Dentistry
Good morning. The first item of business today is a debate on motion S2M-3584, in the name of Lewis Macdonald, on dentistry. I invite members who wish to speak in the debate to press their request-to-speak buttons.
Today's debate and announcement are about delivering good news to national health service dentists and patients. We will provide dentists who are committed to treating all categories of patients on the NHS with the rewards and incentives that they deserve.
Will the minister give way?
That is a very early intervention from Mr Morgan, but of course I will give way.
Does the good news to patients include a guarantee of a timescale in which they will be able to register with an NHS dentist?
If Mr Morgan will be patient, he will hear what the good news includes.
The good news is intended to encourage dentists to stick with or, indeed, to come back to the NHS and thereby to enable patients to access NHS dentistry where they want it.
In March this year we published our three-year action plan for improving oral health and modernising NHS dental services. We have committed a record amount of new and additional funding to support delivery of the action plan.
Further to the point that Mr Morgan raised in his earlier intervention, the crisis of access to NHS dentists in many communities is happening now. In many communities, particularly in the rural areas that I represent and including the town of Alyth, there are no longer any NHS dentists, which means that people have to travel formidable distances for treatment. What will be done now to address the fact that people are losing access to essential NHS dentistry services?
My answer to Mr Swinney is the same as my answer to Mr Morgan: if he will have patience, he will hear what we are going to do now.
The additional funding amounts to an extra £45 million in this financial year, rising to £100 million next year and £150 million in 2007-08. Cumulatively, that is additional investment of £295 million in oral health and dental services. Of that total, £237 million will go towards supporting primary care dental services—in other words, to the high street dentist.
I will outline today how we intend to invest the additional money that we are committed to spending in the current financial year.
I congratulate the minister on the substantial amount of money that is being invested in dentistry. How many dentists will it bring back into the NHS?
There have been three interventions so far in which members have asked me to pre-announce my announcement. My answer to Mary Scanlon is that if she listens to what I say about what we are investing, she may make her own judgment about how successful it will be in providing an incentive to dentists to return to the NHS.
We will spend £4 million this year and £29 million will be provided over the four year action-plan period to support improvements to oral health. In particular, we wish to build on the most recent figures for children's oral health. The national dental inspection programme confirms the best-ever oral health among five-year-olds and shows that the measures that we are taking now are already having a positive effect. However, there is more to do.
Will the minister give way?
I must make some progress, but I will give way later if members' questions have not been answered.
Two consultants in dental public health are working with NHS boards to develop our agenda. We are actively recruiting staff, including oral health promoters and dental health support workers.
Most NHS boards are already well on their way to meeting the nursery school tooth-brushing target, with in excess of 70,000 children brushing daily. Several boards have started to extend the programme into primary schools that have the highest need. We have two programmes in place—one in the west of Scotland and one in the east—to improve oral health among young children and to target those who have the worst dental health by offering additional preventive care by dentists and dental care professionals. In addition, we are providing £29 million over the action-plan period—£4 million of it this year—to support improvements to education and training in the dental workforce. A number of measures are already in place to achieve that end.
The dental schools will achieve an output of 135 dental graduates from next year and will exceed that target by 2008, with a potential 180 graduates by 2010.
How can we take any comfort from that figure when research shows that only 3 per cent of those dental students intend to work in the NHS?
I will answer that directly. To support the expansion, we are funding additional senior staff linked to the outreach programme for each dental school. A new bursary scheme is currently being finalised; it will be tied to a commitment from students to work in the NHS for five years after their graduation and it will be offered from next year.
We are also expanding existing training in order to deliver more than 200 new dental nurses in 2006-07 and 250 in 2007-08. We are now producing the first ever dental therapists trained in Scotland. Courses are already in place in Glasgow and a new one started this month in Edinburgh. We will match the increased output from the dental schools with vocational training places for all dental care professionals. A number of additional measures are currently being developed; for example, the clinical effectiveness programme that is based in Dundee.
Has the minister made any progress towards reaching a decision about whether Scotland requires a third dental school to replace the one that was closed by the Tories some time ago?
I accept the member's point. We have made a commitment to consult by 2007 on the need for a third dental school.
I will move on from education to primary care dental services, which is the nub of many of the questions that have been asked this morning. This year, we will provide £37 million in new and additional funding to support primary care dental services. We are well on course to exceed the commitment that we made some months ago to double the general dental practice allowance this year. Last year, that funding amounted to £4 million and since publication of the action plan, we have made two quarterly payments totalling over £5 million through the allowance, which supports dentists' practice costs. We have also increased the remote areas allowance to £9,000 a year and are extending it to more practices.
We have already made available in this financial year £5 million to assist with practice improvements. Half of that money is targeted at meeting decontamination requirements. Central purchasing contracts have been arranged for dentists through Scottish healthcare supplies and we are currently finalising contracts for clinical waste disposal.
Critical and central to all those measures is our ensuring that the significant additional funding for primary care dental services goes to dentists who remain loyal to the NHS or to those who choose to return to the NHS in response to the incentives that we provide.
I will share some comments that relate to discussions with the British Dental Association Scotland, which is the nub of Shona Robison's amendment. I assure members that officials have been in regular contact with the BDA and the profession more widely since and before publication of the action plan. I met Robert Donald, chairman of the Scottish dental practice committee—which is the negotiating committee of the BDA—and his officials at the beginning of October. I made it clear to Robert Donald, as I make clear again today, that the additional money that we are providing beyond the increase in the general dental practice allowance is intended to encourage dentists to stick with the NHS. Our position—that we require a commitment from dentists to treat all categories of patients in order to access the extra funding—is non-negotiable. I have made that position clear, both publicly and in meetings with dentists, since then. It is important to be clear about those discussions with the BDA.
Clearly, we want the BDA to support our proposals enthusiastically; after all, it represents half the profession in Scotland. It is a significant player and we want it to be on board. However, as the BDA has been unable to agree to the principle of NHS commitment, it has been necessary for me and my team to move ahead and to define the commitment in more detail.
Yesterday, I made our position clear publicly—for the benefit of MSPs and our constituents who are finding it difficult to access services—and directly to the BDA. I will reiterate what I said yesterday to ensure that everyone is clear about it. The test of NHS commitment is that a practice needs to treat 500 NHS patients and 100 fee-paying adults per dentist, and its gross NHS earnings must be at least £50,000. Practices need to maintain or increase their registration profile to continue to qualify for the additional allowances.
We all accept the need for more incentives to attract dentists back into the NHS. However, the minister will appreciate that in many parts of Scotland there are no NHS dentists. If the package that he has announced does not succeed in attracting more dentists back into the NHS, what is his plan B?
I will give members the details of the package, because doing so might provide an answer to the question that several members have asked about whether we will succeed in getting more dentists back into the NHS.
We have signalled to dentists our intention to introduce reimbursement of the current market rental of dentistry premises to NHS-committed dentists. Valuations are under way, and in the December payment schedules we will make an interim payment of £4 million towards those valuations and that reimbursement. Final payments will be backdated to April 2005. Moreover, to reward dentists who are committed to NHS dentistry, we will again double the general dental practice allowance to 12 per cent of gross NHS earnings. That represents a further investment of £7 million in NHS-committed practices.
Since I took up this ministerial post and assumed responsibility for dentistry, I have sought to engage with dentists throughout Scotland and their representatives. Although there has been disagreement in some areas, we have reached clear agreement on others. For example, many dentists are concerned about the costs of decontamination, which must be met. Although we have already made £2.5 million available this year to address those costs, we realise that some items in the dentistry statement of remuneration are particularly affected by the need for decontamination. As a result, I announce a further increase in the item of service fees, mainly for root-canal treatment, which will provide more than £1 million to support delivery of those critical services.
I also announce a range of increases of up to 70 per cent in the continuing care and capitation allowances, which will provide an additional £10 million in a full year to support registration of adults and children in the NHS. Moreover—this is not relevant to this financial year—we will introduce from next April an allowance of £9,000 per dentist to dentists who serve disadvantaged urban areas to match our existing commitment to practitioners in remote and rural areas.
Will the minister give way?
Will the minister give way?
Given the time, I really must make progress.
The current NHS system already provides additional financial support for treating children who have learning disabilities. By doubling the continuing care payment—which will mean an extra £2.8 million a year—we will extend that provision to adults in recognition of the additional time that is required to treat such patients. Furthermore, from early next year, as part of our drive towards prevention, we will spend £2.8 million a year to make fissure sealants available to all children who have permanent molar teeth.
We are making those significant investments in order that we reflect the value that we place on NHS-committed dentists and the services that they provide. My vision for the future, which is shared by other Executive ministers, is of an NHS dentistry service that is delivered, in the main, by motivated and well-rewarded general dental practitioners. I realise that there is a place for a salaried service and we have invested significant funds in that. However, I acknowledge the point that has been made by many people to whom I have spoken that the future delivery of effective NHS dentistry depends on high street dentists' continuing commitment, and on attracting back dentists who have chosen to reduce their NHS commitment.
I believe that that combination of measures and the requirement for commitment to the NHS to access this significant additional funding will persuade many dentists that they will be better off either sustaining their commitment to the NHS or coming back into the service if they have chosen to go elsewhere. The record funding package and the measures that I have outlined today demonstrate our continuing support for NHS dentistry to the benefit of patients and practitioners.
I move,
That the Parliament notes the widespread concern about loss of access to NHS dentists; endorses the view that public resources should be focussed on the provision of NHS dentistry available to all and measures proven to improve oral health; welcomes the progress that has been made to date in implementing Improving Oral Health and Modernising NHS Dental Services in Scotland; recognises the positive developments in improving oral health, supporting dental education and training, increasing the workforce and supporting primary care dental services, and acknowledges the vital contribution which NHS dental services make to health improvement and patient care.
We must end the foghorn diplomacy that we have seen of late. It is unhelpful and, indeed, is in danger of alienating ordinary dentists, the vast majority of whom want to do the best for their patients. We accept that a small number of dentists have not put their patients' interests first; however, that is not true of the majority of dentists, who are a bit fed up with being portrayed as greedy and insensitive to their patients' needs.
I agree completely—it would be entirely inappropriate to portray the vast majority of dentists in that way.
What is the Scottish National Party's view of the difference in principle between the BDA's approach and that of the Executive? We believe that additional funding should be given to dentists who are committed NHS dentistry, but the BDA does not.
I will address that question in a moment.
The tone and atmosphere of discussions are sometimes almost as important as the issues that are being discussed, and I am very concerned about the tone and atmosphere of the current discussions—indeed, about the lack of such discussions. It is hard to see how, in such an atmosphere, the dentistry profession will be encouraged to agree to the proposed deal. Of course, it must agree: what will happen to the Executive's plans if many dentists simply walk away? We must remember that, in the research that the Health Committee commissioned in February, only 3.5 per cent of primary care dentists stated that they intend to increase over the next two years the time that they spend treating NHS patients.
Without the co-operation of general dental practitioners, the Executive's plans cannot and will not be delivered and the crisis in NHS dentistry will worsen. Access problems cannot be resolved simply by increasing NHS-salaried dentists, which—although we welcome the move—will bring only a relatively small number of dentists into the system. They cannot be resolved by making a few deals with companies such as Integrated Dental Holdings Ltd or, indeed, by welcoming into Scotland a small number of dentists from Poland and elsewhere. Even with the most optimistic forecasts, such measures will not be enough to fill the gap. We need GDPs to stay with the NHS or, if they have left it, to rejoin, but I am afraid that such an aim will not be achieved in an atmosphere of hostility and bad faith.
On the tone of the negotiations, does Shona Robison share my concern that Robert Donald, who is negotiating with the Executive on behalf of the BDA, is also the chairman of a company called Independent Care Plans UK Ltd and actively promotes private plans around Scotland?
That is an example of the problem that I have been highlighting. There is fault on both sides in the negotiations and, for the record, I agree with the Executive that adults should be included in the definition of NHS commitment. However, if we are to have the best chance of success, the onus is on the Executive to create the right atmosphere.
I have to say that I have been very concerned about the Executive's approach. For example, it ran to the press just as yesterday's talks were about to start. Does that help in reaching a successful outcome? I suggest that it does not. Moreover, on the attempts to sideline BDA Scotland, it is neither here nor there whether the Executive likes the organisation. The BDA is the professional association and trade union for dentists in the UK and, like it or not, the Executive will have to agree the deal with it.
The Executive's release of the answer to Stewart Stevenson's parliamentary question on dental salaries is another example of an attempt to brief the press to make dentists look greedy, without mentioning that the gross figures that were referred to are required to pay for staff costs and premises, too. That was disingenuous to say the least, and was seen by ordinary dentists as an attack on them.
It is important to clarify for the record that the parliamentary answer that was given to Stewart Stevenson stated specifically that it referred to dentists' gross earnings from NHS work.
The Executive's spin doctors put the spin that I described on the story when they were speaking to the press. A bit of honesty in the debate would not go amiss.
My concern is about what it all means to the patient. There are patients who cannot get access to a dentist or who are in danger of losing the dentists whom they have at the moment. A huge gamble is being taken that dentists will sign up to the deal, despite failure to agree its terms with their representatives. I would like to know what evidence the Executive has that its strategy will work. Can the minister guarantee that progressing the proposals without the agreement of the BDA will not lead to acceleration of deregistrations? I also want the minister to answer in summing up the question that my colleague, Richard Lochhead, asked: what is plan B?
On the detail of the plan and the definition of NHS commitment—bearing in mind that we saw the plan only yesterday and that the dental profession has not yet responded to it—we support the broad principle that a practice must provide general dental services to all categories of patients in order to secure the new allowances. We also agree that the required number of registered NHS patients appears to be reasonable and is not a particularly high threshold. We have some concerns, particularly about measuring NHS commitment on the basis of gross NHS earnings, which must be £50,000 or above per dentist if they are to receive 100 per cent of the new allowances. One of our concerns is about the position of part-time dentists, many of whom are women, who might be disadvantaged by the criteria. I ask the minister to respond to that concern in his summing up.
As I said, what is on the table is broadly acceptable to us, but it is the way in which the plan has come about that concerns us most, and we believe that that puts at risk the chances of its being successfully implemented. If the dental profession itself does not sign up to the plan, it will not be good for patients. The Executive's target is that an additional 400,000 patients be registered with an NHS dentist by March 2008, but only last year nearly 58,000 patients were deregistered as more dentists left the NHS. Access to dentists in many parts of Scotland remains as difficult as ever, and that is before we even discuss delivery of the free dental checks which, if access is not improved, will be a theoretical rather than a real entitlement, which will lead to further public dissatisfaction.
There is not a problem only in primary care: secondary care dental services are also a real cause for concern, with a rise in overall waiting times for all specialties since 2004. In Glasgow, patients have to wait 15 months for specialist orthodontic work, compared with 30 weeks in 2004. We must get that part of the system right, as well.
In frustration, the people who can afford to are turning to the private sector. There has been a huge increase in the number of people taking out private dental plans. However, not everyone can afford to do that, and those who can afford to should not have to. Given that they pay their taxes, people should be entitled to treatment through the NHS. The Executive will be judged on whether everyone who wants access to an NHS dentist will get access to an NHS dentist within a reasonable timeframe. It is unfortunate that the minister could not provide my colleague, Alasdair Morgan, with a timeframe for that.
Those are some of the challenges that we face. There are other challenges to do with training of dentists; our support for a third dental school is on record. We are a bit fed up of hearing about endless consultations on that and we want to see some progress.
The proposals that the Executive has made will not turn the situation around, but the plan could be a step in the right direction if, and only if, the Executive can take the dental profession with it. That can be achieved only through constructive dialogue between the Executive and the British Dental Association, so we look forward to a bit more of that.
I move amendment S2M-3584.2, to leave out from "welcomes" to end and insert:
"acknowledges the vital contribution which NHS dental services make to health improvement and patient care; believes that to progress implementing Improving Oral Health and Modernising NHS Dental Services in Scotland requires the co-operation of the dental profession, and therefore urges the Scottish Executive and the British Dental Association urgently to reach agreement on the definition of ‘NHS commitment' in order to secure the future of NHS dentistry in Scotland."
NHS dentistry has all but disappeared from parts of Scotland, as more and more dentists become disillusioned by the pressures of bureaucracy and low fees, which have put them on the often-cited treadmill of drilling and filling. They have been in the situation of seeing patient after patient without having the time to deal properly with them or to look at their overall dental welfare.
If dentists pick them up, today's announcements should help to allay some of the concerns that have resulted in dentists leaving the NHS. However, I know from my dealings with them that dentists who have left the NHS have absolutely no intention of returning to it, whatever is on offer. Given the current general anger and distrust in the profession, I have no confidence that the measures will result in the commitment that the minister requires from dentists if they are to access the funding that is on offer.
What would Nanette Milne do to encourage dentists who will not return "whatever is on offer", to use her words?
We can more or less forget about the dentists who have left the service. We are considering those who have not yet left. I have to say that I agree with the BDA, which is looking for a sliding scale of commitment. The minister is saying that there will be an absolute cut-off point before any funding can be accessed, but the sliding scale is a much more interesting proposition, so I am upset that he is not negotiating that with the BDA. There is great distrust, and I really do not think that dentists will come back. They are continuing to deregister patients from the NHS, and dentists to whom I have spoken are basically angry.
The situation does not augur well for the implementation of free dental checks for all in 2007, but that is probably just as well, because it is wasteful to extend free checks to people who can perfectly well afford to pay for them, especially when there are not enough NHS dentists to carry out the treatments that may be identified after check-ups.
As most dentists are independently contracted to the NHS, they are perfectly within their rights to opt out of the service. Their being lambasted by successive ministers as being greedy and disloyal to their patients—we have heard that in this chamber—does nothing to improve the situation and it will certainly not help to keep disillusioned dentists in the NHS or to entice back those who have left. The profession is extremely angry, and the attitude of ministers has infuriated dentists.
Will Nanette Milne give way?
No. I need all my time.
The action plan that was put on the table several months ago left dentists wholly unimpressed, and they have continued to leave the service in significant numbers. The aims of the plan were seen by the professionals as being laudable, but they do not really think that the increase in committed dentists can be achieved. In the eight months since the plan was announced, there have been on-going negotiations between the Executive and the British Dental Association, as the minister has said, but there has been a failure to agree the terms of the financial package and dentists continue to leave the NHS. The negotiations were certainly not helped by yesterday's announcement of the commitment that the Executive expects. I was listening to Andrew Lamb on the radio this morning, immediately ahead of a meeting that he had been expecting to have yesterday afternoon, and he was clearly incensed.
The stopgap measure of recruiting overseas graduates as salaried dentists in the NHS will, although it is welcome, have little impact on the worst-affected areas of Scotland and will not provide a long-term solution to the problems of NHS dentistry. The plans for the dental outreach facility in Aberdeen to bring senior dental students into the north-east and the funding for the extra 20 students who started training in Dundee are welcome too, but will there be enough teaching staff to train them? I am told that there may be some difficulty in recruiting staff from Dundee to Aberdeen.
Will Nanette Milne give way?
I will not give way. I am short of time.
There is difficulty in getting staff who are willing to come to Aberdeen. I am told that lecturers from fairly far north may be asked to come out of retirement to provide that service in Aberdeen. I have to say that that is anecdotal evidence, but there is concern that it might be the case.
There is no apparent shortage of young people who are willing to train in dentistry, but there is real difficulty in retaining them in the NHS workforce. As in other professions, there is a high proportion of female graduates, most of whom will want time out to raise a family. Many male graduates, too, are taking time off work to pursue other interests—often not in dentistry. A University of Dundee study said that most students want to work in mixed private and public practices.
Considering that many of the problems in dentistry stem from the closure by the last Conservative Government of the third dental school in Scotland, does the member now acknowledge that that closure was a mistake, and would she support the Liberal Democrats and the Executive in moving towards a third dental school for Scotland in Aberdeen?
That dental school was closed a long time ago, and it was closed on sound advice at the time. The information that I am getting from dentists is that there are enough students; the problem is that they are not staying in the service. Only a very small proportion have said that they will commit themselves to NHS dentistry. The possibility of companies such as IDH putting NHS dentistry services in place might help. However, its staff turnover is high, and patients will not get continuity of care from it.
The present situation is unacceptable, with the NHS failing to recruit young dentists or to retain those who have been contracted to it. Most dentistry is delivered in high street general dental practices. Overheads are high, so the offer of help with some of those overheads is welcome, but even with that help, the financial rewards for dentists are not huge. Silly figures have been bandied about in the press, although I accept that the minister has said that they are gross figures. The public, however, does not see that they are gross figures. That puts dentists into bad repute, because people think that they are earning huge salaries. In fact, their take-home money is relatively small, when one looks at the training that goes into their expertise. The minister is promising a great deal of money, but it still falls short of what the BDA says is required. Dentists have been unimpressed by the offer.
My party feels that we have to examine how oral healthcare is delivered in other countries and to learn from their experiences. We would like to see NHS dental services available for everyone, but we may have to look outside the NHS. That is recommended even by some dentists in the health service.
You must finish now.
I was going to speak a bit more about my policies, but the minister would not pay much attention to them anyway. Instead, I encourage him to look carefully at my amendment and to support it.
I move amendment S2M-3584.1, to leave out from "endorses" to end and insert:
"is further concerned that the Scottish Executive's initiatives will not entice dentists back to the NHS; recognises the increased support in dental education, employment of overseas dentists and financial packages enacted by the Executive but sees this as a stopgap solution which will do nothing to stem the tide of dentists leaving the NHS in the future; calls for more initiatives for dentists to undertake preventative work, a reduction in bureaucracy and for the Executive to create a more genuine and innovative debate on the future of dentistry, and further calls on the Executive to engage positively with the wider profession to ensure that reforms and initiatives enable every patient to have access to a dentist."
I remind members that if they speak over their time—Mrs Milne was 40 seconds over hers—that will cut out members on the back benches.
I start by apologising to the chamber for being late. I did not avail myself of the irresponsible drinks promotions in the foyer last night and went home, then suffered from the traffic this morning.
I appreciate being able to make this speech. I start by saying that it is quite amusing and heart-warming to hear the Tories sticking up for low-paid workers. It will be interesting to see whether they stick up for local authority workers, such as the women who are currently being bullied into accepting unacceptable compensation for equal pay. I hope that the Tories will sign my motion on that.
Is it in order, Presiding Officer, to point out that this is a debate on dentistry?
I am giving Ms Leckie another second to get into the debate.
It was irony. My amendment refers to the inequalities that undoubtedly exist in dental health status. Although areas such as Lanarkshire definitely benefit from community dentistry, which has been a success of health policy over the years, the inequalities in dental health persist. There is inequality even in the free distribution of toothbrushes and toothpaste: the more affluent areas of Lanarkshire get more toothbrushes and toothpaste per head of population than the more deprived areas do. Those figures come from a recent Lanarkshire Health Board publication.
The Executive, dentists and health boards have a long way to go to address the inequalities in dental health and to allow people greater access to a dentist. It is true that rural areas suffer most from a lack of access to dentists.
We must tackle head on the fact that dentists are, in effect, rewarded for repair work; they are rewarded not for preventing ill health or for preventing decay but for the number of fillings and procedures that they carry out. The poor dental health of the children of Lanarkshire is a cash cow for dentists. That is completely unacceptable.
I do not subscribe to the notion that dentists are low paid. I understand that payments to most dentists are not as high as has been portrayed in the media, but compared with the Scottish population, they are very well paid: 75 per cent of Scots earn less than £25,000 a year.
We have created a rare elite in dentistry, and that is the focus of my amendment. We need radical action to face it down. We must widen access to education for dentistry and we must ensure that, in future, dentists are not a rare, privileged elite, but a common profession that is rewarded fairly and appropriately. It should not be an exclusive profession that can hold patients to ransom.
It is apparent that when it comes to big business, private health providers or elites in society, the Executive—encouraged by the SNP—takes an approach of all carrot and almost no stick, although I appreciate that it is perhaps applying just a wee twig to the BDA at present.
I find it shocking that the SNP's only answer to the problems of dental provision is more carrot. It wants to stuff dentists' mouths full of gold. The SNP wants to keep rewarding dentists with more when they ask for it—unlike Oliver Twist. Dentists, along with consultants in the health service, have had more carrots stuffed down their mouths than Bugs Bunny.
I am grateful to the member for allowing me to intervene. I ask her: what would she do?
I do not think that the member has read my amendment. What I would do is quite simple in the short term: as the amendment says, I would get a commitment from people who are trained by the state to continue to work solely for the NHS for at least five years, under a salaried scheme. I thought that the SNP supported that. I have an amendment that Shona Robison lodged a wee while ago that refers to having more NHS-salaried dentists. I wonder whether that is still the SNP's position.
It is.
Well, in that case, I hope that the SNP will support my amendment. It is time to face dentists down; it is time to demand a commitment; and it is time to run NHS dentistry to meet the needs of patients, not of dentists. That is where the negotiations should be focusing. If the BDA is a trade union, it will be happy to participate in collective negotiations on a salary scale.
The amendment does not refer to current dentists—I do not claim that it is a panacea. However, it does attempt to tackle the problem head on. It would open up access to training and would get from the dentists we train an NHS commitment for at least five years. That is a policy to which the Executive aspires and which its consultation found a majority of correspondents to be in favour of. I am encouraging the Executive to grasp the nettle on those two points.
When surveyed, the vast majority of NHS patients in Scotland say that they want NHS dentistry. In rural areas, they are taken hostage and are blackmailed into going private. In effect, NHS dentists have been blackmailing low-paid workers with exorbitant fines that chase them off the NHS register and then have been holding them to ransom to bring them back to their surgeries as private patients. That is completely and utterly unacceptable. We must take radical action. It is time to face them down, not roll over.
The situation is completely unacceptable. If this Parliament, with its devolved powers, is not able to tackle the elites of our society and apply the same sticks to them as it does to teenagers, asylum seekers and pensioners—people in the most vulnerable sections of society—it is not worth the money that we paid for it.
I move amendment S2M-3584.3, to leave out from "welcomes" to end and insert:
"regrets that inequalities in dental health status and access to dental services persist; believes that NHS dental provision is under serious threat; further believes that radical action in recruitment and widening of access to dentistry training is urgently required, and believes that the dentists whom the state educates and trains should be required to give a minimum commitment to NHS service of five years, within an agreed NHS salaried career structure."
The short time that is available to us this morning is hardly enough to deal with what is probably one of our most intractable problems. It is certainly among the most difficult that I have come across during my time in public life. The seeds of the current problems in dentistry were without question sown in the late 1980s and early 1990s. The failure of the Government at that time to modernise the terms and conditions under which dental practitioners were paid for NHS work, coupled with the closure of the Edinburgh dental school, led, in part, to the problems that we face today. When the closure of the dental school was proposed, the British Dental Association said that there was a real risk of an oversupply of trained dentists. That turned out to be a terrible irony.
I commend the Executive for creating the opportunity for up to 15 extra dental students to graduate each year, for its action on the outreach centre in Aberdeen and for the forthcoming consultation on a new dental school in Aberdeen. I also welcome the important package that the Deputy Minister for Health and Community Care announced this morning, which covers workforce, education and training aspects and deals with oral health and general dental services.
There is no doubt that health boards have taken considerable strides in recruiting NHS salaried dentists, who are being deployed around the country. Borders NHS Board has made use of some of the available funds, and I am pleased to see new dentists and staff in Hawick and Kelso, in my constituency. There has been investment in new surgeries and facilities. My understanding is that further recruits are to be sought—despite local Tory critics' pronouncements—among the next wave of Polish dentists. Therefore, some Polish dentists will join the Polish community that already exists in the Borders.
The new investment will help to deal with pain relief and urgent dental work for individuals who are not registered with a practice, as well as with the traditional forms of community dental work for children and the elderly. However, we should be clear that, although the investment in NHS salaried dentists is welcome, it cannot possibly fill the gaps that have recently been created. In other words, the welcome investment is necessary, but it does not represent all the solution; rather, it forms part of the solution in certain areas.
I will address briefly one of the points that Carolyn Leckie made. It is absolutely essential that we promote better dental health. By investing in dentistry, we are dealing with the problems caused by a failure to invest in health promotion. We still need to do more in schools and in the community to invest in dental health promotion. That is something on which Liberal Democrats are very clear.
On the Executive's proposals to enhance general practice, the investment of £295 million is clearly significant and is more, I think, than the Opposition demanded. The question is how that sum will be divided. Around £60 million will go on workforce education and training and on oral health and general dental services over three years, which will leave around £237 million for the NHS salaried sector and general dental practitioners. I am sometimes asked how much money will go to general dental practitioners. My view is that it will be the great balance of that £237 million, for the simple reason that general dental practitioners represent the most important component in delivering dental services.
We know from the figures that came out in response to a question from Stewart Stevenson what dentists generally earn. However, it is important to stress that we have been discussing gross earnings. That is why the package is directed at cutting some of the costs of general dental practice. I think that dentists should continue to earn significant sums from the NHS, because the work that they do is immensely valuable. It is critical. Dentists work very hard in a difficult profession—one in which I would not want to engage. The prospect of peering into other people's mouths is not something that appeals to me or to many other people. It is a very difficult job.
The Executive's package is a huge investment, and I sincerely hope that the sceptics in the dental profession will recognise it as such. The minister has confirmed that the statement of dental remuneration will commence in April 2006. That will usher in a huge simplification of the charging scale, with the number of variables going from about 400 to about 40. Surely that will address the bureaucracy that dentists have raised as an issue in the past.
The minister has set the access threshold for new money at a sensible level. A dentist with 500 or more patients need take only 100 NHS fee-paying adults to access the package. It is hard to envisage why any dentist could not reach that threshold and thereby qualify. I take the point that has been made about part-time dentists, and I hope that the minister will address that issue in due course.
I record my party's welcome for the allocations that have been announced today, for the general dental practice allowance, for the rent rebate scheme, for practice improvements, including decontamination, and for capitation and continuing care. The package should encourage dentists to continue to take NHS fee-paying patients and I hope that it will draw dentists back into taking such patients. Indeed, we all have a duty to help to persuade dentists to take NHS fee-paying patients, because there is nowhere else to go.
We now come to the open debate. We are three minutes behind, so I will be tight on members' six minutes.
I note what you say, Presiding Officer.
Of all the issues that constituents have presented to me over the years, the lack of access to dental services, NHS or private, is among the most common. It is also one of the most frustrating. Over the past few years, the situation in Dumfries and Galloway has worsened, despite the efforts of the Scottish Executive and Dumfries and Galloway NHS Board. A steady stream of dentists who worked under contract to the NHS have decided to terminate their contracts, abandoning thousands of loyal patients as they shorten their lists. We have then seen the unedifying spectacle of patients, many of them elderly, and adults on low incomes, being forced to queue for hours in the hope of being accepted on to private lists.
Who is to blame?
The Conservatives—that is who is to blame.
Adults on low incomes, who include pensioners, are each being charged anything from £12 to £18 per month and do not have the option of paying for their treatment as they go or making their own insurance payments. One pensioner couple told me that they were being asked to pay almost £450 for two check-ups a year, with any treatment incurring further costs. Unfortunately, as Richard Baker said, many dental practices are now also requiring patients to pay an additional insurance premium. A practice, which might have 1,200 patients, could be taking in £250,000 before it performs any treatment on patients.
I would not want to be a dentist, and I have much sympathy for dentists, but I want them to come back to the NHS. The people I care about are my constituents who cannot get a dentist and who sometimes cannot get dental treatment even if they are in pain. I stress again: my primary concern is not for the dentists, but for my constituents. Why should somebody who takes in £250,000 before they carry out any treatment get extra money off the NHS because they treat one or two children for free?
We all know the history of the sorry problems, which arose from decisions taken by the Conservative Government. In fact, I will not altogether blame the Conservatives. As it happens, they were supported and advised by the British Dental Association, on the ground that the BDA wished to avoid
"either underemployment or unemployment of dentists".
Heavens above—what a successful trade union! The BDA obviously had considerably more clout with the Government than the National Union of Mineworkers did. Am I being uncharitable in thinking that the BDA helped to engineer the problem to the profit of its members and that the dental schools at University College London and the University of Edinburgh were closed as a consequence? The decision was questioned at the time and, indeed, opposed by the senate of the University of Edinburgh. We all know what the consequences have been.
I am not saying that we can rewrite that dismal history. The problems that it caused are not easy to solve, not least because it takes seven years to train a dentist. Opposition politicians have talked a lot of nonsense about the Scottish Executive and Dumfries and Galloway NHS Board being complacent or failing to act, which is simply not true. I have been in touch with Executive ministers on the issue regularly over the past few years and I am aware of the many incentives that it has offered, such as golden hellos, additional payments for designated areas and grants to dentists who want to establish new practices, to try to tempt more dentists to join the NHS. Sadly, many of those efforts have been countermanded as yet more contracted dentists opt for the golden road.
How many golden hellos have been paid in Dumfries and Galloway?
I have absolutely no idea, because I have not asked that question.
The minister has addressed the Executive's approach, which I support fully. I will say a bit about what Dumfries and Galloway NHS Board is doing. It has applied for permission to appoint a number of salaried dentist posts—I believe that six have been filled and one is pending. It is also finalising negotiations with Integrated Dental Holdings to provide 10 NHS dentists, who will be located in three fully equipped surgeries. I hope that they will be in place within the next six months. A recruitment drive was held in Scandinavia at the end of last month. I understand from the medical director that the board is now considering how it can translate the interest shown by dentists there into permanent NHS dental posts.
I admit that I was disappointed when I heard that NHS Dumfries and Galloway had not received any of the first 15 Polish dentists. However, again, we find a lot of nonsense being talked by Opposition politicians who say that Dumfries and Galloway was being ignored. It was not; the health board did not ask for the dentists. I wondered why not, but the reason given in a letter from Dr Angus Cameron dated 3 November is that it did not feel able to provide accommodation for any of the first tranche, but it is interested in the second tranche. I say to the minister that Dumfries and Galloway is a seriously affected area, so he should please give favourable consideration to any request from NHS Dumfries and Galloway for the second tranche of Polish dentists.
The board is also in negotiation with the chief dental officer and a recruitment agency in Czechoslovakia regarding the possible recruitment of dentists from that country. In addition, I understand that the full business case has been drawn up for a dental centre in Dumfries, which, when fully operational, will have 16 dental surgeries.
Another interesting approach is the proposal to develop local training for dental technicians, who would be trained to undertake routine procedures that do not require the expertise of a dental surgeon with seven years' training. We can go down that road. Approaches have been made in general practice to allow other professionals to take on some of the more routine work and to liberate the highly trained dentists for more difficult procedures.
All in all, there are a number of things about which to be optimistic. There have been so many disappointments for people over the years. I appreciate that at the moment people might be taking it on trust that some of the things will work, but I believe that if we work together we can improve this desperate situation. We need to do so, because if we do not, the oral health of people in Dumfries and Galloway, which is already poor, will just deteriorate.
There are two sides to this coin: the patients, or those who try and often fail to become patients; and the dentists. We know that Scotland's dental performance is pretty dismal in comparison with that of other countries, notably that of our old friends in Scandinavia and the Netherlands, who somehow manage to turn in a much better dental record than we do. As well as our bad national dental record, which is historical, there are other pressures that have led us to this debate today.
The Health Committee's research from earlier this year, which we debated on 21 April, showed that, in the past two years, just over 10 per cent of dentists in Scotland increased their number of NHS hours, while more than 25 per cent reduced their NHS work. I do not suppose that that comparison has changed markedly since then; although it might have changed for the worse rather than for the better.
In Tayside, which is of particular concern to me, nearly 30 per cent of dentists have cut the number of NHS hours they provide and, more worryingly, 41.5 per cent are either not accepting new children into their practices or are operating a waiting list. In Perth and Kinross, the picture is even worse. I believe that I am right in saying that no dental practice in the area is taking on new NHS patients. I guess that that is common to many other parts of the country. It means that many people are being forced into the private sector or off the dentist's couch altogether, simply because they cannot afford treatment. Elaine Murray illustrated the point graphically.
Tayside NHS Board, like other health boards, has taken steps to alleviate the situation. Dentists working from the Drumhar medical centre include an additional salaried dentist who was taken on to deal with emergency work only for children and the elderly on the basis of people phoning first thing in the morning for an appointment that day. The centre intends to take on two or three more salaried dentists to add to that provision. However, the restrictions on who can obtain an appointment mean that there is still a huge unmet need in Perthshire.
There are plans to expand the number of salaried dentists. I know that a bid is in for a 24-strong community dental service. I understand that the outcome of that will be known by early December. By way of a little gentle lobbying, I say that I hope that the bid is successful, because it would make a huge difference to the situation in Perthshire.
Many members have similar stories from their areas. In many parts of the country, the ratio of dentists to population reinforces what we know of people's real-life experiences from the cases with which we deal daily in our postbag and in our surgeries. It is getting harder and harder to find an NHS dentist who is willing to do NHS work. Without such dentists, it is difficult to see how improvement plans can be delivered, much less the promised universal oral health assessments.
Earlier this year, I decided to conduct a small, local survey of dentists in my constituency to ascertain their views and concerns. All dentists were sent a questionnaire. We had an excellent response rate, as evidenced by the 25 per cent who returned the questionnaire within a day of receiving it. The speed with which they responded showed their concerns. The single most important reason for their moving out of the NHS was finance, which was followed closely by lack of time.
The flight from the NHS has led to other obvious consequences. There is now a big difference between waiting times for an appointment for NHS patients and those for people who have gone private. I am concerned that the situation that exists in other parts of the health service will be replicated, with private patients being taken quickly and others having to wait quite a long time.
In the survey, dentists were asked what they would do to change things. It was depressing that some of them felt that the situation was irredeemable—a word used directly in the survey. Others simply said that there should be either more money or more dentists, or a combination of the two. That is not exactly rocket science.
I join other members in saying that taking on the dentists is not a particularly helpful way forward. I will be interested to see whether today's announcement attracts back any of the dentists whom I surveyed. The minister can be sure that I will resurvey them on the basis of the announcement. However, some of the comments that have been made today are highly unlikely to encourage them back. We must take care that we do not end up driving them out instead of attracting them back, as a result of the attitudes that are being expressed.
Jamie Stone mentioned the Polish recruitment.
It was Euan Robson.
I attributed the remark wrongly. Everybody welcomes that recruitment drive. I would like to hear the minister expand on how the Executive intends to roll it out in future, the global numbers and so on. Tayside NHS Board has not asked for any of the dentists; at the moment it does not think that it will have to. However, it is precisely such thinking that is needed to stop the immediate rot.
There are anomalies that must be addressed. I cannot understand why it is possible for dentists to get assistance to start a new practice but not to buy out an existing practice if a dentist is retiring. I wonder whether that anomaly could be considered in the future.
The SNP recognises the mountain that is to be climbed in tackling the problems, including our appalling record and the appalling state of our system of dental care. There are ways of making progress. I am sure that everyone in the chamber hopes that we find them.
In my first members' business debate, which was five years ago this month, I raised the issue of a lack of NHS dentists in my constituency of West Aberdeenshire and Kincardine. That was the first of many debates in which we have discussed and highlighted problems in accessing NHS dental services.
Aberdeenshire continues to have fewer NHS dentists per head of population than anywhere else in the country, so it is not surprising that I and other members who represent Aberdeenshire have continued to raise the issue. However, I am pleased that the Deputy Minister for Health and Community Care has confirmed that the Scottish Executive is taking action to address the problem. My main criticism, which is that it has been a long time coming, is tempered by my delight that action is forthcoming and is being directed in the right way.
It has been a long haul since we got specific proposals on dentistry into the Liberal Democrat manifesto for the 2003 election, including commitments to introduce free dental checks for all, to ensure that everyone in Scotland has access to NHS dentistry regardless of where they live and to reform the outdated remuneration system for dentists. I say to the SNP that our manifesto also made a commitment to open a third dental school for Scotland, in Aberdeen, to address the long-term lack of dentists, which is a direct result of the disastrous decision of the previous Conservative Government to close the Edinburgh dental school, which we have already heard about.
The member should correct me if I am wrong, but has he not been a member of a party that has been part of the Executive since 1999? If his party has a manifesto commitment to open a dental school in Aberdeen, it is taking a gey long time to get round to meeting that commitment.
The second stage of the long haul—I say to Tricia Marwick that we are talking about a long haul and not easy soundbites—was to reach agreement with the Labour Party in the coalition partnership agreement. We managed to have all our proposals included, except for the commitment to open a new dental school in Aberdeen. However, it was agreed that the Executive would consult on that proposal during the session. I hope that the minister will confirm in his winding-up speech that he will launch the consultation to open a new dental school—which, after all, would be in his own constituency—and complete it by 2007.
I turn to the dental action plan. When Rhona Brankin announced that plan some eight months ago, in March, I expected swift action. As I said, it is disappointing that we have taken so long to reach the point that we have reached, but I am delighted that, contrary to earlier rumours, the minister has not gone off down the wrong track. I do not blame the minister for those rumours, which came from elsewhere.
Over the past eight months, the Scottish Executive has not reached an agreement with the British Dental Association on the implementation of the dental plan—we have heard the reasons for that. It was rumoured that the Executive would go down the route of simply relying on salaried dentists employed directly by the health boards to implement its dental strategy, which would have been a disastrous way to proceed. I am glad that the minister will not go down that route. Common sense points to engaging with the high street dentist and the Executive is doing so.
The dental plan that was announced in March is good. I said then that if the plan was properly implemented, it should alleviate and solve the problems that we face with NHS dentistry. The plan will cut red tape by reducing the number of items of service that dentists must deal with, reform the remuneration system for dentists and increase funding for the general dental service by 75 per cent. That is double the amount of money that the official Opposition clamoured for, which is ironic. The situation is rather remarkable. The plan will also ensure that public money is used to increase access for NHS patients.
Will the member give way?
I have already given way and do not have enough time to do so again.
The minister has set a so-called hurdle, but the number of NHS patients that a dentist must have before he or she can access the increased funding has been set very low. That is to be greatly welcomed as a realistic way of increasing access to NHS dentistry for all. A dentist needs a minimum of only 100 non-exempt patients and 400 exempt patients to access the new funding. That is a reasonable commitment to ask of our dentists in return for accessing the increased funding from the Executive.
In the past, I have not been slow to encourage Executive ministers to take action to solve the dental crisis that we face. With the plan, we are now well on the way to solving that crisis. The plan is good and I am pleased that ministers are implementing it sensibly, although we must of course work with the dental profession to overcome any implementation problems in a constructive and positive way. If our aim is to have free dental examinations for all by 2007, it is obvious that we must ensure that everyone has reasonable access to an NHS dentist, no matter where they live in Scotland.
The implementation plan should ensure that the Executive's policy will be effective and I hope that every member will get behind it. We can, of course, continue to improve the service, not least by opening a new dental school in Aberdeen—I am not, of course, prejudging the results of the consultation—but the action plan should result in the most radical reform of NHS dentistry since 1948 and lead to the end of the crisis that has been building in Scotland since the actions of the previous Conservative Government took effect.
I am conscious of the time and will finish by saying that I certainly back the position that the Executive has taken to address the dental crisis in Scotland. I believe that it has clearly made the right judgment and therefore urge colleagues to back the motion in today's vote.
It is a mark of the Executive's commitment to creating better access to improved dental services that the minister has brought the issue back to the chamber in a year in which we have had a number of debates on dentistry and the announcement of the Executive's £295 million dental action plan, which represents an historic level of funding. I have regularly taken part in these debates with other colleagues from the north-east and the issue is undoubtedly one of concern throughout Scotland.
Will the member explain how the concerted campaign by the Labour Party in Grampian to portray dentists as greedy and selfish will help to retain dentists in the NHS and to attract others back into the NHS?
That is a sweeping and inaccurate generalisation. Mr Lochhead should listen to my speech and be informed for once. I will not take any lectures from him on media strategy.
Grampian has one of the lowest rates of dentists per head of population, as Mike Rumbles has said. The time that is spent on NHS dental work is below the average and a number of dental practices have recently gone private. The situation has been vividly portrayed in television pictures of queues of patients snaking round dental practices as they wait to reregister on private dental payment schemes. As a result, many of us have called for local action to improve access to dental services. It is important to highlight that there has been a significant response to that call.
Plans are now in place to build a dental outreach training centre in Aberdeen that will recruit dentists to our area and treat patients. Salaried dentists are already being appointed by NHS Grampian to provide NHS treatment and there has been immediate local investment through the dental action plan.
We also called for national action, which there has been. Not only has there been the action plan but, before it, increased grants for dental practices were made available. Since then, bursaries for students have been introduced to encourage them to practise in the NHS and the number of people applying to study dentistry has increased.
In that context, it is bewildering to see dentists still opting to end the provision of NHS treatment. We hope that today's announcements are the beginning of the end of that. We must recognise in the debate that many dentists are committed to the NHS and provide excellent treatment through the NHS—I have always been keen to highlight that—but more people in the profession must play a greater role in improving access to NHS services and ending the pictures of patients queuing at practices. It is extremely disappointing that dentists have continued to go private. Only two months ago, in Woodside, in Aberdeen, a long queue of patients waited outside a practice to sign up to a private plan. Many of them, including elderly patients who had been with the practice for decades, started to queue from 7 o'clock in the morning. Before I am criticised for attacking the behaviour of practices, I say that I know that other dentists—whatever their views of the general situation in the past—do not approve of patients being forced to queue in such a way. That is shameful behaviour by those practices.
I spoke to people in the queue at Woodside about the situation and was confronted by a dentist who was not from that practice. He told me that he was there as a friendly colleague to assist the dentist. In fact, he was a director of a firm called Isoplan who has actively encouraged practices to leave the NHS. He has advised dentists who do so to send out letters telling patients that their children will be deregistered if they do not sign up to the payment plan and that the dentists are leaving because of the erosion of funding for NHS dentistry. That is a deceit because, leaving aside all the other grants that are available, fees that were set by an independent panel have risen year on year. It is no wonder that when I held a public meeting in Aberdeen on the issue in the summer, people questioned the commitment of some dentists and their professional bodies to NHS provision, especially when we hear that so much of the funding for the action plan will go to high street dentists. I hope that we can turn things round.
I agree with the professional bodies that the type of work that dentists can do in the NHS, the length of time that they have to do it and the bureaucracy that they have to deal with should be reviewed. However, although dental treatment for children is a priority, many people will find it bewildering that dentists are arguing for more NHS funds for practices that do not have adult NHS patients. NHS funds should be invested in practices providing NHS treatment. We have called for action from the Executive and we have got it. Dentists have asked for more funding and are being offered it. Now we need the profession to engage seriously in constructive negotiations with the Executive and to show that it, too, wants there to be improved access to NHS services. We want to work with the profession; let the profession show that it wants to work with us. The top priority for dentistry in Scotland must be to address the great need that patients have for improved dental health.
We have heard a statement from Lewis Macdonald on the Executive's big plan for dental action. Too many times, the Executive has promised to get to grips with the dental crisis in Scotland and I am sure that the people in Tayside and Fife, who have seen their dental service disappear under the Executive, will not be smiling at the latest plans, which appear to be little more than a sticking plaster for the problems of dentistry.
The point has already been made in the debate that it does the Executive no favours at all that it has failed to engage properly with the British Dental Association and has, instead, indulged in soundbites and posturing and attacked dentists. Already this morning, we have heard people accusing dentists of being greedy and selfish. That does nothing to help the debate.
Does the member agree that our strategy has received widespread support, including the support of all consultants in dental public health, all clinical directors of dentistry, the chairman of the Scottish Dental Practice Board and the Scottish Consumer Council? How does that support fit with the comments that the member has just made?
If I may, I will quote from the chairman of the BDA's Scottish dental practice committee. He said:
"Health ministers seem determined to force their views on dentists, issuing statements and press releases with no attempt to discuss these complex issues with representatives of the profession."
That is not about the strategy.
That is a quotation of something Robert Donald said, which the minister will be familiar with.
There is a convenient scapegoat for the members of the Executive parties who are desperate to displace blame for the crisis that has occurred over the past six years. What do they pick on? The closure of the dental school. Dr Elaine Murray was gracious enough to accept that, at the time, the industry wanted the dental school to be closed because it was concerned about the oversupply of dentists. As we well know, the problem is not to do with the lack of dentists in training but to do with the retention of dentists in the NHS. Only 3 per cent of dental undergraduates say that they are considering a full-time career in the NHS. The problem is not the lack of dentists being trained, but the lack of dentists who want to go into the NHS.
I agree that retaining dentists in the NHS is a critical issue, but will the member accept that the BDA shares our view that there must also be an increase in the total number of dentists?
I quite accept that the BDA now says that there needs to be an increase in the total number of dentists. However, I remind the members of the Executive parties that the Executive has been in power for six and a half years and it is time that it moved on from blaming all the ills of Scottish society on the previous Conservative Government, which was in power eight and a half years ago. Let us end the blame displacement.
With regard to NHS dental services in Tayside and Fife, Tricia Marwick unearthed some figures that show the shocking truth. In 2004-05, 4,537 patients were withdrawn from NHS registration in Tayside. The situation is worse in Fife, where 10,540 patients were withdrawn from NHS registration. There has been a mass exodus. In fact, more than half of all patients who were withdrawn from NHS registration in 2004-05 came from Tayside and Fife. That meltdown in Tayside and Fife underlines the crisis that is happening across Scotland.
This summer, the local dental practice in my home town, Alyth, in Tayside closed down permanently, leaving no dentist in the town. Nobody in the town can remember any time when Alyth did not have its own dentist. In 2004, a new dental practice was opened in Dunfermline in Fife. When it opened, hundreds of local residents queued for hours to register. I understand that that is by no means a unique experience. Surely it proves that the Executive must do more to deliver affordable dental care.
Earlier this week, I was in Thurso—in Jamie Stone's constituency—with the Enterprise and Culture Committee. One of the issues that we were discussing was economic development and ways in which people could be attracted to come and live in the area. In that regard, the issue of access to NHS dentistry was raised. We were told that people in Thurso face a round trip of more than 200 miles to find a dentist. Such quality-of-life issues are vital to our attempts to attract people to live in rural areas. They will do that only if they have access to decent services. We cannot consider problems in isolation. If we are to try to address population decline, we have to be aware of other problems.
I want to deal with the NHS recruiting Polish dentists. I have nothing against Poles and I welcome the arrival in January 2006 of 32 Polish dentists, six of whom will be employed in Fife. However, that is only a quick fix for shortages in dentistry.
In case there is any doubt about the politics of the situation that we are discussing, I will quote Alex Falconer, who was Labour MEP for Mid Scotland and Fife until 1999. Earlier this year, he wrote to the Dunfermline Press and West of Fife Advertiser, saying:
"I have two health problems. One is my ear. Under the Tories, I saw a consultant within three months at the Queen Margaret. My other problem is asbestos pleural plaques. Under the Tories, I saw a chest consultant once a year at the Queen Margaret.
After eight years of Labour, I have now waited over six months to see an ear consultant at the Victoria. I also have to travel to the Victoria to see the chest consultant.
Also under the Tories, I had an NHS dentist. Now I don't have one and the prospect of getting one is remote."
That is from a gentleman who was an elected Labour politician but who is now making statements against his own party. The minister does not need the Tories to tell him what is wrong; he can listen to his own representatives.
Jim Wallace will be followed by Marilyn Livingstone. I might have to cut the time allocation for speakers after Mr Wallace.
It was interesting to listen to Murdo Fraser, who was long on criticism and totally bereft of—I cannot even say "short on"—any constructive proposals as to what to do.
In contrast to what we heard from the Conservatives, we heard from the minister a welcome announcement that fleshes out the action plan that was launched by Rhona Brankin in March, committing some £295 million of additional money to dental services, the bulk of which is going to primary dental care.
As many speakers have indicated, people in many parts of the country have problems accessing dentistry and my constituency of Orkney is no exception. It has been a number of years since the only independent practice announced that it was going private, which put a great deal of pressure on the NHS system. That practice left Orkney and we are now solely dependent on the NHS salaried service. Of course, that means that there are some patients who were previously with the independent practice who are still waiting to go on a list and that those who come to the county have a long time to wait before they can get on a list. I agree with Murdo Fraser's point about the economic implications of that. If we are trying to attract people to come to an area for reasons of economic development, a key factor will be what kind of medical and dental care they can get. There is an important economic dimension to the issue.
Undoubtedly, the problem is one of recruitment. When the independent practice went private, it was not as if there was a lack of support from the Government. Funding was available, but there was a problem in trying to recruit people to fill the gaps.
Murdo Fraser's defence of the closure of the Edinburgh dental school is all very well, but we simply cannot get dentists as easily as turning on a tap; there are lead times. Therefore, decisions that were taken to close the dental school in the late 1980s and early 1990s have an impact many years down the track. That is why the Executive is addressing the situation by expanding the intake of dental students, by establishing outreach centres in Inverness and Aberdeen and by consulting on a new dental school in Aberdeen. Although we realise that those measures cannot produce dental graduates overnight, we know that it is important that we take steps such as establishing the post-graduate fellowship in remote and rural dentistry.
Does the member acknowledge the urgent need for a decision on an Aberdeen dental school? England is to establish a new dental school, which will create competition for the few professionals who could teach at the Aberdeen school.
The SNP has come slightly late to the argument for a new dental school in Aberdeen. A new dental school in England might not necessarily be a problem, because a substantial number of students come from England to Scottish dental schools as a result of the lack of places in England. If a new dental school in England meant more scope for Scottish students to enter Scottish dental schools, that might well be to our long-term benefit.
Golden hellos have been given and the deputy minister talked about a bursary scheme. All such measures have been directed towards the encouragement and recruitment of dentists.
Will the member give way?
No—I want to make progress.
It is important to retain dentists in the national health service. My constituents depend totally on the salaried dental service. In his opening speech, the deputy minister said:
"there is a place for a salaried service".
I welcome that. When Mr Kerr replies to the debate, I hope that he will say more about the salaried service. The people who are involved in that are committed to the national health service. After a couple of years, a newly qualified dentist in private practice can earn twice the maximum that can be paid to a salaried dentist. That is an issue if we are to retain dentists in the salaried system.
We cannot allow a system to grow up in which salaried dentists might gain the impression that they are seen as a second tier—I know that that is not the minister's intention. We must underline that the value of such dentists to those whom they serve is primary. What steps are being taken to encourage salaried dentists to remain in the NHS and what further commitment payments might be made available to them?
The issue of facilities goes hand in hand with that of salaried dentists. We have heard about the efforts that are being made to help with facilities in the independent sector, but if more salaried dentists are to be appointed, facilities will be required in the national health service. In Orkney, after the clinic in Stromness that is due for completion next year is ready, not much scope will be available to establish many new salaried posts, although they are needed. Orkney NHS Board has made a bid to build more surgeries in Orkney. Three additional surgeries would allow two or three more salaried practitioners to be recruited and would provide the opportunity to undertake some of the training work that is needed, which allows something better to be offered in recruitment.
New centres for therapists are being established in Aberdeen and Inverness. We should ensure that similar incentives to those for dental practitioners, such as remote and rural allowances, are provided to encourage therapists and hygienists to accept posts in our remote and rural areas.
A number of people who are well qualified as dentists in their own countries—in Asia, for example—have applied for jobs here in professions that are ancillary to dentistry but have had difficulty in obtaining visas.
You must close now.
I ask the minister whether he can do anything to fast-track that process.
I welcome what has been announced—
No—you must close.
However, I would also welcome assurances from the minister about the salaried sector.
Speeches from now on will be five minutes each.
I thank the Presiding Officer for the opportunity to contribute to this important debate. As we have heard, the developing issue of access to a dentist is becoming an increasing concern, particularly to many of my constituents and to people the length and breadth of Fife. I am constantly approached at surgeries and meetings in my constituency about dentists deregistering their patients. The most recent figure is that the registrations of nearly 11,000 people throughout Fife has been withdrawn. We are becoming aware of the reasons for that, but knowing the reasons does not make the situation more palatable.
As we have heard, the dentists involved will offer only private dental treatment at a cost that many cannot afford. That is impacting on the most vulnerable in the community. Many of my constituents who have received letters about deregistration have told me that they are concerned and anxious and that they cannot pay. Like the minister, I am concerned about the problems that we are storing up. Only this week, an increase in oral cancer cases has been reported, particularly among young women. We must ensure that dentistry is available to all, regardless of the ability to pay.
The Tory contribution has been astonishing. The closure of the Edinburgh dental school has had a major impact on the number of dentists today. As Jim Wallace said, a magic wand cannot be waved to conjure up new dentists; recruiting them takes time and commitment. We are suffering from the legacy that we were left by the Tory years—the changes that the Tories made to the NHS and their deregulation policy. However, we are where we are.
What can we do and what are we doing? I pay tribute to the dentists in my constituency who have continued to work in the NHS. The new dental practice in Templehall, which Gordon Brown opened earlier this year, has registered 1,500 NHS patients and hopes to accept another 1,500 when it fills its vacancies for dentists. The number of people who tried to register with that NHS dental practice was astonishing.
I very much welcome the seven-surgery dental access centre in Kirkcaldy, which is expected to become operational in mid-January 2006. Like Jim Wallace, I think that we should get away from a two-tier system. It would be appropriate to examine remuneration for dentists who are committed to the NHS. I also hope that the seven Polish dentists who will join the dental workforce in February will help to fill gaps.
I welcome the access clinics, which provide short courses of treatment to fix problems with fillings, broken dentures and so on. However, the solution is that people should have access to their own dentists.
I thank all those who are involved in the triage service in Fife, which is funded through the community dental service. That operation employs between 16 and 20 people and provides a good service to the people of Fife. Emergency services are provided at the weekend through a rota system. However, my constituents need access to NHS dentists. On behalf of my constituents and patients throughout Fife, I ask the minister to make Fife a designated area, so that we can benefit from the additional Executive funding that that would bring, which we need. The figures stack up.
I welcome the commitment that the deputy minister gave to provide funding to support primary care dentists. I also welcome the action plan that Rhona Brankin introduced and which Lewis Macdonald has fleshed out today. Dentists are asking for more money, more dentists and more help with capital funding. I welcome the additional funding of £30 million for capital, £29 million for oral health and £37 million to support primary care dental services. We should not apologise for rewarding dentists who stay in the national health. My constituents find it confusing to see newspaper headlines about incomes for some dental practitioners when they are sent letters to inform them that they have been deregistered.
The action plan will go a long way towards solving the problem. We need to increase the number of dentists in the health service and to increase training. I support the motion in the deputy minister's name.
When I read the first line of the motion, which says:
"That the Parliament notes the widespread concern about loss of access to NHS dentists",
I thought about the words "widespread concern". In Fife, there is more than widespread concern; there is anger, fury and bewilderment that so many people have been deregistered in the past year. Other members have referred to the figures that I extracted from the Executive, which show that 10,500 patients in Fife were deregistered last year. That is a third of the total who were deregistered in Scotland. Fife NHS Board can offer only an emergency service to a 77-year-old woman in Kirkcaldy who simply cannot access a dentist. The deputy minister's response to my asking what advice I could give her was to complain about the dentist who deregistered her.
The crisis has been a long time in the making. I fully accept that the closure of the Edinburgh dental school created problems, but I say to Labour and Liberal Democrat members that the Executive has been in power since 1999. This crisis has not appeared suddenly. It is the result not just of the fact that not enough dentists are coming through, but of the fact that we are losing the dentists that we have. We are in this situation because the NHS cannot retain them. In Fife, there is no doubt about the fact that we are in crisis.
Does the member accept that dentists have business decisions to make and that the decision to deregister a patient is taken by their dentist alone?
I accept that totally. However, the minister is responsible for the NHS in Scotland and has a duty to ensure that NHS treatment is available to those who want and need it. No one can need it more than a 77-year-old woman who does not have access to the kind of money that would allow her to have private care. It is for the sake of such 77-year-old women that we need to have this debate and to continue to push the Executive on the issue.
When I first read the Executive's action plan, I thought that it meant that from 2005 onwards all old-age pensioners would be entitled to a free oral health examination. I want the minister to listen to this point, because I expect a response to it when he sums up. At the time, I thought that I would ask the minister what he would say to the 77-year-old woman whom I have mentioned. However, during today's debate I read the action plan more closely. It says that from 2005 onwards, NHS adult patients aged 60 and over will be offered a free oral health examination. That means that people must be patients to be eligible. The 77-year-old woman who has been deregistered has no dentist to carry out the examination for her.
I turn to the problem of recruitment. I have been contacted by a number of dentists in Fife. One obstacle to recruiting people as dentists is the entrance criteria. I understand that dental schools require five As at first sitting in fifth year. Most pupils who achieve such results do not come from our state schools. We must increase the number of people who have the opportunity to become dentists, because I am sure that, after they qualify, the commitment of such people to the NHS will be greater than that of others.
Shona Robison referred to the "foghorn diplomacy" that we have seen recently. The minister will have received the same e-mail that I picked up this morning. It is addressed to Mr Macdonald and is from an extremely hard-working dentist in Fife. She has 1,700 NHS patients and is absolutely furious about the misconceptions and misinterpretations that have appeared in the press over the past few days. She writes:
"I was told that you held a press conference and that the information they were given was misleading … I feel that you have an obligation to TELL THE TRUTH and to correct this misinformation that has been printed as many of the public will take it as being gospel and factual. I am not going to put up with people coming in every day now saying that I am loaded, when I work hard for what I earn and this is the surest way of many more of us going PRIVATE and reducing our patient base which may perhaps be what you actually want us to do? Today is the closest I have come to saying that I have had enough!!!"
That dentist has 1,700 NHS patients, is treating them, is working hard and is sick to death of the misinformation that is being put into the public domain by ministers. It is about time that we recognised the hard work of NHS dentists and did everything we can to retain them.
We last debated this subject on 21 April, in the unfortunate circumstances of the run-up to a general election. I had hoped that the somewhat calmer political circumstances surrounding today's debate would lead to a more constructive approach, but I am not convinced that they have. A constructive approach is what the vast majority of my constituents in Galloway and Upper Nithsdale, who currently have no access to any form of dental service, let alone NHS dentistry, urgently require and assuredly deserve. I care about them every bit as deeply as Dr Murray does.
Like Tricia Marwick, I am somewhat bemused by the opening sentence in the motion that is before us this morning. As Mike Rumbles pointed out, since the earliest days of the Parliament, rural members from all parties have increasingly drawn Parliament's attention to the issue. However, it was not until 17 March this year that Rhona Brankin, the then Deputy Minister for Health and Community Care, uttered the first words on dentistry in the Parliament, after almost six years of its existence. In response to questions following her statement that day, she said:
"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."—[Official Report, 17 March 2005; c 15542.]
She must be very relieved that she was reshuffled, so that she does not have to lead today's debate.
Will the member give way?
My time has been cut, so I cannot take an intervention.
The stark reality is that eight months on from Rhona Brankin's statement, an increasing number of practitioners are leaving the NHS, none has returned and surveys continue to show that 3 per cent of dental students intend to practise full time in the NHS. I welcome the bursary arrangements that the minister has announced, but I suspect that after five years the trend for people to leave will continue.
We have now reached the sorry situation that my local health board, Dumfries and Galloway NHS Board, is hoping to be allocated a number of Polish dentists from the second tranche of imported professionals. I share Elaine Murray's plea for the Executive to look on that bid sympathetically when it comes in.
The board is also seeking to place a highly lucrative contract with a private company, Integrated Dental Holdings, to establish a number of NHS practices across the region. One of those is likely to be in Newton Stewart in my constituency, to service the west of the region. That is fine, but what does it say to the one remaining dentist in Newton Stewart who still deals mostly with NHS patients? I could tell members what he thinks about it, but I do not have time to do so. Members should take my word that he e-mailed me on the subject yesterday in order to make me aware of the strong distaste that he feels for the way in which the Executive has treated him. He highlighted the fact that the new primary dental services contract and the large number of incentives with which IDH will be tempted north of the border will hugely disadvantage existing NHS dentists, who until today have been offered virtually no support to ensure that they remain NHS dentists. Like Roseanna Cunningham, I await with interest my constituent's reaction to today's announcements by the minister.
The sad conclusion that I draw is that there is virtually nothing to suggest that any of the Executive's actions, well intentioned though they may be—I believe them to be well intentioned—will lead to any improvement in the delivery of NHS dental services in remote rural areas. Members from all parties have drawn attention to that point today. The time may have come for us to differentiate between how dental services are delivered in remote rural areas and how they are delivered elsewhere.
I suggest constructively that the Executive indulges in a bit of blue-sky thinking on this desperately important subject. It will have to encourage, rather than bully, the dental profession to think laterally, too. The answer to the problem may lie in the Canadian model of rural dental practice to which I referred in April's debate. The idea is not new, it works and it accepts the absolute fact that, for historic, social and economic reasons, newly qualified dentists will always tend to congregate in our major centres of population.
Under the Canadian model of care, most dental services are provided by therapists, hygienists, prosthetic technicians and dental health educators, who are largely locally recruited and trained. The dental practitioner carries out an initial examination, determines the dental plan and performs only the more complex treatments. He or she covers a wide area and has a very large number of patients under his or her umbrella. However, the practitioner's expertise is maximised and the local training of the allied professionals provides a welcome layer of quality employment for many young people—who currently in Scotland have to go elsewhere to seek work.
The problem calls for radical thinking and acceptance that Polish dentists and corporate investment do not provide a long-term solution to it. I commend the Canadian model warmly to the chamber.
Of course I welcome any investment in dental services and the principle that a commitment to the NHS by dentists will be rewarded. However, I am concerned about the fact that dentists themselves must be on board. Earlier there were a few raised eyebrows when the British Dental Association was described as a trade union. It is a trade union, in the same way that the British Medical Association is, although it is not Trades Union Congress affiliated.
I mentioned the British Medical Association. It may be interesting to make some comparisons between these two closely related professions, which have a similar method of training and similar regulation, but which seem to have taken different paths over the years. To an extent, some of what the minister announced indicates a convergence of those paths. For example, an announcement was made on the payment of notional rent for dental premises that are owned by the practices. General medical practitioners have been able to claim such a payment for many years; the practice in which I was a trainee in 1979 was paid a notional rent for the premises that it owned. The measure is a very late catch-up for something that already happens for doctors.
I am not unsympathetic to the sentiment behind Carolyn Leckie's amendment, because I know that there have been scenes of people queuing to register for dentists. That people should have to do that is clearly unacceptable. If something is unacceptable in Scotland today we condemn it, but I hope that we also look to see why it happened. Condemnation is not enough; it is necessary to sort out the root causes.
Dental debates tend to have a bit of déjà vu about them. I went back to the Scottish Parliament information centre figures that I looked at for the previous debate on dentistry. The figures show that, as other members have said, there is a clear problem with the retention of dentists. The figures for 2003 were the last figures given; they indicate that in that year, 83 dentists under the age of 55 left NHS practice in Scotland. The paragraph underneath the figures states that it is surmised
"that this could be due to dentists taking a career break or leaving Scotland."
That suggests that it is not just that dentists do not have a commitment to the NHS—they are losing their commitment to the profession or certainly to practising that profession in Scotland. We must seriously address that matter.
Although I welcome dentists from overseas, such as the Polish dentists who have been mentioned, we cannot plunder the rest of the world to meet our dentistry needs; we must grow our own and we must keep them once we have grown them.
I would be interested to know what proportion of vocational training places will be in remote and rural areas. As I come from the Highlands and Islands, I obviously have concerns about the issue. I will go further than that because it has been shown—I am talking about doctors but I am sure that the point is transferable to dentists—that if students are recruited from those areas they are much more likely to go back and work there.
There is also an issue about how the profession is portrayed. I am sure that if a potential school leaver in Wick or Thurso says that they fancy studying dentistry they will get, at the least, a ribbing from their school fellows. The profession has an image problem, which it is in all our interests to address. Some comments that have been made have not been helpful.
I note the minister's announcement that the £9,000 for rural practitioners will be extended to other deprived areas. Although I do not condemn that step, because I recognise the needs in those areas, I do not want it to dilute the commitment to direct dentists to rural areas. The problems of people being able to access a dentist are the same in rural areas as they are anywhere else, but there is the additional problem that in order to do that they might have to make a 200-mile round trip—as has been said. That is a serious issue.
I recognise what the Executive has done on the allied dental professions. I hope that that initiative can be expanded, because I see that as a way forward in the provision of some services. I echo Alex Fergusson's comments about recruiting those people from and training them within the areas in which they will work. The end product is not the number of people who deliver dental care; it is the dental health of the population. If we can promote that in ways other than by throwing more dentists at the problem, that is welcome.
The targets in the action plan are modest. For example, by 2010, 60 per cent of five-year-olds should have no signs of dental disease. That means, however, that we expect 40 per cent of children born this year to have dental disease when they start school. The 60 per cent target is modest and it should be more than achievable.
The minister has made some useful announcements this morning. However, we must address a set of fundamental questions about the shape of the service that we are trying to provide in Scotland.
Let us be clear that there is no guarantee of access to general dental services in the same way as there is to general medical services, and there has not been for a considerable period. In that context, the question that we must address is how we can best integrate private dental services with the dental services that are provided under the NHS. That issue must be addressed properly, without some of the catcalling and name calling that has taken place in the chamber today and in recent weeks. Let us be clear that there will be private dentistry and NHS dentistry for years to come. We must work out how we can make the two systems work together in the best interests of patients.
We must also address the general oral health of the population. It is fair enough for members from rural areas to highlight the problems there, but the worst oral health problems in Scotland are in the west of Scotland, in places such as Clydebank. When we discuss what our policy should be for dentistry and oral health in Scotland, I want the needs of my constituents to be considered close to the top of the tree, because those needs are greatest. For me, the test of the measures that the minister introduces will be how well they work in deprived areas in Scotland in particular. I welcome the £9,000 allowance that will now go to practitioners in deprived areas. I ask the minister exactly what he means by deprived areas, how those areas will qualify and how dentists can be certain that their practice will qualify. That will be a real consideration for dentists in areas such as mine, who might be considering whether to stay or to move out. I urge the minister to give us the clearest possible indication of how the deprived-area payments will work.
It is also important that the minister has announced today that mechanisms and initiatives on oral health, such as the initiative on toothbrushes, will be funded. I would like more targeted support for oral health to go to areas such as Glasgow, Clydebank and Greenock, which is represented by my colleague Duncan McNeil. When we talk about the health of Scotland, those areas and those initiatives are crucial. The issue is not only about dentists and payments to dentists; it is about how we get parents and children in those areas to maintain their dental health. I do not want people to need fillings and extractions; I want them to have healthy teeth. I want dentists in my area to practice conservative dentistry—
A laudable sentiment.
That is not necessarily Alex Fergusson's form of conservatism; I mean cautious and preventive dentistry. I want dentists to have the time and capacity to help people to maintain oral health.
I brought dentists from my constituency and other deprived constituencies to meet the minister recently. We all emphasised the point that the current fee system, which is based on treatments, does not lend itself to the approach that I have outlined. I hope that the minister will greatly simplify how dentists are paid and rewarded. I also want him to highlight how dental businesses—they are businesses—can be supported to have the important facilities that practices need, such as effective decontamination facilities.
We must also consider how dental practices pass from one practitioner to another. Many dental practitioners are getting towards the end of their career and they want to know how their assets—the practice premises, good will, their lists and so on—can be transferred on.
I hope that when the minister responds he will address some of those important points.
We go now to closing speeches. I call Carolyn Leckie to close for the Scottish Socialist Party. Time is now very tight, so you have six minutes.
Thank you very much, Presiding Officer. The debate has been useful and there have been many good speeches. Unusually, some of the best have come from the Labour benches. I will return to that point.
It is important to look at the situation in Lanarkshire, as it flags up certain anomalies. Lanarkshire has probably the second poorest oral health record in Scotland, but it is managing to increase steadily the registration of patients with NHS dentists. That says a lot, not only about the urban nature of Lanarkshire, but about the culture of dentistry there, which is reflected in its community dentistry service and the number of salaried dentists in Lanarkshire NHS Board. That situation exposes as a myth the claim that there is a universal crisis in dentistry in Scotland in terms of rewards, as the BDA sees it. What does that tell us about dentistry in rural areas and the demands of certain dentists, who say that they are not getting enough money? The example of Lanarkshire, where registration is increasing, shows that such claims are not accurate and that we must dig beneath them.
Des McNulty is right about oral health in areas such as Lanarkshire, where only 30 per cent of children aged five are free of dental decay, which is less than halfway towards the Executive's target. That is a shameful statistic and we must turn that situation round urgently. Even within Lanarkshire, there are gross inequalities. For example, in the past year, 700 five-year-olds in Lanarkshire have had gross decay or abscesses that required urgent treatment. Seven hundred children aged five have had to go through that traumatic experience—that is unacceptable.
There are however, massive disparities between different areas. For example, whereas only 1 per cent of five-year-olds in Cumbernauld and Kilsyth needed urgent treatment for decay and abscesses in the past year, 33 per cent of five-year-olds in Airdrie and Coatbridge required such treatment. That is unacceptable. There is no excuse for it, because it clearly can be addressed. There is no fundamental difference between the weans of Cumbernauld and the weans of Airdrie and Coatbridge. We must—and can—do much more to remove that disparity.
This Executive is positioned to the right of Thatcher on health policy—there has been more privatisation under Labour than there was under Thatcher. Despite that political positioning, it is becoming a wee bit of a regular phenomenon to see the Executive being attacked from the right from both sides of the chamber. That demonstrates the SNP's trajectory: it supports privatisation in the NHS and, as we saw during yesterday's debate in the chamber, the temperance movement.
Murdo Fraser—my heart bleeds—berated speakers for calling dentists greedy and selfish. I do not remember anybody—apart from Mudro Fraser—using that phrase. Similarly, I remember only the Tories using that phrase when they were talking about firefighters, nursery nurses, NHS workers, civil servants or—dare I say it—miners. The Tories called them all greedy and selfish. I am sure that those workers would have benefited from a white coat and a drill to save them from such attacks. I certainly do not take any lectures from the Tories about workers.
Our amendment offers three immediate and practical measures to address the dentistry problem. The amendment is neither a panacea nor a revolutionary manifesto.
Why not?
Because Mr Stevenson is just not up to listening to it.
Our amendment is based on the majority of the responses to the Executive's consultation. The amendment refers to widening access. Tricia Marwick made a good contribution on that when she referred to an elite. There are unnecessary academic barriers to entering dentistry that preserve the profession as an elite one. One of the ways of breaking that down—and producing dentists who have a commitment to the NHS—is to allow people to get into dentistry whose background is that they have fought for the NHS. That can be done by lowering the unnecessary academic barriers and supporting such people in their education. That takes us into the territory of the grants system, bursaries and the taxation question. I do not believe that the Executive's initiative goes far enough, but I will not go down that road.
The other suggested measure in our amendment is for dentists to make a basic commitment to work for the NHS, under a salaried scheme, for at least five years after qualifying. I do not think that that is too much to ask. It should not be done by using a carrot; it should be a demand, a commitment and a condition within an agreed salary structure.
I now call Jamie Stone to close for the Liberal Democrats. Again, you have a strict six minutes.
Thank you very much, Presiding Officer. As is the custom, I will comment briefly on the main speeches in the debate. After that, I will make two pertinent points about my constituency that I have drawn from the debate.
The Deputy Minister for Health and Community Care, Lewis Macdonald, gave us good news indeed. There will be increased funding, which is allegedly greater than what the Opposition parties asked for—it is a record funding package. The minister talked about nursery school tooth-brushing projects, the bursary scheme—more of that anon—and the increase in remote areas allowances. Those are welcome bits of news, as far as I am concerned.
Shona Robison pointed out the importance of dentists agreeing to the package. That poses a question for Carolyn Leckie, who talked about negotiations and spoke several times about "facing them down". That takes us to the nub of the problem. In this day and age, a negotiation is an agreement between two parties and a meeting of minds. The devil is in the detail for the Executive, but what it is attempting is laudable. My colleague Euan Robson said that we must all now go out as ambassadors of the Parliament and plead with dentists to get back into the NHS system and take on NHS patients. By doing that, we can help the ministers in their laudable endeavour.
Nanette Milne referred—not once or twice, but three or four times—to angry dentists. I have to say that, although her point might be valid to her, we are getting in our postbags letters from angry patients and constituents. Surely our first and foremost duty is to those people. If we forget that, we are forgetting why our electorate put us here. That must be uppermost in all our minds.
Euan Robson, in a lighter aside, announced that he would not like to be a dentist peering into our mouths. I certainly say amen to that. We would not like him to do so. However, he raised the issue of the Polish dentists joining the Polish community in Scotland. I thought that that was a nice way of putting it. Poles and other nationalities have been joining this country for many years and they are very welcome. I must be careful what I say, but I just hope that Polish dentists who come to Scotland get slightly better treatment than appears to have been dished out to some doctors in my constituency. Because that matter is sub judice, I will not go any further at this stage.
Elaine Murray referred to Polish dentists, too, and Roseanna Cunningham, in an amazingly clairvoyant speech, predicted that I would mention them. She obviously knows me far better than I realised. Mike Rumbles made a predictable but entirely laudable speech on the subject of the new dental school in Aberdeen. I think that we all hope that the consultation exercise will have a positive result.
I ask members to consider a suggestion. When the Conservatives argued that the problem is not that there are not enough dentists, my response was, "Hang on a minute." If the number of dentists is increased, there will eventually be dentists who cannot get into the private sector and who will then come into the public sector. It is worth thinking about a saturation attempt. There is work to be done on that front. I do not necessarily subscribe to that position, but it should at least be considered.
In fairness to Murdo Fraser, I should say that he made one good point, which was echoed by Jim Wallace. That point was how on earth we can attract people to Orkney, Shetland and Caithness if we cannot offer quality public services. Ministers will know that that is what lies behind my thinking on maternity services, which is an issue for another day. Jim Wallace also rightly pointed out that we must not forget the value of the salaried dentist and the disparity between the apparent rewards of the salaried and the non-salaried.
Jim Wallace also referred, properly, to the subject of visas for foreign nationals. There was a very sad case in my constituency. It concerned a Syrian—members can understand how difficult things would be for him in the present circumstances. He was a dental technician. We badly need such services in Scotland, yet we could not help him. More is the pity, he had to return to Syria. His personal circumstances were very sad, but I will not say anything further about that.
Alex Fergusson talked about blue-sky thinking and the Canadian model. We could all agree that the more we can think our way out of problems, the better.
In concluding, I will raise the two points that I hinted I would raise. First, I again welcome the bursary scheme. I assume that it will be centrally controlled in as much as it will be administered via the dental schools, but will ministers consider whether health boards—or whatever they come to be called in years to come—will be able at least to have some input? Boards should be able to tell dental schools that they desperately need a dentist in, for example, Orkney or Shetland.
The second point concerns travelling dentists. I know that issues arise to do with decontamination of equipment, but work could be done on that. Individual health authorities have considered the issue over the years, although perhaps in a slightly piecemeal way. When we consider the size of areas such as Dumfries and Galloway, Sutherland, Ross-shire, the outer isles and the northern isles, it is clear that the issue should be revisited.
I would be grateful if ministers could come back to me with their thinking on bursary schemes. The idea is highly constructive. In another place, something similar has been done for the armed forces. Getting somebody's time is part of the deal. I would be interested to know about contractual obligations and about how the system would work. Ministers should remember that we can target people if we get input from the health authorities.
When professionals come to live in Caithness, my constituency, they may spend some time there, meet a local girl, marry and become enamoured of the golf courses. They very often stay and that is what we want.
I acknowledge Des McNulty's measured contribution, in which he wondered about the private and NHS sectors working together. He also made another crucial point, which has been lost in the debate. He pointed out that, although Glasgow has the highest number of dentists per head of population, it has the worst dental record in Scotland. On the other side of the coin, Grampian has the lowest number of dentists per head for children, yet the region has the best dental record in Scotland. We have to consider the wider context—not only the number of dentists, but how we can achieve an excellent level of health care, especially for children.
Many members have mentioned the BDA. I regret that, after yesterday's long debate, I saw the BDA's briefing only this morning. However, it is worth pointing out some points that the association makes. It says:
"This move towards private care is prompted by lack of investment in NHS dentistry and frustrations with the current NHS system, including the lack of time dentists can spend with patients offering preventative advice and the type of materials they are allowed to use."
Whether that is right or wrong, we have to work with the BDA. Let us consider partnerships and outcomes and results.
The briefing also says:
"The growth of private care is also driven by the availability of new clinical procedures and heightened patient demand for treatments such as white fillings and tooth-coloured crowns that may not be available on the NHS."
Like every other profession, dentistry is demand driven as well as supply driven.
When Labour has nothing to say, it blames the Tories. By May next year, Labour will have been in government for eight years. Labour members have to be a bit grown-up and start taking responsibility for the decisions that they have made.
Nine years.
Yes, it will be nine years.
Over three years, £295 million will be invested. However, the central questions that were raised by all sides at the beginning of this debate have still not been answered. How much will the fee for NHS dental services be increased to cover the cost of treatment and to keep dentists in the NHS? I listened carefully to Lewis Macdonald. The reduction from 400 to 50 in the number of items covered by the item of service fee is welcome, as it will reduce bureaucracy. He also mentioned root canal treatment. I remember being told by a dentist that it cost more than £200 to carry out that treatment, yet the fee for the service at that time was less than £50. I am sure that there are many other similar examples. Are dentists being paid properly or are they having to subsidise the service?
The minister cannot guarantee that any general dental practitioners who have moved out of the NHS to the private sector will come back.
Let me finish the point.
There has been more investment, but more than half of it is crucial and much-needed funding for work on infection, contamination standards and training. In other words, more than 50 per cent of the investment is to stand still.
As was announced in March, we will be addressing dentists' remuneration next year. Does Mary Scanlon welcome the additional £37 million for primary care dental services that I announced today?
I would welcome anything. However, the minister has not come forward with any information so that Roseanna Cunningham and I—and others—can say to people, "Don't you worry. Your NHS dentist is not going to leave now. Ministers have made sure they will be paid. All will be well." We have not been given the reassurances that we have sought.
Many members, including Carolyn Leckie, have spoken about the earnings of dentists in private practice—around £120,000. However, that does not take into account the costs of running a business, as Des McNulty said. Those costs cover staff, insurance, heating, lighting, training, administration and borrowing, among many other things.
I would have hoped to hear, before £300 million was allocated, some commitment from the dental profession for the measures that ministers have negotiated. The minister said little about free dental check-ups. When giving evidence to the Health Committee, Professor Tim Newton said:
"the Executive is unlikely to be able to fulfil the promise to deliver on the check-ups."—[Official Report, Health Committee, 1 February 2005; c 1594.]
He had surveyed almost 3,000 dentists.
The system much lauded by Mike Rumbles will only give people an assessment of what needs to be done, tell them how long they have to wait to get it done and advise them of the cost of the treatment, which for many will be prohibitive. Six months later they will get another dental check-up to tell them the same thing again. The dental check-up is welcome, but it is certainly not the whole answer. The BDA says that it needs an increase of £348 million a year: how much will £295 million over three years achieve?
One of the dangers in debates such as this is that we oversimplify the issue. We all have to concede that it is immensely complex.
In an especially interesting and relevant contribution, Des McNulty referred to the underachievement in oral health in his constituency. I accept his points; they were absolutely true. Nonetheless, in the greater Glasgow area, there are 7.48 dentists for each 10,000 of population—the highest ratio in Scotland. The issue is much more complex than taking a simple measure of the number of dentists. However, we cannae do it without dentists, so it is important that we talk about the numbers.
In the area that I represent—Grampian—we have just over half the number of dentists for each 10,000 of population that people in the greater Glasgow area have. Our figure is 3.9. Elaine Murray's concerns over the issue are graphically illustrated by the fact that her area is at the very bottom of the table, with a figure of 3.46. In areas where there are few dentists, it is clear that too many people cannot access dental services. That applies both to private and to NHS services in certain areas, including, for a time, one of the large towns in my constituency. Simple nostrums do not deliver the answers to complex problems. On that basis, we welcome the debate that the Parliament has had today.
There is nothing so glad to the heart as a sinner who repenteth. I welcome the additional resources and the setting of priorities. I need only look back to the "Draft Budget 2005-06", which is about a year old, to find that there is only one reference—in a very large document—to dental services, on page 56. None of the targets and objectives for the health service refers to dentistry and the proposals for the years up to 2008 show a flatlining budget for general dental services for four years in a row from 2004-05. The response by the Executive and the changes that it has made are most welcome, but they are comparatively recent. That illustrates the value of sustained parliamentary pressure from members of all parties—I include in that members of the Executive parties, some of whom have had a Damascene conversion.
When he opened the debate, the Deputy Minister for Health and Community Care said that the Executive's measures were good news for dentists and patients. I would prefer him to have said that they were good news for patients and dentists. Although the difference is subtle, the change of emphasis is not trivial. Let us not talk about dentists, except in so far as they meet patients' needs. My colleague Tricia Marwick made the fine point that we need a degree of clarity on what "patients" actually means; I am sure that the minister will be able to give us that clarity. Unless it means all the people in Scotland who wish to access NHS dentists, we will be missing a trick. I hope that we will get reassurance on that.
The minister said that we must encourage dentists to rejoin the health service, but that might require a lot of courage on their part, given that there will be no substantial economic benefit to them as individuals. Dentists can make quite a lot of money in the private sector, although I would not seek to suggest that dentists in the NHS sector are impoverished. However, dentists who have gone to work in the private sector find that they can spend more time with their patients for similar money and feel that they provide a much higher quality of service. That is one of the fundamental difficulties that we face in recovering from the neglect of dental services that was started during the Tory years. I believe that dentists want to do a good job in delivering good oral health for the people of Scotland.
The minister said that we must have patience. That is certainly true in the sense that there is no quick fix that will deliver a solution overnight but, as Mao Tse-Tung said, a journey of 1,000 miles starts with a single step. We have made slightly more than a single step; we are on the case and we will continue to watch what gets delivered, as distinct from what gets done. The two are quite different—action is no substitute for achievement.
It is true that the dental health of our five-year-olds is the best ever, which is good, but NHS boards will continue not to move dentistry as high up the agenda as I and colleagues would wish it to be until there is a statutory duty on them to deliver NHS dental health services. I do not propose a date by which that duty should be imposed, because that would be for me to succumb to simplistic, knee-jerk reactions, but I think that we should say that we will have a statutory duty in the future, when the resources are in place and we have a plan that sustains that approach. That will give confidence to dentists and—more to the point—patients.
Richard Baker let down the tone of the debate when he attacked some dentists' conflict of interests. On conflict of interests, I need only refer to some of the member's Labour colleagues. Eight days after ceasing to be a Government minister, Baroness Symons became a director of British Airways. Alan Milburn, a former Secretary of State for Health, is now a consultant to Alliance Medical, which has big contracts with the NHS. The former UK energy minister, Brian Wilson, works for AMEC Nuclear and, within months of being Lord Chancellor, Derry Irvine was working as a consultant for Hutchison Whampoa, which wants £77 million from the Government. I ask Richard Baker to think again on conflict of interests.
We can discuss the past ad nauseam, but we cannot change it, so the SNP will make common cause with the Executive to tackle Scotland's oral health deficit. We now need the Executive to make common cause with the dentists.
That was a good speech, which was ruined by a 30-second meander. Nevertheless, I welcome Stewart Stevenson's comments on dental services.
Like Lewis Macdonald, I believe that what we have outlined this morning is good news for patients and dentists. We listen to debates such as this morning's with great interest. I welcome the widespread support of members of all parties for the measures that we had already outlined and those that we announced today. For some reason, some people seem to assume that the Executive has not been working on dental issues since 1999, but that is not the case. The measures that we take will continue to make a substantial difference.
As I indicated to the Conservatives, we have had widespread support for our plan—all the consultants who work in dental public health, all the clinical directors of dentistry, the chairman of the Scottish Dental Practice Board and the Scottish Consumer Council are behind it. I am certain that the measures that we are taking will make the substantial difference that we want them to make.
I have been heartened by the support that members of all parties have expressed for our commitment to the NHS. As Lewis Macdonald explained, dentists who have a reasonable patient base and who treat both children and adults will benefit substantially from our recent announcements. We are not showing bad faith by explaining to the people of Scotland the efforts that we are making to ensure that NHS dentists will stick with their patients. It is only right for us to do that. That is what we have sought to do and it is what we will continue to do.
As the process unfolds, we want both to bring dentists back into the NHS and to keep those dentists who already work there. However, in common with many members, I cannot support the position of those dentists who say that children will be treated as NHS patients only if the parents sign up as private patients. Some dentists are asking parents to sign up to a private dental insurance plan before they will treat their children. In this day and age, it is not acceptable to use the prospect of NHS treatment for children as a carrot to ensure that the parents sign up for private dental treatment. I know that my colleague Lewis Macdonald will take up that ethical matter with the president of the General Dental Council.
I welcome and broadly support what Shona Robison said. In particular, I was heartened that she felt that the package was broadly acceptable. On part-time dentists, as others have recognised, the figure that we have set under the new allowance scheme is fairly reasonable. The figure of £50,000 is an average for each dentist working in a practice, including full-time and part-time dentists. If a dentist feels that that is unreasonable or that all the criteria have not been met, there is an appeals mechanism that they can use.
It would be helpful if the minister could confirm that the £50,000 is prorated to the hours that are worked.
The figure is £50,000 per dentist. The member's point is about full-time equivalents, on which the position is clear.
We have been negotiating with the BDA for many months and we will continue that process. We want to work with the BDA and we will continue to do so.
We will be constructive in ensuring that Nanette Milne's point is addressed. Lewis Macdonald is involved in that process. She mentioned dental outreach and academic staff, of whom there is a shortage around the UK. We are working on that and we will seek to ensure that training of such specialists takes place.
Carolyn Leckie spoke about the situation in Lanarkshire. The resources that we are investing are targeted first at areas of deprivation. Our quality assurance process has picked up that some problems have occurred in Lanarkshire, which we are addressing. We will ensure that the resources that are deployed in Lanarkshire target areas of deprivation and those people who are most in need.
Elaine Murray referred to the situation in Dumfries and Galloway. I reassure her about the golden hellos: for example, there will be four golden hellos for independent dentists; depending on the work that we are doing with the board, five or six Polish dentists will go to Dumfries and Galloway, as she requested; and there will be six golden hellos for dentists undertaking vocational training. That is on top of all the measures that Dumfries and Galloway is taking to resolve those problems, as Elaine Murray outlined.
Euan Robson articulately raised many of the key issues that we face, such as the thresholds that we set and the role of part-time dentists. On the Polish dentists, there will be 12 in the first phase, 12 in the second phase and 15 in the third phase. They will be placed all around Scotland, to try to resolve some of the short-term difficulties that members so much want the Executive to address. That is right and appropriate.
On Roseanna Cunningham's point about funding for taking over existing practices, I confirm that our revised access scheme will include funding to support dentists to take over existing practices and to help other practices to move to better premises.
Mike Rumbles correctly made a point regarding the dental school in Aberdeen. We will do what is in the partnership agreement. However, we also look forward to the opening of the Aberdeen outreach training centre in autumn 2006.
Jim Wallace mentioned the salaried service. We are working assiduously on that matter. The review has just been completed and the career structure for salaried services has already been developed. As Jim Wallace knows, boards have substantial capital available to invest in such facilities and £30 million of additional central funding is available for capital development, which will address some of those issues. There are many grants and allowances for salaried general dental practitioners, new and returning practitioners, remote practitioners, vocational trainers, out-of-hours services and other such measures. I assure Jim Wallace that we are listening to the professions and responding to their demands to ensure that we adequately support them.
Will the minister take an intervention?
Sorry, but I need to make progress on other members' points.
Marilyn Livingstone rightly raised local issues and identified the good work that is being done in Fife in the triage service and in services in the community, particularly emergency services. Fife requested to be classified as a designated area. Since then, it has secured seven Polish dentists to assist it. We have written to Fife to ask whether it still feels that that is appropriate and we await its response.
I reassure Tricia Marwick that the Executive has been working on dentistry issues since 1999. The action plan is simply another step in the process of ensuring that we secure the access to services that patients want. My colleague will be writing to dentists to reassure them about our action plan. No press conference was held on the issue of a parliamentary question. The standard process was followed in response to a question. We pointed out that the figures were gross earnings and not to be interpreted in any other fashion.
I was not sure which Parliament I was in, never mind which debate, when Alex Fergusson made his comments. We have been discussing dental issues in PQs, at question time and in debates for many years. We are not bullying dentists; we are working with them. Government support for dentistry in Scotland is at historic levels. As a result of that continued support, dentists will come with us. Rhona Brankin would be proud to be in the chamber today, having launched the action plan on 17 March. We have had an additional 50 dentists in Scotland in the past year and we are on target to have 200 extra dentists by 2008. Work is going on now that will achieve for patients.
In relation to the IDH contract that Alex Fergusson referred to, a proposal from Dumfries and Galloway on that is awaited. IDH provides NHS dental services in many parts of Scotland and England and it contains two dental corporations recognised by the General Dental Council. It represents another way of providing the services that everyone in Scotland wants. We have widened our intake of dental students. We are recruiting more widely and more effectively and we have doubled the number of applicants. Eighty per cent of this year's intake is Scottish; we would therefore expect them to stay in Scotland.
There are many other points to which I would like to refer, but time is not on my side. At the heart of the agenda are our proposals on the oral hygiene of children and on preventive care. That fits absolutely with our proposals in "Delivering for Health", to ensure that we prevent people from getting unwell. In this case, we want to prevent people from developing bad oral hygiene. The Executive is making a huge effort—in schools, for example, through its interventions regarding fruit and water. It is making a huge effort on oral health promoters and dental health support, on the work of the mobile units and on the focusing of resources on less well-off communities. Action is being taken now on public health measures for oral health—on the workforce and education, on the general practice allowance, on the rent rebate scheme and on emergency dental services. All those measures will work together to ensure that we improve our oral health, increase the dental workforce, improve education and training and modernise our system. It is for us all to do—it is for parents to do, it is for the NHS to do, it is for dentists to do and it is for the Parliament to support the motion.