That item is the short debate, and the short debate is to be presented today by Peredur Owen Griffiths. And I call on him to speak to the topic that he has chosen. 

Diolch yn fawr, Llywydd, and just to let Members know that I've agreed to a request from Sioned Williams to make a short contribution at the end of this debate.

Over the past few weeks, I've been getting to know the different aspects of my portfolio. I'm the spokesperson for communities and older people. As you might expect, a large part of this covers social care. For those of you that know me, it'll come as no surprise that I've been talking to the people that I meet about different aspects of my portfolio. Indeed, when I visited my dentist, it came as no surprise that dentistry and oral health came up, in particular oral health in care homes.

During our conversation, my dentist talked about some of his long-standing patients, some of whom he’s seen move into care homes. Under his care, his patients had maintained healthy teeth and gums for many years, until they moved into a care home. He's been shocked to see how many of his patients have had a dramatic decline in their oral health since moving into a care home. I then mentioned this conversation to a friend of mine. They echoed the experience. Their father had dementia and had to move into a care home. When he stopped eating they assumed it was because of the dementia, but actually it was toothache. His oral health had declined dramatically after moving into a care home.

The Deputy Presiding Officer took the Chair.

Now, staff in care homes are working their socks off—I don’t think there’s many here who would deny this—but, inevitably, things move down the priority list. Indeed, dental care, for many of us over the last 18 months, has taken a back seat due to the need for social distancing, and I’m sure care homes, who have been especially vulnerable to infection during the pandemic, have been mindful of this.

By its nature, dental care is one of the most difficult health services to restore during a pandemic. The written statement issued by the Government last week acknowledged this matter, and I don't think there will be many people who disagree with assertions such as, and I quote,

'During a respiratory virus pandemic, dentistry has been one of the most complex areas of primary care delivery to scale back, provide and recover.'

This is due in part because so many of its procedures generate aerosols, and also the proximity of the dentist to their patient in dental care delivery. This has led to many dentists only fulfilling requests for emergency treatment, so check-ups have had to be put on hold for the time being. I fear that this is especially the case in care homes.

To get to the crux of this debate, we must rewind the clock back to 2014, when the Older People’s Commissioner for Wales published a report called 'A Place to Call Home?'. This was a review into the quality of care that older people receive in care homes. The report found that dental care was lacking in many areas and many care homes. In establishing its conclusions, the report used evidence from the British Dental Association, which highlighted that there are high levels of unmet dental need in care home residents, and with many only receiving dental care when they develop a problem.

Pressure such as this thankfully led to the last Government's Gwên am Byth oral health programme in 2015, which aimed to improve oral hygiene and mouth care for older people living in care homes, through the development of a consistent all-Wales approach. It aimed to plug the shortfalls in dental care for older people in a care homes, by ensuring that an up-to-date mouth care policy is in place; by training staff in mouth care; and by keeping a register of that training. It also aims to ensure that residents have regular mouth care assessments that lead to an individual care plan, and that they are referred to a dental team if necessary.

In 2019, it was announced that funding for this programme was to be doubled to £0.5 million a year to ensure that the programme was rolled out fully in all care homes in Wales during 2020-21. This was obviously welcome. Good dental care is crucial to so many aspects of health. In the last few years, there has been mounting evidence that gum disease may be linked to dementia. Even for people with dentures, good oral hygiene is vital, as bad practice can lead to aspiration pneumonia. But, since the update we received from the previous health Minister on 23 December 2019, we have had no further updates or Government statements on the matter.

If I think that a week is a long time in politics, an awful lot can happen in two years—and this is especially true when you consider the events of the last two years. Within a few weeks of the last update of the Gwên am Byth programme in December 2019, news started to emerge about coronavirus, and this has obviously dominated the health agenda ever since. In the last 18 months, coronavirus has changed so much of what we know, but this is especially true of the care home sector.

Now, I was hoping that the Government statement of last week would mention oral care in care homes, but it did not. There was mention of COVID, controls and contracts. There was mention of targets, timescales and tools. There was mention of vulnerable groups, various measures and valuable aspirations, but no specific mention of oral health in care homes. And given that the last update we have on the Gwên am Byth programme predates the pandemic, I would like to put this issue back on the agenda with this debate.

In a blog from last year, Tom Bysouth, the chair of the Welsh general dental practice committee of the British Dental Association said that at-risk groups have become, and I quote, 'a ticking time bomb' since the outbreak of the pandemic. He said that Gwên am Byth was put on hold along with Designed to Smile, which is aimed at children. He said that vulnerable adults and children should not become the lost groups in this pandemic when it comes to dental care, and I agree completely.

In the meantime, I only have anecdotal evidence to draw upon, like the experiences I spoke about at the beginning of this debate. We all know that oral hygiene is vital. We know that advances have been made—there are fewer dentures in glasses of water at the sides of beds, compared to a few short decades ago. This is due to advances in dental care. My fear is that this has been greatly set back during the pandemic. I raise this matter here in the Siambr today not to criticise the Government, nor residential care homes, nor dental practitioners, who work so hard, but to ensure that dental care for older people is on the agenda, that it is being actively investigated and that contingency plans are being drawn up to react to the sweeping changes that this global pandemic has had on social care. These plans are needed. If they're in the process of being planned, we need to hear about them.

We drum into our children the importance of brushing their teeth. In fact, when we first get teeth, the people who look after us drum into us that we must brush our teeth. This should be the case throughout our lives. We should be helping our older people in care homes to maintain those childhood habits. That's why it's so important that this topic remains on the agenda. In addition, we know that a person's oral health can deteriorate in a short space of time, so we must consider how top-class dental care can be delivered to care home residents during a pandemic. I hope that this is something we can all agree on. I hope we can work together to bring back the momentum on this important issue. And I do hope that we can provide more than just a smile. Diolch yn fawr.

I'm pleased to make a brief contribution to this important debate. The General Dental Council notes that, because of the pandemic, which has exacerbated health inequalities, that older people and those considered clinically vulnerable face increasing challenges in accessing all sorts of dental care, and it's clear that some care home residents fall into that category. And I believe, even before the pandemic, that there was a need for an additional focus on this area in order to tackle the inequality in dental provision across the generations.

The aim of the Welsh Government in this area is laudable, and I welcome the guidance on ensuring that individuals are supported to care for their teeth, and that appropriate oral healthcare is available and that oral health is monitored. But the key question for us is how do we track this. It appears that a lack of up-to-date research in Wales is a problem, and I would be grateful to hear what plans the Welsh Government has to track the aims of Gwên am Byth. How can you know if Government guidance is being implemented? Thank you.

I call on the Minister for Health and Social Services to reply to the debate—Eluned Morgan.

Thank you, Dirprwy Lywydd. I'd like to start by thanking the Member for raising this important issue of dental services for people in care homes. As Members will know, the aim of the Gwên am Byth programme, introduced in 2015, which has already been referred to this afternoon, is to improve oral health and oral care for older people living in care homes by developing a consistent approach across the whole of Wales. Now, the programme tackles health inequalities by ensuring that some of the most vulnerable people have fair and appropriate access to oral healthcare. We know that the oral health of many of those people does deteriorate when they move into care homes, very often as a result of a decline in their general health and the fact that they hadn’t been as mobile in previous years, including those living with dementia.

Gwên am Byth runs alongside 'A Healthier Wales', as the response of dental and oral health services. The principles of the programme do ask care homes to ensure the following things: the first is that there is an up-to-date oral health policy in place; second, that staff are trained in oral health; third, that residents get regular assessments of oral care and health; fourth, that the assessment leads to an individual care plan, with the aim of maintaining good oral health; and, fifth, that residents are referred to a dental team, where necessary.

Our experience following the first five years of the programme has demonstrated that securing improved oral health for people in care homes is complex and challenging. Over half of care homes now participate in the Gwên am Byth programme, and almost 8,000 residents participate. We have had positive feedback from the care home staff and residents, carers and community dental services that provide the programme. As a result of the progress made, in 2019 my predecessor announced that funding would be doubled to £0.5 million, and I am pleased that Peredur noted that in his contribution. Thank you for that.

The programme is now a key part of the Care Home Cymru programme, which is funded by the Welsh Government and provided by Improvement Cymru and Public Health Wales. Integrating with Improvement Cymru has strengthened Gwên am Byth further, making it an integral part of the national work undertaken in Wales to improve oral health among adults.

We don't have many debates these days that don't refer to the huge impact of COVID on the provision of public services, including general dental services and oral health programmes for people across Wales of all generations. Last week, as you noted, I shared a written statement with Members outlining the gradual progress made in dental services, and it confirmed that the contract reform that we anticipate will be delayed until April 2022. And, whilst COVID-19 continues to cause concern in terms of public health, dental teams do need to maintain the appropriate virus containment systems.

During a respiratory virus pandemic, dentistry has been one of the areas of primary care that’s been most complex to diminish, to provide and to restore, particularly given how common the use of aerosol treatments are, such as fillings, and how close the clinician is to the patient in providing dental care. Now, I visited the dentist last week, and when the dentist came in it was like seeing somebody who’d just been walking on the moon, given all the equipment. As services increase capacity gradually, dental teams continue to prioritise emergency care. They are dealing with the needs of vulnerable groups and with lengthy waiting lists for treatments, as a result of the reduction of dental services, and are reintroducing regular assessment and care as their capacity increases. Some of those people who are vulnerable and need emergency care will include those in care homes who participate in the Gwên am Byth programme.

So, we know that the return of services will continue to be gradual, and we recognise that people across Wales have not had the regular check-ups that they've been used to. However, the service has adapted to prioritise urgent care, and I would like to take the opportunity to thank dental teams and health boards for their commitment and dedication during the last 15 months to maintain access to essential dental services for those in the population experiencing pain and problems. And, yes, that does include people who are in care homes. 

Now, we know that this has been a very challenging time, and we recognise the impact that COVID-19 has had on individual members of the dental team and on the profession as a whole. As the risks of COVID-19 reduce, more treatments will be able to be provided. Now, we need dental practices to continue to follow strict infection control measures, including social distancing, to protect practice staff, patients and the wider community. Practices are encouraged to see patients using suitable recall periods, determined by their patients' needs and risk.

Now, given the need to shield vulnerable residents in care homes, active face-to-face engagement during the initial phase of the pandemic was paused. The majority of dental care professionals were unable to directly access care home staff and residents for face-to-face contacts at the time, which is what you've noted. However, many local community dental teams remained in contact with the care homes by e-mail and phone call contact. The Care Home Cwtch—a peer support network for care home managers—was set up by Care Home Cymru and PHW to help assist care home managers during and beyond the pandemic. Now, this platform provides the opportunity for Gwên am Byth leads to integrate with care home staff to deliver oral health and hygiene information and skills-building sessions.

Infection control and isolation in care homes is much more difficult than in the controlled clinical environment of a hospital or a dental clinic. People receiving social care often have underlying conditions that make them more at risk of infection and death from COVID-19. Some people require physical help with aspects of daily living, such as eating, washing and mouth care, making complete isolation very difficult for them. Now, this has added further complexity to the provision of the programme during the pandemic.

The need for face-to-face contact in care homes is under regular review, and local teams will be guided by service providers on the level of activity in each care home. Gwên am Byth teams have maintained regular contact with care homes throughout the pandemic, whilst monitoring and managing emergent needs where appropriate. This has ensured an approach that prioritised urgent needs, as well as the wider provision of dental services in Wales. And I'm incredibly grateful to the community dental services across Wales for the efforts they've made to ensure care home residents can access the advice and interventions where appropriate throughout the pandemic.

Now, just as much as the challenges and complexity of providing dental services, I fully recognise the impact that COVID-19 has presented in care homes. And it's highlighted that care homes have different levels of workforce experience or resources to be able to fully engage in the Gwên am Byth programme. It's commendable that many care homes have already fully engaged with the programme and are achieving excellence in mouth care standards. However, our aim prior to the pandemic remains: we expect to see the programme available in and offered to all care homes for older people in Wales.

To address this inequality and widen access to the programme, I've introduced a simplified offer and approach that is intended to facilitate more care homes being able to meet the essential minimum standards and take part. This is called Essential Gwên am Byth. Those homes that are already fully engaged will continue to be supported to sustain excellence in mouth care standards. The simplified approach can be initiated in care homes that have not started the programme or have found it difficult to comply with the current all-Wales approach. By adopting this approach, all care homes across Wales can be included in the programme, and all residents can benefit from the benefits that are being offered through Gwên am Byth. The programme, including the offer of Essential Gwên am Byth, is now resuming.

With the success of the vaccine roll-out, use of digital training and the availability of lateral flow devices, the risk to community dental staff of entering care homes is now greatly reduced. The recovery is well under way, and we have incorporated learning from the pandemic into the programme as we look ahead, including the greater use of digital technology to deliver the training element, which will result in the offer being made to all residential care homes in Wales. As the services continue to recover, I hope that the simplified offer will enable all care homes to be a part of this programme, ensuring that some of our most vulnerable groups have access to the oral health they require. But thank you very much for bringing the attention of the Senedd to this really important matter. Diolch.

Thank you, Minister, and that brings today's proceedings to a close.

The meeting ended at 18:00.