Official Report 1058KB pdf
The final item of business is a members’ business debate on motion S6M-17893, in the name of Alex Rowley, on provision of national health service dentistry. The debate will be concluded without any question being put.
Motion debated,
That the Parliament is concerned by the availability of NHS dentistry provision, with specific concerns relating to some dental practices reportedly making the decision to no longer provide dentistry on the NHS for adult patients; understands that the operators of Breeze Dental Care in Fife have indicated their intention to restrict the NHS dental care that they provide to only those under the age of 26, affecting patients of both their Cowdenbeath and Cardenden practices; further understands that this decision has caused considerable stress for existing patients, who have reportedly been told that the only option to remain with the practice is to sign up to a private payment plan, which many cannot afford; regrets the reported anxiety that this has caused for some patients who have used the same dental practice for many decades of their life and are now unable to find any other dentists in their local area accepting new NHS dental patients; is troubled by situations such as this when a dentist decides to no longer offer NHS dental treatment, but existing patients have no recourse to move to another dentist due to a lack of availability in the provision; believes that this situation is unfair and risks disrupting continuity of care, which can be vital for people who have attended a local dentist for much of their life; understands that, in responding to this latest practice removing NHS provision, NHS Fife has said that “There is a national shortage of qualified dentists currently and this remains a significant issue impacting NHS dentistry across Scotland, including here in Fife”, and that “Health Boards like NHS Fife have no means of compelling practices to provide NHS dental services, and with the shift over recent years from smaller NHS-run practices to larger corporate entities, we have very limited influence over practice decisions”, and notes the belief that, as a result of many people across the Mid Scotland and Fife region, as well as across Scotland, finding it difficult to access NHS dentistry, the Scottish Government should review the availability of provision as well as what action can be taken to ensure that people remain able to access NHS dentistry.
17:37
I thank the MSPs who signed my motion to enable us to have the debate, and I thank my business manager for allocating time for what I believe is an important issue that the Parliament and the Government must do more to address.
I brought the debate to the chamber as a result of being contacted, time and again, by constituents who have been struggling to access a national health service dentist and, more recently, by constituents who are being told that their dentist has decided to withdraw from NHS provision and who are being given a choice to either sign up to a monthly payment plan or leave the practice.
An example comes from an email that I received from a lady in Cowdenbeath some months ago. She stated:
“Dear Mr Rowley,
I am emailing you to see if there’s any advice or help you can give me as I am stressing out. I received an email from a local dentist saying they are no longer doing NHS only private and must decide by beginning of June or I will be put off list altogether—won’t have a dentist.
Mr Rowley I was with Breeze for 45 yrs. I am a pensioner in June. Tried six dentists in”
Dunfermline,
“even went in to them in person not taking any new NHS!!! This is absolutely shocking! Finally went down to Cowdenbeath dentist Stenhouse Street—not taking anyone on NHS just now.
Why can’t I get a dentist it’s a disgrace!!! Breeze offering private payment plan monthly, that’s not counting the treatment you might need and can’t afford.
Really upset me very much. Why can’t I get into a dentist what’s the problem!? This is a shocking disgrace. Hope to hear from you.”
Another lady, from south-west Fife, said:
“My current dentist has informed me that they are no longer offering NHS treatment. I have tried and exhausted all possible means of finding a new dentist. I am not in pain and am willing to go on a waiting list. Even the waiting lists are closed!!! So I find myself at a complete loss. I am usually reluctant to use the word ‘entitled’—but in this country, currently, NHS dental care is my entitlement. Yet there is absolutely no provision. What do you suggest I do?”
When I raised the matter directly with NHS Fife, its chief executive officer responded:
“There is a national shortage of qualified dentists currently and this remains a significant issue impacting NHS dentistry across Scotland, including here in Fife.
Health Boards like NHS Fife have no means of compelling practices to provide NHS dental services, and with the shift over recent years from smaller NHS-run practices to larger corporate entities, we have very limited influence over practice decisions.
We are, however, committed to supporting practices to improve access to NHS dentistry within our control and remit.”
I acknowledge that the Government is trying to address the issues with a 15 per cent increase in this year’s dental services budget, and I welcome the additional investment, including the establishment of the Scottish dental access initiative grant. That new grant has, in part, led to a new six-surgery facility opening in Dunfermline, which has registered its first 3,000 NHS patients since July.
That is very welcome, but much more will need to be done. A total of 3,000 people signing up so far shows the sheer volume of those who are not able to access NHS dentistry; the numbers across Scotland are in the tens of thousands.
When I found out about the welcome new developments, I wrote to people who had contacted me, including the two ladies I quoted earlier. One thanked me and said that she had been able to sign up with the new dentist in Dunfermline. The other lady responded that she had tried to register, but the lists were closed. When I looked on the website of the new practice, it said:
“We have been overwhelmed by the response from those who have signed up already. We have decided to pause sign ups for now to cater to those who have signed up already.”
As I said, it is very welcome that the Government now recognises that action is desperately required, but much more will be required to address the underinvestment, for a decade and more, that has led to the unacceptable situation in which tens of thousands of people find themselves unable to access NHS dentistry.
I will outline why that is important. NHS Fife has always emphasised that emergency care remains available. However, preventive dental care is significantly less expensive than the cost of treating advanced dental disease. In addition, maintaining good oral hygiene helps to prevent common problems such as tooth decay and gum disease, which can lead to tooth loss, bad breath and more serious health conditions such as heart disease, diabetes and respiratory infections, and which are linked to some forms of cancer.
It is therefore crucial that, in a developed country such as Scotland, the population is able to access dental care. As one constituent put it to me, being able to access a dentist must be a requirement that every citizen can expect.
I welcome the steps that the Government has taken this year, but much more must be done. If larger corporate entities are taking over smaller practices and removing NHS provision, we must be clear that alternative provision will be put in place. Dentistry is far too important to allow communities to be left beholden to such large corporate entities, which put profit before people.
We have to recognise that, while the Government has started to take action, much more has to be done. Every individual in the country should be able to access an NHS dentist, and if they cannot, the costs of that will be massive for people and their health and for the Government.
We move to the open debate. I remind all members who are seeking to contribute to check that they have pressed their request-to-speak button, and I remind members that speeches should be of up to four minutes.
17:45
I thank Mr Rowley for lodging the motion to allow us to debate the matter. As I represent a rural region that is affected possibly more than most areas in respect of access to NHS dentistry, I sympathise with his constituents.
I agree with Mr Rowley that the decisions by privately owned dental practices to withdraw care and increase charges are hugely concerning and need exposed. In the south of Scotland, we have seen many of the same challenges affecting patients’ access to dentists, which in some cases has been hugely restricted or withdrawn completely.
Over the past two years, nearly 25,000 people in Dumfries and Galloway have been deregistered from NHS dental practices. That includes 2,500 in Lochthorn, 4,000 in the DADDS practice and 1,000 people in Stranraer. Over the past couple of years, I have engaged in a lot of casework on the issue.
I am grateful for the Scottish Government’s roll-out of the Scottish dental access initiative, which is delivering opportunities for investment in rural dentistry and rural practices.
Will the member give way?
Give me one wee second.
In Moffat in my region, for example, Moffat Dental Practice took on 2,000 new patients after securing grant funding from the dental access initiative. That funding helped to provide an additional NHS dentist in the practice and supported local training efforts.
Does the member agree that it is too little, too late and that the Government is not doing enough? We are still seeing dentists in Dumfries and Galloway deregistering and providing only private services.
As I said, there are still issues that need to be addressed, and I will come on to discuss potential solutions.
I urge any practice in rural Dumfries and Galloway, in the Borders and in parts of South Ayrshire to get in touch with the Scottish dental access initiative to see what they can do to boost and expand their services and the number of patients they serve.
In the time that I have, I highlight that I believe that we can go further where needed—for example, by introducing mobile dental services to go directly to communities where dental coverage is reduced and bring care to the doorstep until a longer-term solution can be found. Deploying mobile units would allow the NHS and dental professionals to react quickly to closures or the withdrawal of services and to ensure that locals who are affected continue to receive NHS dental care. I am keen to hear from the Minister for Public Health and Women’s Health whether mobile dental services could be pursued in Galloway as an action to assist.
Across Scotland, we have seen a revolution in preventative care that is aimed at ensuring that patients do not need treatment in the first place. For the past decade and a half, the Scottish National Party Scottish Government has delivered the Childsmile programme to every child under 12, with a focus on those who are under five.
Over that period, the proportion of those in primary 1 with no tooth decay has improved. Children from the most economically deprived households saw the biggest benefit, and the health inequality gap between those children and those in the wealthiest households is closing. The commitment to engaging in the early years to prevent issues from arising later in life, when they increase the pressures on care services, also drives the Scottish Government’s policy on funding dental treatment for all those aged under 26 in our country, which was introduced four years ago and is putting money back in the pockets of hard-pressed households during Westminster’s cost of living crisis.
There is a lot more that can be done in dentistry, just as there is always much that can be done for our health and care sector. However, I know that our Scottish Government is committing to do all that it can to provide the best possible treatment for our citizens, regardless of where they live. The areas of Scotland that face the fewest problems are those that have less trouble maintaining their populations and have a younger demographic.
Attracting dentists to our communities is as hard as attracting people in any other profession, as there are clearly challenges in pulling newly qualified professionals away from the urban cities. Fixing the challenges of rural dentistry also means tackling the much bigger—and, to be frank, more complex—issues around the demography of regions such as Dumfries and Galloway, and our NHS can play a part in that. I will stop there.
17:49
I am very pleased to be able to speak in this evening’s debate, and I thank Alex Rowley for bringing it to the chamber.
Four and a half years ago, the SNP made some very bold promises about the future of NHS dentistry across Scotland. However, with the end of the parliamentary session now in sight, the fact is that many communities do not have a dentist whom they can go to; indeed, such a prospect is a distant dream for them. We know that thousands of Scots have not seen a dentist for a number of years, and the number of young people who require dental treatment in hospital has increased in each of the past four years.
From every corner of Scotland, we are repeatedly hearing that practices are no longer accepting NHS patients, and whole areas of Scotland are now being classified as dental deserts. There are also countless stories of constituents being forced to take private treatment, and even stories of patients doing dentistry on themselves because they do not have the opportunity to get treatment.
Alex Rowley’s motion rightly highlights the problems with Breeze Dental Care in our region. Patients were very used to going to the practice; however, it said that it was no longer able to provide NHS services and that patients would have to sign up to a payment plan. That has been happening with lots of other dentists and in lots of other areas, and it is a real issue for individuals.
As for those areas of Scotland that are affected, I know that, in my area and region, countless stories and amounts of information have been going back and forth, and MSPs will have found their inboxes full of such things. Dental services across Stirling are on a knife edge, and many locations are suffering. Infinityblu Dental Care and Implant Clinic, for example, announced that it would no longer be taking any NHS patients in the Callander area, except for those under the age of 18. Many people had been going to that practice for decades; at the time, constituents were told that they needed to go to other locations, and they were hugely concerned about that. Those in Callander had to go to Crieff or Auchterarder, which is a considerable distance to travel. The practice made it clear that it did not want to make such decisions, but it found that it was losing revenue on every NHS patient whom it treated. Since then, there has been an improvement in the situation.
I recognise that the Government is trying to do something, but its approach is not having an effect everywhere, and some locations are still finding it really difficult. Residents in the example that I highlighted are still hoping for a full return of adult NHS dental services, and I am disappointed that that has not happened, although I know that the Government, along with the health board—NHS Forth Valley—is still working to find solutions. Solutions have been found in some areas, but not in all, and more work needs to be done to ensure that people get the protection that they need for their oral health.
Regardless of what the Government is doing, the fact is that there is a genuine need to tackle this agenda. As I have said, we are coming towards the end of this parliamentary session, and I hope that the Government will finally take note of the flood of casework that MSPs are having to cope with. I have seen the situation in my region, and other MSPs are saying the same thing. The solution to it will, no doubt, be no easy fix—we acknowledge that—but we also feel that, instead of tinkering around the edges, the Scottish Government must commit to building the sort of modern dental service that communities, and those in rural environments in particular, need, and to ensuring that that approach to dentistry is in place for them. I and many others will keep calling for that repeatedly, because what is required is a safe support mechanism for individuals across communities.
17:54
I thank Alex Rowley for bringing forward this important debate. His contribution showed us how the situation feels for our constituents out there today.
Dentistry needs to be viewed as part of the prevention agenda in health in Scotland, and access to timely and routine dental care is crucial to achieving that goal.
An issue that I want to raise at this point, and which should be important to us in the chamber, is the persistent and widening oral health inequalities that we have in Scotland, with the most deprived communities experiencing significantly worse outcomes than our more affluent ones. Equal access must be part of our plan, because good oral health helps to prevent systemic health conditions, including cardiovascular disease, respiratory infections and problems, diabetes and pregnancy complications. It is integral to our overall health and wellbeing. Sometimes we forget that, but if we want to close that gap, dentistry must be seen as playing a part in health outcomes and health inequalities.
It is critical that people have access to an NHS dentist—that is the key. Today’s debate has highlighted that access is a problem for our constituents. They are not receiving regular check-ups and, as we have heard, there is consensus across Scotland that it is becoming harder and harder to register with and access an NHS dentist. In the current system, patients are unable to access NHS care. Dentists are in short supply, which means that practices have vacancies that go on and on, and they cannot fill them. There are fewer dentists who are willing to treat our NHS patients. Alex Rowley gave an example of how we are pushing people to the private sector.
Those challenges are well known and of long standing. Alex Rowley spoke about some of the initiatives that the Government has put in place, but, as others have said, we need to do more. Even those within the profession have argued that the model of dentistry is not fit for purpose and that it fails patients.
I will consider some data from my region of South Scotland on registrations and contact with dentists. In Dumfries and Galloway, only 65 per cent of the population is registered with an NHS dentist. Dumfries and Galloway is an example of a dental desert, and the issue of the recruitment of dentists plays a huge part in that. In Ayrshire, a dental practice in Mauchline—my home village—reported having an NHS patient waiting list of 1,000 people.
To return to the point about inequalities, some people are lucky enough to be registered with an NHS dentist, but there are significant numbers of people who cannot register, which leads to more and more inequality.
In Ayrshire and Arran, less than 60 per cent of registered patients living in the most-deprived areas had contact with an NHS dentist in the past two years. That compares with 73 per cent or more of patients living in some of the least-deprived areas.
I hope that today’s debate highlights that we need to fix the crisis. The Government’s approach has been piecemeal. We appreciate the actions that it has taken, but there needs to be leadership to ensure that a two-tier system does not exist in dentistry and that we can move forward.
I support the motion and I thank everyone who has contributed to the debate.
17:58
I thank Alex Rowley for bringing the debate to the chamber. He presented it in a grounded and honest way, because he reflected on the strengths as well as on the weaknesses, which he quite rightly highlighted.
It is good to have the debate, because we are getting on to being two years on from the review of the funding system. An indication was given at that point that that would start to improve the situation, but in many circumstances—certainly in my constituency—the situation has not improved. In fact, it has deteriorated since.
Before the 2023 review of the funding, we had the closure of the Newburgh, Glenrothes and Leven practices, which have not reopened. We have also continued to see practices not opening up for the registration of NHS patients. The Cupar dentist, which is run by the Real Good Dental Company, is now emergency only, and it has been like that for months.
People are desperate to get treatment. They cannot even get the check-ups, and they are desperate to get routine treatment. Unless they are in an emergency situation, they are just not seen, because we are short of dentists.
I have some examples that I sought from constituents. One constituent says that there has been no registration for two years. A couple from St Andrews have had to go to Glasgow to get check-ups, and another constituent said that their surgery had closed a year ago, since when they have been unable to register with another dentist. That constituent cannot afford to go private and their teeth have never been in such a state. There are many examples of patients who are struggling because of the lack of treatment. They cannot afford to go private and they certainly cannot afford to go to Turkey to get their teeth sorted, as some people can afford to do. Therefore, we still have a problem. There seems to be a particular issue in rural and more deprived areas, which requires particular attention from the Government.
It is not just a case of going private or abroad. Even if someone is registered, that does not guarantee that they will get the treatment that they need, as we have seen with the case of the Cupar dentist. Some people can wait for a very long time. Their practices are so overwhelmed with the shortage of dentists that they find it difficult to treat all their patients, even if they are registered. We should not really be looking at registration rates, because once someone is registered with a dentist, they are often registered with that dentist for life. It used to be that they would have to renew their registration regularly. The registration process does not really indicate the quality of the service that patients are receiving.
What are the solutions? We need to look at the particular problem in rural areas, and at the General Dental Council process for foreign dentists who are in this country—apparently, 6,000 of them in the United Kingdom are not going through the system. That issue is primarily the responsibility of Westminster and the GDC, but we need to get it resolved. Through the budget process, which the Liberal Democrats voted for, we negotiated the inclusion of an additional £3 million for an increase in the number of training places, and that is starting to come through.
As Fergus Ewing MSP has said previously, we also need to consider how we can keep dentists who are trained by the state in the UK not only in the country but in the NHS. Dentists used to serve a certain period in the NHS before they could take on private work. That has changed, and we need to consider whether we can reverse that trend and keep dentists in the NHS for much longer.
18:02
I thank Alex Rowley for securing the debate. I am sure that we all have constituents who have been in touch about access to dental care, but the problem is more acute in rural areas. In January, I was shocked to read that 2 million Scots, including 177,000 children, have not seen a dentist in two years, and that a number—significantly lower, admittedly—have not seen a dentist since the Covid pandemic. There is also worrying data about access to dentistry among children in deprived areas, where it appears that the figures are going in the wrong direction.
Emma Harper has referred to the fact that, as many members know, Dumfries and Galloway has one of the worst rates of NHS registration by some margin—40 per cent of those living in the south-west no longer have access to NHS dentists. That is a shocking statistic and one that shows that the current model of NHS dentistry simply is not working in Scotland, and particularly in rural areas. The model for funding NHS dentistry is clearly not fit for purpose.
Last year, I was struck by something that Emma Harper referred to, which is the number of people who were being deregistered in Scotland, particularly in Dumfries and Galloway. Overall, 25,000 were deregistered, but the figure in one fell swoop was 2,000. At the same point, last October, no NHS dentists in Dumfries and Galloway were registering new NHS patients. Those moving into the area were not getting access to NHS dentistry and those living there were being deregistered. That means significant problems, particularly for those from a lower-income background. The subscription model, which now appears to be the norm in Scotland, is clearly not affordable for many of the constituents who have been in touch with me.
This is part of a broader problem about access to rural healthcare and the problems that rural residents face more generally. Many members will be aware of the recent withdrawal of bus services in Dumfries and Galloway, which means that people are having to take very long bus journeys, and they sometimes have long waits in between buses, even when moving between towns and villages that are relatively close. That puts in place another barrier to accessing healthcare and dentistry, particularly for those who do not have access to a car or for those who are elderly. The minister should consider that in relation to rural housing, because the recruitment of dentists into rural areas is undoubtedly being undermined not just by the disconnections in rural transport but by the lack of affordable rural housing.
The other issue that I have been struck by is that of accessing emergency dentistry, which was seen as a panacea for some people. Someone who was not registered with a dentist and who needed an extraction could access emergency dentistry relatively easily. Last year, however, it emerged that adults seeking extractions in the Dumfries and Galloway health board area had to wait 43 weeks if they could not access that through a primary care setting, compared with just 10 weeks in 2019-20. For children, the waiting time was a staggering 42 weeks, compared with nine weeks just four years before.
There are clearly problems in relation to the dental position throughout Scotland, but the situation in rural areas is particularly dire. The Scottish Government must redouble its efforts to work with the profession and with our rural communities to ensure that they do not become dental black spots or dental deserts. That does untold damage to people’s health and can in some cases lead to life-threatening conditions, as was the case for a constituent who came to a surgery in Canonbie recently. That is, frankly, unacceptable in modern Scotland.
18:06
I, too, thank Alex Rowley for securing the debate. We are both familiar with the challenges around access to NHS dentistry in our region of Mid Scotland and Fife and across the country, with numerous concerns having been raised with us by constituents—both patients and dental practitioners—over a period of years.
Not only have dental practices been closing; many are either reducing or entirely ending NHS provision for adult patients, leaving patients in the position of having to pay for private care or having no access to a dentist. That is entirely at odds with the belief that everyone should have access to NHS care when they need it. Instead of high-quality free NHS dentistry being ensured for all, many people are now being pushed into private practice, sometimes effectively to subsidise the delivery of NHS services at the same practice. They often have no choice, because the alternative that they are faced with is to leave the practice and not receive dental care, as they cannot get registered with an alternative NHS dentist. We know the potential consequences of that from the terrible examples of DIY treatment and from cases of people enduring discomfort and declining oral health. As other members have said, regular dental checks are important, as they identify other oral health conditions and allow for early prevention and treatment.
The move to lifetime registration in 2010 should have resulted in a change to how we measure access to a dentist. Lifetime registration does not always reflect access, and we need to focus on the number of people who are actually accessing NHS care. The headline figures that the Scottish Government promotes say that 95 per cent of Scots are registered with an NHS dentist, but what really matters is the proportion of those who have actually had contact with a dentist in the past two years, which is much lower. At the start of this year, out of those who were registered, 1.8 million adults and more than 177,000 children in Scotland had not seen a dentist in that period, and 28 per cent of registered adults had not had an appointment in five years. Those are the figures that we need to focus on.
The number of NHS practices is still in decline, with NHS provision reducing or ending completely at many practices. The British Dental Association is clear that the fall in attendance at dental surgeries will mean a bigger burden from a higher rate of dental disease and the likely widening of health inequalities. Unless we improve access to dentists now, it will cost the NHS far more to deal with the consequences. We need to consider preventative measures that can be applied to the approach to dental care more broadly. For years, those in the profession have been calling for a move to a more preventative system, instead of the drill-and-fill model. Instead of that comprehensive change, however, there has been only tinkering, which has simply not been good enough.
I recognise that there has been some positive news in Fife more recently, with the opening of a new practice in Dunfermline, although Alex Rowley has highlighted the stress that is being experienced and the demand for that service. I also recognise that that has been supported in part by funding from the Scottish dental access initiative and that there are plans in place for Leven and Glenrothes. However, we have to remember that not only do those new practices come in the context of a greater number of closures and restrictions on access to NHS dentistry, but that NHS services are under significant pressures nationally and that the supply of dentists is finite. Therefore, for every community that benefits from a new practice, there will be more communities that miss out. That is the crux of the problem.
To address the problem, we need to not only increase the number of qualified dentists, but ensure that there are adequate numbers of technicians, nurses and hygienists, who are all vital parts of a practice. I have spoken to dentists in my region and they want to see every avenue explored to expand routes into dentistry and related roles. That includes ensuring that more students are being trained, by lifting the cap on numbers and encouraging them to stay not only in Scotland but in the NHS, as well as facilitating routes for qualified practitioners from other countries to be able to practice here—that is an area that I have previously spoken to the minister about.
I recognise that there is a role for the UK Government, but there is more that the Scottish Government could explore to see what we can do here and whether we can make progress.
18:11
I thank Alex Rowley for bringing this important debate to the chamber. NHS dentistry is a critical issue that affects thousands across Scotland—nowhere more than in my constituency of Galloway and West Dumfries. I am not surprised that Emma Harper is the only SNP back bencher who is prepared or brave enough to try to defend the Government’s position—it is done through gritted teeth, no doubt.
The situation in Dumfries and Galloway is dire, and I will not apologise for repeating some of the stark figures. We are the worst affected area in Scotland, with only 63 per cent of the population registered with an NHS dentist. According to a formal response from NHS Dumfries and Galloway, 45,432 patients lost access to an NHS dentist between September 2021 and September 2024.
In 2019, Scotland had approximately 3,400 dentists providing NHS services; by 2023, that number had fallen to 3,240—a drop of 167 dentists, which is a 4.9 per cent fall over that period. Although some might argue that that fall is significant, the number of dentists, even though it is falling, is not the main issue.
This has not happened overnight. I have raised concerns with successive First Ministers—Nicola Sturgeon, Humza Yousaf and their health secretaries. Despite repeated promises, the situation has only worsened under John Swinney.
I respect minister Jenni Minto and I have no doubt that she wants to sort the issue. In 2023, she said that she was
“working closely with NHS Boards on local solutions, particularly in remote and rural communities.”
In 2024, Neil Gray promised that they were
“developing a Rural Delivery Plan to address the challenges faced by rural Scotland.”
Those are fine words, but where is the delivery? Where is the plan? It will no doubt be too little, too late. Where are the bespoke solutions for Dumfries and Galloway?
On the ground, patients are being deregistered in the tens of thousands and forced to travel miles for treatment or pushed into private care that they simply cannot afford. I lodged a parliamentary question asking where the funding has gone when patients are shifted to private care. Has any of that money been reinvested in our region? I also asked how much NHS Dumfries and Galloway has saved due to reduced provision, and how those savings are being used. The answer was that payments come from a national budget, with no separate allocation for boards. Although the minister boasted of a 15 per cent increase in the budget, that means nothing to my constituents who cannot get an appointment.
Dentists are walking away from NHS work because the current contract is financially unsustainable. Fees do not cover the cost of care, especially for complex treatments, and rising overheads make it impossible for practices to survive on NHS rates alone. Yes, fees were increased during the pandemic to keep practices afloat but now, the system is broken. The result is that there is virtually no NHS dental provision in the south of Scotland.
I admit that there have been some positive steps, such as the outreach facility in Dumfries, where 12 final-year dental students provide emergency care for unregistered patients. That is welcome, but it is a sticking plaster over a gaping wound. Even then, retaining those students locally is nearly impossible due to the chronic shortage of affordable housing, which is, yet again, another SNP failure.
This is a crisis of the SNP’s making. Years of underfunding, poor workforce planning and ill-conceived policies have created a perfect storm. Unless the Government changes course, the situation will only deteriorate.
However, behind every statistic there is a real person. Last week, I received an email from a constituent in Stranraer. His family has been forced into private dental care, which is an impossible burden as the cost of living continues to rise. He is deeply worried about the long-term impact on his children, who need regular preventative care but are being priced out of basic health services.
His story is echoed in hundreds of messages that I have received from across my constituency. Those are not isolated cases. They are the lived reality of families who feel abandoned, unheard and increasingly desperate. Scotland’s rural communities are proud and resilient, but they should not have to fight this hard just to access the care that they deserve.
My colleagues in the Scottish Conservatives will not stand by while children go without treatment, while parents choose between groceries and dentist bills and while elderly residents lose the dignity of basic health provision. This is not about dentistry on its own; it is about fairness and dignity. Until every family in Dumfries and Galloway can access NHS dental care without fear, without cost and without delay, we will keep fighting, because they deserve better.
Under this failing SNP Government, we are a long, long way from having the confidence to smile again.
18:15
I thank my friend Mr Rowley, a member for the Mid Scotland and Fife region, for presenting this important motion on the terrible state of NHS dentistry in Fife, which I was pleased to sign.
We have heard a series of passionate speeches from across the chamber about patients—our constituents—who have been forced to go private for their care or who cannot access dentistry at all and are left to languish. We know that, increasingly, many of Scotland’s citizens are having to rely on our underresourced public dental service for routine care that, just a few years ago, they would have been able to get routinely from an NHS-registered practice. We see that situation playing out across Scotland, especially in places such as Fife.
NHS dentistry is quickly becoming a thing of the past. The well-off go private while the less well-off fall through the gaps and are left behind. That is against everything that the NHS was set up to achieve.
In Scotland, oral health has too often been treated as a nice thing to have rather than an essential part of preventative healthcare. We choose to celebrate genuine successes in public health such as Childsmile—a programme that was set up under the previous Labour Government in Scotland and has continued under the current Government—while ignoring the fact that more and more of those who call Scotland their home are missing out on essential dental care.
Oral health care is not just about addressing pain when it is experienced or keeping plaque at bay; it is about early detection of many conditions that are critical to whole-body health, such as diabetes. It is also about protecting a person’s ability to consume and enjoy food and retaining jaw structure so that, throughout a person’s life, they can recognise themselves in a mirror—that is actually a public health matter, as it helps to maintain good mental health. Good healthcare is a vital part of a holistic approach to medicine, and it must be available for everyone in regard to dental treatment.
We have heard about a number of rather shocking cases. Mr Rowley described a shocking case concerning his constituent, and it is disgraceful that, when trying to register, she was left in such a situation.
Although the Government has taken measures such as reforming the pay system, which may have had a marginal effect, we are still seeing a clear trajectory towards an exit from NHS dentistry. When dentists leave, there is very little incentive for them to return to NHS dental practice—the business model simply does not make sense, and they are certainly getting plenty of customers, because those who can afford to pay will push their way to the front. It is the people who are left behind who we really need to concern ourselves with.
Members have referred to a number of potential solutions. I do not think that anyone here has a desire to simply comment on failure; we are all eager to find solutions, because we all have a stake in this. Solutions that have been suggested by the profession and members include the mobile dental facilities that Ms Harper proposed for South Scotland—I know that NHS Tayside operates one such facility, and perhaps there is more to be done in that regard.
It might also be worth considering the gap in relation to emergency treatment. We know that NHS remuneration for an emergency item is just £20.80, but the private fee for the same treatment is approximately £130. Bridging the gap in the remuneration for emergency treatment could assist in bringing about a change in behaviour.
Additional preventative measures, such as building on water fluoridation and considering issuing enhanced fluoridated toothpaste to over-50s, could represent an opportunity to improve general public dental health.
We should look at the training pipeline. There are about 150 training posts for dentists every year, but the number that is available for dental therapists is restricted—there are only 40 a year. In concert with our activity in relation to dentists, could we expand the role of dental therapists to increase overall capacity when it comes to routine check-up activity and, potentially, baseline dental treatment, such as fillings? Those are all practical measures that could be delivered.
We must concern ourselves with the glut in the number of available training posts. About 6,000 overseas dentists are waiting for General Dental Council registration; they cannot sit the exam, and some have been waiting for up to four years. The chief dental officer in Scotland was exploring with the royal colleges the idea of setting up a separate route for dental training registration in Scotland, but I do not know whether that has been progressed.
We must act urgently on all those measures because, ultimately, our constituents are suffering as a consequence of the present situation. Let us get on with finding practical solutions to stem the flow.
I invite Jenni Minto to respond to the debate.
18:21
I, too, thank Alex Rowley for bringing the debate to the chamber. It is important that we can use this space to talk about the concerns that members hear about from their constituents, and which I hear about from mine. I very much appreciate the tone in which the debate has been conducted, and I welcome members’ valuable contributions.
I reaffirm the Scottish Government’s commitment to securing equitable and sustainable access to NHS dental services. As many members have pointed out, in November 2023, we brought in a new payment reform as part of a comprehensive modernisation of the service. That prevention-based model is delivering high levels of service and has been welcomed by the profession, but I recognise that that is not the case across the board, which is why we are focusing on other opportunities.
I welcome the official statistics that were published last week, which show that more than 7 million courses of treatment have been delivered since the introduction of the payment reform in November 2023. That demonstrates that the significant continuing investment in NHS dentistry is supporting high volumes of patient access to NHS care and is delivering on our aims to sustain NHS dental services. In the quarter that ended in June 2025, 1.14 million courses of treatment were delivered. In the same quarter, 998,000 patients were seen by NHS dentists. As others have pointed out, 95.7 per cent of Scotland’s population are registered with dentists.
I remain absolutely clear that payment reform is only the first step in ensuring the sustainability of the service, which is why our recently published operational improvement plan sets out key actions to improve the NHS dental workforce and to support equity of access to NHS dental services across Scotland. That is backed by an increase of almost 15 per cent in funding in 2025-26, which takes total funding to more than £500 million for the first time. I echo Willie Rennie’s point about the support that we got from the Liberal Democrats in that area.
I agree with Mr Rowley, Ms Baker and others that prevention is hugely important, as is teeth hygiene, especially in the early years, which we are addressing through the Childsmile programme. That fits within our population health framework, in which dentistry is a key aspect of health prevention work.
Will the minister give way?
Once I have finished my point.
I was struck when one director of dentistry told me—I think that others have made this point—that a person’s mouth gives an indication of their health, which is why dental health is so important. That is why, along with the chief dental officer, I have pressed for dentistry to be included in the preventative health agenda and have increased the budget this year.
If those initiatives are working, why does the minister think that, in some of the most deprived areas, the number of children who are presenting for dental treatment is falling rather than rising?
That situation is very concerning, which is why we have continued to invest in Childsmile, and we have increased the budget, given the impact of the pandemic, when children were not able to see their dentist and Childsmile nurses were not able to visit children. We have ensured that that activity has ramped up again. We have a number of dental nurses who can go out and provide that education. I do not have the figures to hand, but we are seeing improvements.
I am acutely aware that access continues to be challenging in some areas of Scotland. Fife and Dumfries and Galloway have been mentioned. The challenges are largely due to historical non-dentistry-specific recruitment and retention difficulties in those areas, which some members have recognised.
We continue to make available a range of additional financial support to areas of unmet dental need, and we will work to better target that as part of the commitments that are set out in our operational improvement plan. This year, we have taken targeted action in Shetland and in Dumfries and Galloway through the provision of additional funding to sustain access to dental services and ensure that there is adequate patient care.
Finlay Carson and Emma Harper mentioned the outreach facility that NHS Dumfries and Galloway has been operating, where 12 undergraduates are providing care. I am pleased to say that it is looking at how it can expand that.
That is in addition to practice funding support that is provided through the Scottish dental access initiative. As Alex Rowley said, a practice in Dunfermline with five SDAI-supported surgeries opened in August. We have also been able to approve applications in Inverclyde and in Dumfries and Galloway.
Increasing the dental workforce is a priority for the Scottish Government, and I am encouraged by the progress that we are seeing, with the number of high street dentists working in Scotland increasing by 5 per cent in the past year. We have also committed to providing additional funding this year, to increase the number of domestic dental students by 7 per cent from this month. We are growing the pipeline of staff entering the NHS workforce and providing additional capacity for NHS dental services in the future.
What about the issue of large companies? As NHS Fife said, it has no control over them, and they seem to pull out of providing NHS dental treatment, which leaves communities with no access to services.
I will come on to that exact point, because we have talked about that in relation to the governance of dentistry.
Alexander Stewart asked for there to be broad change. We are making that change. We are also looking beyond domestic capacity and working closely with NHS Education for Scotland to deliver an innovative training package that will better support dentists who qualified overseas in achieving registration as a dentist with the General Dental Council. In fact, the chief dental officer and his team met the organisation today to press it to be a bit more flexible in that regard.
Carol Mochan and, I think, Willie Rennie called for my leadership on the issue. Acting with leadership is exactly what I have been doing. As others have pointed out, the regulation of dentists remains reserved to the UK Government. I am very disappointed that, despite discussion at four-nation meetings, which I led and in which all nations spoke of their concerns for the dental workforce, the UK Government has decided not to proceed with the necessary legislative changes to enact provisional registration for overseas qualified dentists. Although that makes the delivery of our programme with NES more challenging, I remain committed to exploring all alternatives to widen our pool of available dentists in the shorter term, in addition to growing our domestic talent. I would appreciate support from Scottish Labour in speaking with the UK Government about that.
Will the minister give way?
I will continue on this topic and then come to Mr Carson.
Immigration is another matter that is reserved to the UK Government. I do not understand why the UK Government chose to remove key dental care professions from eligibility for the skilled worker visa from July 2025. That will impact on dental nurses, hygienists and technicians—exactly the roles that Claire Baker spoke about—who could help us to improve the dentistry service that we provide.
I share the British Dental Association’s concerns about the significance of those changes to the capacity of dental practices and to dental treatment. The move comes amid a significant drop in the number of dental professionals relocating from the European Union to practise in the UK following the UK’s exit from the EU, which puts further strain on dental care in our communities. I have therefore written to UK Government ministers to urge them to reconsider those detrimental changes, which will further negatively impact our available workforce.
I have no issue with agreeing that leaving the EU will have had some impact on the number of dentists in Scotland, but the elephant in the room is that, although we have seen a reduction of 4.9 per cent in the number of dentists, that pales into insignificance compared with the number of dentists who have opted out of providing NHS services. That is the main issue. Will the minister outline why she believes dentists are opting out of providing NHS services?
I thank Mr Carson for his intervention. As he will recognise, dentists operate independent businesses, and it is up to them to decide on their model. That is why we introduced payment reform in November 2023 and why we are continuing to work through the regulatory, workforce and governance issues. That touches on exactly the point that Mr Rowley made about corporates.
As part of further long-term transformation, my officials are taking forward work to consider how we strengthen the existing governance model in NHS dentistry to improve the patient experience and ensure that patients can be seen and offered the appropriate care. As part of that, we are exploring options to make mandatory training for dentists, with its focus on patient safety, more efficient and flexible, to expedite recruitment across Scotland.
Officials are also looking at opportunities for boards to influence the provision of care in their area, including consideration of a declaration of compliance to raise awareness of dentists’ terms of service and their social and community responsibilities. They are also considering how to support boards in ensuring that dentists and dental bodies corporate adhere to those commitments.
I recognise that, in some of the areas that have been discussed today—specifically Fife, which a number of contributions have focused on—overreliance on practices with certain business models can present issues when the NHS footprint is suddenly reduced. I have therefore tasked my officials with looking at the issue to better secure continuity of care for affected patients.
In closing, I reassure members that, through the introduction of a new payment system—which, as I have been clear in saying, was the first step—and through investment in our workforce and local tailored solutions, we have implemented a policy framework that will support NHS dental services and deliver on our ambition to ensure high-quality, sustainable and equitable public services.
Meeting closed at 18:32.Previous
Decision Time