Dr. Alison Dougall:

I would like to respond to Deputy Durkan's question about access to care and how to nudge people to access it before something becomes a problem. The major change required is oral health has to become everybody's problem. We have to integrate the mouth with the rest of the body and work with our medical colleagues, community nurses and midwives to nudge people at appropriate times. This is really important in early childhood, but it is critical in older age, too. We find that for the first time older people are retaining their teeth. In the past they went into older age with dentures. People make more medical appointments as they get older but fewer dental appointments, although their risks are higher because of medicine, poor eyesight, lack of dexterity and finances. Pathfinder surveys examine how we can signpost people in order that they have really good levels of oral health as they age. As one in five people over the age of 80 years will get dementia, we need to make sure the teams that are caring for people with dementia take oral health seriously because we have the technology to prevent and reverse disease if we catch it early. Our problem is that people with dementia who have not received any care for perhaps eight or ten years present with advanced problems which at that point are very difficult to treat. That is a real priority. It is a new problem, but the nudges about which the Deputy talks mean redesigning the way we provide care. For homeless populations, we need more drop-in centres; for older people, we need to make sure services are local because they are least likely to be able to travel. Therefore, we need to make services accessible and affordable and design domiciliary care services in such a way that we can take teams into residential homes. They do not need to be dentists; we can work with teams of hygienists who can effectively and economically reverse disease. This is incredibly important and it is highlighted in the community services. We need to work with the professions and our colleagues in other areas of medicine to design services to reach more people at risk.