Meeting of the Parliament

Meeting date: Wednesday, February 8, 2023

Official Report 1297KB pdf

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National Health Service Dentistry

The next item of business is a debate on motion S6M-07812, in the name of Alex Cole-Hamilton, on addressing the crisis in NHS dentistry.

15:25  

I am very pleased to rise for my party to speak in this debate. There is a dentistry crisis in Scotland. It can be felt everywhere—it is visited in each of our mailbags and is inflicting pain on people up and down the country every day—yet the Government’s amendment seeks to delete that reality from the parliamentary proceedings. That is astonishing. Again, it shows the cognitive dissonance that we have come to know well from the Government, which has its head in the sand and displays the dead hand of ministerial disinterest in things that matter to real people.

Indeed, it was a show of astonishing timing that the Government published a letter last night that evidenced its paltry effort in kicking issues down the road, with promises of jam tomorrow to our hard-working dentists.

Far too many Scots face huge obstacles in accessing NHS dental check-ups. The number of NHS treatments that are being conducted is dramatically below pre-pandemic levels. Liberal Democrat research has revealed soaring waits for dental treatment, with some patients waiting more than three years for help. Imagine having to deal with dental pain for three years—it is astonishing.

The situation is dire right across the country. Eleven health boards recorded patients having to wait more than a year for treatment. A freedom of information request to health boards showed that dentists submitted about 3.2 million claims for NHS work between January and November last year. That sounds like quite a lot, but if we compare that with the 5.6 million claims for NHS dental work in 2019, we start to understand the quantum of the problem and the fall-away in dental work.

Put simply, many people either are forced to wait months for NHS dental treatment or are unable to access NHS care at all. In rural communities, the situation is even more acute. In Orkney and Shetland, the number of NHS dental claims has fallen by more than 50 per cent, while many practices in Dumfries and Galloway have closed their doors to NHS work entirely. The warning lights are well and truly on, and they are blinking, but the Government’s response has been achingly slow.

Let us think about how we got here. The business model for dentistry is straightforward. There has always been a balance between NHS work and private work, but, over time, stagnation in payment for NHS work has led to that balance shifting inexorably towards private work. That is not the fault of dentists—they have people to employ, lights to keep on and bills to pay at home. It is a result of, as I said, ministerial disinterest in the funding model. We know from senior dentists that the Government has, in their words, had its head in the sand.

I note that the Government has, once again, referenced the impact of the pandemic. The pandemic has, of course, had an impact. We know that that is, in large part, why there has been a backlog of procedures. However, as Paul Gray, the former chief executive of NHS Scotland, said, the crisis in our NHS, including in dentistry, was always coming—Covid just hastened the date.

The Government talks in lofty tones about protecting our NHS from privatisation. It rightly speaks of prescription charges being a tax on the sick. However, under the Scottish National Party-Green Government, thousands of people are denied the dental treatment that they desperately need. Why are they denied it? It is because they simply cannot afford to pay for private treatment, which is the only other option available to them.

Of those who responded to a United Kingdom-wide poll that was conducted by my party last year, a quarter of people said that they were forced to pay for private dental treatment. Many people said that they delayed seeing a dentist despite suffering pain. When the pain got too bad, many of those who could not afford to go private turned to DIY dentistry. That means that they carried out dental work on themselves or asked somebody equally unqualified to do it for them.

Last year, a staggering one in five people who failed to get an NHS dental appointment resorted to that. Imagine that. We are not living in the dark ages; this is 21st century Scotland. The fact that so many people are being forced to take such a measure is a national scandal and an absolute indictment—

Does Alex Cole-Hamilton agree that, since the Scottish Conservatives previously brought a debate on dentistry to the chamber, things have got worse?

Dr Gulhane is absolutely right: things are getting worse.

I am sad to say that I sometimes fear that we are becoming inured to the level of crisis in our dentistry profession. [Interruption.]

Excuse me. Could we not have sedentary chitchat, please? Thank you.

If the cabinet secretary wants to come in, I would be quite happy to take an intervention.

Does Alex Cole-Hamilton recognise that Brexit, along with the pandemic, has had an impact on the dental workforce? If so, does he therefore disagree with his party’s leadership, which wants to keep us out of Europe?

Wow. I think that I have turned up to the wrong debate. [Interruption.] Nevertheless, I invite the cabinet secretary to explain that to senior dentists, who have told us that his Government has its head in the sand.

Obviously, Brexit has played its part. My party opposed Brexit and it is still opposed to it. Nevertheless, the cabinet secretary cannot once again shirk any responsibility by either blaming the pandemic or Brexit for his Government’s inadequacies and his own ministerial disinterest.

I wish it were just hyperbole, but when healthcare in this country is in such dire straits that people are literally being forced to pull out their own teeth, the use of the word “crisis” in the motion feels far too modest, and I cannot believe that the Government sought in its amendment to remove that word.

It should go without saying that tooth care, like any other form of healthcare, should be universally accessible and free at the point of delivery. Scottish Liberal Democrats were instrumental in introducing free dental checks in Scotland when the party was in coalition with Labour and in pressing for a new dental school to address shortages in the dentistry workforce. However, over the past 15 years, Scottish dentistry has been left to rot in the incapable hands of the Scottish National Party.

We find ourselves in this situation because our national health service has been starved of funding. The money that dentists are being given every time they carry out an NHS procedure is not going far enough to make the work sustainable, with some even running at a loss. Unsurprisingly, more and more dentists are becoming fully private, with only 18 per cent of practices taking on new NHS patients.

The Liberal Democrats have solutions. We want the Government to reform the existing funding structures for dentistry, so that dentists are incentivised to take on NHS patients. We want the Government to rewrite the NHS recovery plan so that it includes dentists in more comprehensive ways and properly recognises the importance of dentists in the course of that recovery. People are suffering. It is time that the Government woke up to that.

I move,

That the Parliament believes that there is a crisis in NHS dentistry; notes that the number of NHS dental check-ups and treatments being conducted are dramatically below pre-COVID-19 pandemic levels; further notes with concern that the number of dentists who are carrying out NHS work has fallen in 11 NHS boards, with the chair of the British Dental Association’s Scottish Dental Practice Committee warning of a “wholescale exodus” from the sector; understands that most dentists are not accepting new NHS patients and that polling has shown that many of those registered have been unable to get appointments; believes that the lack of government action to resolve this is leaving people in pain and will cause wider mouth health issues to be missed, and calls on the Scottish Government to rewrite the NHS Recovery Plan so that it includes dentistry fully and properly recognises the importance of dentists in the course of the recovery, and to urgently reform the funding structures so that dentists can return to taking on NHS activity and enable more patients to be seen.

I call Maree Todd to speak to and move amendment S5M-07812.3. You have up to six minutes, please, minister.

15:32  

I am grateful for the opportunity to debate the important matter of access to NHS dental care, given the unprecedented impact of the pandemic and the uncertainty that that has caused. I am pleased with the progress that we are making, and I am glad that we were able to confirm that we are maintaining the current bridging payment until 31 October, incentivising NHS work.

I am sure that everyone in the chamber will recognise that NHS dental services have undergone a significant and prolonged period of recovery. Members will recall that patient access to NHS dental services was severely reduced during the pandemic, as sensible public health precautions were required to mitigate the possible transmission of Covid-19 in dental surgeries. We are seeing encouraging signs of improving patient access to care.

The Scottish Government supported dental practices through the pandemic, including through the provision of an additional £150 million to maintain the sector. That includes vital financial support payments being made to contractors to secure continued NHS dental service provision.

NHS dental services are on the road to recovery. I am sure that members will wish to share my admiration for NHS dental services as sector recovery continues. That is highlighted by the completion of more than 1.6 million NHS examination appointments between April and October 2022.

In 2022-23, an average of 300,000 courses of treatment a month have taken place, highlighting an improvement on the 2021 figures.

Far from the picture that Alex Cole-Hamilton has painted, that means that we are on course for an increase of 40 per cent in NHS dental activity compared with 2021-22. It also means that we have made considerable progress towards pre-pandemic levels.

Additional support payments have been provided in each quarter of the current financial year, on top of item of service claims, to support contractor incomes and, crucially, to enable patient care to be delivered.

Will the minister give way?

Certainly—if the member is brief.

The minister talks about the uplift in dental work compared with 2021-22. I remind her that non-aerosol generating procedures were not allowed in 2021-22, so an uplift of 40 per cent is hardly something to be congratulated on.

It is progress!

There you go. It is undeniable that we are making progress—really good progress—towards pre-pandemic levels.

We are still in the midst of a global pandemic.

Will the member give way?

Give me one moment to make some progress.

There is now a clear necessity to provide continued support to the sector as we move to the payment system reform. The improving picture on patient access to care underpins the need for longer-term, sustainable payment system reform to provide surety of NHS provision. The development of the NHS dental payment reform has been built in the spirit of clear engagement with the sector; indeed, I am really pleased to report to members that the chief dental officer’s advisory group, which contains practising NHS dentists and members of the dental team, has been prominent in developing the clinical requirements of those reforms, building on our oral health improvement plan approach.

In discussion and engagement with the British Dental Association Scotland, there has been further development of the payment system reform programme, which is informing us on the correct course to take to seek agreement on the overall package of reform.

Members will welcome the open approach to the development of reform with a focus on preventative care. The payment system reform supports enhanced clinical discretion and will support clinicians to deliver effective, high-quality care to patients.

I welcome the minister’s contribution, which is outlining reform, but can she please give us a timetable?

The timetable is clearly seen in the commitment to maintaining the bridging payments to the end of October this year; we expect the new system of reform payments to be in place by then.

The Scottish Government has ensured that NHS dental services are well placed to recover from the impacts of the pandemic to deliver care for the oral health of the whole population. We are committed to tackling the pandemic-related backlog in routine dental care and have supported the sector continuously.

The improved position reflects well on the commitment of NHS dental contractors and their wider clinical teams.

The minister has mentioned improvements. Could she point to the improvements in Dumfries and Galloway? Dentists are not leaving the region but leaving the NHS—we are seeing a huge increase in private dental care.

The member is well aware of the particular conditions in Dumfries and Galloway, which have contributed to the situation in which we are now. That area is particularly impacted by Brexit. More than 60 per cent—[Interruption.]

The member should go ahead if he wants to make another intervention.

Briefly, Mr Carson, because the minister should now be bringing her remarks to a close.

I appreciate the minister taking the intervention.

The Brexit remark was going to come; we were just waiting for it—it is like bingo. Dentists are not leaving dentistry; they are leaving the NHS to go private.

I know that the member does not like us to talk about Brexit. However, more than 60 per cent of the dental workforce is European, so it is undeniable that Brexit is a factor in the situation that has arisen in the member’s region. What we are seeing here is the member’s head in the sand about a situation that his party has brought about in his local area.

The early intervention to support enhanced examinations in February 2022, which includes the provision of a fee for child examinations, is reflected in the official statistics, which show considerable progress in the delivery of patient care and treatment as we come out of the pandemic. I am clear that our support of the sector has ensured its recovery.

As well as the impact of Brexit on the workforce, a whole year of dental students have not qualified. However, despite those challenges, we have seen a 23 per cent increase in dentists providing NHS dental services from 2007 to 2022—the period that the SNP has been in power.

You are over your time; you need to conclude, minister.

More than 95 per cent of the Scottish population continues to be registered with an NHS dentist—a situation that we are determined to progress and improve.

I move amendment S6M-07812.3, to leave out from the first “believes” to end and insert:

“recognises the impact that the COVID-19 pandemic had on the provision of dental services; thanks all NHS dentists, dental nurses and wider staff for their efforts to provide dental care for the people of Scotland; supports the reform of the NHS dentistry payment system to ensure that the recovery that has been seen in the last year can be built upon; understands that the bridging and multiplier arrangements supported significant increases in activity; notes that, since the start of the pandemic, dentistry has been provided with over £150 million of additional support to sustain the sector; further notes that 95.4% of people in Scotland are registered with a dentist, an increase of 44.3% since 2007; commends the work of the Childsmile programme, which is delivering preventative efforts to improve dental health now and in the future; welcomes the abolition of NHS dental charges for everyone under the age of 26, and supports the removal of all such charges by the end of the current parliamentary session.”

Thank you, minister.

I call Sandesh Gulhane to speak to and move amendment S6M-07812.2.

15:39  

NHS dentistry is in crisis. That is happening on the SNP’s watch, yet when we listen to the minister, the message seems to be, “Aren’t we doing well?” That does not wash. This is really not the time for tiresome, self-congratulatory spin.

I am very clear in acknowledging the challenges that the sector faces at the moment. Would Sandesh Gulhane join me in recognising the very welcome statistic that there has been a 23 per cent increase in the workforce in NHS dentistry during the SNP Government’s time in office?

The minister will hear in the rest of my speech how badly the Government has been doing when it comes to NHS dentistry, so I ask her to listen. [Interruption.]

Excuse me. Please resume your seat for a second, Dr Gulhane.

Obviously, this is a very important issue, but we really need to listen to everybody and extend to others the courtesy and respect that we would all hope to have extended to us as individuals.

No matter how many Scots are registered with a dentist or what age groups are entitled to free NHS dental care, members miss the point if patients cannot access NHS dental services or if dental practices are going to the wall. The SNP-Green Government must get a grip and bring forward a credible plan to both restore routine dental care and tackle the enormous backlog—and that plan should not include moving the goalposts.

What do I mean by that? We understand that the latest draft of a revised statement of dental remuneration proposes to create capacity by changing the frequency of NHS oral check-ups from once every six months to once every 12, 18 or even 24 months. In other words, that means a cut to patient care and further privatisation by the back door, as patients who want to be checked out sooner will need to pay. So much for preventative healthcare—and the proposal should be considered against a backdrop of particularly worrying reports from dentists of children’s poor oral hygiene and health, especially in areas with higher levels of deprivation, and a growing requirement for early tooth extractions.

The Scottish Government must act on the dire warnings from the British Dental Association that the system is broken. This is about not simply hearing but heeding the words of professionals. If a new sustainable NHS dentistry model is not in place by October 2023, the decision to extend the 1.1 multiplier—which, we must remember, has fallen sharply—as a bridging payment will lead to inevitable collapse.

The traditional high-volume, low-margin model is unsustainable. Without reform, practices will be pushed into bankruptcy or forced to drop NHS services altogether. Practices point out that they already face the risk of providing NHS care at a loss in relation to laboratory work.

I will give an example. Practices receive £153.34 for a full set of upper or lower dentures. That includes the 1.1. multiplier. The average lab bill is £90, so the margin is £63.34, which is split 50:50 between the practising dentist and the practice owner—who, in turn, must pay at least two members of staff over five or six appointments. As another example, a single extraction is £20.30 gross. Many dentists book a 30-minute appointment for such treatments, and rushing them helps neither the staff nor the patient.

The system is now geared towards saving the Scottish Government money, and not towards patients’ dental health. Can the Scottish Government reasonably argue that practice owners can afford to support any of those treatments, or that experienced associate dentists will continue to accept NHS dentistry work? Motivation is genuinely at an all-time low.

Material and lab fees have risen by 20 to 40 per cent across all practices.

Will the member give way?

The member is in his final minute.

That can be supported only through a greater emphasis on private treatments and by putting many deserving, but non-urgent, NHS patients on an indefinite waiting list until something gives.

There is also a lack of dental nurses and dentists, which means that many practices are unsustainable and will fold. Recent data indicates that claims submitted by NHS dentists for dental work are 43 per cent down on 2019 levels and suggests a growing exodus from the NHS workforce.

Across his health and social care brief, the cabinet secretary is responsible for multiple failures. It is time for the Government to work with dentists to prevent a collapse of NHS dentistry and to provide the sector with adequate financial support so that it can continue to offer NHS dentistry. I make this plea: heed the words of the professionals and deliver the care.

I declare my interest as a practising NHS general practitioner.

I move amendment S6M-07812.2, to insert at end:

“; believes that a root and branch reform of dental tariffs is required to ensure that dentists can holistically manage oral health; recognises what it sees as increasingly worrying reports from dentists of poor child oral hygiene, especially in areas with higher deprivation, and a growing requirement for early tooth extractions, and believes that the Scottish Government’s lack of a dentistry recovery plan will only exacerbate this growing health inequality.”

15:45  

Labour agrees with the Liberal Democrat motion and will support it if it is unamended. Our amendment seeks to add a request that the Government provides an update on the progress that has been made with its oral health improvement plan, which I hope is something that every member can agree with.

I thank the member for Edinburgh Western for bringing his motion to the chamber for debate. NHS dentistry and dental services are often overlooked and tend not to generate the headlines that we see in relation to acute NHS services or, indeed, mental health services, but that does not mean that they are any less important. After all, in the same way that we will all need some form of medical treatment during our lives, we will all need dental treatment, too. Therefore, it is vitally important that people can rely on dental services and are confident that they will be able to receive treatment in a speedy manner when the time comes.

That takes us to the very heart of the issue. At present, there is a postcode lottery when it comes to the availability of dental services in Scotland. In August last year, the British Dental Association and the BBC identified more than 8,500 dental practices across the UK that they believed held NHS contracts. As part of their research, they contacted almost 7,000 practices to find out whether they were able to offer appointments to new adult or child NHS patients. In Scotland, a staggering 82 per cent were not accepting new patients. Even more shockingly, the researchers were unable to find a single practice in Dundee, Midlothian, Dumfries and Galloway, Moray, Orkney, South Ayrshire or the Western Isles that was taking on new adult or child NHS patients.

We face a crisis that is creating a two-tier dental system in Scotland. Patients who are unable to afford private dental care are forgoing services entirely in a crisis that risks collapsing NHS dentistry in Scotland in the long term to a basic extraction service—getting a tooth yanked out, if you needed to, because you were in pain.

We are already seeing the beginning of that demise. In 2022, more than 2 million fewer patients were seen by NHS dentists, compared with 2019. When it comes to participation rates, the situation is even worse and tells a tale of widening oral health inequalities among children and adults. In September 2008, the gap in child participation rates between the most and least deprived quintiles in Scottish society was 3 percentage points. In September last year, it was 20 percentage points, which is the highest difference that has ever been reported. That is shocking. Over the same period—from September 2008 to September last year—the gap in adult participation rates between the most and least deprived quintiles grew from 3 percentage points to 11 percentage points, which, again, is the highest difference that has ever been reported.

Why does that all matter? It matters because those cold, hard facts are illustrative of a bigger problem—an inertia in the Scottish Government when it comes to our healthcare system and, in particular, inequality in our healthcare system. We know what problems our NHS faces. One of those problems is that of staff retention, which exists in dental services, too.

Just last week, the BDA issued a stark warning:

“In just two months the ‘bridging payments’ to NHS practices in Scotland will cease. There is no clarity on what support will take its place.”

That is a terrifying prospect.

As Paul Sweeney may well know—Alex Cole-Hamilton might have mentioned this—we have agreed to extend the provision of bridging payments till October. I am sure that he will welcome that.

I accept that that is the case, but, as my dentist told me yesterday, that will not offset the multiplier effects that were previously in place, and it does not address the financial detriment that is faced by dentists. There is no reason for them to engage. The extension of bridging payments is not sufficient to address the problem.

The situation is compounded by the fact that many dentists—young dentists, in particular—are simply leaving the profession. The BDA went on to warn that

“An exodus from the workforce appears to be in motion”,

and that

“Dentists are reconsidering their futures working in a broken system”,

as is happening with junior doctors.

That should be of huge concern. Without a highly skilled and trained workforce that is able to provide NHS dental services to adult and child patients, a fundamental cornerstone of our public dental system will collapse and, when it does, it will be those from the most deprived backgrounds who will suffer. My plea to the minister and the cabinet secretary is simple: listen to the sincere warnings from professionals in the field, harness their expertise and bring to the Parliament a plan that can command support from across the chamber before it is too late.

I move amendment S6M-07812.1, to insert after “Scottish Government to”:

“provide an update to the Parliament on the progress made in delivering on its Oral Health Improvement Plan, which was published over five years ago,”.

We move to the open debate.

15:49  

The Liberal Democrats seem to have spooked the health secretary. On the eve of this debate, he rushed out a letter to NHS dentists across the country. In it, he promised an extension to the interim bridging payments to October, when they were supposed to have been sorted in April, as he referred to. He also said in the letter that he was “pleased” and “grateful”, but I do not think that many dentists will be pleased with and grateful for the Government’s performance.

Under the current funding system, dentists are losing money with every procedure that they undertake. Sandesh Gulhane gave some excellent examples. Lab costs for dentures are estimated to have gone up by 50 per cent. One dentist told me:

“I have made dentures recently and lost £6.00 on”

every single

“job.”

As in so many other sectors, the SNP Government is expecting private work to subsidise public work. That is happening with nurseries and in higher education, too.

My dentist told me that one of the biggest increases in costs is for dental equipment and supplies that come from the European Union. That has made a big difference to their margins.

The member is absolutely right, and that reinforces the case for the Government to reflect on the real costs that dentists are facing, or else we will drive more of them into the private sector, which will have a direct impact on those who are seeking NHS treatment.

It is pretty clear that it is increasingly difficult to see an NHS dentist. The numbers are transparent. Although there has been an increase since the record lows of the pandemic period, it has been modest. We have heard that, since 2019, there has been a 20 per cent fall in the number of dentists performing NHS procedures, and around a quarter of people seeking a dentist appointment have not been able to get one. That is really stark.

The situation forces more people into private treatment. Those people are expected to pay not only for their own treatment, but for the SNP’s underfunding of NHS treatment. I do not think that it is particularly fair that people who are desperate to get NHS treatment have to go private and are also having to subsidise NHS treatment. The SNP is killing NHS dentistry by stealth.

Patients in my constituency are hunting from practice to practice to access treatment. I have to say that it is, therefore, an utter farce that the SNP continues to promise that it is going to abolish all NHS dental charges. That goal is worthy and not unreasonable, but it misses the point of the crisis in NHS dentistry. Someone might be able to get free treatment if they are being treated under the NHS, but only if they can get an NHS dentist. Treatment will not be free for everyone; it will be free only for those who can get through the door of an NHS dentist. Yet the SNP gets its headline.

Will the member take an intervention?

The member is just concluding.

This comes at a time when, following the pandemic, the people who need dentistry most are the slowest to come forward. As Paul Sweeney rightly identified, that is exacerbating inequalities, particularly among children. We are posing a significant risk to the population, who may be at risk of diabetes, HIV and cancer.

It is no surprise that there has been an increase in the number of people resorting to treating themselves. The cabinet secretary needs to accept that there is a crisis in NHS dentistry. If he does not do something about it soon, it will get a whole lot worse.

15:54  

I am glad that the Liberal Democrats are using this parliamentary debate to address NHS dentistry in Scotland. After reading the 2021 Scottish Liberal Democrat manifesto to learn a bit more about their party’s plans and ambitions for dentistry in Scotland, I am afraid to say that the Lib Dems did not mention dentistry once in that. On the other hand, back in 2021, when Covid was still very real, the SNP dedicated a whole section in our manifesto to how we can improve dentistry services, and action has already been taken.

It goes without saying that significant challenges face dentistry and our health service in Scotland, but we need to recognise the impact of the global pandemic, which has been the biggest shock to our NHS in its 74-year history. The NHS is not going to recover in a few weeks, as all the Opposition parties demand; recovery will take years.

Will the member take an intervention?

Will I get the time back, Presiding Officer?

There is no time in hand.

Apologies to the member. I will not take the intervention.

Let us dive into some facts. Right now, more than 95 per cent of people in Scotland are registered with an NHS dentist. I was shocked to learn that, back in 2007, only 44.3 per cent of people were registered with a dentist. The progress is down to the work of this SNP Government and represents a massive uptake, following years of decline under Labour and Lib Dem Governments.

Examinations and appointments are again up, following the massive backlog that was the result of the global pandemic. To date, the SNP Government has provided more than £150 million of financial support to maintain the capacity and capability of NHS dentistry. I am not sure whether Alex Cole-Hamilton is aware that, in a proactive move after the pandemic, the payment system of fee per item that incentivises NHS dental teams to see patients was reintroduced last April. Public Health Scotland statistics show how the measure has increased patient examination appointments, so that they are back to pre-pandemic levels, allowing more patients to be seen and dental practices to register more patients as they work though the pandemic backlog.

Since the SNP came into office, considerable progress has been made in dental services and oral health improvement. The Scottish Government has removed dental charges for all patients under 26—that is around 600,000 young Scots—as a first step towards scrapping charges for all in Scotland.

Partly because of that policy, our children’s oral health, particularly in deprived communities, is improving dramatically, with the primary 7 group showing better results than ever. The childsmile programme was introduced in nurseries and schools. I witnessed the programme in practice last week on a visit in Troon. Great work is being done.

We have more dentists per head of population. In Scotland, we have 59 dentists per 100,000 in comparison to 43 per 100,000 down south. Do we want more dentists? Yes. However, due to the pandemic, we had a whole year when no dental students qualified.

Immigration could play a key role in tackling the backlog. I await the groans from the Tory benches when I say that the hard, cold fact—and this is not Brexit bingo; this is not a game—is that Brexit has had a significant, detrimental impact on recruitment of health and social care staff.

Will the member give way?

The member is in her final minute.

One hard, cold fact is that the rate of dentists joining the register has halved since the EU referendum. The Nuffield Trust report, “Health and Brexit: six years on”, which was published in December, describes the UK’s dentist workforce as a particular concern. It says:

“Before the EU referendum, consistently well over 500 dentists trained in the EU and EFTA registered in the UK each year. They made up around a quarter of additions to the workforce. This dropped sharply around the time of the referendum, to around half its previous level, and has never recovered.”

I am sorry. I have run out of time, Presiding Officer. I will conclude there.

15:58  

I thank the Liberal Democrats for using their debating time to bring this hugely important issue to the Parliament.

Members will be aware of my long-standing interest in the preventative health agenda. Dentistry sits firmly in the category of preventative healthcare. Furthermore, when we discuss health inequalities, we cannot avoid the fact that the most deprived areas are suffering far more than the least deprived areas.

I had hoped that, given her experience, the minister would be prepared to accept that there is a long-standing issue to do with access to dental care and that there is a disparity between the most and least deprived areas when it comes to oral hygiene. I had hoped to discuss the issue without politics getting in the way, because it is far too important an issue for members to play politics.

However, reality bears no resemblance to the Government’s amendment.

Will the member take an intervention?

I want to make some progress first.

Covid makes its usual appearance in the Government’s list of excuses when we discuss anything that is health related. For the record, I looked at trends in the percentage of registered patients who participated in NHS general dentistry services in Scotland from 2006 until now. The minister should be aware that it has consistently fallen, from a high of 96.7 per cent in 2006 to 65.7 per cent now. All that Covid did was accelerate an already chronic problem.

Furthermore, the number of dentists working in the NHS has been steadily declining over the past six years, with the biggest decline in the past two years. We can extrapolate those results to conclude that an already declining state of oral health and hygiene in Scotland has been accelerated, and it is reasonable to conclude that the most deprived will suffer the worst consequences.

I have convened the cross-party group on health inequalities for nearly seven years, and our frustration is that the issues that we discussed way back then are the same issues that we discuss now, only they are much worse. Our amendment, which I hope will get the support of members from across the chamber, is born out of

“increasingly worrying reports from dentists of poor child oral hygiene, especially in areas with higher deprivation, and a growing requirement for early tooth extractions, and believes that the Scottish Government’s lack of a dentistry recovery plan will only exacerbate this growing health inequality.”

Those words may be in our amendment, but they are also a direct quote from a senior dentist.

Good oral hygiene is the epitome of the preventative health agenda. By investing in early intervention—

I am absolutely sure that the member will welcome the enhanced child examination fee that has been in place since 2022. Does he also welcome the fact that, in 2003, 45 per cent—less than half—of primary 1 children had no obvious decay but that, by 2021-22, that number had increased to 73 per cent? That does not fit with the narrative that the member is presenting about the SNP’s management of preventative health in children.

What the minister just said does not fit with the narrative that we hear from dentists day in and day out. It is about time that the SNP Government started listening to the people who work on the front line, because the words in our amendment that I mentioned are a direct quote from a senior dentist.

By investing in early intervention, the Scottish Government would avoid much more costly and invasive treatments further down the line. The issue is not just cost; it is also about investment and being able to continually reinvest in the dentistry profession to the betterment of the profession and its patients, and tackling that growing health inequality.

It is no good for the Scottish Government to create ambitious targets with no route to related outcomes of their policies. I had hoped that we would have an honest and open debate on this very serious and escalating health crisis, but, unfortunately, we are not getting that from the Scottish Government. An “everything will be fine” and “nothing to see here” policy will not wash, and it is time that the Scottish Government accepted the severity of the situation, that its policies to date have not worked and that we need a complete root-and-branch review of dentistry.

16:02  

Our NHS dentistry services are experiencing unprecedented levels of pressure and, not for the first time in the health sector, the Scottish Government has taken its eye off the ball. Its mismanagement of NHS dentistry has left the sector fighting for its survival.

Since the onset of the pandemic, more than 6 million NHS dental appointments in Scotland have been lost. That includes essential annual check-ups, which are a cornerstone for maintaining good oral health, as any potential issues can be identified early and properly assessed, which boosts the likelihood of a positive outcome.

Since coming to power, not only has the SNP-Green Government presided over the privatisation of dentistry services in Scotland, it has accelerated the process of privatisation. In response to any criticism or scrutiny, as we have again seen today during the debate, the Scottish Government gives its excuses, one of which is to state that 95 per cent of Scots are registered with a dentist. However, being registered with a dentist is meaningless if you cannot access an appointment for several weeks or if you cannot afford the expense of going private, particularly in our most deprived communities where access to such appointments is crucial.

The impact of the widespread privatisation of dentistry services is a marked increase in health inequalities, most prominently among children. New research from the British Dental Association has found that the proportion of people who have visited their dentist in the past two years has fallen from 65 per cent in 2020 to only 50 per cent in 2022. Three in every four children have visited their dentist in the past two years compared with just more than one in two children in the most deprived communities.

When the SNP came to power, as we have already heard from my colleague Paul Sweeney, the difference in dental participation rates between children from the most affluent areas and those from the most deprived communities was only 3 per cent; it is now 20 per cent. That is a shameful statistic, which is indicative of the SNP’s shambolic management of NHS dentistry and its lack of targeted action over 15 years to reduce health inequalities.

We are faced with the reality of dental care being a privilege that can be accessed only by those who have enough disposable income to seek private treatment.

I would like to say that I was pleased to hear the minister confirm that the Scottish Government has extended the bridging payments, which update the NHS fees to help dental practices to deal with rising costs—that is what the minister said would happen—but I do not think that we have had any acknowledgement of the multiplier effects or the systemic issues with the current funding model, which is completely broken and is accelerating the shift away from NHS dentistry and into private practice.

Will the member take an intervention?

I am in my last minute, but I will take a very brief intervention.

Does Paul O’Kane think that dentists would agree that holistic oral health is a priority and that we should not continue with the drill-and-fill model that the Scottish Government is pursuing?

In my speech, I think that I have outlined the importance of the relationship with the dentist in ensuring that a person’s appointment is their gateway to the services that they require for good oral health.

“What’s needed now is real reform to a broken system. There can be no more kicking the can down the road—a sustainable model must be in place come October.”

Those are not my words; they are the words of the chair of the British Dental Association’s Scottish dental practice committee, David McColl.

As a matter of urgency, the Scottish Government must fix the systemic issues in the current funding model if it is serious about maintaining a universal NHS dentistry service across Scotland. We need to shift the debate away from the proportion of the public who are registered with a dentist and focus on who is able to access a dental appointment.

If action is not taken, we will see the end of dentistry as we know it in Scotland, with a two-tier system of care: one for the rich and one for the rest.

I have to ask you to conclude now, Mr O’Kane.

That will only exacerbate and further entrench existing health inequalities in oral health.

16:07  

I, too, am pleased that we have time today to discuss dentistry. Dentistry is a part of the health service that often gets lost when we are discussing wider health issues. It is a hugely effective preventative health measure that involves not only teeth and gum health, but finds other potential issues and conditions.

As it has done on all parts of our health service, Covid has placed unprecedented pressure on dentistry, so I commend all the dentists, therapists, hygienists, nurses and technicians who put their wellbeing, and sometimes their lives, at risk to continue delivering essential healthcare during the pandemic.

It is only right, though, that we look at the issue in the context of how dentistry is delivered in Scotland, which is fundamentally different to general practice and other healthcare services. As such, our response to Covid recovery for dentistry needs to be different to our response for other parts of healthcare.

The mixed model of private dentistry, general practice and the public dental service creates a complex system that the public are not always confident in negotiating. It also opens real risks of there being uneven and inequitable delivery of dental services across the country.

We should also consider expanding the role of the public dental service, with healthcare boards fully delivering dental services. Historically, that has been reserved for communities that are unable to access dentists—for example, people who live in care homes—but in recent years, the NHS has successfully delivered full dental services in remote and rural areas including the Western Isles, which had been badly served by general practice. The public dental service provides an existing model that could be expanded to cover more communities—especially communities in which private and general practices are closing, or where growing populations are not adequately served by existing practices.

Although the model of delivery might be different, there are clearly lessons that can be learned from the way in which GPs have adapted to delivery of primary healthcare—not least through successful use of allied health professionals as part of wider health teams in surgeries. The wider categories of dental care professionals include dental therapists, hygienists, technicians and extended duty dental nurses, who can provide a wide range of services, from extractions to preventative care. They are already used extensively across Scotland, but currently have to work on a refer-down model, in which patients must see a dentist before being referred for further treatment to a dental care professional. That is the opposite to how GP practices work, where it is now common to see a nurse before being referred for further treatment elsewhere, and it is not how dental care professionals work in other parts of the UK. Reviewing the model and changing to a refer-up system could significantly ease current pressures on dental services and ensure that we are making full use of our well-trained and highly skilled dental care professionals.

I welcome the removal of dental care charges for under-26s and I hope that we can, before extending it to the rest of the population, look at how to roll that out quickly to groups for whom paying for dental care is a barrier. Some groups are already exempt from charges—for example, people who are pregnant and people who are in receipt of various benefits. However, I do not think that those exemptions are—especially in the current economic climate—capturing all the people for whom dental treatment might be a luxury that they cannot afford. I hope that we will be able to devise a targeted approach that addresses both availability of dentists in some areas and affordability.

We also need to look closely at why some people are not attending dental appointments and at how we can remove some of the barriers. Some people to whom I have spoken simply got out of the habit of going during the pandemic and have not got round to booking a check-up. We need to address that issue.

Dentistry is one of the greatest examples that we have of preventative care, so we need to ensure that everyone who might need dental care has access to it. We need to look at where and how it is delivered and make sure that it is not too long until the abolition of dental care charges.

16:11  

I have been concerned about the recruitment of dentists for some time. In 2018, local Inverurie NHS dentist Navin Aziz came to see me, claiming that, because of the Brexit vote, the profession was already seeing a 90 per cent drop in applicants for dentist vacancies. That was in the period before the actual withdrawal from the EU. Of course, now EU dentists need a work visa to come here—a visa that is difficult to get—and Mr Aziz was right; applications from the EU have all but ceased.

Mr Aziz also runs a couple of practices in the Highlands and was looking to recruit dentists from outwith the EU under the sponsor licence scheme, but there is a requirement for the dentist to earn £50,000, which was not within the pay scale that he could afford.

Will the member take an intervention?

I do not have time.

Therefore, dentists could not apply through the other visa routes.

At that point, Amber Rudd was the Home Secretary, so I wrote to Ms Rudd and called on her to put in place contingency visa arrangements to take into account the impact of Brexit on dentists. I referenced another pressure that was highlighted at the time in a survey by the British Dental Association, which found that more than 50 per cent of NHS dentists across the UK were considering leaving the profession within the next five years and that a third of members over the age of 55 were looking to take early retirement. Unfortunately, I did not hear back, but that might have been because there were umpteen Cabinet reshuffles at that point.

Since then, Mr Aziz is in the fortunate position of having an SNP member of Parliament to take up his case with the current Home Secretary, but sadly he is coming up against the same brick wall. Mr Aziz continues to be unable to fill vacancies for which he has willing applicants. Incidentally, he is my parents’ dentist and they never have a problem getting an appointment, despite his recruitment challenges.

My colleague Jackie Dunbar will not speak in today’s debate, but she was telling me earlier of a similar case that she has. She is happy for me to relay the case because it mirrors Mr Aziz’s issue. She has a constituent who runs a dental practice in Aberdeen. He wanted to give a job to a dentist from Afghanistan to fill a vacancy, so he wrote to the Home Secretary to ask whether dentists are on the occupation shortage list in the UK and whether a specific scheme is in place to resettle dental graduates from Afghanistan, given the issues over there—

Will the member take an intervention?

Well, I will have to, won’t I?

I thank Gillian Martin for taking the intervention and I apologise for hijacking her speech. However, since my NHS dentist was mentioned, I want to give them a shout-out and thank them very much, and to thank all the NHS dentistry team. I broke a tooth last Thursday, so I called my dentist. It was not an emergency because it was not sore, so I was given an appointment for next Wednesday. I got a call this afternoon to say that there had been a cancellation and was asked whether I wanted to come in this afternoon. Obviously, I could not. I just wanted to thank that dentist and say that people can get appointments from the dentistry team.

I thank Jackie Dunbar for that. I will mention my dentist as well, since we are all mentioning our own dentists. I already mentioned to Willie Rennie the issues that my dentist is having in relation to costs and the time that it takes to get dental supplies. That issue, too, is a result of Brexit.

The Tories are terrified of us calling out Brexit, but it is a massive problem for dentistry—and so many other sectors—because we cannot magic qualified dentists out of thin air. The minister and other SNP members have outlined the actions that have been taken to try to improve things. We have introduced new incentives for recruitment and retention of NHS dentists to certain areas within NHS Grampian and other areas. That includes “golden hello” arrangements, under which NHS dentists can receive up to £25,000 over a two-year period. However, we must also be able to take on overseas dentists who want to come here. Until that happens, we are running to stand still.

16:15  

Almost exactly a year ago, I spoke in the chamber about my concern that the very existence of NHS dentistry in Scotland was under threat. In February 2022, the outlook was bleak, and I regret to say that the SNP has presided over the near collapse of NHS dentistry. We know that more than 6 million NHS dental appointments have been lost since the first lockdown. Statistics that were published last month show that 2 million fewer patients were seen from January to November 2022 than were seen in the same period in 2019. Only 50 per cent of Scots who are registered with a dentist have seen one in the past two years.

Dentists tell us that the SNP Government is presiding over the back-door privatisation of NHS dentistry, which is a direct result of lack of funding and lack of incentives for dentists to offer NHS services. At the very time when NHS dentistry needs support, ministers appeared to be intent on withdrawing bridging payments from April, so I am delighted that that arrangement will continue until October.

If we are being honest, the statement of dental remuneration, which is about as old as the NHS itself, is no longer viable. However, the Government needs to recognise that the multiplier has been cut substantially—urgency is still required. I accept the minister’s comments and I will take them as a commitment that reform will be in place by October.

Pre-pandemic levels of clinical activity are not possible and there are serious concerns about staff recruitment and retention, which we have heard about from a number of members. However, the Government has not acted fast enough, so we will probably end up with fewer NHS dentists as a result.

In all seriousness, I have listened to members of the Labour Party and other members across the chamber who are, rightly, calling for reform. Does Jackie Baillie have an idea of what that reform should look like? For example, does she agree with the fee-per-item model, or does she think that it should be scrapped? If so, what should it be replaced with?

More than a year ago, I engaged with the minister about that subject and suggested that the way to do it would be to bring dentists in to discuss such matters, as the Government is doing. However, there is no urgency to those discussions. I talked about the suggestion a year ago, but the SNP Government has since presided over more dentists leaving the NHS.

Dental care in Scotland is becoming the privilege of those who have the deepest pockets, who can afford to go private. What a shameful indictment that is of the SNP’s approach to healthcare. Let me illustrate part of the problem. David McColl, who is chair of the BDA’s Scottish dental practice committee, has told us that the fee that dentists pay to a lab for denture repair is £26.40. However, the amount that the Scottish Government will provide for the repair is only £24. NHS dentists are being asked to run services at a loss and to subsidise the NHS, with barely enough funding coming in to pay staff—and the cuts are set to get worse.

The number of high street NHS dentists in Scotland has fallen by more than 5 per cent since the pandemic. Patients with excruciating mouth pain are often forced to turn up at accident and emergency departments because they cannot get appointments with an NHS dentist.

The situation is in danger of getting worse. The growing inequality that is becoming synonymous with the SNP’s governance of Scotland is increasing in dental provision at an alarming rate. In September 2022, children and adults from the most deprived areas were less likely to have seen their dentist within the past two years than those from the least deprived areas, and the gap is widening. Scottish Labour introduced childsmile when we were in Government, because we were determined to tackle inequalities in oral health and to ensure that every child in Scotland, regardless of their background, had access to dental services. It is heartbreaking to see that the considerable progress that had been made in child dental health is now going backwards.

The SNP Government’s failure is creating a two-tier dental system in which people with money to spend go private and people who do not have money go without. Shame on it.

16:19  

Today, we have heard the scale of the crisis in NHS dentistry in Scotland. It is a profession “on its knees”, in a system that is “broken”—words that we are hearing all too often in the chamber under this SNP-Green Government.

Millions of dental appointments have been lost since the start of the pandemic—millions of missed opportunities to treat early tooth decay, prevent dental disease and detect the early stages of oral cancer. There is uncertainty over future funding in a system that is already chronically underfunded and there is an “exodus from the workforce” according to the British Dental Association. All of that is happening against the background of the SNP’s 2021 manifesto commitment to scrap NHS dental charges for everyone in Scotland.

The minister, Maree Todd, talked about reform, but she was unable to give any timetable and, once again, the SNP Government blamed Brexit and the pandemic. That is deflection and denial. The Government also took the credit from Labour for the childsmile programme, which was interesting.

I agree with Willie Rennie: this is an utter farce—just like Gillian Martin refusing to take an intervention from my colleague but taking a seemingly staged intervention from her colleague Jackie Dunbar.

Alex Cole-Hamilton shone a light on the fact that the Scottish Government wants to delete reality and that ministers’ heads are in the sand. Dr Gulhane raised the serious issue of many dental practices going to the wall because they are running at a loss—he gave example upon example of that. Paul Sweeney talked about the postcode lottery and Brian Whittle said that this Government operates an “everything will be fine” and “nothing to see here” model.

The Scottish Conservatives’ amendment highlights widening oral healthcare inequalities—something that was glaringly absent from the Liberal Democrats’ motion. According to Dr David McColl, chair of the BDA’s Scottish dental practice committee,

“Patients in Scotland’s poorest communities are paying the price for the crisis in dentistry.”

Make no mistake: SNP ministers cannot peg widening inequalities in oral health outcomes on the pandemic alone. Like so much with this SNP Government, it is a problem that has been years in the making. For example, the national dental inspection programme 2018 revealed that, although 86 per cent of children in Scotland’s least deprived areas had good dental health, that figure was only 56 per cent for children in the most deprived areas.

Of course, as we have heard today, the SNP likes to trumpet the number of people registered with an NHS dentist in Scotland. That is so typical of the SNP’s smoke-and-mirrors approach to policy and political PR—

Using facts?

—but it is the participation rate, which measures contact with a dentist in the past 24 months, that matters most, so, let us take a look at it. The participation rate has fallen by almost 15 percentage points between 2020 and 2022—

Anything happen in those years?

—with adults and children from the most deprived parts of Scotland less likely to attend than those in the least deprived areas.

Excuse me, can we please hear Ms White without interruption?

The cabinet secretary obviously does not like what I am saying.

The reality is that we are seeing a decline in dentistry under this SNP-Green Government. Dentistry in Scotland is on a cliff edge.

Humza Yousaf announced today that the bridging payment will remain in place until 31 October this year, after months of uncertainty for dental practices that feared that they might collapse. He and the SNP Government must urgently get a grip of the situation and bring forward a credible plan to restore routine dental care and the confidence of the profession.

16:24  

I thank the Liberal Democrats for bringing this important debate to the chamber. I will try to address a number of the points that have been made and the key themes that have come up.

From the outset, I say that no one in the Scottish Government is saying that everything is rosy in the park. In fact, the first line of our amendment recognises the impact that the pandemic has had on NHS dentistry, and, of course, we acknowledge that there were challenges even before the pandemic.

Therefore, I agree with members across the chamber who say that there are challenges in access to NHS dentistry. There is no doubt that some of those issues are more acute in some localities, such as Dumfries and Galloway and the Shetland Islands, as has been raised with me directly in this chamber.

I also acknowledge that there is a challenge around the current payment system, and that is why we are engaged in reform, and we are doing that work at pace.

However, as in Jackie Baillie’s response to my intervention, it was very telling that, for all the talk of reform, nobody in this debate has given any detail of what that reform should look like.

Will the cabinet secretary take an intervention?

I will give way shortly, but when I asked Jackie Baillie what that reform should look like, she gave a completely incoherent answer with no substance whatsoever. At this point, she might want to give more detail.

I am sorry, but I had an hour-long discussion with Humza Yousaf’s minister and the chief dental officer a year ago, and that discussion has not been acted on. If the cabinet secretary wants me to take an hour of his time now to give him that detail, I would be happy to do so.

Perhaps the cabinet secretary will answer a question. I acknowledge his acceptance of the impact of Covid. Has he estimated how much it will cost to clear the current backlog and how much time it will take to do so?

Of course, all of that depends on the payment per item and the fee for that item, and we are very much engaged with that conversation.

All that I asked for was one bit of detail from Jackie Baillie, and, in fairness, that applies not just to Jackie Baillie—I asked the question of everybody, quite genuinely and seriously. [Interruption.] I will give way shortly.

If there is some detail around the reform that members think that we should bring forward, they should bring that to our attention. If members do not agree with the fee-per-item model and agree with the salaried model, I ask them please to make that clear.

Will the cabinet secretary take an intervention?

Bob Doris rose—

Paul Sweeney rose—

I will give way to Gillian Mackay, who was first.

I thank the cabinet secretary for giving way and I apologise to everyone else who rose.

Would the cabinet secretary reflect on my suggestion of changing to the refer-up model, so that we can make the best use of dental therapists and hygienists, rather than always sending people to a dentist in the first instance?

I thought that that point was very well made and I was going to come to it later on. Gillian Mackay was one of the few members who was able to give some detail of what reform we should see.

To the Conservatives and other members who suggest that there has been no progress in recovery, I suggest that they look at the facts and figures. Between April and October, 1.6 million NHS examination appointments were completed, with an average of more than 300,000 courses of treatment per month. Although we are not quite there yet, that means that we are on course for more than 3.5 million courses of treatment in 2022-23. That compares with 1.5 million in 2020-21 and 2.6 million in 2021-22.

Will the cabinet secretary take an intervention?

I will do so very briefly.

I appreciate the cabinet secretary giving way. He says that there are solutions and that there are specific issues in Dumfries and Galloway. What interventions will he undertake to stop NHS dentists from ceasing to provide NHS services and moving into the private sector? That is happening right across Dumfries and Galloway. What can he do to address that?

For the sake of brevity, I might write to Finlay Carson with details on what has been done specifically in Dumfries and Galloway. A number of interventions have been tried and tested. There has been some return for those investments but not much, which I accept. I know that the board has assembled a local dental task force, and we expect detail imminently on the next steps that will be proposed for Dumfries and Galloway. Given that I am running out of time, I will write to Finlay Carson with more detail on that.

To suggest that the SNP Government has not supported the dental sector is incorrect, because there has been £150 million of funding for the sector throughout the course of the pandemic.

Of course, with regard to the issue about privatisation and people feeling that they have no choice but to go private, we are incentivising NHS dentistry through the multiplier. Some members have asked why we are reducing the multiplier from 1.3 to 1.1. The multiplier was set at that level during the pandemic when the majority of aerosol-generating procedures could not be done, and there were severe infection prevention and control restrictions. Those IPC restrictions have, of course, loosened, so because of the importance of making sure that we get value for the public purse, it is right that we begin to reduce that multiplier in a phased manner.

I must ask you to conclude, cabinet secretary.

Will the cabinet secretary take an intervention?

I am afraid not—I am out of time.

The cabinet secretary is beyond his time.

I will say that we will continue to ensure that we resource and fund the sector and ensure that NHS dentistry is available for all our population.

Thank you, cabinet secretary. I call Liam McArthur to wind up, for up to 6 minutes.

16:29  

The Government is often accused in this chamber of lodging motions or amendments that smack of complacency, of ministers being quick to pat themselves on the back, or of the belief that any concerns, however serious, can be brushed aside with an expression of ministerial gratitude to those working in the sector. Indeed, despite what the cabinet secretary said in his closing remarks, this debate has provided textbook examples of those three character traits. However, I must say that the complacency, self-satisfaction and almost patronising dismissiveness of the letter that the cabinet secretary sent yesterday to dental practitioners around Scotland takes the biscuit.

As Willie Rennie observed, you could almost hear the grinding of teeth in dental practices from Shetland to Stranraer as Mr Yousaf breezily declared in that letter that he is

“pleased to see how well the dental sector has been performing”.

The lack of self-awareness or understanding of what NHS dentistry is crying out for that led the cabinet secretary to insist that the bridging payment has

“supported the sector to provide significant levels of NHS patient care during this difficult time”

will have had dentists reaching for their drills with dark thoughts on their minds. Fundamentally, it reflects a failure on the part of the cabinet secretary and his chief dental officer to actually listen and respond to what those in and representing the sector have been saying for months.

I have written to the Government about pressures on NHS dentistry in Maryhill and Springburn, and in particular recruitment and retention issues and drift to the private sector. In remote and rural areas, there is a recruitment and retention allowance and an incentive for newly qualified dentists. I wonder if that could be enhanced and extended to urban areas. There is a specific suggestion for the Government to take forward.

I thank Bob Doris for prior sight of his intervention. I certainly agree with the point that he makes, if not all of the detail.

As Alex Cole-Hamilton said in opening the debate, the term “crisis” is often overused. In the face of what we see happening in areas from A and E to mental health, perhaps it is unsurprising that other aspects of the broader crisis have dominated the headlines and Parliament’s attention. Yet any objective analysis of NHS dentistry across Scotland right now can only lead to a single conclusion: that the sector is in crisis. Dental check-ups and treatment remain dramatically below pre-pandemic levels. Eleven health boards record waits for over a year for treatment. The BDA has confirmed that dentistry in Scotland is still

“light years from business as usual”.

The number of dentists who are doing NHS work has fallen, while the chair of the BDA’s Scottish council has warned of a wholesale exodus from NHS work.

As one dentist told me last night upon receiving Mr Yousaf’s letter,

“the current system is the cause of the exodus, and I suspect that this announcement sounds the death knell for this era of NHS dentistry.”

He added:

“There will be a lot of practices making some tough decisions over the coming days”.

That position is reflected around the country.

Will the member give way?

I will take a brief intervention.

I will be very brief. I just wonder whether the member has an answer to the question that I have asked others. What is the detail of the reform that he would like to see? Does he agree with the fee-per-item model? If not, is there a different model that he would propose? I would be very keen to hear that.

The point that dentists are making is that they are being involved in committees and consultations to which they are feeding in their views and those views are being completely ignored. I think that that communications breakdown between the Government and the sector is of more concern than the ideas that are coming forward from other political parties.

As others have said—[Interruption.] Sandesh Gulhane made a point—[Interruption.]

Let us hear Mr McArthur, please.

—about the impact on preventative healthcare. He, Paul Sweeney and Brian Whittle talked about the yawning and expanding gap in health inequalities.

Siobhian Brown was perhaps right to talk about free dental checks, but as Willie Rennie pointed out—

Mr McArthur, I ask you to stop for a second. There is a discussion going on in the chamber and I would be grateful if it could cease so we can hear Mr McArthur.

Thank you very much, Presiding Officer. Siobhian Brown talked about free dental checks, but as Willie Rennie pointed out, the free dental checks work only if there is a door through which to go to be seen by somebody who can carry them out.

Gillian Martin talked about the impact of Brexit and being unable to magic dentists into existence, and that is absolutely true, but it means that we should be doing all that we can to discourage people from leaving NHS dentistry in the numbers currently happening.

Gillian Mackay was absolutely right to make the point about a refer-up programme; it is something that has also been mentioned to me. The role of therapists could be expanded, where they have the training already but just need to be allowed to deploy those skills.

Alex Cole-Hamilton was right to point out the particular challenges in rural and island areas. Just this week, I have been contacted by constituents highlighting their experience. One father explained how the absence of a registered orthodontist in Orkney has left his daughters unable to access important orthodontic work at a key stage in their teenage years. The implications of that are potentially far-reaching and are about not just the cost of future work but the emotional toll. I know another constituent who recently forked out around £6,000 for orthodontic work that her daughter desperately needed.

Another constituent was in touch to explain that they had moved to Orkney two and half years ago and that they and their family were still unable to register with an NHS practice. They have explored private dental care, but the costs are prohibitive, and they are a far cry from the First Minister’s promise of an NHS free at the point of delivery. Even getting children registered has proved impossible, leaving many children with no experience of going to the dentist, which increases the risks of poor habits or even phobias developing.

The fact that the public dental service has not fallen over completely is due to the commitment of dentists and dental practices across Scotland, yet that commitment has been rewarded by disorganisation and disrespect from the Government. The Government might be able to remove the word “crisis” from the motion; would that the minister expended just as much effort on trying to address the crisis in reality.