National Health Service (Dental Charges) (Scotland) Amendment Regulations 2006 (SSI 2006/131)<br />National Health Service (General Ophthalmic Services) (Scotland) Regulations 2006 (SSI 2006/135)
National Health Service (General Dental Services) (Scotland) Amendment Regulations 2006 (SSI 2006/137)<br />National Health Service (Optical Charges and Payments) (Scotland) Amendment Regulations 2006 (SSI 2006/138)
National Health Service (Charges to Overseas Visitors) (Scotland) Amendment Regulations 2006 (SSI 2006/141)
Item 2 is subordinate legislation. We have been asked to consider five instruments under the negative procedure, on the charging regime for eye and dental services. The instruments are interrelated and follow on from legislation that the committee considered. I invited Executive officials to the meeting to give a brief explanation of the purpose of the instruments, after which members might have questions. The item affords officials an opportunity to comment on how we are where we are. I ask them to be as brief as possible.
Thank you for inviting us. It is good to have the opportunity to talk to you about the regulations. Briefly, they are about the introduction of free NHS eye and dental checks in Scotland. They also provide for a number of minor things, such as the uprating of optical voucher values. They extend from 16 months to three years the dental registration period for patients who are registered under the NHS. They also prevent dentists from charging patients a fee—over and above any NHS charges—in exchange for NHS treatment. As well as introducing free eye and dental examinations, the regulations provide for the introduction of new and extended oral health and eye health examinations. My colleague Eric Gray will give you more detail on that.
The present system allows patients to claim a basic dental examination every six months. Excluding children's examinations, which are included in dentists' capitation payments, a basic examination and two more detailed examinations are available if suggested by individual need. In addition, those who access occasional treatment at a dentist will also be entitled to a free assessment.
Will all dentists be required to provide the free dental check to all patients, regardless of whether they receive NHS treatment or are on an NHS list, and regardless of whether the dentist provides NHS treatment? We all know that many dentists no longer do so. Will all dentists have to provide the free dental check for all patients?
The provision applies to dentists who are registered on an NHS list.
So only NHS dentists?
Yes.
Does that mean that in many parts of the country free dental checks might be difficult to access?
That is right.
Obviously, we recognise that there will be access difficulties in certain parts of the country, which is why the Executive is putting in £295 million over three years to expand NHS dentistry provision.
So adults who are currently unable to access NHS dentistry within a reasonable distance will not get a free dental check unless they are prepared to travel to somewhere where there is an NHS dentist?
Such people will be able to access NHS dentistry either through one of the five existing dental access centres—several more are being funded through the primary care modernisation fund—or through a dentist who is prepared to register them as an NHS patient.
If people are unable to register with an NHS dentist but are able to get their dental examination at a facility such as the dental school in Dundee, will they be able to claim travelling expenses for that, or will they need to meet their own travelling costs?
I believe that they will need to meet their own travelling costs.
Jonathan Pryce mentioned that there are five dental access centres. I seem to recollect that the announcement suggested that such centres would focus on carrying out fairly complex treatment. If the dental access centres' time is taken up with free dental checks because no one else will provide those, will that not cause a problem?
Quite a number of centres were provided with money through the primary and community care premises modernisation programme. The centres that we have mentioned have been proposed as dental access centres rather than as additional surgeries in an existing health centre.
How will patients access the dental access centres? Will they need to be on an access centre's list?
No. For example, Chalmers dental centre in Edinburgh is really for unregistered patients. If people have a problem with their teeth, they can go to the Chalmers Street centre where they will be triaged by the reception people and then treated by a dentist.
If the access centres are to provide free dental checks, is there not a danger that people will queue outside their doors trying to get a free dental check? The publicity around the dental access centres suggested that they would be for patients who were having problems.
That is right. Normally, people who are experiencing dental pain would go to an access centre.
So the role of the access centres is not to give people free dental checks.
No. As part of the examination, people would get an assessment before they received treatment.
The dental access centres are not primarily for providing free dental checks. They exist for a range of reasons but their primary role is to provide treatment to patients who are not registered with an NHS dentist.
If people turn up for a free dental check at a dental access centre, will they be seen?
It is likely that they will be seen, but that will depend on the demands that are placed on the centre at the time. The centres will prioritise patients who are in extreme pain over people who turn up in perfectly good health. I expect that most centres will be able to deal with people who turn up in the hope of receiving a free dental examination.
Should we anticipate that dental access centres will have waiting lists? If people who turn up for a free dental check cannot be seen until considerably later, will we end up with waiting lists at such centres?
That will depend on the level of demand that is experienced by each centre.
How many access centres are there?
There are five designated access centres.
Is that for the whole of Scotland?
There are five for the whole of Scotland at present. We have provided funding for another six. The important thing to recognise is that a lot of additional resource is being put into expanding NHS dentistry. The minister's objective throughout the process is to make more NHS dentistry available throughout Scotland.
Several members now want to ask questions. Before I allow them to do so, can Jonathan Pryce name the current five access centres and tell us where the other five are likely to be situated?
There are access centres in Kirkcaldy; Dunfermline; Stirling; the Glasgow dental school; the Chalmers dental centre in Lothian; and, I think, the Dundee dental school. We have committed funding to Kilbirnie in NHS Ayrshire and Arran; Cowdenbeath, Cupar and Glenrothes in NHS Fife; Bonnyrigg in NHS Lothian and a further centre in Dundee.
As is clear from some of the questions that have been asked, having regulations for free dental checks means having access to NHS dentists. Can you confirm that it is the Scottish Executive's intention to reach an agreement with the British Dental Association for NHS high street dentists to be able to provide checks, and that there will be salaried dentists in each health board area by the due date? Other members of the committee have expressed concern that the Scottish Executive may not be able to meet the commitment that it has made. We must ensure that everyone understands that the checks will be provided by high street dentists, salaried dentists and so on.
You are absolutely right that there will be access to checks through the salaried dentist service and the community dental service for patients who have difficulty accessing an NHS list.
Throughout Scotland?
As I am sure the committee is aware, the Executive is recruiting 40 Polish dentists to enhance the capacity of the salaried service.
I am looking at the dates on which the instruments come into force. Do I detect a sense that members would like to consider them further? The 40-day deadline is 5 May. We have an agreement to deal with the instruments by 30 March, but we could come back to them straight after the recess, if members would like a longer period of consideration.
No.
My question was about the national waiting times centre, but I am shocked by what I have heard. If free dental checks have been introduced to prevent dental disease, people must be able to access such checks. I am also astonished that people will not be helped with their travel expenses for getting to centres, given that large areas of the country do not have dentists.
Which instrument are you asking about?
I wanted to ask about the waiting times centre, but when I heard that people would not be helped with travelling expenses—
You have gone on to SSI/2006/142, which is a separate item on the agenda. In any case, the instrument has been withdrawn. Can we park that for the moment?
There are implications for people who have to travel to access cardiothoracic and dental treatment. If we introduce free dental inspections, people must be able to access them.
Access is an issue that is in all our heads.
Can we assess the scale of the problem of accessibility? None of the centres that you mentioned is north of Dundee. There are no dentists in much of Scotland north of Dundee. Do we know how many people are not registered with a dentist and where they are? Is there any means of finding out that information?
Approximately 50 per cent of adults are registered with a dentist.
But where? There will be a big disparity as to where they are.
We can certainly provide you with a note on that.
I would appreciate that.
Nobody else wishes to contribute at this point. The Subordinate Legislation Committee has not raised any issues from its perspective. Prior to the meeting, no comments had been received from members—although there have certainly been some now. No motions to annul have been lodged. Are we agreed that the committee does not wish to make any recommendation in relation to SSIs 2006/131, 2006/135, 2006/137, 2006/138 and 2006/141?
We may wish to make some comments, however. I think that we ought to do so, given that we have discussed the issues.
Judging from what I have heard of the questions and answers, there has been a misunderstanding. It is as though free dental checks will be available only at the five centres that have been mentioned. That is patently not the case, however. I do not know why members are getting exercised about the matter.
I agree with Mike Rumbles. There are other issues that we will wish to examine. If we wanted to, I am sure that we could resurrect the dental inquiry that we began. For the moment, the proposals are those that are before us. I second the suggestion that we approve the instruments. We have had time to submit our concerns and recommendations, and—
My expectation was not that there would be such limited access to the centres. There are areas of the country where there is no access to NHS dentistry at present. Without an access centre, there will effectively be no free dental treatment for some people.
My constituents in Aberdeenshire have the lowest level of access to NHS dentists of anywhere in Scotland. I am not under the impression that people must go to one of the five dental access centres to access the free dental checks. In the Grampian NHS Board area, salaried dentists are being recruited. The second prong of the Scottish Executive's approach is to reach agreement with the British Dental Association on high street dentists. We are being unnecessarily exercised about the issue at the moment. There might come a time further down the line when no agreement exists between the BDA and the Scottish Executive, in which case we will have a real issue. That does not apply now, however.
My understanding is that access to a dentist who provides NHS treatment is required. Rather than holding up the SSIs at this stage, we should agree to them. There are issues, however. There are areas of the country where people do not have as easy access to dentists providing NHS treatment as elsewhere. Perhaps we would like the Executive to monitor the situation and let us know how the services are rolling out. It will be impossible to gauge how much of a problem there might be until we find out whether people do have difficulties with access. The Executive is trying to increase the coverage of dentists providing NHS treatment. I hope that there is not too much of a problem there. We would not wish to hold up the SSIs but, now that the issues have been highlighted, we will want to keep a close eye on them.
I do not think that anyone is suggesting that we hold up the instruments before us. While approving them, we should not, however, have a problem with sending out a comment that reflects the discussion that we have had about them. The committee is concerned about the fact that those people who are not registered with an NHS dentist will not be able to access free dental checks. It would be remiss of us not to mention that, although we approve the SSIs, we are concerned about the situation and, come 1 April, when people will be entitled to free dental checks, many will not be able to exercise that entitlement because they are not registered with an NHS dentist. That is a fact. We should at least reflect to the Executive the comments that we have made today.
The clear answer to the question is that we are agreed that we are not going to make a recommendation on the instruments. However, we can draw the attention of the minister to our comments during this short discussion. We will make sure that that forms part of what we say.
I see that the officials are shaking their heads. Could we hear a little bit more from them?
I think that we have probably asked enough of the officials. I do not want to extend this item much further. We have now agreed—
If they are going to provide—
Helen, I am sorry, but the time for questions has now passed. I have asked the question and we have agreed.
We have not asked a question; we are just asking if the information—
I have asked the committee the question in respect of the instruments. We have moved past that.
So you do not want information from the officials when they are here to give it to us.
The point for that has passed. The committee has agreed to the SSIs. There will obviously be some follow-up, and the officials can expect some follow-up questions from members in respect of this matter—and not just committee members, I suspect. However the committee has agreed not to make any recommendations on the SSIs. I think that that now stands. I wish now to move on to item 3 on the agenda.
National Health Service (Travelling Expenses and Remission of Charges) (Scotland) Amendment Regulations 2006 (SSI 2006/142)<br />National Waiting Times Centre Board (Scotland) Amendment Order 2006 <br />(SSI 2006/144)
We have two negative instruments before us. The Executive indicated this morning that it is withdrawing the National Health Service (Travelling Expenses and Remission of Charges) (Scotland) Amendment Regulations 2006 (SSI 2006/142), and that it will be re-laying them. I draw that to Jean Turner's attention in particular. We will therefore not be dealing with that set of regulations this afternoon.
Meeting suspended until 15:35 and thereafter continued in private until 16:05.
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