Plenary, 17 Mar 2005

Meeting date: Thursday, March 17, 2005

Official Report 757KB pdf

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Dentistry

The next item of business is a statement by Rhona Brankin on dentistry. As is normal on such occasions, the minister will take questions at the end of her statement and there should be no interventions during it. While the minister prepares, it would be helpful if members who wish to ask questions could press their request-to-speak buttons.

The purpose of my statement is to provide the Executive's response to the consultation documents "Towards Better Oral Health in Children: A Consultation Document on Children's Oral Health in Scotland" and "Modernising NHS dental services in Scotland". In the action plan that we are publishing today in response to those consultations, we outline measures that represent the most substantial programme of work that has ever been undertaken to address Scotland's poor oral health record and to provide better access for patients and an attractive package for the professional staff whom we wish to recruit to, and retain within, the national health service.

On fluoridation, I can confirm that the Executive will not change the current legislation in this Parliament. By maintaining the current position, we will still retain powers to allow national health service boards to consider whether, in the light of local consultations, they wish to make an application to Scottish Water to increase the fluoride content of the public water supply in their areas. Our decision recognises the case for, and the benefits of, fluoridation. In the absence of popular consensus in Scotland as a whole, we will retain the existing legislation.

On the two consultations, I do not need to remind colleagues that Scotland has an appalling oral health record. Our children have some of the worst teeth in Europe. Currently, only 45 per cent of children are free from dental decay, but the problem is even more prevalent in areas of high deprivation and poverty. In some parts of Glasgow, more than 60 per cent of children have dental disease before they reach the age of three and five-year-olds have average levels of dental decay that are six times greater than is experienced in other parts of the United Kingdom. By the time that they reach the age of 14, two thirds of all Scottish children have dental disease. On average, people in their parents' generation have 10 fillings and have had eight teeth removed. Over half of all 65-year-olds have lost all their teeth.

In addition, access to NHS dental services has been a problem and in some parts of Scotland it has become a major problem. I recognise the justified concerns that many people have about the current system. Today, dentistry has become increasingly complex and we continue to feel the effects of the closure of the Edinburgh dental school by the Conservative Government in 1996. We inherited a system that was in difficulties. We have taken action already, but it is now time for more radical measures.

Our main, but not exclusive, focus will be on those whose need is greatest and on whom the greatest potential impact could be had: children and older people. Having learned the lessons from some of our European neighbours, we will make much better use of the talents and potential of the whole dental team. We will invest unprecedented levels of resources in public health programmes that will target those most in need.

Given the size of our nation, the children's toothbrushing programme that we will implement will be one of the largest in Europe. The Scottish programme currently involves more than 1,400 nurseries and 60,000 children in daily toothbrushing and provides free toothpaste and toothbrushes to the children. The number of children involved will be doubled, as the programme will be offered to all children in nursery and to those children in primary schools with the highest levels of dental disease. Our longer-term aim is to roll out the programme to all primary schools.

The potential significance of our action plan can be highlighted by the results of a pilot in Dundee, where a supervised fluoride toothbrushing programme in primary schools that had high levels of dental disease helped to reduce dental decay by almost half among children by the age of nine.

The implementation of our school meals policy, "Hungry for Success", is under way in all schools and we are working with local authorities to ensure that fizzy drinks have no place in primary schools and are replaced by water and milk in all our schools and nurseries. We will give responsibility to community health partnerships to achieve a more co-ordinated approach to oral health across community-based services, building on parenting programmes such as sure start and starting well.

Scotland's parents have a responsibility for the oral health of their children. As with diet and exercise, instilling a culture of toothbrushing and mouth care early on is a task for the family and the home. We will support parents in that task. We will promote oral health and prevent dental disease in our children from birth through to the teenage years. We will offer dental care to all children from the earliest stages and will implement new schemes to promote registration and preventive activity from birth. Our goal is that, on starting nursery, all children will have access to dental care and advice from a member of the expanded dental team. We will aim for an increase in the number of children aged three to five years who are under dental supervision from 66 per cent to 80 per cent. Our goal is for every child to be registered with a dentist and we will monitor progress closely. We will introduce a new programme that is targeted on those children in greatest need. It will include new, enhanced services for those with extensive caries, including mobile dental units working in our most deprived communities.

We will also provide better preventive services for older people and disadvantaged groups. The first phase will be implemented by introducing, later this year, free oral health assessments for people aged 60 and over. That will include an examination of the soft tissues for oral cancer and it will underpin the move towards a preventive service for all.

The consultation on modernising NHS dental services produced a consensus on the need for substantial change to meet the expectations of patients and dental professionals. We have already started along that path, uniquely in the UK, by introducing a number of measures that are aimed at improving the recruitment and retention of dentists and by introducing support for practices, including practice improvement funding and practice allowances. There are encouraging signs that those Scottish allowances are starting to pay dividends, particularly in respect of the increased numbers of new dentists joining the dental lists in Scotland, but we need to do much more.

We already have more dentists per head of population than the UK has. We will further increase the number of dentists in Scotland by more than 200 by 2008. To do that, we will increase dentist output from our dental schools, offer dentists incentives to return to Scotland and recruit from outwith Scotland. We will also increase the number of dental therapists in training by 33 per cent. Dental therapists can provide a wide range of dental treatments as part of the dental team. We will introduce better training for all members of the team, from dental nurses to practice managers, and help to reduce the administrative burden on clinical time.

However, we also need to ensure that those independent-contractor dentists who have been, and continue to be, committed to the NHS are suitably rewarded and that they increase the amount of time that they devote to the NHS. That means giving them better support for their premises, information technology, staff, and health and safety needs, in return for their commitment to the NHS. The more work they do for the NHS, the more support they will get. We also need to strengthen our salaried services, particularly in areas where there are insufficient independent-contractor dentists to meet the needs of patients.

To resource this radical overhaul of dental services, we will be providing unprecedented financial support—an additional £150 million over three years—to achieve our goals in oral health and NHS dentistry. That is the biggest-ever investment to support NHS dentistry in Scotland. In the first year, we will be providing an extra £45 million to improve oral health and support NHS dental services. That will rise to £100 million the year after and will build up to £150 million of additional funding by 2008.

The action plan, which we are publishing today, contains a radical list of actions that we are determined to implement in the next three years, and we will make a substantial start from next month. In addition to the doubling of the practice allowance, which I announced last week, we will provide a further £5 million to help dentists to improve their practices. We will give NHS boards authority to appoint directly salaried dentists to meet local needs. In addition, we will increase the remote areas allowance for NHS dentists to £9,000 per year.

We will provide further infrastructure support for premises by introducing a rent reimbursement scheme and we will modify our existing dental access scheme to provide funding for dentists who wish to take over practices while maintaining NHS services. We will also begin an IT programme to support dentistry by providing and maintaining a connection to NHSnet for all NHS dentists.

We will modify the commitment payments scheme to recognise the contribution of part-time dentists who are committed to the NHS. We will provide £1 million to support emergency dental services further.

We will cut red tape in surgeries by radically simplifying the system of dental remuneration: we will reduce the current 450 items to around 45 to 50 items. We will introduce a financial support package for professionals complementary to dentistry and we plan to introduce a bursary scheme for dental students who commit to NHS dentistry on graduation.

Those are only the first steps and our action plan outlines the further work that will be undertaken over the following two years.

No one on the partnership benches underestimates the challenges. Many members have been quick to highlight unacceptable cases and to proffer solutions, but it is the Executive that has devised and costed the plan and which will deliver the plan. We will deliver better oral health for Scotland's children, provide access to dental services wherever people are in Scotland and deliver an NHS dental service that people will want to use and will be proud to work for.

Because there are 20 minutes into which to fit questions and my screen shows that 18 members want to speak, I will allow the first three members two questions, but subsequent members will have only one question each.

I thank the minister for the advance copy of the statement and welcome the £50 million a year—that is exactly the estimate that the SNP gave last week of the minimum that is required to make a difference. It is a pity that that funding was not delivered six years ago.

First, I ask the minister to elaborate on the funding package that is available to get more dentists doing more NHS work. Specifically, on the oral health assessment, the dental profession has said that free dental checks will not be achieved for £7.05. What is the new fee under these proposals for that important preventive measure? Finally, with this investment, will the minister guarantee to everyone who wants it access to an NHS dentist by 2007?

I think that Shona Robison has selective amnesia. She said last week that she thought that additional funding should be between £40 million and £50 million.

In total.

Absolutely. That was in total. We are providing £150 million of new money. It is important to make that distinction.

We are committed to providing free dental checks by 2007. As I have said, we intend to introduce later in 2005 a free oral health assessment for those aged 60 and over. That will be reviewed with the intention of rolling it out to all, but those patients will be entitled to that free dental examination before 2007. We will roll out the fuller dental examination for those aged 60 and over in 2005 and the situation will be reviewed with the intention of rolling it out for everybody. We guarantee that in the longer term everybody will have access to NHS dentistry. That is what we intend to provide and it will start with the commitment to provide free NHS dental checks by 2007.

I, too, thank the minister for the advance copy of her statement, which contained a lot of warm words and a number of welcome things. However, I do not think that the British Dental Association will agree that £50 million a year is what is needed to attract dentists back into the service, because it has clearly stated that more than double that amount is required.

First, a reduction in red tape is welcome, but if the number of items to be charged for is reduced tenfold, will that mean that the remaining 45 to 50 items will attract a significantly larger fee than they do at present? Is there any indication of what the fees will be? How will other items be funded? Secondly, the Executive wants to train significantly more dentists and professionals complementary to dentistry, but are enough trained staff available in colleges to provide that training in the near future?

I make it clear again for the benefit of the Conservatives that we are making available £150 million of new money.

Conservatives have asked in the past about remuneration systems that are based on capitation. We believe that the best system of remuneration is a mixture of rewards. We do not think that it is effective to put all one's eggs in the capitation basket. One of the dangers of doing so is that a practitioner might seek to do as little as possible, as the money will be paid in any event. Indeed, there was some evidence of that in the past. The best way forward is to have a mixture of capitation and fees.

To make it clearer, the £150 million of additional money—[Interruption.] Let me make it clearer, because it is important. It is not just a question of £50 million of additional money. In 2005-06 there will be an additional £45 million, in 2006-07 the figure will rise to £100 million, and in 2007-08 there will be £150 million of new money. That is good news for dental services in Scotland.

The Liberal Democrats very much welcome the biggest-ever shake-up of NHS dentistry since the NHS was formed more than half a century ago. There is no doubt that the Executive's plan will solve the dental crisis that has engulfed the north-east in particular but which has affected every part of Scotland. Will the minister confirm that the resources that she has just focused on will increase by £150 million by 2008? That is a rise of 75 per cent, from £200 million a year to £350 million a year, in just three years.

Absolutely. It is important to make the point that, in total, we will be spending £350 million by 2008. I am grateful for Mike Rumbles's support. I know that he has worked hard to secure better dental services in Grampian, and that he welcomes the proposal to open a dental outreach training centre in Aberdeen and to consult further on the possibility of a dental school in Aberdeen.

I, too, welcome the minister's long-awaited statement on this substantial investment. The minister and her predecessors will be aware from my correspondence of the serious situation in Dumfries and Galloway, where no dentists—private or NHS—are taking on patients at the moment. Patients who phone the health board to ask to be put on a list are just put through to a recorded message.

Is the minister sure that there is enough capacity within—[Interruption.] Members are laughing, but this is serious in my constituency. It is not a laughing matter. Is the minister convinced that there will be sufficient capacity in areas such as Dumfries and Galloway to enable dentists to reopen their lists? If they are unable to do so, what further measures are available to enable NHS boards to fulfil their obligation to provide NHS dental treatment to children and other vulnerable groups?

As I said in my statement, NHS boards will now be able to access directly and employ salaried dentists. That will be hugely important in some of the more remote and rural areas in Scotland, and I hope that it will benefit Elaine Murray's constituency. In addition, as I have announced, the remote areas allowance, which is based on NHS commitment, has been increased from £6,000 to £9,000. We are committed to the provision of NHS dentistry wherever people live in Scotland. We have a clear responsibility to ensure that there are enough dentists and that dentists are encouraged to practise in rural areas.

At a recent meeting with Dumfries and Galloway NHS Board, I was told that it would take five years for lists to open to NHS patients. Can the minister give a date by which she feels that the measures that she has announced today will enable constituents in Dumfries and Galloway who are not currently registered with a dentist to receive NHS treatment?

The figure that Chris Ballance quotes was given before today's announcement. We estimate that, by March 2008, an additional 400,000 people will be registered with an NHS dentist. The ability of NHS boards to employ salaried dentists will make a huge difference in rural and remote areas.

I thank the minister for her statement and welcome the unprecedented levels of spending on dental health. She talked about the expanded dental team. How does the Executive intend to utilise better those who work in the professions complementary to dentistry? I welcome the announcement of a support package for those professionals, but how does the Executive intend to use them to improve access to dental care?

We have said that we will increase the number of dental therapists by 33 per cent. It is hugely important that we have a complete dental team. There are jobs that dental professionals other than dentists can do. For example, in the past, dentists spent time polishing teeth. This morning, I visited a nursery school at which children as young as 14 months old were being taught how to brush their teeth. Dental therapists and dental nurses will play a key role in introducing youngsters to oral hygiene and toothbrushing. They will be hugely important in releasing dentists to carry out the more complex examinations and treatment. By increasing the number of professionals complementary to dentistry, we will ensure that we have the number of professionals that we require to make NHS dentistry available to all who need it.

I thank the minister for her statement and welcome many of the measures that are contained therein, which will also be welcomed by constituents in the Grampian region who are suffering some of the worst problems in this regard. Does she think that it is too late for many dentists who have gone private to turn back and return to the NHS, or is she confident that they will all do that? Will she also answer the question that Shona Robison posed: what fee will be paid through the NHS to local dentists for delivering free oral assessments?

I am confident that the attractiveness of the package that I have announced this afternoon will encourage dentists to return to the NHS. It is hugely important that that happens in areas such as Grampian, where people have lost access to NHS dentists. I am glad that Richard Lochhead welcomes today's announcement. I am sure that he will join Mike Rumbles in welcoming the proposal to open a dental outreach training centre and the proposal to consult further on the possibility of a dental school in Aberdeen.

I welcome the minister's excellent statement. I am sure that it will be welcomed throughout Scotland. Given the fact that the Breastfeeding etc (Scotland) Act 2005 will come fully into force tomorrow, does the Scottish Executive plan to take any action to clarify and promote the dental health benefits that are associated with breastfeeding?

We supported the Breastfeeding etc (Scotland) Bill, and believe that breastfeeding is very important in developing calcium in babies' teeth and in giving them strong teeth and healthy gums. In Scotland, problems have arisen because youngsters have had access to sugary fizzy drinks from a very early age. In that respect, our advice on breastfeeding and healthy weaning for young mothers will be hugely important for children's oral health.

Will the new fees for oral assessment and other dental work take account of the six-minute infection control period between each patient? I also remind the minister that she has not answered the second part of Nanette Milne's question on training.

The new fee structure recognises the increasing need to take infection control into consideration and the additional administration and practice running costs that will be incurred. Moreover, I have announced today that the general dental practice allowance, which the Executive introduced, has been doubled. In 2003-04, which was the first year of the allowance, we made around 600 payments totalling £2.5 million. This financial year, we expect to pay out £4 million. We will support practices with these new types of funding, which are in addition to the fees that they are already paid, and we are confident that those moneys will cover the costs of existing demands on dental practices.

I warmly welcome the minister's statement, in particular its emphasis on prevention. Does she agree that the foundations for good dental health are laid in the early months and years? Further to her answer to Elaine Smith's question, will she assure the chamber that she will work to embed the promotion of good oral health not just in early-years settings but in ante and post-natal education care and support programmes across Scotland?

Yes. I agree fundamentally with Susan Deacon, which is why women who become pregnant will receive an oral health pack that explains the importance of looking after their children's teeth and gums as soon as they are born. We acknowledge that providing early years dental care and the new dental care programme in nursery schools will be hugely important.

However, the issue is more than just dental care at nursery school. Our parenting programmes will provide additional support initially in our more deprived areas to build on the good work of projects such as sure start and starting well. We will ensure that youngsters are breastfed to begin with and then are weaned on to other milk and water instead of being given fizzy and sugary drinks, and that they are encouraged to eat fresh fruit and vegetables. Of course, we have already introduced a programme in our schools that encourages youngsters to eat fresh fruit. Coupled with our huge toothbrushing scheme—the largest ever in Scotland—that will make a significant difference to the incidence of dental caries.

Although the statement is most welcome, we should acknowledge the fact that a large number of people out there who are perhaps among the poorest and most disadvantaged in our society have not accessed any dental services in recent years. I seek the minister's assurance that she and the dental services will work very closely with health departments, general practitioners, social work and suitable care organisations to identify, reach out to and target the people who are most in need of this most welcome investment.

Absolutely. My statement is underpinned by the need to improve the oral health of all people in Scotland. However, that need is clearly much greater in some communities than it is in others. As a result, the communities in greatest need will receive additional support for parenting. Moreover, dental professionals will target the areas in greatest need of dental care. There will be additional support in the form of mobile dental vans reaching into our most deprived areas to ensure that youngsters in those areas have access to dental care and to increase the number of youngsters who are registered with dentists. The longer-term intention is that every young person in Scotland will be registered with a dentist, but the numbers are low in particularly deprived areas. We will start by targeting such areas, in the first instance by increasing numbers of registrations.

I am sure that the simplified fee structure will be welcomed, but will the minister say any more about the level of fees, particularly for oral inspection, bearing in mind that it is a crucial dimension in the retention of dentists in the NHS?

I am unable to give the member more information about specific fees at the moment because the matter is still subject to negotiation with our dentist colleagues. People should be content with that.

The fee structure is intended to ensure that dentists are properly rewarded and that they are able to undertake preventive work, which is what dentists have told us they want to be able to do. They have a system that is beset by red tape and bureaucracy. We have announced today that we will improve and simplify that system and we have announced a significant package today that will motivate and encourage dentists to join the NHS and keep them treating patients in the NHS. That is our aim and I am confident that we can achieve it.

What was the fee on which the increase to £355 million was based?

The fee is a subject for negotiation. [Interruption.] I will continue to answer the question. I have announced today that we have responded to what dentists have asked us. We have simplified the fee structure. We will drastically reduce the number of items on which the fee is based from around 450 to between 45 and 50, as dentists asked us to do. That matter is subject to negotiation with the dentists and members would expect nothing less than that.

Will the minister tell us a little about the discussions that she has had with the dental profession so far? The Executive is committing a lot of resources to dentistry, which is welcome. Has the minister received an equivalent commitment from dentists to provide the services that patients require in every part of Scotland? I ask that question as one of many patients who have felt badly let down when my family's NHS dentist went private.

As the member knows, there was extensive consultation with dentists when we were drawing up the plan. It is important to say that wherever someone lives in Scotland and whoever they are, they should have access to an NHS dentist. One of the difficulties for people in recent years has been in accessing NHS dentists. The package that I have announced today will encourage people to come into NHS dentistry, it will encourage dentists to stay in NHS dentistry and I hope that it will encourage dentists who have gone into private practice to come back into NHS dentistry. I am confident that the package that I have announced today will do just that.

That concludes questions on the statement, which I let run on in view of the large number of people wishing to participate.

On a point of order, Presiding Officer. I waited until this stage to raise my point of order because of the importance of the statement. At 5 past 3, I was able to get from the press gallery copies of the press statement, the ministerial statement and the six-year action plan. Members were unable to get copies of that material until after the minister had completed her statement, yet the media had them at the beginning of the statement. Is that not disrespectful to the Parliament? Can you ensure that it does not happen again in future?

I am not in a position to ensure that at all. The release of the documents before the statement is a matter for the minister. As to when documents are released to the press and to members, members must appreciate by this time that any complaint about that is properly a matter for the Executive.