Chamber and committees

I thank Ruth Maguire for securing the parliamentary time for such an important debate. Tragically, cancer is a major cause of death in Scotland. All of us have likely been touched in some way by its impact, and I know that all of us long for the day when it is eliminated for good.

It is a sobering thought that two women in the United Kingdom died today from cervical cancer, and this evening another nine women and their families are coming to terms with a diagnosis of cervical cancer. Some are mums, and some face the devastating prospect of losing their fertility as part of their treatment. However, there is hope, and that is through the cervical screening programme and the HPV vaccination programme.

On the latter, I was struck by the figures that were reported by Jo’s Cervical Cancer Trust: cases of cervical cancer have fallen by 97 per cent among women in their 20s as a result of the vaccine. I understand that in Scotland, uptake rates for the first dose of HPV have consistently exceeded 90 per cent, as Ruth Maguire said, and that is to be welcomed. However, as she pointed out, uptake levels for cervical screening are not as high, and that is where improvement is most needed.

Public Health Scotland data is available only for the period up to 31 March 2021, but it shows that the uptake rate for cervical screening was 69.3 per cent among eligible women. Worryingly, as Ruth Maguire said, uptake has declined in recent years and is especially low among women aged between 25 and 29.

Ruth Maguire also flagged up the multiple barriers to accessing a screening appointment. Anxiety and embarrassment can mean that women delay or decide not to do it. As she pointed out, experience of sexual trauma can also prevent women from being screened, and there are accessibility issues for women with a disability. Pain and fear of the result can also act as obstacles. We must do everything that we can to address those barriers, and it is important that we see leadership at the highest levels.

Jo’s Cervical Cancer Trust and other charities were vocal in their calls for the urgent appointment of a women’s health champion in Scotland. Bizarrely, that role was promised by the Scottish National Party as a “Medium-Term” action as part of its “Women’s Health Plan”, which is intended to cover only the period from 2021 to 2024.

I am pleased to see the position has now been filled by Professor Anna Glasier. However, like many of us, I was deeply frustrated by the time that was lost over the prolonged appointment process. I know that Professor Glasier is keen to focus her work on the menopause, endometriosis and polycystic ovary syndrome. I hope that she will also work with health boards and charities to improve cervical screening uptake and to explore new ways to facilitate that process.

In the meantime, I urge all eligible women to please, please book a cervical screening appointment when the letter arrives—it could save your life.

—but it is the participation rate, which measures contact with a dentist in the past 24 months, that matters most, so, let us take a look at it. The participation rate has fallen by almost 15 percentage points between 2020 and 2022—

Today, we have heard the scale of the crisis in NHS dentistry in Scotland. It is a profession “on its knees”, in a system that is “broken”—words that we are hearing all too often in the chamber under this SNP-Green Government.

Millions of dental appointments have been lost since the start of the pandemic—millions of missed opportunities to treat early tooth decay, prevent dental disease and detect the early stages of oral cancer. There is uncertainty over future funding in a system that is already chronically underfunded and there is an “exodus from the workforce” according to the British Dental Association. All of that is happening against the background of the SNP’s 2021 manifesto commitment to scrap NHS dental charges for everyone in Scotland.

The minister, Maree Todd, talked about reform, but she was unable to give any timetable and, once again, the SNP Government blamed Brexit and the pandemic. That is deflection and denial. The Government also took the credit from Labour for the childsmile programme, which was interesting.

I agree with Willie Rennie: this is an utter farce—just like Gillian Martin refusing to take an intervention from my colleague but taking a seemingly staged intervention from her colleague Jackie Dunbar.

Alex Cole-Hamilton shone a light on the fact that the Scottish Government wants to delete reality and that ministers’ heads are in the sand. Dr Gulhane raised the serious issue of many dental practices going to the wall because they are running at a loss—he gave example upon example of that. Paul Sweeney talked about the postcode lottery and Brian Whittle said that this Government operates an “everything will be fine” and “nothing to see here” model.

The Scottish Conservatives’ amendment highlights widening oral healthcare inequalities—something that was glaringly absent from the Liberal Democrats’ motion. According to Dr David McColl, chair of the BDA’s Scottish dental practice committee,

“Patients in Scotland’s poorest communities are paying the price for the crisis in dentistry.”

Make no mistake: SNP ministers cannot peg widening inequalities in oral health outcomes on the pandemic alone. Like so much with this SNP Government, it is a problem that has been years in the making. For example, the national dental inspection programme 2018 revealed that, although 86 per cent of children in Scotland’s least deprived areas had good dental health, that figure was only 56 per cent for children in the most deprived areas.

Of course, as we have heard today, the SNP likes to trumpet the number of people registered with an NHS dentist in Scotland. That is so typical of the SNP’s smoke-and-mirrors approach to policy and political PR—

My question is for Fraser Morton. You have talked us through follow-up towards action. In your submission to the committee, you raise concerns that no person or organisation would be compelled to accept or implement a recommendation. Based on your experience, how likely is it that a recommendation would not be implemented by a public body? What specific ways would you like the powers of the PSC to be strengthened so that they can enforce the recommendations?

Do you mean similar to the Health and Safety Executive?

My line of questioning builds on the previous one. It is directed first to Rosemary Agnew and then to Simon Watson. I was particularly interested in your comments about the breadth of the remit of the PSC and the lack of clarity about the role’s relationship with the existing clinical guidance landscape. I have two questions. First, how would you envisage your organisation working with the PSC? Secondly, are you concerned about the potential for duplication and overlaps?

I have a quick question for Rosemary Agnew. The Finance and Public Administration Committee recently highlighted concerns regarding the financial impact of having yet another commissioner. This builds on what Dr Gulhane has said. What resourcing is necessary for the officeholder to be effective?

I had two questions, but the second has just been answered, so I thank you for that.

My understanding is that the proposed approach in Scotland would mean that the commissioner would not consider individual cases but would instead monitor systemic issues: you have talked about the golden thread.

The “First Do No Harm” report emphasised that a patient safety commissioner should be a public leader with a statutory responsibility to champion the value of listening to patients. Are you satisfied that the approach that would be taken in Scotland would satisfy that recommendation?

Baroness Cumberlege, in Scotland we have the Scottish patient safety programme; the NHS incident reporting and investigation centre; Healthcare Improvement Scotland; professional regulatory bodies such as the General Medical Council; the Patient Rights (Scotland) Act 2011; a patient advice and support service that is provided by Citizens Advice Scotland; and the Scottish Public Services Ombudsman. How do you envisage a patient safety commissioner fitting into a seemingly saturated landscape without duplicating the work of existing bodies? Is there any evidence of that occurring in England?

On a point of order, Presiding Officer. I am finding it difficult to hear my colleague because of the conversations that are going on in the chamber.