Torbay Council: Improving oral health through dynamic local partnerships

Torbay Council has worked with NHS Devon and the two other Devon local authorities to establish a county level steering group to address issues of reduced dental access and poor oral health. The steering group oversees a suite of oral health improvement programmes with a children and young people focus, and extending to vulnerable adult groups at greater risk of poor oral health. Programmes are funded through NHS dental contract underspend and overseen by the council’s Overview and Scrutiny Committee. This is a unique, ambitious, and successful partnership.

Poor oral health has a significant impact on population health and wellbeing as well as presenting avoidable costs to the NHS:

• Tooth decay is a preventable disease which leads to pain and infection. This affects children’s eating, sleeping, school readiness and their ability to thrive.
• When young children have problems due to tooth decay, they may need to have the decayed teeth extracted under general anaesthetic, which can be distressing for families as well as needing to take time out of school and work.
• In addition to NHS costs, hospital tooth extractions for children cost at least 60,000 missed school days per year. Children who develop tooth decay when they are young are also more likely to experience decay and need more dental treatment throughout the rest of their childhood and adult life. 

Torbay Council recognised that the oral health of the population is a key statutory duty of the local authority, but that improvements would need to include the NHS as responsible body for high street dental access. In order to improve one area of responsibility, both organisations needed to work together. 

NHS Devon had access to a dental underspend (due to the impact of COVID-19 and a reduced take up of the national NHS dental contract resulting in less dentists). Local authority Oral Health Leads, in the absence of a dedicated budget, decided to advocate with NHS Devon for allocation of that contractual underspend into mitigating oral health programmes. 

Local authority Oral Health Leads had a clear picture of need, drawing on key data sets (such as Epidemiological Surveys of dental caries in children and extractions in hospital settings due to dental caries), as well as anecdotal evidence from frontline services, families, and educational settings regarding the impact on health and wellbeing of poor oral health.

The three Devon local authorities had the evidence of the need, but no dedicated budget outside of an already pressured public health ring fenced grant. A partnership was required with NHS Devon as well as influential sector partners (such as Peninsula Dental Social Enterprise) to agree a programme of oral health improvement activity, to be funded through NHS dental underspend. NHS agreement was required as well as an effective partnership steering group (comprising those with the ability to make or recommend funding decisions) as well as a convincing evidence base, leaning on the available data.

The local authority Oral Health Leads, recognising the interests of steering group members, as well as clear population need, wanted to achieve an equitable offer for the population of Devon – implementing long term, evidence based and innovative programmes on a whole Devon footprint.

The aim is to improve the oral health of the population (particularly marked in areas of inequality/vulnerable groups) and alleviate the impact of reduced NHS dentistry. 

A joint local authority approach was agreed to advocate for the allocation of NHS Devon dental underspend. This included using the Overview and Scrutiny governance function to arrange a joint review meeting. At this meeting NHS Devon agreed to fund a series of evidence based programmes – list, funding envelope, and timeline to be agreed by NHS Devon and local authority leads. It was also agreed to establish a dedicated steering group to oversee the process, spend and performance monitoring.

From the outset, there has been a recognition across the steering group of the need to adopt a partnership approach to commissioning and resourcing. NHS Devon have the funds but are limited on capacity, while the joint local authorities has capacity but not the budget. Accordingly, in oral health programmes, the NHS fund and the local authorities procure, commission and contract manage. This approach also applies between the local authorities themselves – for example in regard to the oral health training service for non-dental professionals, the NHS fund, Torbay Council procure and Devon County Council provide a commissioning lead-officer to work alongside the Torbay Procurement Team.     

A series of programmes have been implemented from 2024/25, funded by a five-year NHS funding agreement, approximately 900K per annum. This includes extending the supervised toothbrushing offer to all primary schools (Reception year) and nurseries across Devon, and establishing Open Wide Step Inside – a classroom based learning programme for primary school Year 6 pupils. 

Further funding has been agreed to increase scope to vulnerable adult groups through a new Inclusion Groups Service (focus on homelessness) and a non-dental professional oral health workforce training service. 

In February 2026, the NHS agreed a further two year funding (now seven in total) to extend the supervised toothbrushing commitment to match the five year allocation of DHSC funding to roll out a mirror programme. Thanks to the fact that Torbay are already delivering against the national requirements, the council have been able to extend delivery to cater for additional year groups in the schools in areas of greatest inequality.   

In 2025, the partnership and delivery was recognised through a nomination in the MJ Awards reducing inequality category.

• Be clear about direction and priorities: In order to achieve meaningful partnerships, you need a clear direction from national policy (National Dental Recovery Plan), understanding of partner (NHS Devon in this case) responsibilities and priorities and a solid evidence base for change or investment.
• Think about how governance can facilitate effective and accountable partnership: You need to be aware of the governance structures and tools to enable negotiation, and bring partners into a formal arena that incorporates formal agreements, follow up and specific timed actions. This was achieved through the local government Overview and Scrutiny function.
• Be innovative: lean on the data and anecdotal feedback to outline population need as well as refer to the evidence base of what works, but be prepared to innovate as you design.       

Mark Richards, Public Health Specialist [email protected]