Chamber and committees

As I did in the previous debate, I thank all the professionals working in the sector for their hard work. I also thank the BDA for its briefing ahead of the debate.

I met the BDA on Monday and had a good discussion with it about several of the issues that have been covered so far. It raised issues, particularly those relating to the backlog that has been created by the pandemic, that practices across the country are working hard to overcome.

With regular check-ups not happening during the pandemic, many changes or problems that would have been picked up early have surfaced only when patients have experienced pain and disease has been much further advanced. We have heard many stories of people being unable to access treatment and the potential risks of that.

The pandemic has undoubtedly had an impact on the delivery of the childsmile programme, with children missing out on that for a time. The education on good brushing and oral hygiene habits that the programme produced are incredible, as are the preventative measures that were mentioned earlier. I would be grateful for an update from the minister about the status of the programme and on whether those who may have missed some of the programme due to the pandemic have the opportunity to catch up.

In our conversation, the BDA acknowledged the difference in administrative burden that the reformed payment structure gives, but it said that the outcome and effect of that structure cannot be known as yet. Its briefing to us for today’s debate said the same. Some patients may still be on a course of treatment that was started under a code on the previous fee structure, so the full effects may not be seen for some time. I asked the BDA about what the measure of success of the new payment structure looks like. It would be useful if the BDA and the Government laid that out clearly. No two practices are the same in terms of size, structure and services, and rural and urban practices have their own differences and challenges, too. Given that it is so difficult to compare practices, it would be useful to define what the measure of success is for the new payment structure and when we might see that coming to fruition.

There is a widening gap in registration levels between the least and most deprived areas, especially in the registration of children. More needs to be done to ensure that parents register where they can and that, where there are difficulties, parents are given support to find care. Some of the causes behind the dip in registrations are complex. We need to fully understand the dip and address it urgently.

In my conversation with the BDA, it also raised the issue of access to general anaesthetics for dentistry in hospitals and the number of cancellations. The greatest number of general anaesthetics that are administered to children is for dental issues. That can be for a multitude of reasons, but it is often to reduce the trauma for invasive procedures where children cannot tolerate the same level of treatment as adults may be able to.

Access to general anaesthetics is also relevant for adults who have a disability or a particular medical condition that requires enhanced treatment. Waiting times for such treatment is often overlooked. In the interests of making a helpful suggestion somewhere in the debate, I hope that the cabinet secretary or the minister may raise the issue with health board, to ensure that people are getting the treatment that they need in the manner that they need it.

We need to closely monitor the changes that have been made recently to dentistry and ensure that they are achieving everything that they need to, while promoting good oral health and hygiene and reinforcing programmes such as childsmile, in order to ensure good oral health for all.

On a point of order, Presiding Officer. My vote does not appear to have registered. I would have voted yes.

Absolutely. Thank you.

That was great. Thank you.

Do you think there is a tendency for local authorities to go with the default option rather than looking into other more creative ways of providing services? Are they all so stretched across the board that that is standing in the way of their capacity for thinking differently about how they come at things?

I will go to Ryan Murray first, because you raised in your opening statement the variability of implementation of the different SDS options. How can we raise awareness among older people in particular of the options under SDS? For many families, this might be the first time that they have had to access the care system at all and many—mine included, when we came to that point with elderly grandparents—just took what was offered rather than looking into the other options that were available. What should we do to address that, and the variability of the way in which different local authorities implement different SDS options?

I am very aware that, on the other end of things, for many young people, SDS is also quite difficult in certain local authorities.

In having the opportunity to do things differently, is there an element that is potentially adding more risk to an already overburdened system by looking at how things could be done differently? Maybe exploring them and giving them a try with certain people is just too much for some social workers, given their case loads when dealing with that, and giving people space is one of the things that can open up creativity across the piece.

Coming back to Ann Marie Penman’s comment about the broad nature of care plans, do you think that there is a willingness to write those plans in a broad way in order to give people the creativity to spend money as they wish? Is that happening in some places and not in others? Is it the luck of the draw, depending on which local authority you are in, who your social workers are and so on?

Thank you—that was really useful.

I have a somewhat wider question for Dr Nolan. With the previous panel, we discussed variability in implementation of SDS, in particular for different age groups. Does awareness need to be raised about the different options that exist? Again, I highlighted to the previous panel the fact that, for my family, the default provision was a 15-minute visit for an elderly relative; that was what we were given, and we never questioned it. I know that care happens in local authorities in different ways and that some local authorities treat different age groups differently. Does more awareness need to be raised in that respect?

I welcome Tim Eagle to the chamber. I sincerely hope that his jokes are better than Craig Hoy’s.

I thank those who are leaving their positions in Government for all their work. I have found Elena Whitham and Michael Matheson to be constructive; they engaged well with me on a variety of issues. I am looking forward to working with Neil Gray in his new role as Cabinet Secretary for NHS Recovery, Health and Social Care, and Christina McKelvie as the new Minister for Drugs and Alcohol Policy. I know how fierce they both are in their approach to their portfolios. There are many challenges to deal with, and I am sure that they will take the opportunity to be open and collaborative, as their predecessors were.

My party is pleased to see the return of transport to a Cabinet position and we congratulate Fiona Hyslop on her return to Cabinet. My colleagues are looking forward to continuing to work with her on cutting car miles, improving rail and bus services and improving connectivity across the country.

I also congratulate Màiri McAllan on her expanded portfolio. Joining up the economy and net zero will, we hope, open up all the opportunities of a green economy.

Finally, I congratulate the two new ministers, Jim Fairlie and Kaukab Stewart, on their first appointments to the Government. I know that my colleagues are looking forward to working with both of them. It is worth noting the significance of Kaukab Stewart’s appointment, making her the first woman of colour to enter Government. That will make not just the Parliament but the Government better reflect Scotland as a whole.

We hope that the recess has given the new ministers some time to get to grips with their new portfolios, even if it has not given them a rest. I am sure that their friends and families are proud of them, and we look forward to working with them on what comes next to bring Scotland a bright future.