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Added 23 February 2024

What is this report?

This report:

• Explains why people experiencing homelessness might struggle to maintain good oral health and access dental services. This will include feedback from a focus group of Experts by Experience.

• Looks at the different types of NHS dental service and how people experiencing homelessness can be supported to receive treatment.

• Investigates alternative models of dental care, developed specifically with people experiencing homelessness in mind.

• Offers some recommendations as to how access to dental services can be improved.”

Who is it for?

This report is for anyone commissioning or designing dentistry services and want to make them more inclusive for people who are homeless.

Summary

The difficulties faced by people experiencing homelessness in accessing dental services are varied and can be significant.

They range from a lack of information about how dental services work, to being refused care from a dental practice. In common with other socially excluded groups, many people experiencing homelessness have endured trauma, which can also affect their ability to seek and receive treatment.

It’s getting even more difficult to find an NHS dentist and many lists are full. I’ve tried 4 different dentists in my local area, with no luck.

Seeking treatment

To explore these difficulties further and how they might be overcome, we held a focus group with Expert by Experience participants, all of whom have direct experience of homelessness.

Participants spoke about how they didn't feel that dental services were accessible to them, and what came across strongly were:

  • a lack of clarity on entitlement to NHS dental treatment
  • the belief they needed to provide ID or a current address to sign-up with a dental surgery
  • digital exclusion, e.g., the requirement to sign up and/or complete forms online
  • the attitude of some dental practice staff and the feeling they were being judged for experiencing homelessness
  • the impact of the increased risk of things like anxiety and unresolved trauma on accessing dental care
  • inadequate training for dentists and front facing staff in trauma and psychologically informed approaches and in understanding the complexities faced by people experiencing homelessness

Key recommendations for better provision:

  • It is important to encourage collaboration between VCSE organisations, dentists and local commissioners.
  • Alternative funding streams and flexible commissioning should be explored. Alternative models are summarised below
  • Support through peer and/or link worker advocacy helps people experiencing homelessness to access and complete dental treatment
  • Practical guidance and information are a must

There should be signposting by surgeries who cannot see you due to the waiting list, with advice on where you can be seen.”

Inclusion health dental service models

The unintended consequences of most current NHS dental service contracting and the clear message from focus group participants are that regular treatment pathways do not feel accessible to people experiencing homelessness and they need dedicated support.

The mobile dental van

Organisations such as Dentaid23 and Colgate24 offer free, ad hoc dental care in a mobile van setting. While Colgate currently works specifically with children, Dentaid works with people experiencing homelessness, in collaboration with day centres, accommodation providers and community buildings to offer free dental care for people who are not able to access an NHS dental practice.

The partnership model

The model focuses on improving access within existing NHS contracts via collaborative cross-sector delivery. This entails local health commissioners, dental practices, VCSE organisations and people with lived experience working collaboratively to help vulnerable people access dental care in their area.

Peninsula Dental Social Enterprise Community Clinic

Peninsula Dental Social Enterprise (PDSE) Community Clinic31 is a building-based community dental clinic in Southwest England. The team that set up the clinic wanted to respond to the severely limited access to dental care for people experiencing homelessness in the city and the need for a dedicated service that met their specific needs.

Talk To Us

6M5A1791-Edit

Jo Prestidge

Head of National Practice Development

Jo is Head of National Practice Development at Homeless Link.