratory research project Health & Social Care Integration Event Edinburgh 8 th May 2014 Stan Burridge

3. London Housing Foundation A Pathway project Funded by

4. With funding from London Housing Foundation Pathway worked with the Eastman Dental Hospital, Groundswell UK, dentistry, homelessness service providers, as well as homeless, ex-homeless people to explore

5.  Some of the practical issues which prevent homeless and ex- homeless people accessing dental treatment.

6.  We also looked at some of the attitude barriers (both by the patient and the practitioners) which impacts negatively on those accessing dental treatment

7.  Some of the practical issues which prevent homeless and ex- homeless people accessing dental treatment.  We also looked at some of the attitude barriers (both by the patient and the practitioners) which impacts negatively on those accessing dental treatment  What level of dental need there is within these groups

8.  Some of the practical issues which prevent homeless and ex- homeless people accessing dental treatment.  We also looked at some of the attitude barriers (both by the patient and the practitioners) which impacts negatively on those accessing dental treatment  What level of dental need there is within these groups  What impact are those needs having on the individuals overall quality of life

9.  Some of the practical issues which prevent homeless and ex- homeless people accessing dental treatment.  We also looked at some of the attitude barriers (both by the patient and the practitioners) which impacts negatively on those accessing dental treatment  What level of dental need there is within these groups  What impact are those needs having on the individuals overall quality of life  The importance of restorative dentistry and oral care to homeless people

10.  Some of the practical issues which prevent homeless and ex- homeless people accessing dental treatment.  We also looked at some of the attitude barriers (both by the patient and the practitioners) which impacts negatively on those accessing dental treatment  What level of dental need there is within these groups  What impact are those needs having on the individuals overall quality of life  The importance of restorative dentistry and oral care to homeless people  What experience homeless and ex-homeless have of receiving or accessing dental care

11.  Some of the practical issues which prevent homeless and ex- homeless people accessing dental treatment.  We also looked at some of the attitude barriers (both by the patient and the practitioners) which impacts negatively on those accessing dental treatment  What level of dental need there is within these groups  What impact are those needs having on the individuals overall quality of life  The importance of restorative dentistry and oral care to homeless people  What experience homeless and ex-homeless have of receiving or accessing dental care  What potential difference treatment could make to an individual’s recovery and life chances

12.  Some of the practical issues which prevent homeless and ex- homeless people accessing dental treatment.  We also looked at some of the attitude barriers (both by the patient and the practitioners) which impacts negatively on those accessing dental treatment  What level of dental need there is within these groups  What impact are those needs having on the individuals overall quality of life  The importance of restorative dentistry and oral care to homeless people  What experience homeless and ex-homeless have of receiving or accessing dental care  What potential difference treatment could make to an individual’s recovery and life chances  And finally we continue to explore some practical ways to improve awareness of and access to quality dental advice and care

13. Our working journey We began by conducting some peer-led research using a survey tool and with 149 current and former homeless people in a range of settings for example day-centres and drop-in’s We then selected 14 of those to undergo a clinical assessment at Eastman Dental Hospital After that we have Supported and continue to support a small number of those ‘patients’ in accessing a mainstream dentist to follow the treatment they were assessed as needing – and gathering their experience We have continued having contact with a range of dentistry and homelessness service providers to explore barriers to treatment and options for change

14. Survey respondents (n=149)

15. Percentages registered with dentist

16. Reasons for not registering (n=61)

17. Barriers to registration (n=23)

18. Some findings about levels of need Dental pain was reported by more than one-third of the 149 people completing the survey and six of the fourteen people attending EDH Bleeding gums were reported by four in ten of the survey and EDH clinicians diagnosed gum disease in twelve of the 14 people they assessed Based on a standard quality of life screening tool, people involved in the research reported that dental problems impact ‘fairly often ‘or ‘very often’ on their: o diet and nutrition (23% of survey respondents and 57% of EDH clients); o social interaction and confidence (32% of surveys and 64% of EDH clients); and/or o ‘general satisfaction with life’ (34% of survey respondents and 43% of EDH clients).

19. Some of the barriers to access o lack of clarity about entitlements and access options o high levels of dental anxiety and previous bad experience o inconstancies in what General Dental Practices and Community Dental Services are able to offer patients o the impact of benefit changes on demonstrating eligibility and accessing treatment o financial barriers faced by people on low pay requiring several stages of treatment, each requiring payment o delays getting treatment, particularly for people needing to be treated in hospital dental services because of risk factors or complex needs o limited coordination and understanding between community- and hospital-based services o impact of substance misuse on treatment options – some based on clinical concerns and/or assumptions

20. Some good news, including the quality of treatment and support people received once they get access to services; the positive impact of initial contact with understanding, non-judgemental, and caring dentist/s in overcoming high levels of dental anxiety and boosting patients’ confidence to seek help; high levels of compliance with treatment, particularly when supported by a trusted staff member (eg. hostel key worker) or peer advocate; powerful stories about the positive impact getting help with long-standing dental problems is having for individuals with poor previous experience and complex unmet needs.

21. Next steps – and opportunities for further collaboration - will include continuing to support and learn from the journey through dental treatment of some of the EDH ‘patients’; further investigating supply-side issues and constraints within General Dental Practice, Community Dentistry Services and Specialist Dental Services; engaging a range of dentistry and homeless service providers to share our findings and consider their implications for practice – and for policy-makers or commissioners; raising awareness of rights to treatment and care, how to access it, and benefits of doing so; building capacity to effectively support homeless people to access advice and treatment; and your suggestions, please…………?

22. www.pathway.org.uk stan.burridge@pathway.org.uk