Dental care for vulnerable people in Wales: position statement

7^th November 2025

Vulnerable individuals and population groups in Wales must have fair access to high quality, compassionate dental care.

The purpose of this position statement is to influence dental policy and planning, including resource allocation, at national, regional and local levels within Wales.

This position statement should also act as a reminder to public bodies in Wales that proactive actions to create an inclusive service, with a coordinated person-centred approach is a key priority and a legal responsibility under Duty of Quality and the Well-being of Future Generations (Wales) Act 2015.

This position statement is in relation to vulnerable individuals within Wales, whether they are currently accessing dental services or not.

The key focus of this statement is to influence Welsh Government’s development of national policy and programmes. This includes direction and intervention nationally on allocation of resources, to ensure appropriate, timely care is available to vulnerable individuals. 

Other NHS Wales organisations, especially Health Boards, have key roles in resource allocation to ensure consistent, effective, high-quality services are available.

A separate WDC position statement is being developed on oral health inequalities and therefore this statement should be in considered alongside that document.

Vulnerable patients often face significant barriers to accessing dental care. Without tailored support, these individuals risk deteriorating oral health, which in turn affects their nutrition, social interaction, dignity, and overall health and well-being.

Welsh Government’s ‘A Healthier Wales’ long-term plan for health and social care emphasises person‑centred care, especially for those with long‑term or chronic conditions. It commits to coordinated tailored services, which ‘treat the person, not the condition’ through multi‑agency working, one‑stop clinics, and proactive advice. The plan specifically recognises people living in deprivation and chronic illness as priority groups for early public health intervention, to prevent worsening of health, reduce demand on emergency services, and help individuals live well for longer.

Reports by the Senedd Health Committee (Jan 2025) highlighted that vulnerable groups are still underserved and called on the Government to deliver on the promises made in ‘A Healthier Wales’.

Vulnerable persons definition

Welsh Government produced a Welsh Health Circular in August 2022 (reviewed in August 2024) regarding the Community Dental Service (CDS). In that document, vulnerable people were defined as follows:

Vulnerable people may be defined as those for whom inequality of healthcare has been demonstrated. Individuals differ in their needs and abilities, but many will have special care needs which may not be met by general dental services. Individuals are also affected by factors such as socio-economic circumstances and geography. Improved oral health can improve the general health of vulnerable people.

Vulnerable people are often at increased risk of dental and oral disease and are likely to include those who are unable to: 

• co-operate with routine dental care
• understand the need for dental care and good oral hygiene
• maintain good oral hygiene without assistance; and
• readily access dental services (patients who require a hoist to transfer to the dental chair)

They may also be: 

• people with complex and chronic health needs which may include medical, physical, or mental health needs
• socially disadvantaged, including asylum seekers, homeless people, and people with substance misuse issues
• Looked After Children (LAC) or children at risk with dental disease who are severely affected and not being taken for dental care
• frail and vulnerable older people, including those living with dementia and people who live in care homes who are unable to access care from GDS

These definitions are underpinned by: 

• Social Services and Wellbeing (Wales) Act 2014
  • Vulnerable groups
• Care Act 2014
  • Vulnerable adults
• Children and Families Act 2014
  • Vulnerable children

Vulnerable people often have complex health and social care needs and services require more time to organise and provide care, including dental care, for example special care patients, phobic adults, children living in temporary accommodation etc. Vulnerable people also do not readily have representation of their needs or are unable to effectively advocate for themselves. Hence comparisons of number of patients seen in the Community Dental Services with local general dental services are not useful or helpful.

CDS is responsible for the delivery of national oral health programmes Designed to Smile (improving children’s oral health) and Gwên am Byth (improving the oral health of older people living in care homes).

There is a variation in Health Inclusion Services across Wales and access to dental assessment and care is often not a part of the Health Inclusion Services in Wales. Cardiff and Vale University Health Board provides a Health Inclusion Service, which offers a range of medical treatments, including dental services, to individuals who find it difficult to access healthcare and who are not registered with a GP. This includes homeless people, asylum seekers, and individuals affected by sex work.

Recent work by the Inclusion Health Service, Public Health Wales, highlights the high dental need and significant barriers to receiving dental care faced by people in contact with the criminal justice system. Being in prison offers an opportunity to engage with dental services, often for the first time in many years. Prisoners may be released before their course of treatment (such as, provision of a denture) is completed, and it is currently extremely challenging for that treatment to be continued within the GDS, creating a barrier to continuation of care and a waste of resources, and serving to increase oral health inequalities.

Welsh Dental Committee is supportive of Welsh Government’s legislative and strategic intent of identifying and prioritising health services for vulnerable groups, provide person-centred care and reduce health inequalities. 

Welsh Dental Committee is concerned about current levels of staffing, resource, funding and waiting times within Community Dental Services, which are key to providing an effective service for vulnerable people and communities.

Welsh Dental Committee recognises that access to routine dental care is a fundamental right and supports:

• proactive identification and outreach to vulnerable individuals
• special care dentistry pathways that provide compassionate high-quality care in community and secondary settings
• flexible delivery models, including domiciliary care and joint working with carers, GPs, social workers, and voluntary organisations
• training and support for dental teams to deliver inclusive person-centred care
• integration of oral health into care planning for individuals with complex needs

The following recommendations are made to Welsh Government, Health Boards and other relevant public sector organisations in Wales:

• Welsh Government have a legal responsibility to pursue the 7 well-being goals, described in The Wellbeing of Future Generations Act including “a healthier Wales” and “a more equal Wales”, and must take steps to reduce inequality and support the vulnerable individuals and communities through sustainable development. Oral health must be recognised and considered as a core element of health and wellbeing.
• Public bodies such as Local Health Boards, NHS Trusts, and others must set and publish well-being objectives, including enhancing healthcare for vulnerable groups, and take all reasonable steps to achieve them. Again, this must include oral health and dental care.
• Actions must follow the 5 sustainable‑development principles of long‑term thinking, prevention, integration, collaboration, and public involvement, which directly support better outcomes for vulnerable people.

Record and respond to the needs of vulnerable populations using consistent data collection

• Data collected on vulnerable groups must include information about their oral health status and need for dental care
• Oral health and dental services data should be analysed to understand the demand for dental care including special care dentistry services and whether that need is being met. Dental services data should be linked with wider health and social care databases to understand their overall need and opportunities for co-ordinated care. Quantitative data should be supplemented with information on lived experience of population groups impacted by inequalities.
• Waiting times for oral health assessment and dental care for vulnerable groups should be monitored closely, and steps taken by Health Boards to address them, enabled by appropriate levels of funding from Welsh Government.

Proactive and ongoing actions needed to reduce oral health inequalities

• Remove barriers for health and social care teams to refer vulnerable patients or patients/carers to self-refer to the Community Dental Services and improve referral pathways to and from special care dentistry.
• Embed oral health in multidisciplinary care plans for vulnerable patients and explore the opportunities to provide interventions to prevent oral diseases as of part of multidisciplinary care plans.
• Safeguarding considerations for vulnerable groups must be considered in planning, provision and management of services including operational management of missed appointments (Was Not Brought) and no access visits.
• Offer accessible communication methods and adapted appointment processes.
• Ensure that digital transformation of the service, to increase efficiency and sustainability, does not lead to digital exclusion of vulnerable people and exacerbate oral health inequalities.
• Welsh Government to work closely with health boards to reduce waiting times for specialist care dentistry.
• Invest in workforce to ensure a workforce adequately trained, competent and supported to deliver prevention and sustained specialist dental services to vulnerable people.

The WDC will review this statement annually which will include discussion on the progress made against the committee’s recommendations.

WDC Secretary: committeesecretariat1@gov.wales