Gwên am Byth: a programme introduced to improve the oral health of older people living in care homes in Wales - from anecdote, through policy into action.

Introduction and context This paper describes how research and evidence influenced Welsh Government policy to fund a programme (Gwên am Byth - A Lasting Smile) with the aim of improving the oral health of older people living in care homes. It describes how collaborative multi-agency working supported development and delivery of the programme. The context was policy in Wales. This included the Welsh Government response to the public inquiry into Mid Staffordshire NHS Foundation Trust, the report into care homes by the Older People's Commissioner for Wales, and the Welsh Government Health and Care Standards for Wales which include a standard relating to oral health. The aim was to introduce a programme, Gwên am Byth, to support 'oral hygiene and mouth care for older people living in care homes through the development of a consistent all-Wales approach'; this aligns with contemporaneous NICE guidelines.Materials and methods Recurrent Welsh Government funding was identified to support a community dental service (CDS) led programme (Gwên am Byth). A multi-professional team led the development and testing of materials and resources to support the programme, underpin training for care home staff, and allow them to assess and provide safe mouth care for residents. A Welsh Health Circular was published to ensure a consistent all-Wales approachResults New staff have been employed in all health boards, and an assessment tool has been developed and is in the final stages of validation. All Wales resources have been published for induction, training and education, and to support care home staff. Evidence-based care plans have been produced which link to individual residents' risks and needs. There is close working with other health and social care professionals. By March 2019, half of all care homes were participating in the programme to a greater or lesser extent. Over 5,000 health and care staff had been trained, and over 5,600 residents had been assessed and supported with delivery of an individual mouth care plan. There has been positive feedback from care home staff, residents, carers and CDS staff, although barriers to delivery remain.Discussion This paper describes programme delivery in the four years since Gwên am Byth began. The drivers for change are described and the need to influence Welsh Government policy decisions when funding was available. The authors discuss issues which can impact on the pace of change, and ways in which health and care staff can effectively work together to implement improvements.Conclusions Starting with a blank page, a national programme has been established with the aim of improving the oral health of older people living in care homes in Wales. The paper describes the lessons learnt in implementing the programme and notes that Welsh Government has recognised the value of Gwên am Byth by committing to double the recurrent programme funding.