Oral health strategy – the case for rapid research
In the Long Gallery of the Parliament Buildings at Stormont last month, the mood among those who had gathered to explain, learn more about, and debate the issue of oral health in Northern Ireland was collegiate and positive. However, it could be argued that there were good reasons why this should not have been the case.
The ‘Oral Health Matters’ summit had been organised by the British Dental Association (BDA), when perhaps it should have been the Executive or the Department of Health taking the lead – with the BDA, and other interested groups, acting as consultees and sources of expert advice.
In addition, when an initiative such as this is taken, there is usually a goal; in this case – it could reasonably be expected – that would be to deliver a new oral health strategy (or, at least, a refresh). The last strategy was published in 2007.
Why it was the BDA taking the lead, and not politicians or public health officials, was not raised. But in a sense, it does not matter now; the key people and organisations were in the room and there appeared to be broad agreement about what progress had been made in the past 12 years, what challenges remained, and a willingness to work together on actions that will help improve the population’s oral health. One delegate, however, did raise the issue of the strategy age. He argued that while there might be consensus on the problems, and potential solutions, the lack of a ‘new’ strategy left nothing tangible for everyone involved to rally round.
Simon Reid, the Chief Dental Officer, did not completely disagree on that point, but he did express concern about the length of time that devising a new strategy might take and the delay in taking action this would cause. The 2007 strategy took two years to write, he said, and – if my ears served me correctly – he recalled it had had the input of a health department trainee at the time, who happened now to be sitting to his left; one Michael Donaldson, today’s Head of Dental Services at the Health and Social Care Board.
In his presentation earlier, Reid had acknowledged the strategy’s vintage, but argued that it was a “significant piece of work”, whose key principles – prevention, complimentary health promotion, partnerships, and reducing inequalities – hadn’t changed. The recommendations were still valid, and targets had been met, said Reid.
He did say that within partnerships, there should be more “embedding” of oral health in wider public health. In addition, he said there should be consideration of new targets.
This may all be true. But, still. The delegate’s point about there being nothing to rally round holds. Reid’s announcement of two ‘options groups’ – focused on the oral health of children and the elderly – was welcomed. Their work and outcomes will be observed with interest. It might be an idea, though, to reconsider the notion of producing a new strategy. An internal deadline for delivery in the first half of the new year could be set,
allowing for ‘2020 – and beyond’ to be incorporated in its title.
We’re not advocating the adoption of a ‘Design Sprint’, as developed by Google Ventures (www.gv.com/sprint). “Working together in a sprint, you can shortcut the endless debate cycle and compress months of time into a single week”. No, clearly not in this context. But, perhaps look to the work of the Nuffield Trust on rapid research.
“Many health care organisations use research to make decisions around management and organising care,” says Dr Cecilia Vindrola-Padros, a member of its Rapid Service Evaluation Team. “This evidence might come in different forms, but one of the conditions for its use is that it will need to be available at a time when it can still inform decision-making processes.”
She adds: “The changing climate and priorities of many health care organisations means that many important decisions are made quickly. As a consequence, any research hoping to inform these decisions must be flexible enough to deliver findings within reduced timeframes or on an ongoing basis, in the form of emerging findings.” (read more)
Dr Vindrola-Padros’s own work in this field suggests the definition of rapid research can extend from five days to six months.**
The launch of a new oral health policy for Northern Ireland in the spring of 2020 ought to be do-able.
** Quick and dirty? A systematic review of the use of rapid ethnographies in healthcare organisation and delivery. Vindrola-Padros C, Vindrola-Padros B. BMJ Quality & Safety 2018; 27:321-330.