Dentistry
Good morning. The first item of business is a debate on motion S2M-2549, in the name of Shona Robison, on dentistry.
The state of our nation's teeth is one of the biggest public health challenges facing Scotland, with 55 per cent of children having dental disease by the age of five. For many people in Scotland, getting access to a national health service dentist has become an impossible quest. Hardly a day goes by when there is not a story in the press about another dental practice closing its doors to NHS patients. We know that 40,000 dental patients have been taken off NHS lists in the past two years and that dozens of dental practices have closed. This is an opportunity for the Parliament to have its say on what the Minister for Health and Community Care must include in his statement next week if we are to rectify the situation and ensure that NHS dentistry has a future in Scotland.
The power of Scottish National Party debates is clear for everyone to see this morning, with the minister's announcement in the press that
"Every child in Scotland is to be guaranteed access to an NHS dentist".
That is an excellent result for a morning's work, as I am sure all members will agree. The question for the Deputy Minister for Health and Community Care, however, is where the Executive is going to find the dentists to carry out that work.
A report recently commissioned by the Scottish Parliament's Health Committee found that, among primary care dentists, 42 per cent of those
"currently treating children were not accepting new children for NHSScotland dental care or were using a waiting list."
With respect to adults, it was reported that
"only 37% of Scottish dentists are prepared to accept all categories of adults as new NHS patients.
One-quarter admit to scaling down their NHS commitment and only 3.5% of primary care dentists say they intend to increase the amount of time spent treating NHS patients over the next two years.
The study … concludes that the Executive's flagship pledge to give"
free oral health assessments
"to everyone by 2007 will be difficult to meet without a significant increase in NHS dentists."
The report made it clear that
"ministers' plans to lure retired dentists back to work in the NHS with incentives were unlikely to be successful."
The report also stated:
"A significant increase in NHS Scotland provision required to meet pledges to improve access to dental services is unlikely to be achieved with the type of incentives currently available".
That all comes at a time when our chief dental officer is allowed to go part-time. That is just not good enough.
The key problem has been the chronic underinvestment in NHS dental services over the years, which has led to NHS work becoming less and less attractive to dentists, both financially and in terms of the quality of service that they can offer their patients. The pledge to introduce free dental checks—or oral health assessments, as they should be known—by 2007 must involve more than a cursory look in the mouth. Dentists must have time to spend with patients to carry out a proper assessment of their needs.
The British Dental Association has made it clear that, without major changes to remuneration, there will not be enough dentists prepared to carry out oral health assessments for the current princely sum of £7.05, which does not even cover their cost. If we are serious about shifting the focus of NHS dentistry to preventive work, there must be financial incentives for carrying out that work. The Health Committee's report states that nearly 56 per cent of dentists said that an increase in the fee level for such work was required to get them to treat more NHS patients. That is the reality that we are faced with, whether members like it or not.
Consideration must be given to linking oral health assessments with a screening programme to ensure that those who are less likely to access oral health assessments for themselves or for their children are targeted. Many of those who live in our most deprived communities are already entitled to free dental checks, but they do not take them up. We must address that problem if we are to deal with the horrendous dental health record in those communities. A screening programme can help to achieve that.
Another mechanism to encourage dentists to remain and to do more within the NHS is the provision of assistance with infrastructure costs. Many premises urgently require to be improved. For many of them, the overhead costs do not make doing more NHS work financially viable. That must be addressed. Such support would help to improve the quality of service provided; it would also improve the level of commitment that a practice gives to the NHS. We need to reduce bureaucracy and simplify the fee scale, which currently contains more than 400 items of service.
We must also increase the dental workforce if such an approach is to work. The dental workforce has never recovered since the Tories closed the Edinburgh dental school in 1996. Other small European countries, including Denmark and Norway, have double the dentist-to-population ratio of Scotland and, of course, a much better dental health record to go with it.
The British Dental Association has estimated that at least 215 additional dentists will be required if the Executive is to keep its free oral health assessment pledge. We need to increase the number of salaried dentists from the 90 posts that are currently filled. Such posts must be targeted at places where lack of access to NHS dentists is most acute. We also need to expand the workforce further by increasing the number of undergraduates on training places and, crucially, by expanding the number and role of professionals complementary to dentistry. A lot more work could be carried out by dental nurses, hygienists and technicians to free up dentists to carry out more of the complex work. That would require a bigger investment in training and education.
The member is aware that the BDA wants three times as much investment. What is the SNP arguing for? What can the SNP come up with by way of an investment package?
As a minimum, we require £40 million to £50 million of funding in addition to the money that is already going into dental services. The oral health assessment will not be carried out for £7.05; it requires at least £20, plus investment in infrastructure and more money towards salaried dentists. A minimum of £40 million is required.
I hope that the minister will listen to the views of members across the Parliament on the best way to address the dental crisis in Scotland. As many dentists have told me, next week's statement provides a one-off opportunity to get it right for NHS dentistry. The challenge for the minister is to get it right, for the sake of Scotland's oral health.
I move,
That the Parliament is concerned about Scotland's poor dental health record; notes that only 3.5% of dentists anticipate increasing their NHS provision in the foreseeable future; recognises that if access to NHS dentistry is not improved, then the commitment to provide universal free oral health assessments by 2007 may not be met, and therefore believes that, in order to meet this pledge and safeguard the future of NHS dentistry, the Scottish Executive must provide incentives for dentists to undertake more preventive work including a significant increase in the fee level for oral health assessments, assist dentists more with infrastructure costs in return for greater NHS commitment, reduce bureaucracy and simplify the current fee scale and expand the number of NHS salaried dentists and address dental workforce shortages by increasing the number of dental undergraduates and expanding the role and number of professionals complementary to dentistry.
I am rather surprised by Ms Robison's choice of subject for this morning's debate, given that the Scottish Executive is making a major statement in the Parliament next week. That rather smacks of political opportunism. If the SNP's concerns are so great, why has Nicola Sturgeon never once raised the issue of NHS dentistry at First Minister's question time since being elected as Salmond's Scottish helper? Why do we have Conservative complacency on the subject, given that the Conservatives were responsible for closing the Edinburgh dental school in 1996? I look forward to hearing what the Tories have to say about that.
As ministers have previously stated in the Parliament, we are committed to an effective and accessible NHS dental service for all who wish to use it. For some population groups in Scotland, oral health has improved steadily. There have been significant improvements in adult oral health: 82 per cent of Scottish adults have some natural teeth, compared with only 56 per cent three decades ago, which was appalling.
We absolutely cannot afford to be complacent, however. For our children, progress has been relatively static, with very little improvement in dental decay levels since the 1990s. Improving oral health, particularly that of our children, must be our priority. We recognise that that will require a co-ordinated approach, with genuine commitment from the dental profession and from individuals and organisations with responsibility for the care of children.
I am interested in the commitment to improve children's oral health that the minister is giving. Will she give an answer to the many constituents who write to me who want to take their children to an NHS dentist somewhere in my constituency but cannot get access to a single NHS dental service for their children's benefit? What is the Government doing to tackle the crisis in rural Scotland?
I could give the member a much fuller response if this discussion followed the announcement that we will make next week. That is one frustration that has resulted from the SNP's opportunism. It is clear that health boards have a responsibility to ensure access to NHS dentists for everybody and there will be further announcements about that next week.
Will the minister take an intervention?
No. I must continue, as I have a lot to say.
In the primary care sector—in which 90 per cent of dental patients are treated—most general dental practitioners are independent contractors to the NHS who are free to choose whether to accept patients on the NHS. That there has been a reducing commitment to the NHS by some general dental practitioners in parts of Scotland is regrettable. To achieve improvements in dental provision, there must be the people to deliver such improvements—there must be the right number of people with the right skills in the right place. That means that we must combine effective workforce planning with measures to recruit and retain dental workers.
We recognise the value and potential contribution of the whole dental team in improving oral health and providing the services that are needed in a modernised NHS. Therefore, we are currently investing more than £800,000 to increase the number of professionals complementary to dentistry who are trained in Scotland. On planning the dental workforce, we have agreed a target output of 135 graduates per year for the dental schools and we have put in place funding to meet that target. We have also introduced a number of other measures to encourage recruitment and retention.
The Deputy Minister for Health and Community Care rightly outlines some good things that have been done, which we accept. However, the fundamental problem is that not enough dentists will do NHS work because they are not remunerated for it. What will the Executive do to ensure that dentists will carry out oral health assessments? Will the remuneration for oral health assessments be increased?
Again, I am not in a position to make announcements before next week. However, I can say that we are confident that our ambitious targets for free dental checks will be met and that we are putting in place the workforce to deliver them.
As I said, we have also introduced a number of other measures to encourage recruitment and retention. This year, 119 dental graduates who are undertaking their training in Scotland are in receipt of our vocational training grant, and an ever-increasing number of qualified dentists are joining our dental lists in Scotland as a result of our golden hello allowance. Through the partnership agreement, we are establishing a dental outreach training centre in Aberdeen that will further boost training opportunities. A number of measures are in place to encourage dentists to further their contribution to the NHS and to locate in areas in which NHS services are underprovided. Those measures include grants that are available under the Scottish dental access initiative and the provision of salaried dentists. There are more than 100 salaried dentists in Scotland, and I expect that number to rise.
Members will recall that in November 2003 we launched the "Modernising NHS Dental Services in Scotland" consultation on future arrangements for primary care dental services. In discussions with the dental profession and the general public, the consultation considered proposals for changes to the system for rewarding primary care dentistry in order to promote prevention, improve access to services and improve recruitment and retention. The consultation recognised the need to ensure that dental services are underpinned by a robust quality framework that is suitably rewarded. The consultation responses have been analysed and we will provide our response to it on 17 March. That response will include further measures to support NHS dental services. I am pleased to confirm that one additional support measure that we will make available to NHS dentists is a substantial increase in the general dental practice allowance, which will roughly double the practice allowance and incentivise NHS work. I am sure that that measure will be welcomed.
There has been a lot of media interest recently in the challenges that NHS dentistry faces. I accept that we need more NHS dentists and that there are particular local access difficulties. However, there is a forthcoming announcement on dental services, and it is fair to say that we have recognised the problems and introduced a number of measures to support NHS dentistry. In addition to the recruitment and retention allowances that have been mentioned, we have made available more than £12 million in the past four years for practice improvements. We have also introduced a general dental practice allowance to assist with practice costs. In the current year, the money for that will amount to around £4 million. In total, in the past year we have provided more than £10 million in additional funding to support NHS dentistry in Scotland. Many of the measures are unique to Scotland and provide Scottish solutions to Scottish problems.
I hope that the measures that I have outlined demonstrate to members our serious commitment to NHS dentistry in Scotland. However, we recognise that we need to intensify our efforts to ensure access to services, and we will continue to work to develop further measures to achieve that aim.
I move amendment S2M-2549.1, to leave out from "is concerned" to end and insert:
"recognises the need to tackle Scotland's poor oral health and improve access to NHS dental services; acknowledges the actions already taken by the Scottish Executive to improve oral health and to recruit and retain dental professionals in the NHS; recognises that further work needs to be undertaken to respond to the outcome of the consultations, Towards Better Oral Health in Children and Modernising NHS Dental Services in Scotland; notes that the Executive's response to the consultations, to be published very shortly, will include measures to address the Partnership Agreement commitments on workforce numbers, training and prevention including free dental checks and will identify the resources needed, and calls on NHS boards, higher education institutions, local authorities, the British Dental Association and the wider professions to engage positively with the Executive after publication to bring early and sustained benefits to the oral health of people in Scotland."
In May 2003, I made my first speech in the Parliament in a members' business debate on dentistry and the difficulty of gaining access to an NHS dentist in the north-east of Scotland. Nearly two years on, the only change has been for the worse, with still more dentists opting out of NHS work and more patients having difficulties accessing dental services, even privately.
Should not the member's first statement on dentistry have included an apology for what the Tories did in 1996 in closing the Edinburgh dental school?
I wonder when a party that has never been in power and is never likely to be in power will stop dwelling on the past and start looking to the future.
The problem of access to dentists is particularly acute in Grampian, Highland and Argyll. Only this week, yet another practice in Grampian—in Oldmeldrum in Aberdeenshire—closed its doors to NHS patients. I am sure that I am not the only MSP from the north-east who has received angry phone calls from patients in that area who have suddenly found themselves without a dentist.
The move towards private dental care has been prompted by a lack of investment in NHS dentistry and frustrations with the current system—particularly with the lack of time that dentists have to give their patients preventive advice. Instead, dentists see up to 40 patients a day on a treadmill of inadequately funded piecework.
Most dentists who move to private practice do so not to increase their income, but to be able to sustain their income on a reduced list size, to give their patients a better service and to gain a better quality of life without the stress of having to push patients rapidly through the system day after day and week after week.
Early retirement is common in dentistry and stress has been identified as a principal reason for early retirement. As in other professions, an increasing proportion of women in dentistry want to have career breaks and to work part-time. Too many dental graduates are moving away from Scotland after they have completed their training, and there are concerns about the current system of charging, which is
"complex and difficult … to comprehend. Any new system must be transparent and easy to understand, with the main drivers being clarity about patient charges; clarity about NHS availability; distinction between NHS and private treatment; and clarity about trust and accountability. Any replacement system must be easy to operate and avoid unnecessary bureaucracy."
Those are not my words, but the words of the BDA.
The short-term measures that the Scottish Executive has introduced in recent years to try to alleviate the current crisis have not solved the problem, and there is no doubt that a new contract is urgently needed if NHS dentistry is to survive in Scotland. The Executive's pledge to provide free dental checks for everyone by 2007 sounds attractive, but it is unlikely to be fulfilled when there is a 10 per cent shortfall of dentists north of the border.
The member has again mentioned the shortage of dentists. Does she agree that not closing the dental school would have meant that we would have had 400-plus more dentists now and that she would not have been talking about a 10 per cent shortfall? There might even have been a surplus of dentists.
Multiple factors are involved. I agree that we might have had more dentists, but I cannot answer for my party's previous actions way back in history. Nonetheless, the system has changed. Many more women are now in dentistry and the whole demography of dentistry has changed in recent years.
The Executive's pledge to provide free dental check-ups sounds attractive; however, in the words of the BDA, a quick look round the mouth to identify holes in teeth is not what is required in modern dentistry. Nowadays, patients' needs have to be assessed, and the implications of medical health and medication for dental health must be considered. Patients need to be given lifestyle and preventive advice. Those things are all time consuming, and that time is not funded by the NHS at the moment.
Children, young people, pregnant women, new mothers and people on low incomes are already entitled to free dental check-ups in the NHS—assuming that they can find a dentist—and we feel that the extension of that provision to people who can afford to pay is not the best use of scarce resources. We would look to introduce a capitation fee for adults that would be similar to that which exists for children, as we feel that that would get us away from the treadmill effect of the current system and would encourage preventive care.
Will Nanette Milne give way?
No, I am sorry. I have quite a lot to say.
You are in your last minute, I am afraid.
Under our plans, children, people on low incomes and the over-75s would be entitled to free dental care. For those who wanted it, we would introduce a voluntary low-cost monthly payment scheme for non-exempt adults, to cover them against large, unplanned bills as an alternative to the present pay-as-you-go arrangements. We would also seek an expansion in the role and number of professionals complementary to dentistry, such as hygienists and therapists, to take over some of the more routine work that is done by dentists, thereby freeing them up to perform more complex procedures and to undertake more preventive work with their patients. In addition, we support the further development of outreach training facilities in Scotland in the expectation that senior students in the later stages of their training in more peripheral parts of the country will remain in the area that they have come to know as students.
Labour promised us great things in 1999, when Tony Blair said that within two years everyone would have access to an NHS dentist. I look forward to hearing, next week, just how the Scottish Executive plans to make good that broken promise.
I move amendment S2M-2549.2, to leave out from "recognises" to end and insert:
"and believes that in order to safeguard the future of NHS dentistry the Scottish Executive should move from fee-based remuneration to capitation-based funding in order to remove incentives for over-treatment and promote preventive measures, expand the role and number of professionals complementary to dentistry in order to free up time for dentists to focus on continuing care, reduce bureaucracy and continue with the development of outreach centres to encourage students to remain in Scotland after graduation."
There is no doubt that there is a crisis in NHS dentistry. That crisis is not recent and it certainly has not come out of the blue. Ever since the Conservatives closed the Edinburgh dental school some 10 years ago, we have been heading for trouble. We have simply been training too few dentists to meet the demands of a modern and effective health service. I agree with Bruce Crawford that the Conservatives should have started their contribution to the debate by recognising the mistake that they made in closing one of Scotland's three dental schools.
The Liberal Democrats have recognised the depth of this crisis. Two years ago, in our manifesto for the Scottish Parliament elections, we stated:
"Everyone in Scotland should enjoy access to NHS dentistry regardless of where they live."
We said that we would reintroduce free dental checks for all and that we would reform the remuneration arrangements for dentistry to reward dentists for preventing dental disease among their patients as well as for treating disease and decay. We also said that we would increase the number of dental training places and establish a new school of dentistry in Aberdeen.
As a result of our taking those pledges into the partnership negotiations with the Labour Party, the coalition Government of Scotland has agreed to encourage preventive dentistry and design appropriate reward measures to support that objective.
The partnership agreement says:
"We recognise the need for an increase in the number of dentists and dental graduates in Scotland. … We will expand the capacity of dental training facilities in Scotland by establishing an outreach training centre in Aberdeen."
That centre is well on the way. It continues:
"We will consult further on the need for its development to a full dental school."
The partnership agreement also commits the Executive to assessing the reasons for the shortfall in dentists and the options for addressing that shortage.
Where is the Executive going to get all the specialist lecturers from to lecture at the school of dentistry in Aberdeen when there is a shortage across the whole of Scotland?
I thank Mary Scanlon for that right and proper intervention. The issue is serious. Because of that shortage, we decided to establish the outreach centre in Aberdeen first, as a practical measure, before consulting on the formation of the dental school.
Tom McCabe, the previous Deputy Minister for Health and Community Care, launched the consultation on the reform of NHS dentistry—the first opportunity to reform NHS dentistry in Scotland for more than half a century. My constituency has the lowest number of NHS dentists per head of population in Scotland, and there is a real crisis in the north-east. Last year, more than a thousand people queued outside Kenny Jones's practice in Stonehaven simply to register as patients. Last Monday, there were similar scenes in Nora Radcliffe's constituency. There is no doubt that a wholesale reform of the system is needed to ensure that such scenes are a thing of the past and that the Executive's promise that everyone will have access to an NHS dentist is fulfilled.
Will Mike Rumbles give way?
I am in my last minute, unfortunately.
In the long term, we need to train more dentists, and I am sure that the promised consultation will show the need for a new dental school in Aberdeen. In the short term, we need to attract dentists back into the system. That can be done in two ways: first, by removing the bureaucracy that is involved in NHS dentistry, thereby simplifying the system; and, secondly, by remunerating dentists properly to allow them more time with their patients. The SNP is arguing for an increase of only £40 million to £50 million in the Executive's dentistry budget. I believe that that is a rather low target. We need and should get a much larger investment than that from the Executive.
What is your figure?
Members will find that out when the minister makes his announcement to Parliament. I am afraid that SNP members' horizons are far too low and they should be ashamed of themselves. Only by investing properly in the future of the dental service in Scotland and by getting rid of the bureaucracy will we solve the dental crisis. I have every confidence that, when Andy Kerr outlines his plans to Parliament, he will have the package that is needed to solve the dental crisis once and for all. I am sure that he will deliver the goods.
I thank Mike Rumbles for that interesting insight into the Executive's announcement of next week. Obviously, Magnus Gardham has dropped below the standards that I expect of him in reporting the Executive's plans. However, let us give the Executive credit for its ambition. If what Magnus Gardham says in today's Daily Record is correct, the Executive
"intends that the service will be open to everyone."
If that is not a recognition of the fact that that is not the current situation, I have never heard one. Of course, Magnus prefaces that statement with the word "eventually". In the same article, Rhona Brankin is quoted as saying:
"In Glasgow, more than 60 per cent of children have dental disease before they reach the age of three. So there is a huge job to be done."
Furthermore, Andy Kerr is quoted by Douglas Fraser, in The Herald, as saying that the problems with children's oral health and dental services throughout Scotland are "quite appalling". We cannot disagree with any of those statements: on the contrary, we agree whole-heartedly with them.
The Executive's record on the issue is quite interesting, and I will go through some of the statements that it has published on the subject. On 28 October 2004, in response to parliamentary question S20-3755, asking how many dentists we would have in 10 years' time, Rhona Brankin replied that the Executive did not know. Two years ago, in March 2003, in response to parliamentary question S1W-34277, asking how many dentists there would be, Mary Mulligan replied that the Executive did not know. In response to parliamentary question S20-4341, asking about the average waiting time for NHS dentistry, Rhona Brankin replied that the Executive did not know. So it continues.
Does Mr Stevenson recognise that it is expected that, by 2006, more than 130 dentists will qualify each year?
If that is true—and I accept the minister's word for it—it is very welcome. However, let me point the minister at some other documents, such as the draft budget for 2005-06. It has nine objectives and targets for the health service, but not one on dentistry. It is not a one-off, though. If we go back a year and look at the budget for 2004-05, we find 14 objectives but not one on dentistry. It is not even confined to two years. If we go back another year, again we find not one objective on dentistry.
Will the member give way?
Just one moment.
If we look further, we will find in the current draft budget that one of the statements of priority is to
"improve dental services through incentives".
Nevertheless, the spending plans in the draft budget show that the money allocated to general dental services for 2004-05 and the following three years flat-lines at £225,176,000.
Does the minister still wish to intervene?
Absolutely. I presume that the member welcomes our commitment to provide free dental checks for everyone by 2007.
Of course I do. However, how will the minister pay for those checks and who will carry them out? Given the record to date, there is not the slightest evidence that we will see any measure that will meaningfully address the matter.
The scope of the problem becomes apparent in a parliamentary answer that the minister gave me yesterday. It appears that Nora Radcliffe, Mike Rumbles and I share the unenviable record of having the lowest number of dentists in any parliamentary constituency. In fact, when I work out the numbers, it becomes clear that we have one dentist for more than 4,000 people. Ken Macintosh is a great deal more fortunate in his constituency—he has one dentist for every 1,700 people. If the extra money—which some suggested before the debate would amount to £10 million—were to be spent in our three north-east constituencies alone, we would still not reach the level of dental care that is available in Eastwood. I hope that, given what Mr Rumbles has—perhaps—announced about the north-east receiving more than that, things will move forward.
Indeed, the number of dentists in the north-east and the Highlands is so low that the resulting high work rate is making it extremely difficult to attract any more dentists. I believe that Mr Rumbles said that everyone should be able to enjoy access to NHS dentistry
"regardless of where they live".
However, we must do something about people in the north-east.
A golden hello scheme has been introduced to attract more people into NHS dentistry. However, in its first year, it was singularly ineffective and brought only six new dentists into the health service. Moreover, those dentists went to NHS Forth Valley, NHS Lothian, NHS Greater Glasgow and NHS Dumfries and Galloway; not a single one went to the areas of greatest need.
Yes, it will help to double the dental practice allowance, but we will wait with interest to see whether that makes a difference for local dentistry. As for the £10 million that has been given over the past year, the previous figures that I received on dentists in the three constituencies to which I referred were obviously optimistic, because there have been closures since they were released. In fact, in my constituency, some people cannot even get a private dentist, never mind an NHS dentist. It is clear that the minister will have to spend money and energy on this substantial problem. Furthermore, some real objectives must be set down in tablets of stone that the Executive can be held to account for in future.
Some of my constituents have had to travel to the Czech Republic, the Netherlands and even Hungary to receive dental treatment. Well, we are hungry for dentists, and we need them now.
The challenge of ensuring access to dental treatment for all has been a growing concern in the north-east, and particularly in Grampian, for many years. Indeed, my first members' business debate and my maiden speech—like Nanette Milne's—centred on the problems of accessing dental treatment, particularly NHS dentistry.
There is no doubt that concerns can only have been heightened by the picture of the lengthy queues that formed at the dental practice in Oldmeldrum when two of the dentists at the practice decided not to continue NHS dentistry. As the motion and amendments point out, that is a problem not only for Grampian. However, there are particular difficulties in our part of Scotland.
Of course I want the Executive to take further action to resolve the situation and I look forward to seeing what happens in that respect. That said, the suggestions that have been made by some in the north-east that the Executive has not sufficiently acknowledged the issue are unfair and misleading, because serious action has been taken and substantial investment made. This debate would have been better informed not only if it had taken place after next week's ministerial statement but if more time had been spent on discussing the further measures that could be introduced instead of on bemoaning the situation.
Does the member think that it would have been best to give the Daily Record its exclusive after next week's ministerial statement?
It was quite right to bring forward constructive proposals for this debate, but we would have had a better debate in the full context of next week's ministerial statement. After all, in a half-morning debate each member has only four minutes to discuss this serious issue. As I have said, I simply believe that the right thing would have been to have the debate after the ministerial statement.
We can debate this matter in a truly informed way only if we properly acknowledge the great efforts that have already been made to meet this challenge. Many of the measures that have been introduced, including the doubling of the remote areas allowance, the doubling of the allowance for trainees in designated areas and the doubling of grants for new and existing practices, have been aimed particularly at the situation in Grampian and show that substantial investment has been made.
There have also been appointments of new NHS salaried dentists in NHS Grampian. Great efforts have also been made to recruit dentists from overseas to the area and Wendy McCombes and her team at the dental postgraduate school in Aberdeen deserve much credit for their success in attracting postgraduate students to train in the city. Such an important initiative encourages recruitment to the region.
I should also mention that not only short-term but long-term strategies have been introduced in Grampian. For example, as Mike Rumbles has pointed out, the partnership agreement to establish a dental outreach training centre in Aberdeen is an important commitment to help recruitment in future. We need such an approach. I must say to our Conservative colleagues that we cannot underestimate how much their rush to encourage the use of private treatment has led to many of the current problems. Only now will more dentists be trained in Scotland since the closure of the Edinburgh dental school in 1996.
It is tempting to consider extreme solutions to force a resolution to this problem, but the SNP's golden handcuffs policy for those trained in medicine in Scotland is noticeable by its absence from the motion. It is clear that the Executive and others must make further efforts to tackle the problem, and I welcome the wide partnership working that the Executive has highlighted as necessary in its amendment. I hope that there can be a constructive liaison with the BDA on how it can encourage more dentists to take on NHS work and on introducing incentives for dentists who carry out preventive treatment as well as remedial dentistry. I think that there is a broad agreement throughout the chamber on that matter and I am aware that the BDA has also said that it wishes to see such action.
Dentists are highly trained and deserve to be remunerated highly—indeed, that is a pertinent issue—but we need to have a dialogue with professional bodies that has a more meaningful focus than fee levels. The profession must be able to play the full role that I know that it wants to in encouraging better access to treatment and promoting dental and oral health in the country.
I agree that more needs to be done, but we can have an informed debate on what should happen next only if we acknowledge what has been done so far. It is only through taking an approach that fully includes everyone who is able to increase access to dentistry, including NHS provision, that we will be able to take full advantage of the Executive's measures to achieve the kind of access to dental services that we all want.
I welcome the chance to debate this important issue, because I am very aware of dental and oral health problems in Scotland. I began my career in 1980 as a school doctor and, in those days, we carried out medical inspection on all primary 1 children. Although we were not dentists, we also had a cursory look at the state of the children's oral health and put the results of the medical inspection on the medical form as a four-digit code. Although we stopped universal health inspections in 1982, I can still remember code 521.0, which was the code for dental caries. Indeed, it is the only code that I can remember. That shows just how much dental decay there was at the time and I am sure that that will still be the case today. As a result, I very much welcome the commitment to provide all children with NHS dental services, although I share other members' concerns about how that will be met.
Poor oral health in children is due not only to a lack of dentists but to other important factors such as diet. Any joined-up policy for improving oral health in Scotland must include robust moves to improve diet, to reduce the sugar content of the food that we are eating and are feeding our children, and to remove sugary fizzy drinks from schools.
However, I do not include fluoridation in any form of preventive dentistry. Indeed, I am very glad that the Scottish Executive has made a commitment not to carry out fluoridation, at least in the meantime, because it is unlikely to work as a way forward. I include in preventive dentistry free toothbrushes, toothbrushing schemes in nurseries and schools and dental health promotion visits by dental hygienists to schools.
One reason why I welcome the debate is that it has given me the occasion to read the Scottish Parliament information centre briefing "General Dental Services: Key Facts", which points out that the BDA has said that a 25 per cent increase in dentists in the UK as a whole is required. The BDA has also said that 215 additional dentists are needed to deliver the free dental check-ups that are promised from 2007. It is a medical truism that screening should be carried out only if treatment can be offered. There is no point in screening people's oral health in 2007 if we cannot go on and treat the problems that are found. The proposals have huge resource implications.
I have no doubt that there is a crisis in dental health care provision. It is tempting to go on about my region, the Highlands and Islands, but other members will do so. I simply point out that rural areas are almost always the barometer of problems, because they show up first there. We are almost certainly not training enough dentists and we are certainly not retaining enough of them. The SPICe briefing contains an interesting graph that shows the numbers of people who have joined and left the ranks of general dental practitioners, with the number of leavers consistently exceeding the number of joiners.
The figures on which the graph is based reveal that the biggest group of dentists who join the ranks of general dental practitioners is made up of those who have completed vocational training. I welcome the moves to carry out vocational training in more remote and rural areas in the hope that people who enjoy the experience will come back to work in those areas. The second biggest group is made up of those who have returned to Scotland. It would be interesting to know why they left in the first place. Allied to those figures is the interesting increase in the proportion of dentists in the 35-to-54 age group who leave general dental practice. They may be taking a career break or choosing to leave Scotland—the issue must be examined.
The largest proportion of those who leave general dental practice is made up not of those of retirement age, who make up a mere 20 per cent of leavers, but of those who are under 35, who make up about 40 per cent. The reasons why people in that age group leave might be well known and researched but, if not, the minister should consider carrying out an in-depth study of why dental practitioners in the different age groups leave and what we can do to keep them. It is projected that the number of dental graduates in Scotland will increase from the 115 who are expected this year to 143 in 2008. That is good, but it would be even better if we kept them.
Mike Rumbles began his speech by saying that the crisis in the dental profession—I am glad that he accepts that there is a crisis—was not exactly a surprise and that it could have been predicted because it was on the horizon for some time. He properly reflected the priorities of the 2003 Liberal Democrat manifesto in setting out the priority that is attached to the issue. However, that begs the question why we have had to wait six years under devolution, including two years under the present partnership agreement, for the Government to slumber its way into action just to give a ministerial statement on the issue. If the Government's standards and ability to deliver public service improvements are anything to go by, the statement will put progress and achievements way into the distance, rather than in the here and now, where we need them.
It is all very well for us to be lectured by ministers, Labour members and Mr Rumbles about how much more appropriate it would have been to have held the debate after the ministerial statement, but we could wait no longer—we have waited far too long for the Government to extract the digit and get on with improving Scotland's health services.
Mr Swinney will note that I did not criticise the SNP for holding the debate at this time; other members did that. However, in retrospect, does he not agree that it would have been better to wait for next week's statement? I am sure that Mr Swinney will find out then that the Scottish Executive's ambition is higher than the SNP's low level of ambition to raise investment in the dental service by just £50 million a year.
Mr Rumbles is free to correct me if I misrepresented his remarks, which I did not intend to do. However, we did not have to wait for the ministerial statement, only for this morning's exclusive edition of the Daily Record, which has a great smiling picture on the front, to find out what the Government is going to do. That makes my point. The Government tries to direct the agenda to suit itself, when it should start directing the agenda to suit my constituents and those of Mr Stevenson, Mr Lochhead, Mr Rumbles, Mrs Radcliffe and other members, who are suffering as a result of the lack of capacity in dental provision in Scotland.
I am most concerned about the effect on children. We all accept that if we influence children's behaviour, attitudes and approach at the earliest stage, we will reap the benefits in the long term. My oral health is a tribute to the persistence of my mother in taking me regularly to the dentist when I was an infant, much against my will. I am grateful to her for that—and, I would add, for many other things. If children throughout Scotland do not have easy access to dental services, we will have enormous problems in the years to come. We have presided over an era—the six years of the partnership Government and perhaps the years since the Conservatives closed the Edinburgh dental school—in which deliberately taken actions have led to the neglect of the oral health of children in Scotland.
Health services must be accessible. Like other members, I represent a large rural constituency. Just because a dental practice is available 10, 20 or 30 miles away, that does not make it easy for people to gain access to dental health care services. People who live in small towns in my constituency where dentists have given up NHS dentistry have to travel an extra 30 or 40 miles to access treatment. How can we expect parents and hard-working families in that situation to deliver for their children? We need the Government to have the highest ambition. If the Government delivers a great injection of resources and energy into dental health services in Scotland, I will have the good grace to welcome that, but it had better do so quickly, because people in the country are suffering and they should not suffer any longer.
It is, literally, painfully obvious that there is a big problem in NHS primary care dentistry; we do not need the SNP or anybody else to tell us that. We could trace the problem back to the independent-contractor status of dentists at the inception of the NHS back in 1945. More particularly, we could trace it back to the deregulation of NHS dentistry in the 1980s and the closure of the Edinburgh dental school in 1996 by another Government, to which a number of members have referred. It would be easy to show that the nationalist agenda would only make things worse; the important issue is to understand the immediate problem and to work together to achieve solutions.
I understand the problem only too well. A substantial number of my constituents in places such as Haddington and Longniddry have been dumped as NHS patients by dentists who have gone private. I declare a personal interest: the dentist who had treated my family for 20 years or so wrote to me last year to say that he was no longer willing to treat us as NHS patients but that he would take us on as private patients, at a price and on the understanding that we would turn our backs on the NHS. By an unhappy coincidence, I lost one of my front teeth at the same time. Therefore, I am extremely grateful to the NHS dentist in Edinburgh who accepted my family as patients when my dentist in the Borders privatised his practice. However, it is not tolerable for any patient to be compelled to make a round trip of 120 miles or more to see an NHS dentist.
I was seriously shocked when a constituent who was in pain came to my constituency office this week to ask for advice from my secretary when he was refused treatment by his local dentist. That is an outrageous state of affairs, particularly in a country that has such an awful dental health record. Patients who cannot afford private treatment are being held to ransom.
Does the member welcome the appointment of two new dentists, in Kelso and Hawick?
That is good news. My secretary got in touch with Lothian NHS Board about that constituent's problem, which occurred in Dunbar. I welcome what is being done, but there is clearly a problem.
We look to the Executive and, importantly, to the dental profession to find solutions that will enable all citizens to get regular dental checks and treatment. It seems clear enough that the Executive is willing to help to find solutions. As the minister said, it has taken steps to increase the number of dentists who are being trained—the target is to have 150 undergraduates starting every year—but it needs to look to the future with the dental profession. Patients should be entitled to expect appropriate commitment from that profession. I understand that the average earnings for dentists in Scotland are between £51,000 and £65,000 a year, after allowing for practice costs. The PayFinder.com website says that dentists are the second best paid professionals in Scotland after finance directors. I do not begrudge them their money, but in those circumstances it should not be too much to expect appropriate commitment from dentists to NHS patients in all parts of Scotland.
The dental profession might accept its share of responsibility for the present situation, but it must play its part in achieving solutions. Like doctors, dentists are rightly held in high esteem and their remuneration is high, but I am beginning to hear some strong criticisms of them. It worries me when I hear people using terms such as "greedy" and "uncaring" about an important group of health professionals.
I conclude by urging the minister to bring the Executive's authority and its resources to bear to help to rebuild NHS dentistry. Scots have some of the worst teeth in the world and people in every part of the country need regular access to good-quality dental checks and treatment. I hope that the minister will direct NHS boards throughout Scotland to identify areas where NHS dentists are required and to take steps to meet that need.
People are entitled to expect the Executive and the NHS to play their part in resolving what is a serious problem, but it is just as important that patients are entitled to expect the dental profession to be professional and to demonstrate a proper commitment to treating NHS patients in return for fair remuneration. The minister has shown that she is listening; I just hope that dentists are listening, too.
I start by agreeing with John Swinney that the Executive has a cheek to condemn any party for bringing forward a debate about dental health when Labour has neglected dental health since it came into power in this Parliament in 1999 and at Westminster in 1997. The Government has accepted that there is a crisis since as far back as 2001, but it has done nothing. Although it concluded its consultation on modernising dentistry last year, a year later it has taken the publication of a report by the Health Committee and the threat of a debate on the subject by Opposition parties to force it to make a statement. Even now, the Executive is not prepared to make a statement today and tell us what it intends to do, although it is prepared to make a statement to the Daily Record. That just about sums things up.
Will the member give way?
I am sorry; I tried to intervene on the minister, but she did not let me. I might give way later.
We need to put the situation into perspective. I remember when I was a small child in what were—in comparison with what we have now, at any rate—the glory days of the welfare state. I noticed at first hand the improvements that resulted from the move to community dentistry and the establishment of clinics. The Florence Street clinic in the Gorbals was brilliant, but before it came into being I had a horrific experience when I was about three years old: a dentist up a close in the Gorbals slapped me around to wake me up from an anaesthetic after an extraction. Thank goodness for the Florence Street clinic. Such clinics have not attracted the necessary investment since then. Their ability to radically change children's oral health demonstrates the arguments for universality.
My next example demonstrates the need for universality even more. The fact that most people are excluded from free dental treatment unless they are on income support or are pregnant can give rise to terrible situations. I remember the awful sight of my mother—who at the time was pregnant with my little brother—standing over the sink with blood pouring out of her mouth because she had taken the opportunity that being pregnant gave her to get all her teeth extracted and to have dentures fitted. She knew that she would not be able to afford any dentistry after my wee brother was born. Such horrors demonstrate the necessity for universality in dental treatment.
Since its inception, the NHS has failed to properly incorporate dental services. We are seeing the symptoms of that now. The system of having dentists attached to community health provision and general practitioner services obviously works very well. That is the case in Greenhills, the area of East Kilbride in which I live. I pay tribute to the dentists there who, despite all the difficulties, are still working to provide NHS services.
We have had some vague commitments to increase the number of dentists. Rhona Brankin said that there might be an extra 10 dentists a year. That would still amount to only a quarter of the 40 a year that were lost as a result of the closure of the Edinburgh dental school, so the Executive is not doing much better than the Tories.
In some responses to the Executive consultation, arguments have been put forward in favour of regressive charging methods, whereby those people who were most in need and could least afford treatment would have an incentive to take responsibility for improving their own health. What utter claptrap. That was the situation that prevailed prior to the establishment of the NHS and it is why, in 1948, a third of dental appointments were for the extraction of all teeth and the fitting of dentures. If we do not act, the state of the nation's teeth will deteriorate even further and we will soon have the situation in which every third person whom we bump into on the street has a set of wallies. We need to act now.
What I hear from all quarters of the chamber about the lack of dental services rings a bell with me. As members can imagine, the remoteness of my constituency means that the problem there is acute.
I want to deal with what other members have said. Shona Robison was correct to mention the need to increase the number of dentists. The revelation that the SNP seeks an increase of £40 million to £50 million in funding is interesting and bears scrutiny. That figure should be compared with the figure that the minister announces next week.
The Executive can increase the level of fees and the amount of infrastructure support that it provides by as much as it wants. What I am saying is that if we are to start to make a difference, a minimum of £50 million is required. If the Executive's figure is bigger than that, we will be the first to welcome it. I am sure that Mike Rumbles knows whether that is the case because he decides Executive policy on such matters.
The SNP's figure has gone from £40 million to £50 million.
The issue is not just about the numbers of dentists; I will return to that point.
The minister is right to talk about the doubling of practice allowances, which is important. Although Nanette Milne and Mary Scanlon represent the nice face of the Tory party—I am trying to be a gentleman—it is very difficult for them to account for the mistake that was made when the Edinburgh dental school was closed. I am afraid that that is an unhappy episode in history. We must learn from that and never repeat the mistake. Mike Rumbles is quite correct to say that in the partnership agreement we have gone for the new dental school. He mentioned outreach, to which I will return, along with Shona Robison's point about the numbers of dentists.
Stewart Stevenson commented on the goal of providing free dental checks by 2007, which is a worthy aspiration. All parties acknowledge the difficulty of reaching that target, but it is right for us to set our sights high. I thank Mr Stevenson for his support on that point.
Is it correct that the member is prepared to set high targets and fail rather than set achievable targets that can be resourced?
That is ludicrous. The member knows me well enough to realise that I would go for a higher target all the way. Nice try.
Eleanor Scott's point about the link with diet was correct and I whole-heartedly endorse it. In a high-quality speech, John Swinney referred to the influence of his mother. The point that he made is true. By taking children to dentists and giving them proper things to eat, we can head off problems. John Home Robertson's impassioned speech spelled out the sorts of problems that we all face.
I turn to my view. The issue almost transcends party politics; that is why I welcomed John Swinney's worthy speech. In the Highlands, Eleanor Scott, Maureen Macmillan and members of all parties—except the Scottish Socialist Party, unfortunately—have been working together with NHS Highland in a think-tank to try to come up with solutions.
I return to the point about the numbers of dentists. That is not the only problem in the Highlands. We could have all the dentists in the world, but how could we persuade them to come to Caithness? In relation to Mike Rumbles's point about outreach, it is interesting that we are in the process of developing a system whereby two or three students will come north to work in a practice in Caithness for a number of weeks or months. The extractions and fillings that the students do will take a little longer, but they have the necessary skills. We hope that the students will come to love that special part of the world, which may increase the chance that they will stay there.
I will finish with a personal comment—it is my view, not that of my party. I believe that in dentistry, and perhaps with GPs, we might be able to be imaginative by emulating what the armed forces do. They pay students a salary while they are at university on condition that they sign up to the colours for five years. We could do that with dental students, who could agree to be put where a particular NHS board wanted them to go. It might be possible for them to be sent to Sutherland, Dumfriesshire or wherever. That sort of creative thinking from all political quarters is what is needed to address the problem.
The minister has done well. I look forward to next week's announcement; I am sure that the figure will be substantially more than £50 million.
I am pleased to debate dentistry—or the lack of it—this week, next week or any time after that. As Jamie Stone said, dentistry is one of the main issues in the Highlands.
If members focus only on the closure of the Edinburgh dental school, they are missing the mark. The retention of dentists is a real problem. Members should be asking how many trained, qualified and experienced dentists are not working in their own profession.
One of the points that John Swinney made took me back to the time when I paid for my two children to have fissure sealing. Although at the time it cost £8 per tooth, my two children are now in their 30s and neither of them has any fillings. As fissure sealing can now be provided free of charge, I hope that it will be made available to more children.
I point out the fact that a million more people in Scotland have their natural teeth than was the case 30 years ago, but in Caithness alone, 15,000 people are on the waiting list for NHS dentistry. In the town of Nairn, people face a wait of almost four years if they want to see an NHS dentist. Dentistry is not just about fillings: an extensive dentistry check-up will pick up the early stages of and the problems that are associated with oral cancer, which is one of the fastest-growing cancers in Scotland.
That takes me to the £16.8 million that Tom McCabe has allocated for free dental check-ups for everybody by 2007. Like Shona Robison, I want to know whether the check-up will be the £7 quick look round the mouth; the more extensive £9.95 check-up; or the full case assessment at £20.80. That point is important. If the free check-up is to be only the basic check-up, 2.5 million people will get it; if it is to be the £9.95 check-up, 1.68 million will get it; and if it is to be the all-singing, all-dancing full case check-up, just over 800,000 people will get it.
By any account, we are not talking about free dental check-ups for every person in Scotland. Whatever check-up it is, it is certainly not what was promised in the partnership agreement. Apart from the question of which check-up is on offer, I would like to know how many dentists the Executive has signed up to provide them. I understand that not many dentists have signed up—certainly not enough. The question of how many dentists do so will naturally depend on the payment that they receive from the Executive.
Although many people in the Highlands can afford the check-up at a price of between £25 and £32, they cannot afford the treatment. Every six months for four years, the free check-up will tell people what dental treatment they need, but all the while they wait to be treated. If people want to shop around for treatment in Inverness, they have to pay £25 to £32 for every estimate.
When we read the Government jargon, we learn that pregnant women and others are entitled to free dental treatment. However, they are entitled to that treatment only if they can find an NHS dentist. I return to another of the points that John Swinney made. Under an MEL—management executive letter—all children should be given three free check-ups during their primary and secondary education. That does not happen in the Highlands and I doubt that it happens elsewhere.
And now for the good news. I attended the dental think-tank meeting in Thurso recently with my colleague Jamie Stone. I commend Cathy Lush of NHS Highland and Professor Bill Saunders, dean of dentistry at Dundee dental school, for their innovative approach to outreach clinics for the training of advanced undergraduate dental students. Although the initiative is not the full answer to the lack of dentistry provision in remote and rural areas, I have no doubt that it will help. I also hope that it will help in the recruitment of local dentists who will act as trainers. The advanced undergraduate students will provide a better integration between our community dental services and the dental school in Dundee.
I have one final point to make, which has not been mentioned so far in the debate. I hope that the Executive will take account of the six-minute clean-up time that is required for infection control, which now takes place between each patient appointment. Naturally, those clean-ups will reduce the time in the working day that is available to treat patients.
I listened with interest to the various issues that have been discussed in today's debate. Clearly, we still have a lot to do if we are to improve the poor state of Scotland's dental health; nobody would disagree with that.
In Scottish dental services, we have matched all United Kingdom developments; in fact, Scotland leads the way on changing dental services.
Will the minister give way?
No. I would like to finish the point. If the member will allow me to do so, I will respond to one of his earlier points.
As I said, Scotland leads the way in changing dental services with, for example, our individual preventive programmes for children. Clearly, we have a long way to go, but we have more dentists per head of population than the UK average.
Will the minister now give way?
No. In reply to the member's point that we have no targets, I suggest that he reads the workforce plan that was published in 2004. If he does so, he will see that by July 2008, we will have 143 dental graduates and, by July 2009, 157 graduates. That is a steady increase and I am sure that Mr Stevenson will want to welcome it.
Will the minister take an intervention?
No, I would like to make progress.
We have made a considerable and encouraging start with the additional funding and short-term measures that we have introduced, including those that are uniquely Scottish. That said, the process needs to be inclusive, not exclusive. If we are to make a real success of improving the dental health of our people, we need to work in partnership with the professions, the service and patients.
Improving children's dental health is a priority for the Executive. A number of the initiatives that we currently undertake relate to prevention: if we are to secure lasting gains, prevention must be the right way forward. I am proud of the toothbrushing schemes that are now to be found in the majority of nursery schools and of the provision of fissure sealants for six and seven-year olds, free fruit for young children and the nutritional guidelines for schools.
We need to do more, however. By ensuring that parents register their children with a dentist at an early age and by providing advice on toothbrushing and the benefits of a healthy diet, we can offer an effective way of improving oral health.
Will the minister give way?
No. If the member does not mind, I would like to make progress.
Prevention cannot start too early. As well as contacting all parents with new babies, we have introduced a unique toothbrushing scheme that already delivers daily toothbrushing training to over half the infants who attend nurseries in Scotland.
There is already a wide variety of initiatives to improve the diet of children throughout Scotland. Those initiatives include fruit for infants in pre-school settings such as local playgroups; support for breakfast clubs; and fruit and salad bars in school settings. The initiatives will increase the consumption of fruit, vegetables and carbohydrates. They are also likely to reduce the amount of unhealthy snacks, crisps and sweets that young children consume and so contribute to improved oral health.
Making cool water fountains or water points available to all young children in educational settings will also make considerable inroads into improving oral health. Our introduction of fissure sealing for the teeth of young children, through the enhanced capitation schemes that are targeted at those in most need, can only assist in the fight against tooth decay.
Will the minister take an intervention now?
No. If I may, I prefer to carry on.
On access to NHS dental services, I am aware that availability in some parts of Scotland is getting worse, particularly for adults. It is unfortunate that some dentists have chosen to move towards the provision of private services. As we have heard, that was encouraged from the time that the Conservatives were in power.
In circumstances where health boards have experienced particular difficulties in providing access to NHS dentistry, we are able to authorise the provision of salaried dentists. We will continue to operate and build on the salaried service. In fact, over 100 salaried dentists now operate in Scotland. Over the past two years, we have also made additional funding available for the provision of emergency dental services. If we can build on that provision, we will ensure that people who suffer unnecessary pain get quick and effective support.
There has been debate about the number of dentists we produce in Scotland and whether that number is sufficient to provide an adequate service. We have double the number of graduates per head of population than the rest of the UK. We have more dentists than ever before in Scotland and we have taken positive steps further to increase the number of dental professionals training in Scotland. We will keep that under review.
The nature of primary care dental services has also changed considerably, not least because of advances in technology.
One last chance, minister?
No. I am in my final minute. I have let Mr Stevenson intervene once already, and it was an exceptionally long intervention.
We need to continue to build on those developments—particularly in the quality and standards of service and in the rewarding of dentists who are committed to the NHS, to ensure that a modern NHS dental service meets the expectations of the people of Scotland.
As I mentioned earlier, the Executive will announce on 17 March its response to the consultations on children's oral health and on modernising NHS dental services. Our response will build on the work that we have already undertaken and will introduce further measures to support both prevention and the provision of NHS dentistry in Scotland.
The minister and her back-bench colleagues may be unhappy that the SNP has chosen this subject for debate. In her opening remarks, she said that she was surprised by the choice. I explain to the minister and her colleagues that the reason why the SNP chose this subject for debate is that it is one of the biggest health issues in our constituencies the length and breadth of Scotland. The minister should perhaps bring the issue to the chamber more often, to let the country know what she is doing.
I have been amazed by the number of people in Grampian who have contacted me on this issue in the past few years. At a meeting just last week, I spoke to a person who asked me—after we had discussed what we were there to discuss—whether I could tell her how she could access an NHS dentist. I then went to the University of Aberdeen to meet an academic to discuss the oil industry. At the end of the conversation, he said, "By the way, can you give me some advice on how to get an NHS dentist, because I've just been deregistered?"
Dentistry is a huge issue in all our constituencies, which is why we have to discuss it here today. As John Swinney said, we are in the sixth year of devolution but we are still waiting for real progress. We are in the sixth year of this Labour-Lib Dem coalition and we now have our sixth deputy minister with responsibility for health who is charged with trying to sort out the mess in the NHS dentistry sector. Iain Gray was the first to have a go; then we had Malcolm Chisholm, Frank McAveety, Mary Mulligan and Tom McCabe; and now Rhona Brankin is at the helm. I know that it is a huge task to follow in the illustrious footsteps of those immense individuals who came before her.
Mr Lochhead mentions how long we have had to wait—and it has been a long time—but would it not be wiser to wait just one more week? I hope that Mr Lochhead will then welcome the Executive's initiatives, which will show much greater ambition than that shown by the SNP.
I have to say that it would be helpful if the minister made more announcements to this Parliament, as opposed to going to the Daily Record. We might then have more of an idea of what the Government is doing.
We hope that this will be sixth time lucky. The minister has the chance to succeed where others before her have failed. The people of Scotland are keen to move on and to get access to NHS dentists in their communities as soon as possible.
The minister has not got off to a great start. One of her first actions was to allow the chief dental officer in Scotland to go part-time. That decision left dentists throughout Scotland completely perplexed. It was a sign of complacency. The minister is not taking the issue seriously enough.
Does the member acknowledge that the chief dental officer will in fact continue to work with the NHS and to work in the education field? That is a hugely important role, given his contribution to what Mr Lochhead will be hearing about next week, in our announcement on modernising dental services.
That just shows how out of touch the minister is. She does not acknowledge the terrible message that has been sent out to patients and dentists in Scotland. At the height of the NHS dentistry crisis, she allows her chief civil servant to go part-time.
The minister has to acknowledge the scale of the crisis. Many members have today tried to illustrate the crisis in constituencies throughout Scotland. Mike Rumbles, Stewart Stevenson and others have talked about the scale of the crisis in Grampian—a crisis that Andy Kerr, the Minister for Health and Community Care, denied existed on his visit to the area a couple of weeks ago. As Mike Rumbles quite rightly said, it is a crisis. There is no other word for it.
Grampian region alone accounts for one third of patients in Scotland who have been deregistered from the NHS over the past few years. No dentist is currently taking on new NHS patients. The local helpline has been inundated with calls from worried constituents. Emergency dental services in Grampian and elsewhere in Scotland have become the first—and perhaps the only—port of call for patients who are trying to get dental treatment. Because they cannot see a local dentist for preventive work, patients are having to wait until the problem is so serious that they have to go to the emergency dental service at the local hospital.
We have heard about the queues at Oldmeldrum, Stonehaven and elsewhere. A Hungarian who is resident in Aberdeen found that it was cheaper to fly to London, then to fly to Hungary for treatment, and then to fly back, than it would have been to pay for private treatment locally.
The problem affects many rural areas, especially the Highlands, the Borders, Dumfries and Galloway and Grampian. People have seen their shops and banks close; now they cannot even get access to a local dentist. Salaried dentists are part of the answer—there should be more of them—but in rural areas that will not work unless a health board unit with a salaried dentist opens up in every community. We have to attract dentists back into the NHS.
I want to touch briefly on the growing problem in hospital-based dental services, which creates more of a logjam for local dental practices. In areas such as Grampian, local hospital-based services are overstretched. There is only one orthodontic consultant to cover the whole of Grampian, although there should be three. We heard about the family from Ellon who had to remortgage their house to get £3,000 for private orthodontic treatment for their 13-year-old son. Their son had been on the local waiting list for orthodontic treatment since he was nine. That is unacceptable; we have to address it.
Does the member welcome the fact that Grampian NHS Board has recently provided orthodontic consultations in the private sector, to try to alleviate the backlog?
Of course I welcome that, but I am trying to convey to the minister the scale of the crisis in NHS dental services—not just in local communities but in hospitals in some parts of Scotland.
We have heard a lot about the benefits of oral health, and Eleanor Scott spoke about diet and other ways of improving oral health.
If we are to deliver free dental checks, we need the dentists. There is no point in making pledges that cannot be fulfilled. That is irresponsible. The minister does not even seem to know how many dentists we will need in Scotland to fulfil the pledge to deliver free dental checks. We have to attract more dentists to work in Scotland and we have to train more dentists here in Scotland.
At present, there are many more applications to dental schools than there are places. There is therefore scope to expand the training of dentists in Scotland. We may have to open new dental schools, because we have to ensure that more dentists are working in our communities.
This Government has somehow—at a time of record NHS investment—allowed dental services to implode in many areas. The Tory party's legacy in Scotland was long dole queues; this Government's legacy will be queues of people trying to get basic access to NHS dentists in their communities. The minister should acknowledge that this is a huge crisis that should be top of her health agenda.