Chamber and committees

We should consider the issue as part of a wider piece of potential work. The petition is broad and covers a number of areas.

In the evidence session that we had with the cabinet secretary, we explored why some of the challenges are not purely healthcare recruitment issues but issues to do with life in rural environments in the first place. If we were to incorporate the petition into a wider piece of work, it would be interesting to hear from other ministers about how their portfolios could support recruitment in rural areas and support people to consider working in rural and remote areas. At the moment, it is people who come from or have a connection with such communities who take up recruitment and training opportunities and then go back to the community, rather than our making working in those areas an easy choice.

Earlier on, you mentioned communication. There is an interesting line that you might already have had to walk, or that you might have to walk in the future, between individual cases that people believe indicate wider patient safety issues but the investigative body believes do not, and stories of multiple cases that patient groups have talked about happening over and over in different places. How do you see your office, and you as the commissioner, communicating to people—who have often been traumatised as a result of their treatment—where the line is between individual cases that involve an individual failing and individual cases that might have wider implications for patient safety?

The First Minister, along with the Minister for Public Health, Women’s Health and Sport, convened a further summit on abortion services earlier this week, which was hugely useful in exploring further themes for my member’s bill. I am very grateful for the Scottish Government’s support.

Will the First Minister update the chamber on next steps and what she sees as the most important steps that we can take to protect and further abortion rights in Scotland?

Will the cabinet secretary take an intervention?

Bob Doris rose—

Paul Sweeney rose—

I, too, am pleased that we have time today to discuss dentistry. Dentistry is a part of the health service that often gets lost when we are discussing wider health issues. It is a hugely effective preventative health measure that involves not only teeth and gum health, but finds other potential issues and conditions.

As it has done on all parts of our health service, Covid has placed unprecedented pressure on dentistry, so I commend all the dentists, therapists, hygienists, nurses and technicians who put their wellbeing, and sometimes their lives, at risk to continue delivering essential healthcare during the pandemic.

It is only right, though, that we look at the issue in the context of how dentistry is delivered in Scotland, which is fundamentally different to general practice and other healthcare services. As such, our response to Covid recovery for dentistry needs to be different to our response for other parts of healthcare.

The mixed model of private dentistry, general practice and the public dental service creates a complex system that the public are not always confident in negotiating. It also opens real risks of there being uneven and inequitable delivery of dental services across the country.

We should also consider expanding the role of the public dental service, with healthcare boards fully delivering dental services. Historically, that has been reserved for communities that are unable to access dentists—for example, people who live in care homes—but in recent years, the NHS has successfully delivered full dental services in remote and rural areas including the Western Isles, which had been badly served by general practice. The public dental service provides an existing model that could be expanded to cover more communities—especially communities in which private and general practices are closing, or where growing populations are not adequately served by existing practices.

Although the model of delivery might be different, there are clearly lessons that can be learned from the way in which GPs have adapted to delivery of primary healthcare—not least through successful use of allied health professionals as part of wider health teams in surgeries. The wider categories of dental care professionals include dental therapists, hygienists, technicians and extended duty dental nurses, who can provide a wide range of services, from extractions to preventative care. They are already used extensively across Scotland, but currently have to work on a refer-down model, in which patients must see a dentist before being referred for further treatment to a dental care professional. That is the opposite to how GP practices work, where it is now common to see a nurse before being referred for further treatment elsewhere, and it is not how dental care professionals work in other parts of the UK. Reviewing the model and changing to a refer-up system could significantly ease current pressures on dental services and ensure that we are making full use of our well-trained and highly skilled dental care professionals.

I welcome the removal of dental care charges for under-26s and I hope that we can, before extending it to the rest of the population, look at how to roll that out quickly to groups for whom paying for dental care is a barrier. Some groups are already exempt from charges—for example, people who are pregnant and people who are in receipt of various benefits. However, I do not think that those exemptions are—especially in the current economic climate—capturing all the people for whom dental treatment might be a luxury that they cannot afford. I hope that we will be able to devise a targeted approach that addresses both availability of dentists in some areas and affordability.

We also need to look closely at why some people are not attending dental appointments and at how we can remove some of the barriers. Some people to whom I have spoken simply got out of the habit of going during the pandemic and have not got round to booking a check-up. We need to address that issue.

Dentistry is one of the greatest examples that we have of preventative care, so we need to ensure that everyone who might need dental care has access to it. We need to look at where and how it is delivered and make sure that it is not too long until the abolition of dental care charges.

I thank the cabinet secretary for giving way and I apologise to everyone else who rose.

Would the cabinet secretary reflect on my suggestion of changing to the refer-up model, so that we can make the best use of dental therapists and hygienists, rather than always sending people to a dentist in the first instance?

Having listened to the debate so far, and in the interest of introducing some consensus, I say that I believe that we all want to achieve the same things: better outcomes for people who receive social care, better terms and conditions for those who work in social care and better support for carers.

Sometimes in this policy area, we rightly discuss who should deliver social care and how, but we do not amplify stories about why it is important. There are parts of NCS work that I think we have no argument with each other about. We all know about the issues that relate to the ban on care home visiting during the pandemic. That practice was in place before the pandemic in relation to outbreaks of various viral infections, but such bans’ negative impact became more apparent as Covid dragged on. We should thank the families who campaigned on that issue for using their stories so powerfully. They often had to relive trauma for the betterment of other people’s experience. I know that some of the issues are on-going, so I encourage anyone in that situation to contact their MSPs.

We have discussed the National Care Service (Scotland) Bill, and issues related to the bill, many times in the chamber, but I want to cover one that we have not heard so much about through the process—young carers. The Carers Trust reflected that the size and technicality of the bill and their engaging in such a vast process could have an impact on those who have a caring role. We need to reflect on that when we talk about co-design, and we need to make sure that input from young carers is targeted and sustainable.

As part of its response to the bill, the Carers Trust has undertaken work with young carers to highlight why the bill is so important to them. The majority of young people whom the Carers Trust spoke to are in favour of a national care service. The issue of breaks is hugely important to them, so I want to offer two quotes from young carers. In the Carers Trust report, one young carer said:

“I want to spend more time 1:1 with my mum and dad … I don’t feel confident enough to go with people I don’t know. I want my breaks to be with my own friends and family and with people I choose … If my mum and dad got more help with my sister this would help me too.”

Another said:

“For a lot of young carers—a break away is not just physical but a mental break—don’t need to worry in the back of their mind about the person they care for. Even if attending a hub ... there is not necessarily a mental break. Helps for them to know the cared for person is safe and being looked after by someone.”

We have heard from carers that the mental break that is described in those quotes is one of the most difficult things to provide. Carers are often so focused on how to get everything done and what the next thing to do is that they find it difficult to switch off when they have time for a break. Due to their caring roles, some carers—we know this, because we heard it from them—became more socially isolated during the pandemic because the number of hours of care that they provided or the complexity of care increased. That resulted in them losing touch with friends or not having time for hobbies that they once loved. The cost of living crisis and what it means for being able to survive—let alone to have expendable income for a hobby—has also had an impact.

We need to work to ensure that the breaks that we bring in fit and support carers. We need to make sure that there is support for carers to find comfort and enjoyment from breaks.

Support, particularly for young adult carers, also needs to be better defined. We hear that many carers feel that their support just stops after they move on from school. For some young carers I have spoken to, that does not feel right; many go on to college or university but find that their day-to-day lives do not change other than in that they are getting their education somewhere else, often further from home.

We can address through the NCS bill some of the issues that affect young carers, but, for many young carers, there are many other issues to address. As the bill progresses, we need to keep that in mind for all carers.

Do the witnesses agree with Baroness Cumberlege’s view that giving a patient safety commissioner responsibility for handling individual cases would make the commissioner less effective in addressing wider systemic issues of patient safety? If not, why not?

Do the witnesses agree with Baroness Cumberlege’s view that giving a patient safety commissioner responsibility for handling individual cases would make the commissioner less effective in addressing wider systemic issues of patient safety? If not, why not?

That is really useful; thank you.

Because of the groups that you are associated with, you have all had similar but varied experiences. Some common themes are coming out. I hope that we have enough time for this question, convener, because I would like to hear each person’s views. If the patient safety commissioner does not take on individual cases and complaints, how could they effectively listen to and promote the voices of patients, or of wider campaigns such as yours?