EXECUTIVE SUMMARY / In one short paragraph please describe this project and what it has achieved.
We will use this in any future publicity material.
Fife Oral Health Care Award is the only award of its kind in Scotland. It has been developed to improve the knowledge and standard of oral health in Fife care homes. To date 15 care homes (of which 5 are Fife Council care homes) have achieved the Award and over 450 care staff have received training. This innovative Award has also instigated a 30% increase in ‘clean mouths’ and a 78% increase in dental referrals from participating care homes.
PLANNING / · a clear rationale, defined processes and focus on stakeholder needs
· contributes to organisation’s goals, community plan and SOA, and national policy context
Following an in-depth survey of oral health within Scottish care homes it was identified that there was a lack of oral health training for care staff and access to dental services was also an issue in certain areas. NHS Fife developed the Award using the recommendations from this survey and using guidance from the Care Commission and NHS Quality Improvement Scotland as well as some local guidance (including Community Dental Service policies and Fife Council’s Joint Health Improvement Plan). The Joint Health Improvement Plan states as an outcome ‘ensuring effective oral care support for older adults'. It was recognised that the main priorities of an Award were to ensure that the oral health of the residents/service users was improved, and that care staff were aware of the importance of improving oral health.
A group was established to develop this Award which consisted of representation from NHS Fife, Fife Council, independent care homes, Age Concern and University of Glasgow.
Using the identified priorities:
Award criteria was confirmed and all care homes should have:
  • A care home oral health policy;
  • A care home oral health identified lead person;
  • 50% of care home staff should have received training (rising to 75% within 2 years).
All residents should have:
  • An information leaflet;
  • An oral health risk assessment;
  • An oral health care plan;
  • A clean mouth (measured using a plaque score index);
  • Been seen by a dentists within the last year;
  • Appropriate toothpaste/denture cleaner (1450ppm);
  • Appropriate toothbrush/denture brush;
  • Named dentures where appropriate.
A pilot was offered to care homes across Fifeof which four became involved. Due to staff changes and restructures only one care home completed the pilot phase; with Southern Cross’ Woodside Court care home receiving the Fife Oral Health Care Award in July 2008.
Following the pilot it was agreed that there should be an increase in the number of residents being reviewed at the unannounced visit. It was felt that 5 residents chosen randomly was not sufficient to ascertain the whole picture. The decision was taken to review 50% of residents at future Award assessment visits as a more representative sample of what was happening within the care homes.
The roll out of the Award was assisted by Fife Council agreeing to participate in the Award and adopting the Oral Health Policy within all care homes. Currently there are 10 Fife Council care homes all of which are participating in the Award at various stages including 4 having received the Award.
DELIVERING / · implemented in all relevant areas and across all the required stakeholders
· carried out in a structured and logical way , using robust and sustainable methods
There are many interventions between the Award team (Award coordinator; oral health promoter/dental health support worker) and the care home; these interventions include:
A basic interview– Meeting with the care home manager / oral health lead person to ascertain the baseline data e.g. which dental services are currently being received within the care home and what training if any has been provided previously;
An initial assessment - Ahygienist and dental health support worker review the Award criteria with the care home including carrying out a plaque score on every consenting resident.
Monthly monitoring - A dental health support worker visits the home to ensure that all oral health resources are present and any oral health queries can be raised at this time.
An Award assessment - The same process as at the initial assessment however this visit is unannounced. Only 50% of the residents are assessed and a requirement of 90% uptake on the criteria is required to achieve the Award.
Training sessions– Provision of training session which are currently delivered in the care home directly to groups of staff by an oral health promoter.
In August 2009 a pilot began rolling out a more cost effective electronic training tool which is available directly from the Award website or by prior arrangement with the Award team. The results of the training are sent electronically to the coordinator who will generate a certificate to the care home for the individual.
IMPROVING +EVALUATING / ·evidence of leading practice and innovation being achieved
·appropriate measurement and learning,and how this has led to continuous improvement
As there are set criteria for the Award it has allowed analysis to be carried out in a straight forward manner. A strategy was produced early in the project and highlighted the areas to be evaluated as follows:
  • Baseline assessment of care home;
  • Assessment of the Award criteria on enrolment compared with when receiving the Award;
  • Evaluation of knowledge pre and post oral health training of care home staff;
  • Evaluation of feedback from care home staff about oral health training;
  • Dental health support worker (DHSW) training feedback.
As the Award progresses there has been additional documentation introduced to assist all stakeholders including a monitoring form which formalises the monitoring visit carried out by the dental health support workers, and ensures they collect all the data necessary during these visits.
A literature review was also commissioned to look at the effectiveness and cost benefit of high concentration fluoride toothpastes and fluoride varnish in older people living in care homes in Fife. The recommendation from this report was for all residents with teeth to receive high strength (2800ppm) fluoride toothpaste on prescription.
A national researcher has been appointed to look at projects relating to oral health improvement within care homes. This researcher will be carrying out interviews with care home managers, carers, oral health leads and residents in the near future.
RESULTS + IMPACT / · a convincing mix of customer perception and internal performance measures
· clear line of sight to the delivery of the Single Outcome Agreement
· a full range of relevant results showing improvement over time
Major improvements have been the result of introducing the Award and just some of these are demonstrated below:
  • There has been a 78% rise in the number of dental referrals which due to the integrated approach has caused a 64% increase in the number of oral care plans being produced for residents.
  • The plaque scoring which is carried out to assess the cleanliness of the mouth has resulted in a 30% increase in the number of residents with a ‘clean mouth’ at the time of the unannounced assessment visit.
  • 20% of care homes initially had an oral care policy. With the introduction of the Award 100% of care homes involved now have an oral health policy.
  • A minimum of 50% of care staff are now trained within these care homes and the training has increased the staff knowledge of oral hygiene products by over 50%.
  • 90.3% of care staff reported never having had any oral health training previously.
  • 96.2% of care staff would recommend the Award training session to others.
As a result of the introductory online training tool practical training sessions will be introduced over the coming months to complement the training and give the opportunity for an integrated approach to care.
With increasing numbers of older people retaining some natural teeth this Award will ensure that residents within care homes continue to have access to the dental team.
Some other Health Board areas are providing oral health training to care staff. Within Fife they achieve an Award and receive recognition, this is a great incentive.
The dental health support worker remit previously focused on education establishments. As the role has developed it was recognised that they could also provide the same support in their geographical areas within the care home setting.
A marketing campaign is being progressed for late 2009 to access the care homes not yet involved and also to inform all other stakeholders of the Award.
Due to the success and positive feedback of the Award;it is now being piloted within Continuing Care hospital wards within NHS Fife with the intention to include all patients who are in hospital for more than 3 months.

COSLA EXCELLENCE AWARDS 2010Page | 1

THE COSLA CHAIR’S AWARD
This category is awarded at the discretion of the Chair and is open to submissions under any of the seven categories. It is awarded to those submissions of exceptional standards or merit demonstrating achievements above the limits stipulated in the assessment/judging criteria for the relevant category. Alternatively, submissions can be considered which can demonstrate being conducted in exceptional circumstances.
Do you wish your submission to be considered for the Chair’s Award? / NO
In about 300 words, please highlight the reasons why this submission should be considered for the Chair’s Award: