13. When we consider complaints, we first look at if the organisation did anything wrong. We do this by comparing what happened with what should have happened.
14. When considering what should have happened, we looked at the Equality Act 2010. We cannot say if the law has been broken, but we can say if NHS England followed the law in its actions.
15. Chapter 1 (S1-S14) of the Equality Act 2010 outlines a list of protected characteristics and says that a person who has a disability falls under this list.
16. Chapter 2 (S15-S27) of the Equality Act 2010 outlines that persons with a protected characteristic should not be discriminated against and reasonable adjustments should be put in place for those with a disability, to stop them from being discriminated against.
17. S149(3) of the Equality Act 2010 states a public authority must have due regard to allow equal opportunities for persons who share a relevant protected characteristic. This involves having due regard to the need to:
• remove or minimise disadvantages suffered by persons who share a relevant protected characteristic (when the disadvantage is caused by the person having that protected characteristic)
• take steps to meet the needs of a person with a relevant protected characteristic
• encourage people with a relevant protected characteristic to participate in public life or in any other activity in which participation by such persons is very low.
18. We have looked at whether NHS England followed the guidance in the Equality Act 2010.
19. The special care dental service guidance says special care dentistry can and does form part of routine care provided by general dentists, where the patient does not need specialist care. It says all dentists need to know the current guidance for special care dentistry patients such as safeguarding, consent, and management of patients taking certain medication. It also says all dental providers are required to make reasonable adjustments for patients with additional needs.
20. The guidance sets out three levels of care:
• level one - most patients who need level one care may receive most of their care from a general dentist, but may need a referral for specialist care for certain treatments
• level two - patients who need level two care have significant needs, such as communication difficulties due to multi-sensory or cognitive impairment, or a disability that significantly interrupts treatment due to the patient’s inability to tolerate procedures. It says these patients need care from a dentist with enhanced skills or experience
• level three - patients who need level three care have severe needs, such as no verbal communication ability or severe cognitive impairment or disability. It says these patients need care from a registered specialist or consultant.
21. This guidance is built around the fact that a standard approach to dentistry does not meet the needs of everyone. The policy removes barriers to accessing NHS dental services. It gives those who cannot get the service they need in a general dental practice an alternative to meet their needs.
22. We understand Mr E says autistic people should be able to get special care dentistry. The policy is a needs-based policy rather than a diagnosis-based policy.
23. Two people with the same diagnosis may have different needs. We know that some autistic people are likely to need special care dentistry, but some may have their needs met by a general NHS dentist. A needs-based and personal approach is about giving services to meet the needs of people with protected characteristics.
24. The guidance says that every person has different needs and not all people can have their needs met by a general dentist. It puts a process and a service in place to fix this. The guidance also recommends that some people may need to see a special care dentist for some treatments, but not others.
25. By people being referred to special care dentistry, it makes sure that there is a process to allow access to dental services. This removes barriers for people who could not otherwise access dental services.
26. We have not seen that NHS England did anything wrong. We are pleased the guidance meets the requirements of the Equality Act and aims to reduce problems in accessing NHS dental care. We will take no further action.