Chamber and committees

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?

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?

We discussed the duplication of effort across the UK with the Patient Safety Commissioner for England. What working arrangements will need to be put in place to ensure that there is no such duplication and that individual issues in different jurisdictions can be tackled, while enabling information to be shared where there might be a UK-wide issue?

These have obviously been traumatic experiences for you all. What support would you like to see sit alongside a patient safety commissioner to support groups or individuals who raise such cases? As you said, sometimes not hearing back or not getting a resolution to a case can further compound the trauma resulting from a mistake or whatever else has happened that has got that person to the patient safety commissioner. Do any of you have any reflections from your experiences or the campaigns that you are part of?

I think that my questions will probably mostly be to Alison Cave. How can the new patient safety commissioner add value to the existing monitoring systems around medicines and medical devices?

I, too, thank Sue Webber for securing this important debate. I extend my thanks to all those with ME who have reached out to Scottish Green members of the Scottish Parliament to share their stories. I understand that when a person’s symptoms are severe, even writing an email can be enough to trigger a flare-up, so I am grateful to all those who have taken the time to share their experiences.

I join colleagues from across the chamber in welcoming the report of the Scottish stakeholder review of the NICE guideline on ME. Myalgic encephalomyelitis—often referred to as ME for short—is a long-term condition that affects around 20,000 people in Scotland. ME is a complicated condition that can vary significantly among different people, so it is extremely important that we accept and adopt some of the key changes suggested in the review. A central part of that is supporting changes in NICE guidelines and ending the cynicism and disbelief that people who live with ME experience in relation to their condition. It is important that we support those who are living with ME by acknowledging their condition, and that we ensure that others who might have the condition are believed and encouraged to come forward and seek medical support.

As we have heard, ME is a condition with varying symptoms that are specific to each individual. Common symptoms include fatigue, sleep disturbance, issues with recovery from physical activities and cognitive issues around memory and concentration. The severity and prevalence of symptoms can vary widely from individual to individual.

There is no specific test to diagnose ME, which makes diagnosis and treatment difficult for many people. Again, I underscore the importance of having a debate on the issue. Post pandemic, now is a vital time to advance the discussion around ME in the public domain. I am pleased to see the Government’s statement regarding the review, and I welcome its support for the NICE guideline.

I would like to focus on the experience of some of my constituents in Central Scotland. One theme that emerged from constituents is the lack of belief among healthcare professionals in patients’ ability to advocate for their own healthcare. Even though the new NICE guideline on ME, which was published almost two years ago, advised against use of treatments including graded exercise therapy, some patients with ME are still being recommended that treatment by doctors in Scotland. One woman described how, during her first appointment in June 2022, the doctor said that he knew that graded exercise therapy got a bad rap, but that it could be effective for some people. When she replied that she would never engage in graded exercise therapy because her daughter’s ME had become severe due to constant pressure on her to do more and to push herself beyond her energy limits, the doctor justified his advice with what the patient believed was further misinformation about deconditioning. That is just one example from many stories of patients who feel that they have little choice but either to accept advice, even if it goes against the research that has been produced by charities that have campaigned on ME, or to be labelled as refusing to engage with their care.

When people with ME need to become their own best advocate, they become less trusting that our healthcare system will acknowledge and address their medical needs. We still have a long way to go in understanding how patients can manage ME long term and avoid issues continuing to appear. I would appreciate the minister outlining actions that have been taken, or are due to be taken, on the report’s recommendation that pilots be funded in various health boards to develop specialist services. I am pleased that patient involvement will be an important part of that work; I fully support that and the third sector collaboration that is to be embedded in the design.

I thank #MEAction Scotland for all the work that it is doing to support individuals with ME. Its advocacy and policy work have done much to give the debate greater prominence, and for the betterment of individuals who live with the condition.

However, we should be clear that ME is not a rare condition: its prevalence is four in 1,000 people in Scotland. It is vital that we begin to acknowledge that the condition is prevalent across the population and that we build in support measures for people to come forward and gain the diagnosis and support that they need.