Dental Services in Grampian
[Applause.] Thank you.
The final item of business today is a members' business debate on motion S2M-43, in the name of Richard Baker, on dental services in Grampian.
Motion debated,
That the Parliament welcomes the proposals for a dental outreach centre outlined by the new Scottish Executive in A Partnership for a Better Scotland; recognises that there are huge challenges in addressing the shortage of NHS dental services in Grampian; further welcomes the fact that all 10 postgraduate training places in local dental practices have now been filled, and welcomes consultation on the further development of dental training in Aberdeen.
It is a great pleasure to make my maiden speech in the chamber this evening and a great privilege to have secured the first members' business debate of this session on such an important issue. Poor access to dental services in Grampian and many other parts of rural Scotland is a problem that the Parliament will have to address.
As this is my first speech, I would like to take a moment to say that I am proud to have been elected to represent North East Scotland. I have not succeeded a Labour member in that position, but I would like to pay tribute to Elaine Thomson for her work in representing Aberdeen North in the previous session. Over four years, she worked tirelessly and achieved a great deal for her constituents on issues such as the future of the energy industry in the north-east. I am sure that members from all parties would like to thank her for her efforts and wish her the best for the future.
I look forward to fighting our region's corner in the Parliament. It has already become clear to me that there are a number of issues on which members for the region work across party lines. Access to dental services is one of those issues, and I am pleased that my motion has received cross-party support. It is a great concern to all of us in the north-east that there are such evident problems in access to dental services in the region—especially access to national health service dentists.
That is a problem throughout Scotland. The number of dental graduates who opt to work in the NHS has fallen from 70 per cent to 60 per cent over the past 10 years. Although there are vocational training initiatives in Scotland, students too often choose to work south of the border once they qualify.
There is a particular problem because of the low number of dentists who provide NHS treatment in the north-east. In the most recent report of the Scottish Dental Practice Board, from 2000-01, it was noted that some 63 per cent of children and 48 per cent of adults were registered with an NHS dentist. Those figures are below the national average for Scotland, which are 65 per cent and 50 per cent respectively. Since that time, the number of available dentists who practise in Grampian has fallen and many primary care dentists have moved away from NHS treatment to private insurance schemes for patients.
The Executive's action plan for dental services in Scotland shows that nearly 25 per cent of children are not registered with a dental practice, leaving them with no on-going dental care at all. That needs to be put in the context of the particular problem in Grampian, where there is one dentist for every 3,600 people. That compares with one dentist for every 2,300 people in central Scotland. In Aberdeenshire, there is one dentist for every 5,000 people. I welcome the proposal in the partnership agreement to introduce free dental checks. For that to happen effectively, we must first ensure that people have access to dentists.
I have spoken today to Robert Donald, who is the chairman of the Scottish dental practice committee. He told me of the shortage of dentists throughout Scotland and pointed out that the Highlands share many of Grampian's recruitment problems.
The fundamental problem in Grampian is recruitment and retention. Many posts for dental staff remain vacant. If that trend is to be changed, we will have to attract more dental undergraduates and postgraduates to the area. From my experience, people who come to Aberdeen to study enjoy living in the area and often stay or return to work there. The challenge must be to foster that environment for dental students.
A start has been made. A golden hello package has been introduced by the Scottish Executive with some £270,000 being allocated to Grampian. Those who are recruiting postgraduates to work in Grampian have had particular success this year. For the first time ever, the Aberdeen vocational training scheme for newly qualified dentists was filled before that of other more centrally located schemes, with all 10 postgraduate places in local dentists' practices being filled.
Is it not true that 10 is a totally inadequate number to fill the number of vacancies in the area, which is somewhere between 30 and 40? Steps should be taken by the Executive to expand the number of postgraduate training places in the area.
It would be good if the member were to welcome the efforts and the progress that are being made. For the first time, we have all those postgraduate places filled. If the member listens intently to my speech, as I am sure he will, he will see that we are already making progress in providing further postgraduate training places in Aberdeen. That is what the announcements in the partnership agreement were about. Last year, a pilot student outreach scheme proved very popular. Final year students from Dundee were attached to practices in Grampian. I welcome the commitment in the partnership agreement to the £4 million dental outreach centre in Aberdeen. That will address some of the points that Brian Adam makes.
The proposal for consultation on further development of dental training in Aberdeen is also welcome. This is an opportune time for that consultation, as key stakeholders meet next week in Peterhead to discuss future plans for dental training in Grampian. It is important that the consultation process is robust and considers all the options. One of those options is the proposal for a dental school in Aberdeen. I believe that the University of Aberdeen has already indicated that it would be willing to be involved in such a scheme. The proposal needs careful consideration. It should be discussed with those who are already involved in providing dental training in the city. I believe that the right decision has been made in developing further postgraduate training first, so that we can gauge its impact.
Without doubt, only a start has been made in addressing the problems of dental service provision in the region and, more generally, of recruitment of dentists in rural areas. I am sure that those will be key issues throughout this session of Parliament. I urge the Executive to make swift progress in encouraging the development of the outreach centre in Aberdeen to ensure that it is adequately resourced, and to listen to the views of those involved in dental service provision in Grampian when considering what further developments will be required in providing additional training. I hope that the general spirit of broad consensus on this issue continues as we all work to ensure far better access to dental services for people in Grampian and throughout the north-east.
Thirteen members wish to take part in the debate. I will try my best to get everyone in. If members stick to three minutes, we might manage to do that.
I congratulate the Deputy Presiding Officer on her appointment.
I welcome the opportunity to speak again about the issues that affect dentistry in the Grampian area. This is not the first time that such issues have been raised in the Parliament—they were raised many times during the Parliament's first session. We acknowledge that there are similar problems in many parts of Scotland. We see the issue not just as a local matter but as a problem that needs to be addressed at a more fundamental level.
I congratulate Mr Baker on raising the matter and on discussing it in his maiden speech, but that is as far as I will go. Members of all parties from throughout the Grampian region have consistently highlighted the problem for more than four years. Although the Executive published its dental health plans in 2000, there has been no progress. I have a file of correspondence on the subject from my constituents and from dentists that is at least a foot thick.
My criticism of the motion—and the reason why I did not sign it—is that it seems to imply that everything is coming up roses. Mr Baker might think that the roses in question are red roses. I am not sure what planet he is on, because there has been no fundamental improvement in dental services in the Grampian area.
I want to highlight a few issues. Not a single practice in Moray is taking on new NHS patients. In my area, there is a very high number of defence personnel. The 18-month reregistration rule means that servicemen and servicewomen who have worked in the Lossiemouth or Kinloss area and are sent somewhere else on a two-year tour of duty cannot reregister when they return to Moray because they have been away for two years.
Increasingly, general practitioners and accident and emergency units are being inundated with patients with dental problems. I have with me letters that I received this week from the Maryhill practice in Elgin. The GPs have written to me and to Grampian Primary Care NHS Trust about the number of patients that they have to see. They say that the reason for that is not lack of dental hygiene but lack of provision. This week, I also received a letter from a pensioner in Cullen. He was told that he was no longer an NHS patient and was given six telephone contact numbers about where he could register. The practices that were likely to accept him were in Aberdeen and Banchory. Those seem to be the only practices that are taking on people such as pensioners. Is that how we treat our pensioners? Anyone who knows Cullen will know that it is not the easiest place in which to look for public transport.
The problem is that the golden hello and the other measures that the previous Executive used to tackle recruitment and retention are not working. I recommend that, once the Health and Community Care Committee is re-established, it should put dental provision throughout Scotland high on its agenda, so that we can come up with cross-party ideas to ensure that patients are not so sorely neglected.
First, I congratulate Richard Baker on securing the debate. I welcome the opportunity to discuss NHS dental service provision in Grampian and the serious and growing problem of recruiting and retaining dentists in that area. As the oldest new girl in the recent intake of north-east MSPs, I am happy to support the motion from its youngest member. Although I do not imagine that such happy political consensus will endure for the next four years, it is vital that we all work together on an issue that is of such importance to the people of north-east Scotland.
The timing of this discussion is opportune, as it comes just ahead of next week's dental healthfit conference, which is being organised by NHS Grampian. The conference will consider the current pressures on the system and the forces and drivers for change within dental health, with a view to planning Grampian's dental services in the medium to long term.
From speaking to local dentists and from reading some of the papers that have been prepared for next week's conference, it would appear that, although Grampian's problems are many and complex, the major issue facing the service is, as Richard Baker said, the recruitment and retention of dentists within the area. As we have heard, against a Scottish average of one dentist to 2,700 patients, Aberdeen has one dentist to every 2,900 patients, while the more rural Aberdeenshire has only one dentist per 5,000.
Despite the clamour from several politicians for the provision of a dental school in Aberdeen, local dentists do not seem to see that as the solution. The existing dental schools in Dundee and Glasgow would already be training enough dentists to supply local demand if the dentists could be persuaded to remain in Scotland and if they could be attracted to the more peripheral areas such as Grampian. Several inducements have already been tried, with varying levels of success.
Many graduates wish to practise where they have trained, so the outreach centre promised by the new Scottish Executive for undergraduate training in Aberdeen is to be welcomed. If that were coupled with good postgraduate facilities in the area, a lifelong learning continuum could be established which, it is reckoned, could go a long way towards retaining good young dentists within Grampian. A good postgraduate centre could provide resources for all members of the dental work force and would become the backbone of vocational and general professional training, which will undoubtedly assume increasing importance in time to come.
I welcome the Executive's commitment to consult on the further development of dental training in Aberdeen, but I suggest that consideration should focus primarily on the provision of postgraduate facilities within Aberdeen rather than the provision of a further dental school for undergraduate training.
I am pleased that dental services in Grampian are the focus of the first members' business debate in the new session and I congratulate Richard Baker on securing it—he and I have something in common in that we both chose improvement of dental services in the north-east as the subject our first members' business debates. I chose the issue as the subject of my first members' business debate on 30 November 2000, so I am delighted that real progress is now being made.
I said during that debate that the focus of my concern was on the difficulty of attracting dentists to areas of rural Scotland in the north and the north-east. Two and a half years ago, I said:
"When I pressed health authorities to provide information on the level of NHS dental provision in the north-east, I was amazed to discover that no such information exists—no one could tell me how widespread the problem of accessing an NHS dentist in rural Aberdeenshire is."—[Official Report, 30 November; Vol 9, c 614.]
It has taken two and a half years of campaigning, but everyone now knows exactly how widespread the problems are. As we have heard tonight, Aberdeenshire has only one dentist for every 5,000 people, compared with one for every 2,900 in the city of Aberdeen and a Scottish average of one for every 2,700 people.
It is true that the Scottish Executive has introduced grants and allowances to try to address the problem. However, the rules state that a dentist who has completed vocational training must apply for a position within three months of completing that training, which is not the most effective method of attracting people back to the profession.
Two and a half years ago, I suggested that there were two solutions to the problem. First, the target of 120 graduates per year had to be increased. I said that, because Scotland produced up to 160 graduates before the Edinburgh dental school was so disastrously closed by the Tories—perhaps Nanette Milne will remember that—we needed merely to restore to that level the number of dentists who were being trained each year. That could be done by establishing a link with the Dundee dental school, which would bring trainee dentists to the north-east in the first place.
Secondly, I said that we need properly to fund a core service, with full funding for check-ups, fillings, extractions and dentures, because the fees that are associated with NHS dental services were outdated. I was pleased to be able to ensure that those proposals reached the Liberal Democrat manifesto for the recent election, together with a firm proposal to establish a new school of dentistry in Aberdeen. I was fortunate to be directly involved in the partnership negotiations between the Labour party and the Liberal Democrats, so I was determined to ensure that those commitments survived; I am delighted that they did. I am also pleased to see Tom McCabe as the Deputy Minister for Health and Community Care—our to-ings and fro-ings on the issue were most interesting.
The partnership agreement says that we will "design appropriate award measures" to "encourage preventive dentistry" and that
"We will expand the capacity of dental training facilities in Scotland by establishing an outreach training centre in Aberdeen."
We will also consult on the need for a dental school. That level of commitment is exactly what is needed to solve the problem; I am delighted that we have an agreed solution and I have every confidence that real action will follow.
In conclusion, I welcome the opportunity that is presented by tonight's debate on the motion to confirm the agreement between the Labour party and the Liberal Democrats to address the shortage of NHS dentists in Grampian by practical measures. Two and a half years of campaigning have paid off.
I welcome every move that is being made to encourage the development of dentistry services in the Grampian area. I am, however, more concerned about the practical side of things—I cannot imagine what it must be like for someone to have to travel 50 miles with raging toothache and then to have to sit and wait for ages to get any emergency treatment. Such a state of affairs is intolerable and those of us who live in more built-up areas cannot appreciate the amount of suffering that is going on.
There are two approaches at the moment. First, the holistic approach seeks to develop much better dental health from infancy through better diet, free school milk and encouragement to drink water instead of fizzy drinks, although I would not go down the road of putting fluoride in the water as a form of mass medication.
There is a more immediate point. I am new to Parliament and am aware that we spend an awful lot of time talking, but I would like to feel that we could achieve something. I will therefore leave it up to members to say whether what I am about to suggest is feasible and could be enacted quickly. What about mobile dental units? They can get out and about easily, they cover huge areas and their staff can cover many patients. I ask the minister whether such units are a possibility and, if so, whether something could be done quickly.
A mobile dental unit was tried in Caithness and Sutherland, but the working time directive made it almost impossible to operate. By the time the dentist got to a village, he had run out of time to work. Perhaps mobile dental units could work in less remote rural areas, but they have not so far been a success in the north of Scotland.
A combination of problems affects rural areas. First, dentists can earn more outside the NHS; private practice has been established in the Highlands for the past 10 to 15 years. Secondly, it is obvious that dentists do not want to practise in rural areas—whether in private practice or in the NHS—so we have to find out why and what is keeping them in the cities.
There is a tremendous recruitment problem in the Highlands. There are six general dental practitioner vacancies in Nairn, Fort William, Inverness, Dingwall and Kingussie. Highland Primary Care NHS Trust, which is recruiting salaried dentists, has four vacancies in Inverness, Sutherland and Caithness. That trust has tried everything—it has advertised overseas and has received some applications from non-European nationals. However, those dentists must sit equivalence examinations that are set by the General Dental Council. The trust is also receiving an increasing number of calls from people who are concerned about its lack of success in attracting dentists to the Highlands.
The problem is snowballing and the golden hello of £10,000 that is paid over two years has not attracted a single extra recruit to the Highlands. We must therefore consider what we have to do to get dentists to move to rural areas. I feel that salaried posts are part of the way forward. Highland NHS Board is compiling for submission to the Executive a bid for the development of senior posts within the dental service. Its objective is to ensure that patients have improved access to specialist services. Recruitment would also benefit because there would be increased opportunities for career development in the Highlands. I urge the Executive to make a positive response to that bid because it is one of the ways forward. If we can have a real career structure for salaried NHS dentists in the Highlands, we might be able to attract more dentists. Other solutions have been offered that perhaps partly answer the problem, but the problem will get worse unless we get to the root of it.
Colleagues from all parties will not be surprised to learn that every time the sun shines in Banchory, Mike Rumbles puts out a press release in The Deeside Piper and Herald to take the credit.
I congratulate Richard Baker on securing his first debate, which is on such an important issue. There has been a cross-party campaign for the past four or five years to bring the issue to the attention of ministers. In particular, I give credit to the many dentists who first called the cross-party meeting that I, Mike Rumbles, Brian Adam, David Davidson and others attended and which kicked off the campaign a few years ago.
As previous speakers outlined, I say to the minister that NHS dentistry in Grampian faces a crisis. Only four of 30 practices in Aberdeen accept NHS patients and only three of 27 in Aberdeenshire do so. Many thousands of people are being disenfranchised from the service. Perhaps one of the most startling statistics is that, as of today, over 54 per cent of people living in Grampian are not registered with any dentist, NHS or private. Therefore, as far as we can make out, 54 per cent of people in Grampian do not go to the dentist.
The situation gets worse every month. In January, 776 people fell off the NHS lists in Grampian. Seven hundred and five fell off in February, 1,673 fell off in March and 1,502 did so in April. There is a separate figure for people who have been deregistered because dentists have retired or moved away from the area, which means that between January and May another 6,863 patients in Grampian fell off the NHS lists. The situation is so bad that about 1,000 people phone the local helpline every month in Grampian to try to find out where they can get access to an NHS dentist. The situation is now so chronic in Aberdeen, for example, that only one or two practices accept children as new patients on the NHS lists. That is surely a serious issue for all members, but especially for the Minister for Health and Community Care, given that we want to get children to attend their local dentist.
Mr Lochhead is in his final minute.
The short-term solutions are not easy—there has been more cash, but it has not had a tremendous impact. However, I think that we are talking about the long-term issues and we all welcome the possibility that there might be an outreach training facility in Grampian in the not-too-distant future.
Several dentists have proposed another short-term solution to the problem, which is the recruitment of dentists from overseas. In the past few months, one dentist has brought over five Spaniards. Several Scandinavians are about to start working in practices in Aberdeen. There exist in other European countries surpluses of dentists who are looking for practices in which to get experience to start their careers. It is a matter of our getting them to come and work in North-east Scotland and, indeed, elsewhere in Scotland. That means that we must extend to overseas dentists the golden hello, in order to try to get them to come here, and we must also offer them the facility to go back to their own countries perhaps three or four times a year. We must also give support to existing dentists in Grampian to train the new dentists who come from places such as Scandinavia and Spain, because at the moment the existing dentists are not compensated for taking time out of their practices to train overseas nationals who come to work in Grampian.
Finally, I call for a survey of the situation in Grampian. As other members have mentioned, there is a lack of available information. There must be flexibility in the available funding and we must get the training facility up and running as soon as possible. We must make recruiting from overseas an absolute priority so that we can start addressing as soon as possible the gaps in NHS dental provision for adults, children and—as Mrs Margaret Ewing said—senior citizens.
I add my welcome to the Deputy Presiding Officer in her new role, and I add my thanks to Richard Baker for giving us the opportunity to discuss a problem that has been on-going for many years.
I first became aware of the problem at least 10 years ago when I worked for the then Grampian Health Board in a community liaison team and had to find NHS dentists for people who had moved into the area or who had moved house within the area. The task was difficult at that time, but at least we could usually find a dentist for people to sign up with. The situation has, however, become steadily worse. A few weeks ago, a dentist in Keith retired and the people from that dentist's list now have no NHS dentist with whom to sign up. It is hard to overstate the frustration and anger in having to say to constituents, "I'm sorry; I can't help. The service isn't there."
The blame cannot be laid at the health board's door, because it has made strenuous efforts to deal with the problem. It has explored the option of salaried dentists and it has advertised, but received no responses. The health board has also implemented the golden hello. As Richard Lochhead said, the board has tried to facilitate the recruitment of dentists from other European Union countries, but Grampian is still 40 or 50 dentists under strength.
Other matters give us cause for concern, such as the age profile of existing dentists. Many are within four or five years of retirement, which means that the situation will become even worse. We must examine the number of dentists who are being trained and, as we train more and more female professionals, we must ask whether we have factored in fully the need to take time out for childbearing, because that matter has not been fully addressed in the dental profession or in many other professions. Young dentists might prefer the opportunity to have a salary to setting up in practice, which has a business side that might not be attractive to them. Questions have arisen over how NHS dentists are remunerated and the limitations that that imposes on the way in which they work, which could be a disincentive to dentists who want to use modern techniques or do more preventive work.
Shiona Baird highlighted some of the good ancillary measures that can be taken to promote oral health. Many of them are being taken and we should do as much as we can on that, because such action is immediate and does not have the built-in delay of training more dentists.
Apparently, about 90 per cent of professionals settle within 70 miles of where they finished their training, so I welcome the commitment to beefing up dental training in Aberdeen, because that will help our part of the world. The crisis exists now and the solutions are largely for the medium-to-long term, but the sooner they are started, the better.
I congratulate Richard Baker on his maiden speech and I congratulate Trish Godman on her first debate as a Deputy Presiding Officer. Richard Baker must have wondered why somebody from Dumfries signed his motion and whether it was a slip of the pen or the mouse that added my name to it. I do not know much about dental services in Grampian, but I can empathise with people there, because the situation is replicated throughout Scotland outwith the central belt, as members have said.
I will say a few words about the equivalent situation in Dumfries and Galloway, which has one dentist for every 4,000 people. I had extensive and helpful communications with Mary Mulligan about my constituents' problems, which resulted in five salaried posts being made available last summer. Although those posts were advertised throughout Europe, we have had not one single applicant for them. We have had one new dentist in the past couple of years. He came from Scandinavia and he did not last long. When he saw the state of my constituents' teeth, he returned home.
Only two dentists have lists open in Dumfriesshire—one is in Lockerbie and one is in Sanquhar, which takes people north of Auldgirth. My family and I have no dentist and my children have not had a dental check-up for two and a half years. Even if I overcame my fundamental dislike of private health care, that would not make the situation much better.
An emergency service has operated between 10 am and 12 pm on Sundays for the past few months. It has received 1,150 emergency calls and it received 43 calls on the first three Sundays of May. That service is pressured, because it relies on dentists to give up their free time on Sundays to operate it. As Jamie Stone said, although we might welcome the idea of free dental checks, we do not have a dentist to go to for those checks at the moment.
Last night, I watched with interest "Frontline Scotland", which discussed the case of the engineer and doctor asylum seekers who want to work in this country. I note that the Scottish Executive is pressing the Home Secretary to allow asylum seekers who have rare skills to work during the time that they are waiting for their claims to be processed. If dentists who seek asylum in this country came to Dumfries and Galloway, I am sure that we would welcome them with open arms and, indeed, with open mouths.
I, too, congratulate Mr Baker and all the new members of the Parliament who have contributed so eloquently to the debate. The retreads like me can cope for themselves.
One Sunday, when the Rev Ian Paisley was delivering a sermon, he described graphically the condition that awaited those members of his congregation who would not ascend to heaven but would go to the other option. He said: "There will be a wailing and a gnashing of teeth." At which point, one of the congregation said: "But, Reverend Paisley, I have no teeth." To which came the answer: "Teeth will be provided." That suggests the problem that we face: what sort of dental service will be provided over the next four years?
Mr Baker rightly highlighted the problems that some of us have raised over the past four years. The solutions, however, have not yet been found. I want to make some positive suggestions to Mr McCabe, which I hope he will pursue—indeed, I made them to his predecessor.
Why are the golden hello payments so restrictive? Why is the group of people who are entitled to receive them so narrowly defined? Surely if we want to attract dentists to provide NHS dentistry, we need to create the widest possible choice from which to draw the widest possible group of people.
We heard earlier this afternoon about the intimations of discontent within the partnership relationship. However—if the partnership is still to be called a partnership—it appears from the partnership agreement that we are to have free dental checks before 2007. Will all dentists, including all those who do not provide NHS dentistry, provide free checks, or will those checks be provided only by those who operate in the NHS? If the latter is the case, the interesting question for the minister is how the policy will be delivered.
Is not the main problem the vast discrepancy between NHS and private rates? A similar problem arises under the legal aid system, whereby legal aid is not available to many people. Why do we still have the 18-month rule and how on earth can that rule be applied to children under five? We register for life with our general practitioners, so why register for such a restricted period with a dentist? Surely that ludicrous rule has to be changed.
I commend the excellent provision for young children in Highland that is led by the public health department. I hope that such provision will be taken up elsewhere. Like Elaine Murray, I am not sure of the details of dental provision in Grampian, but surely fizzy drinks should not be sold in schools anywhere in Scotland. Surely sponsorship arrangements between schools and purveyors of chocolate should be banned. I will be interested to hear whether Mr McCabe agrees with that point.
My final point concerns dentistry in sparsely populated areas. My dentist, Mr Gill, provides dentistry to more than 1,000 patients in the Ardnamurchan area. He retired to the area from Liverpool and is a fine fellow. However, he earns too little to access commitment payments, seniority payments or even assistance with continuing professional development. I put Mr Gill's case to the minister's predecessor. I hope that Mr Gill and others who are trying to provide a dental service in sparsely populated areas in Grampian, Highland or anywhere else will receive a better deal than they did under the previous shower—I mean, previous lot.
I welcome the Deputy Presiding Officer to the chamber. I hope that she has an easy ride. Moreover, I congratulate Richard Baker on securing the debate. The issue has been dealt with on a cross-party basis for some years now and I hope that that will continue to be the case. Tonight's members' business debate is a good way of dealing with the issue, as members will not try to take lumps out of Tom McCabe too early in his career as the Deputy Minister for Health and Community Care.
As other members have pointed out, we need to get dentists into community practice across Scotland, particularly in rural areas. At the end of last week and throughout the weekend, I received a rash of e-mails, letters and telephone calls about the fact that the dentist in Banff has given up his practice. That follows the news that my dentist in Stonehaven has given up. As a result, his partner has had to wind down the work that he does, which has taken out a practice in Peterculter on the edge of Aberdeen. We have had problems in Ballater and Banchory—the list goes on. The coalition Government has to address what is a major issue as soon as possible.
If the problem is in attracting dentists, surely the solution starts with postgraduate training. If we can attract people into postgraduate and supported training in a practice in a particular area, they will stay if they are given career opportunities. Although Dundee dental school is about to double in size and intake, the question is whether a postgraduate training facility in Aberdeen would be able to attract many of those young graduates into practices in the Aberdeen area.
There are other problems. For example, will dentists who provide training places be supported in giving up time from their list work? Brian Adam asked why there are only 10 postgraduate training places. If we are short of 30 dentists but can fill those 10 places, the obvious answer is to expand the number of training places where possible.
As for EU-trained dentists, I proposed a solution to that problem to Grampian NHS Board last week. Indeed, some of my colleagues have heard me talking about the matter. If golden hellos can attract local dentists and provide some flexibility, that is fine. However, if there is no flexibility to provide EU-trained dentists with accommodation, subsistence and other forms of support, they will not come here to train. If they are going to work as salaried dentists, why cannot the health board give them interest-free loans? In the absence of any suggestions from the Scottish Executive, the health board—bless it—is considering that option. Devolving such power to the local health board would benefit everyone by allowing it to focus on such services.
We will also need to support dentists who provide the training. At the moment, they have to carry out private dental work to make a living and to pay for new equipment and so on. That is frightening people off from buying practices. Indeed, it is a terrible problem for my dentist, 82 per cent of whose work load is NHS related. If he goes, that will not just increase the work load of other dentists, but enormously reduce access, particularly for children.
Community dental officers can deal with the housebound, the disabled and children. However, there are not enough of them and they are not being allocated enough resources. A friend of mine who is a community dental officer could fill every hour of every day for the rest of her life with work and still not catch up. I ask the minister to consider how we can use such officers.
I congratulate the Deputy Presiding Officer and welcome her to her new post. I also congratulate Richard Baker on a superb maiden speech and the other members—Nanette Milne and Shiona Baird—who spoke for the first time and made elegant and thoughtful contributions.
Let us not muck about: the problem is absolutely huge. During the election campaign, access to NHS dentistry was possibly the biggest issue in the Thurso area. All the candidates came up against it time and again at hustings and meetings and on doorsteps. We cannot underestimate the problem. Although it has been around for a while, it has increased almost exponentially over the past year or so.
Members have made some helpful suggestions. I will not add any more. We will need to deal with the matter through working together, thinking laterally and coming up with imaginative solutions to the problem. As I have said, we should not underestimate how massive the problem is.
In the far north, there have been anecdotes about people removing their teeth with pairs of pliers. I do not know whether such stories are true. Nevertheless, we can be certain that the current problem will become much bigger in years to come. After all, over a number of years, a rotten tooth will become an abscess or far worse.
The poorest in our society will lose out, because people with the least income will be more inclined to cut out the option of going private, which means that they and their families will suffer. As a result, we must all take the matter incredibly seriously.
Margaret Ewing made the eminently sensible suggestion that the Health and Community Care Committee should consider the matter as soon as possible. The committee should work with the minister. I have talked about lateral thinking and imaginative solutions—that is the way forward. There must be a partnership.
I welcome the wonderful innovation of the axis of Mike Rumbles and Tom McCabe, which is completely unknown in the Parliament. One might almost talk about a pact of steel. I think that political miracles will now happen. Seriously, however, we must take action.
Mr Fergus Ewing was allowed to start with a joke, so perhaps I may conclude with one. A constituent of mine from the village of Portmahomack had a heavy night on the drink and went out on a coble, which is a boat, to get lobster pots. He was ill with the drink and I am afraid that, with the slow, oily swell off Portmahomack, he was sick and his false teeth went over the boat's edge—this is a true story. For a joke, the skipper took out his own teeth and, without the ill fellow seeing him, put them on a hook and let down the line. He said that he had a bite, pulled up the line and said, "Look, Murdo. I have your teeth." An astonished Murdo looked at the teeth, said, "Och, they're no mine," and threw them back.
I, too, congratulate Mr Richard Baker on securing such an important and timely debate. We tend to forget how much progress has been made in dentistry over the years. Indeed, the first dental register was established only in the late 1930s. My first dentist had no qualifications whatever in dentistry but had been put on the register on the basis that, over 20 years, he had not killed too many people. I wonder whether we are heading back to a similar situation.
Something has been made of golden hellos, but I am cautious about their effect. For a new graduate, the golden hello is likely to be substantially smaller than their debts. The introduction of the graduate tax—or the abolition of tuition fees, as the Liberals would prefer me to say—is a strong incentive for graduates to consider posts outwith the United Kingdom.
Will the member take an intervention?
No—there is not enough time in three minutes.
We must try a great deal harder and consider substantially bigger golden hellos.
We have discussed the number of patients per dentist, but things are worse than what some numbers suggest. In Manchester, the figures are down to 1,200 patients per dentist. The basic problem is that there is a huge shortage of dentists throughout our islands. If a dentist has an opportunity of choosing where they will practise, will they practise in Aberdeenshire, where they will have to work four times as hard as they would in Manchester? They probably would not, unless they have an extremely strong attachment to Aberdeenshire.
Reference has been made to the difficulties of getting emergency dental treatment, which people are having to travel 100 miles to receive. Routine dental treatment is an equally big issue—people simply will not go for it.
I suggest that another problem is looming. David Davidson referred to what has happened in Banff. People are finding it impossible to sell on their practices, as no dentists are coming in to buy them. If that continues to be the case, people will not set up new practices. There is a downward spiral and a problem that will take many years to solve. There have been encouraging first steps, but we should not become complacent. I think that things will get worse before they get better, unless the minister can tell me otherwise.
Presiding Officer, I welcome the justified and warm response that you received at the beginning of the debate. I also welcome Richard Baker to the chamber and congratulate him on his speedy efforts to have such an important topic discussed so soon in his first term as an MSP.
During the previous session, the Executive pursued a commitment to providing an effective and accessible dental health service for all who wish to use it. We intend to underline that commitment by pursuing the aspirations that are laid out in the coalition partnership agreement and by keeping the need for incentives that attract and retain students and practising dentists within the national health service under constant review. I was proud to play a part in the work that led to that agreement and to work with my friend and colleague Mike Rumbles on it. I look forward to working with him and other Liberal Democrat colleagues over the months and years to come.
I recognise that there are significant problems with access to NHS dental services in some parts of Scotland and that those need to be addressed in order to fulfil the commitments within the partnership agreement. In the primary care sector, in which around 90 per cent of dental patients are treated, most general dental practitioners are independent contractors who are free to choose whether to accept patients on the NHS. It is regrettable that in many parts of Scotland, including Grampian, there has been a reducing commitment to the NHS by some practitioners.
To address the situation in Grampian we have, since 2000, approved 8.5 whole-time equivalent salaried dentist posts, 5.5 of which have been filled. Grampian Primary Care NHS Trust continues to seek dentists for the three salaried posts in Moray, which will be located at Dr Gray's hospital, Elgin. We are assessing a further application for four salaried posts, two of which will be based in the Inverurie area and two in Westhill.
To achieve improvements in dental provision we need to have the people to deliver them—the right number of people with the right skills in the right place. There is no one answer to planning the work force and the associated service delivery. We recognise the need for a total-system approach, with more graduates, better retention packages—especially in remoter areas—a better contract for general dental practitioners to offer improved lifetime working conditions and trained support staff to undertake some of their duties.
On short-term solutions, given that a number of overseas dentists have come to Grampian to work—there are surpluses of dentists in many European countries—is the minister willing to consider taking new measures to encourage that trend?
I will come to that matter later in my speech. There is a general acceptance that we will keep under review all measures that are necessary to improve the serious situation that exists in some parts of Scotland.
We have already agreed a target output for the dental schools of 120 graduates per year and we have the funding in place to implement that target. We will review that, given the obvious shortages that exist in Scotland.
In the coalition partnership agreement we have undertaken to expand the capacity of dental training facilities in Scotland by establishing an outreach training centre in Aberdeen. That should provide us with the potential to increase the number of dental graduates in Scotland by approximately 20 per year. In addition, we have given a commitment to assess the potential for a dental school in Aberdeen. I hear the assertions that Mrs Newman has made. I am sure that within that consultation and assessment those claims will be tested.
My name is Nanette Milne.
I am sorry. I apologise for getting Nanette Milne's name wrong. We are both new.
We are also now able to offer postgraduate vocational training places for all Scottish graduate dentists. We have put in place funding to increase significantly the number of trained professionals complementary to dentistry, to enhance the dental team.
As well as getting the numbers right, the quality of training is vital. Dentists can register to practise on graduation, but the NHS insists on one year's postgraduate training. In Scotland we have successfully piloted two-year general professional training and aim to increase the provision for all graduates of Scottish dental schools. We have increased the number of training posts in the community dental service to feed that service and to give more dental trainees experience of the needs of those who do not get treatment through the normal channels.
Planning the dental work force is also about having people and their skills in the right place. We need to ensure that dentists choose to live and work in all parts of Scotland. Members may recall that last year we put in place a £1 million package of measures to improve recruitment and retention of NHS dentists and to help to ensure that patients are able to access NHS dental treatment. Key measures include funding for a vocational training place for all new dental graduates; a £3,000 allowance for each new dental graduate taking a training place in areas, including Grampian, where access to NHS dentistry is extremely restricted; a £5,000 allowance over two years for dentists who have completed training and are entering substantive NHS practice, or a £10,000 allowance over the same period where the post is in one of the designated areas; developing and funding an education and support programme for all new dentists who have completed training; and grants of up to £10,000, based on the amount of NHS work, for dentists who establish new vocational training practices and offer a training place.
Earlier this year, we announced a further package of measures, which was developed in consultation with the profession and which included a new practice allowance for dentists based on their NHS earnings. We also doubled the remote areas allowance to £3,000. Mike Rumbles raised concerns about the time taken to apply for such allowances and David Davidson mentioned the golden hello. We are happy to review those matters in the light of the experience of the measures that have been put in place. I say earnestly to members that there is nothing to prevent us from continually reviewing the measures that are in place. There is a strong will to do so and to try to achieve our aspirations.
Members who represent rural areas, particularly Grampian, have made the point forcibly that dentists prefer to be close to the area in which they did their training. I stress that we take those concerns seriously. For example, we have encouraged the dental schools in Glasgow and Dundee to develop outreach training, which will give undergraduates experience in rural areas and hospitals. I assure Maureen Macmillan that we will continue to review the impact of all the measures, particularly in the Highlands.
We have put in place a number of other measures to encourage dentists to further their contribution to the national health service and to locate in areas where NHS services are under-provided. Those measures include grants under the Scottish dental access initiative and the provision of salaried dentists, which is important. The dental access scheme encourages dentists to establish or expand their practices in areas of high oral health need or in areas in which patients wish to be treated on the NHS but have difficulty finding a dentist who is willing to accept them. To date, £1.2 million has been offered to practitioners in Scotland under that initiative, £145,000 of which went to Grampian. We will encourage other dentists who are committed to the NHS to consider whether there is scope to expand their practices with the help of that capital grant.
On Richard Lochhead's point, I am aware of the issue of dentists from other European Union countries, six of whom, I believe, are located in Aberdeen. We will keep that issue under review—our minds are not closed to the possibilities that it provides.
This year, we have made £3 million available for practice improvements for dentists who undertake NHS dental services. Given the previous three years' allocations, a total of £10.3 million has been made available to encourage practice improvements. Shiona Baird mentioned mobile units. As part of our general willingness to review all initiatives that would improve the situation, I am happy to consider that issue.
I hope that the measures outlined above demonstrate to members our serious commitment to increasing NHS dental services. There is no room for complacency and we recognise that we must intensify our efforts to ensure access to services. We will continue to work with the profession and with NHS bodies in Scotland to develop further measures to achieve that aim.
Meeting closed at 17:58.