Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, February 23, 2022

Official Report 1168KB pdf

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National Health Service Dentistry

I remind members of the Covid-related measures that are in place and of the fact that face coverings should be worn when moving around the chamber and across the Holyrood campus.

The next item of business is a debate on motion S6M-03281, in the name of Sandesh Gulhane, on preventing the collapse of national health service dentistry in Scotland. I invite members who wish to speak in the debate to press their request-to-speak button or to put an R in the chat function.

14:56  

We are here today to have a frank debate on the state of NHS dentistry in Scotland in 2022. For sure, Covid-19 has hit dentistry hard, with practices being closed during the early months of the pandemic. Although the service has resumed, infection control measures continue to limit the number of patients that dentists can see in any given hour. Those are serious obstacles, which I will cover more later in my speech.

We should also recognise that, for more than a decade, since well before the pandemic, the Scottish Government’s model for engaging with dentists has been flawed. It is wedded to the old system. There is a lack of focus on prevention, with some regulations even being based on outdated practice. Over the years, the Scottish Government has shown little appetite for reform. In fact—this is typical of how the Scottish Government works—it gave practices and the British Dental Association only one working day’s notice before introducing free dentistry for people under the age of 26.

As things stand, the situation is bleak. The BDA surveyed its members and found that a third intend to leave the profession during the next 12 months.

Does the member recognise that abolishing dental charges was in the Scottish National Party’s manifesto? We had a whole section on dentistry. Why did his party have only one mention of dentistry in its manifesto?

The cabinet secretary needs to think about how businesses work. One working day’s notice is absolutely not enough to allow them to work.

Indeed, there is a risk of an exodus from the workforce, which would mean families losing access to local NHS dentistry altogether. That would hit hardest those in the most deprived communities. We must send a clear message to dental practices and patients that the Parliament is serious about tackling the colossal backlog of unmet treatment and that we have clear ideas about how to ensure a future for NHS dentistry in Scotland for the benefit of the Scottish people.

With dentists having to ventilate rooms for at least 10 minutes between appointments—time that they are not paid for—their hourly rate has reduced considerably. To help, the Scottish Government committed £5 million for ventilation improvements, but if we read the small print, we find that that support is limited to £1,500 per surgery. Dentists say that significant improvements to increase patient flow would cost at least six times that amount, but the Scottish Government is patting itself on the back. Given the issues with schools, I cannot help but wonder what ventilation measures the Government had in mind.

The cost of everything is going up, from disposables to utility bills and dental laboratory fees. The Scottish Government might wish to speak about record high support and investment in incentives in NHS dentistry, but is that spending effective? Is it actually solving anything? If we listen to the professionals who are delivering dental care or look at the Government’s own statistics, we find that the answer is no. More than 3.5 million NHS dental appointments were lost during 2021, and that backlog will continue to grow unless the Scottish Government listens and opens itself up to some fresh thinking.

Patients are suffering. Families are not able to see their dentists. Kids are going without check-ups. The rate of oral cancer in Scotland is twice the rate in the rest of the United Kingdom. The Government has remained silent on that for too long.

Two years ago, at the start of the pandemic, the Scottish Government came up with an emergency funding package for NHS dentistry. It was a typical knee-jerk reaction and, according to dental professionals, it was not fit for purpose. It was a start. However, it is bitterly disappointing that, two years later, there is not an interim package on offer that could pave the way for a longer-term solution. Patients need holistic oral healthcare.

If the member believes that the emergency package that was brought in two years ago to support the dental sector through the pandemic is so flawed, why is he asking for it to be continued?

I will come on to that in great detail, but essentially—[Interruption.] I will tell members if they care to listen. Essentially, it is because we need root-and-branch reform of what is going on. We cannot continue with the current position, because NHS dentistry will be lost.

It has been known for years that the current dental treatment remuneration package is in many ways ridiculous, and I will explain why. Let us consider cobalt chrome dentures. If we consider lab bills and appointment times, dentists are working for less than the minimum wage. Then there are extractions. To take out teeth, maybe to prepare a teenager for braces, dentists are paid only for the first three extractions. However, there is more. The price code for composite white fillings on back teeth for children has no relation to what is required in terms of time or complexity. Taking overheads into account, dentists can make a loss.

In Scotland, dentists are not allowed to place a white filling on the biting surface of a back tooth—they may only use metal—so patients either pay or they are disadvantaged by a mouthful of metal, while a white filling can be offered in England and Wales. There seems to be no reason for that other than the Government’s regulations being out of date.

We are seeing lower patient participation in our most deprived areas. Oral health inequalities will translate into a higher disease burden in the long term as the chances of picking up early signs of decay and oral cancers at routine check-ups are reduced. Delays in treatment will mean higher costs for the NHS and worse outcomes for patients. NHS dentistry in Scotland was in crisis before Covid hit. As we come out of the pandemic, we know that millions of our fellow Scots have missed out on important oral health checks. Dentists are exhausted and demoralised, and many are looking for the exit to change career, take on more private work or go overseas, where demand is high and remuneration is fairer.

Dentists and their staff are being abused by frustrated patients because of how long they have to wait. People think that dentists are rich, but it is worth noting that, between 2009 and 2019, the taxable income of dentists in Scotland was eroded by 35 per cent. The Scottish Government has failed to grasp that NHS dentistry needs to be adequately funded and to retain a skilled workforce including dental nurses, technicians and support staff. If we do not help the profession, we risk losing NHS dentistry forever.

The Scottish Conservatives want NHS dentists to succeed, which is why we are calling for the emergency funding to remain as an interim solution while the Scottish Government discusses a root-and-branch change with the British Dental Association. We also believe that we need a 30 per cent increase in tariffs as an interim measure. We need to ensure that dentistry is financially viable and is based on delivery of holistic, modern, best-practice services and on prevention, rather than on a fee-per-item and drill-and-fill culture.

By supporting our dentists and their practices, we can ensure that they have a fighting chance of working through the backlog, achieving the goal of offering every Scot a dental check-up in 2022 and staying on track in accordance with clinical guidance thereafter.

We will support the Labour amendment.

I move,

That the Parliament notes with concern that almost half of people in Scotland have been unable to see an NHS dentist for the last two years; further notes the Scottish Government’s proposed withdrawal of emergency funding provided to dental practices on 1 April 2022; believes that this funding should be maintained for the upcoming financial year in recognition of the considerable efforts still required to restore services and reduce the significant backlog of patients seeking dental treatment, particularly while maintaining enhanced infection control measures; recognises the importance of regular dental check-ups for people of all ages, both for good dental hygiene and in the detection of some forms of oral cancer; acknowledges the concerns expressed by many in the profession that the current settlement risks making NHS dentistry financially unviable; calls on the Scottish Government to come forward with a plan for ensuring the long-term sustainability of NHS dentistry, including a complete overhaul of the current fee structure to more accurately reflect modern dentistry; further calls on the Scottish Government to increase the dental tariffs provided by government to NHS dentists by a third as an interim measure to sustain NHS dental services, and ensure that all people in Scotland are able to access a dental check-up in 2022 and every year as clinically required thereafter, and calls for the development of a more holistic service that NHS patients deserve, in place of the current conveyor belt system.

15:03  

I thank Sandesh Gulhane for raising the important matter of patient access to NHS dental care. The dental sector has been disproportionately impacted by the nature of the pandemic. In order to protect patients and staff, dental practices are required to operate with specific infection prevention and control measures, including a fallow time between patients and the use of full personal protective equipment.

During the initial lockdown in March 2020, dental practices were closed to face-to-face patient care, and NHS board centres focused largely on emergency and urgent dental care. Since that initial phase of lockdown, dental practices have slowly remobilised, offering increasing levels of care to their patients. Although registration levels remain comparable with those before the pandemic, the proportion of those patients who have attended a dentist in the past two years has fallen from around 70 per cent to 53 per cent. That is entirely due to the impact of the pandemic.

That is why the Scottish Government has supported the NHS dental sector throughout the pandemic with an additional £50 million of financial support payments.

What assessment has the Government made of the impact of the decision to remove the financial top-up support for NHS dentistry from 1 April?

I will explain. What we have done is to very carefully avoid a cliff edge. We are not simply removing that support; we are replacing it with a system that rewards activity, because we are aware that we need to get more patients seen by dentists.

We have given an additional £50 million of financial support payments, and we have also provided specific funding to mitigate the impact of the pandemic on dental activity. That includes £7.5 million of funding for new dental drills, £5 million for ventilation improvements and £35 million for NHS personal protective equipment to date. The Scottish Government is determined to ensure that NHS dental services emerge well placed to care for the oral health of the whole population.

What does the minister say to the British Dental Association, which says that her Government’s approach could spell the end of NHS dentistry in Scotland?

This Government is unashamedly putting patients first in our thinking about how dental services are delivered. In order to ensure that people in Scotland have access to NHS dentistry that is free at the point of need, we are working really hard to support the dental sector. I would be interested to hear from any Conservative who wants to intervene whether they actually support that commitment to NHS dentistry being free at the point of need.

It is interesting, because there is a total lack of a financial package. I wonder if the minister has simply outlined right there a new support measure that is coming in April and how she will continue to fund dentistry. NHS dentistry needs to be free at the point of care, but we need to have a financial package for that, which the minister has not set out.

I am very pleased to hear that commitment from my Conservative colleagues. It is absolutely wonderful to have cross-party support for free NHS dental care for everyone in Scotland. I am absolutely delighted.

Will the minister take an intervention?

I ask the member to let me continue and set out the financial package that we have put in place in order to support that.

We have committed to tackling the backlog in care. We announced an additional £20 million of increased fees this month to help dentists to see more patients face to face, including those from our most deprived communities.

Sandesh Gulhane rose—

I have let Dr Gulhane intervene. I ask him to let me proceed and set out what financial support we are giving our dentists.

That funding announcement is part of a 9 per cent increase in the overall budget for NHS dental services in 2022-23 to support a return to more normal levels of activity. The additional money will deliver enhanced examinations for everyone—children and adults. Children are a key focus as we recover NHS dental care. We have taken steps to expand the funding for the Childsmile programme in dental practices, which will increase its coverage to include those who are 17 years of age.

The Scottish Government recognises the need to address oral health inequalities arising from the pandemic. We will make additional Childsmile interventions of £2 million over two years from April 2022 to support the distribution of additional toothbrushing packs and recruitment of dental health support workers. Those initiatives will focus on families and children who live in areas of disadvantage, especially those from minority ethnic backgrounds.

The National Institute for Health and Care Excellence guidelines state:

“Recall intervals for patients who have repeatedly demonstrated that they can maintain oral health and who are not considered to be at risk of or from oral disease may be extended over time up to an interval of 24 months.”

Looking forward, our vision for NHS dental services is to ensure that all persons with the same clinical needs are treated in the same way, and that special attention is paid to actions that might further disadvantage the already disadvantaged and vulnerable. As part of that, we will engage the sector in suitable reforms that allow dentists to practise modern dentistry, including the introduction of an oral health risk assessment.

Please conclude, minister.

I will.

We are putting in place a number of vital processes. We must link financial support to dentistry—to seeing patients. We must reward NHS dental teams for improving patient access. The focus needs to be on the recovery of the sector—

Minister, I must stop you there, but I ask you to move your amendment.

I move amendment S6M-03281.2, to leave out from “with concern” to end and insert:

“the impact of the COVID-19 pandemic on all aspects of healthcare, not least on the delivery of dental services due to the volume of aerosol generating procedures, and the impact that this has had on patients seeking appointments during this period; acknowledges that the challenges posed by the pandemic, including the backlog of care, are not unique to Scotland; notes the substantial pandemic-related investment in dentistry of the last two years that includes £5 million for ventilation improvements, £7.5 million for new dental drills, £35 million for additional PPE, and £50 million of financial support to dental practices; recognises that investment in NHS dentistry is increasing to a record high level with a 9% increase in the budget for dental services in 2022-23, including extending the reach of the Childsmile programme in high-street practices to young people up to 17 years of age; welcomes that the Scottish Government is providing dentists with an additional £20 million from February 2022 to give them new and additional incentives to see more patients, and that discussions continue with the British Dental Association on further reforms to support recovery; believes that NHS dentistry, like all NHS services, should be free at the point of need and supports the removal of all NHS dental charges to patients by the end of this parliamentary session, and further supports the Scottish Government’s Oral Health Improvement Plan, which underpins that the frequency of dental checks should be shaped by clinical evidence and an individual patient’s oral health risk assessment, with those at the highest risk being seen more frequently.”

15:10  

I never thought that I would stand here and say that the very existence of NHS dentistry in Scotland is currently under threat. The Government’s complacency in light of that is genuinely deeply concerning. NHS dentistry is in crisis. From the millions of lost appointments to the struggle to see an NHS dentist, plummeting staff morale and widening social inequalities, it is clear that urgent action is needed to pull our NHS dentist services back from the brink. Almost half of people in Scotland have been unable to see an NHS dentist for the past two years.

Yes, I know that we have had the pandemic, but the path to recovery is far from clear. Figures from Public Health Scotland show that the number of treatments up to March 2021 was down by something like 75 per cent. That equates to as many as 3.5 million appointments having been lost. That backlog will take years to clear. Measures imposed on dentists by the Government due to the pandemic have meant that the number of patients that NHS dentists are able to see is still severely limited. The British Dental Association has told us that, despite the best efforts of dentists, returning to “business as usual” is still a “distant prospect”.

It is important to note that the restrictions did not apply to private dental treatment, which is a surprising omission by the SNP Government. No wonder so many people were turning to private dental care: the Government has left them with no other choice to get the essential care that they needed.

The consequences of that are likely to be profound. In effect, we are seeing the backdoor privatisation of the Scottish dental sector. It is not as simple as lifting the restrictions and everything will be fine, as 80 per cent of Scottish dentists are planning to reduce their NHS commitment if the Government reverts to pre-pandemic arrangements.

Will the member take an intervention?

I will in a second.

Let me translate that for the Government: “reduce their NHS commitment” means do the same work but in a private setting, and that will simply deepen inequalities.

Will the member take an intervention?

I am very conscious of the time; I apologise to the people who want to intervene.

Only yesterday, I was contacted by a woman who raised the issue of appointment deposits, which was new to me. To attend her free NHS check-up and receive a £13 basic dental clean, she is being charged a £20 deposit. At a time when the cost of living is sky-rocketing, many families cannot afford to part with £20, especially for an appointment that should be routine.

Let me turn to the subject of inequality. Public Health Scotland tells us that fewer than half of adults from the most deprived areas have seen an NHS dentist over the past two years. For the wealthiest areas, it is well over half. Those inequalities are only starker when it comes to children’s dental care, with only 55 per cent of children from the most deprived areas being seen by a dentist over the past two years, while the figure is 20 percentage points higher among those from the least deprived areas.

It was of course Scottish Labour that introduced childsmile. We did that to tackle inequalities in oral health and to ensure access to dental services for every child in Scotland, regardless of their background. I am pleased that the Scottish Government has continued it. It is depressing, however, that the considerable progress that has been made in child dental health is now going backwards. That, coupled with the fact that those from poorer backgrounds are less likely to have received treatment, is nothing short of a national disgrace. Under the SNP’s watch, dental care is fast becoming the privilege of the few who can afford to go private. That is why Scottish Labour’s amendment calls for action to avoid a two-tier dental system.

It is essential that emergency funding for dentists does not stop at the end of March. I do not understand how any Government could look at the current state of NHS dentistry and deem now to be an appropriate time to end support. I note the list of moneys that the minister outlined, and I welcome it, but it is not just a case of needing more money—the current model of funding for dental services needs to change.

The current model is about as old as the NHS itself, which is older than me, and it is no longer fit for purpose—a fact that has been recognised by the chief dental officer. The current fee-per-item model is not sustainable, as it relies on high-volume turnover and does not reflect the need to prioritise prevention or give dentists the time to care.

It is a question not of more examinations but of better outcomes. The Government should really listen to the Scottish Dental Association and the British Dental Association on that point. Consultation on changes was promised two years ago, and again last year, but nothing has happened. I say to the Government: please stop promising to consult and actually do it, before stopping support of any kind—

You should conclude, Ms Baillie.

The Government should consult before it stops support, or NHS dentistry will fall off a cliff edge and end up being privatised on the SNP’s watch.

I move amendment S6M-03281.1, to insert at end:

“; is concerned by the growing inequality in access to NHS dental care, with recent statistics showing that thousands of people in the most deprived areas have not seen a dentist in over two years; believes that immediate action is needed by the Scottish Government to avoid a two-tier dental system, and urges the Scottish Government to take urgent action to ensure that everyone, irrespective of background or circumstances, has access to first-class NHS dental treatment.”

15:16  

I am grateful to Dr Gulhane for securing time to debate this important matter in Parliament today.

As we know, it is estimated that around 5 million people are registered with an NHS dentist in Scotland, which represents 95 per cent of our population. We should all be able to expect a check-up, treatment and assistance wherever and whenever we may need it. Provision should be universal, regardless of where we live or what we can afford. That is the cornerstone of our healthcare system, in which dentistry—as we have heard this afternoon—is a key service.

Of late, however, that reality is diminishing. I know that I am not alone in the chamber when I say that I have had many constituents contact me because they have been unable to access basic NHS dental services. Some have had to wait months for so-called emergency appointments. Jackie Baillie rightly raised the new spectre of deposits for appointments. That is not surprising if we look at data from last summer, which revealed that residents across Lothian were waiting up to six months for routine dental care alone.

I have made it fairly clear that the practice of asking for deposits in advance of NHS appointments is not allowed. We have asked private dental practices to follow NHS rules from Healthcare Improvement Scotland.

I am grateful that the minister and the Government are taking that seriously.

In particular, people have got in touch with me about being unable to arrange appointments for their children. Many children across Scotland have not had a check-up in years. Of course, that is in part down to the pandemic, but there is also an issue of availability. It is particularly worrying that children will not receive attention during such an important growth period in their lives, when expert eyes are needed the most.

When the Government first came to power, it used child dental health as a metric for poverty in the national indicators. However, Scottish patients, instead of being provided with the care that they deserve, are instead being told to look for private care. As that is simply out of the question for so many families, yet another barrier is being placed before those who are struggling the most with the cost of living.

According to the most recent data, only 55 per cent of children from the most deprived areas of Scotland were able to get an appointment, in comparison with 73 per cent in the least deprived areas. That is a health inequality. Dentists in Scotland have warned us that such disparity will contribute towards a healthcare inequality gap in which disease and long-term problems will become more and more commonplace among the most disadvantaged. That simply does not cut it. The issue is not just dental check-ups; mouth cancer can be missed if people do not attend those important screening appointments. There are many groups—

Will the member take an intervention?

I am afraid that I do not have time—I must make progress.

There are many groups across society that need our attention regarding this issue. Only on Monday, I spoke to a constituent who is a veteran. He told me that the huge lack of co-ordination across services means that veterans routinely struggle to access dental care on leaving the armed services. That needs to be noted in any changes that are made to service provision in future.

It is not only our patients who are struggling; our dentists are under enormous pressure. A Scottish dentist, Dr Douglas Thain, said recently that dentists have been repeatedly asked to provide

“a fine-dining experience with McDonald’s resources.”

Dentists are having to sacrifice their own welfare for the sake of providing basic services that they should be given the resources to deliver.

That is, sadly, another example of those who work in healthcare being burdened with poor mental health as a result of the job that they chose to do. That is why my party’s burnout plan, to provide mental health services to dentists and other healthcare practitioners and all NHS staff, is still so important—not only does the current situation put inordinate strain on our dentists, it causes a much deeper problem. Dentists within the NHS are being handed a severe lack of funding and slashed unit prices, which is being combined with an increased demand for dental services. It is a perfect storm.

I can see that you want me to close, Presiding Officer, so I will finish by saying that our dentistry system needs to be accessible to everyone and a radical overhaul is needed. That is why the Scottish Liberal Democrats will be supporting Dr Gulhane’s motion.

15:20  

They often say that life is short and you should smile while you still have teeth. Sadly, there are going to be a lot of unhappy people right across Scotland unless dramatic action is taken to start tackling the enormous dental backlogs, which are growing longer day by day.

Tragically, one of the most serious legacies of the 15 years of this Government’s failures, and there are plenty, is a worrying rise in dental inequalities—nowhere more so than in rural and deprived communities across Scotland that have already been the hardest hit during the past two years of Covid, with fewer than half of adults being able to see their dentist. Perhaps even more alarmingly, only 55 per cent of children were able to do likewise.

To add further to the bleak outlook, dentists have already warned of a mass exodus from this health sector that will leave many people with little or no access to dental care unless new funding and measures are urgently put in place. The British Dental Association has already revealed that four in five dentists will reduce their NHS commitment, leaving huge numbers of NHS patients with a stark dilemma—either go private or simply do not go at all. In many cases, there is no other option—they will have to just bite the bullet, if members will excuse the pun, and pay into an expensive dental plan at a time when most households can ill afford to take on extra expense, or instead watch their smiles disappear. Those are the options.

Like a great many other members, I am sure, my correspondence on dentistry issues has grown dramatically in recent weeks. One constituent in Stranraer, in my Galloway and West Dumfries constituency, told me of the plight facing her in getting access to dental treatment and care for her children. She had always been of the opinion that all children got dental review and treatment free of charge in Scotland. However, that is no longer the case, she informed me. The majority of dentists in the region now refuse to take any children on to their lists unless their parents register privately and pay into an expensive monthly insurance scheme.

There are a few exceptions—one dentist in Dumfries is still accepting NHS patients—but that would involve my constituent taking a 150-mile round trip. Most dental practices state that they are full and unable to take on children, yet if she paid, all of a sudden, her children could be seen. That discriminates against those from less well-off backgrounds whose parents cannot afford those schemes.

Another constituent informed me that their children were registered with a new dentist last October and an appointment was scheduled for January but cancelled. However, if she paid for them to go privately, they could be taken straight away. She said:

“If I was able to pay private I would, but with a growing family and increasing living costs there is no way I can afford it but feel this is the way things are being forced.”

I am also reliably informed that not one dentist in Stranraer is taking on new NHS patients. It raises the question: how many people are expected to afford private dentistry, if they can even find someone?

In Castle Douglas, there is another dentist who is not taking NHS patients, again leaving many families struggling to make arrangements. It is little wonder that the number of children registered with an NHS dentist is declining in my region, which is a situation that must surely be addressed as a matter of urgency.

The warm words from the minister will be of little comfort to my constituents in Stranraer whose children have no access to NHS dentists unless they travel for 150 miles. Can people imagine the outcry if we asked patients in Edinburgh or Glasgow to travel to Dundee to see a dentist?

This SNP Government thinks that an indicator of success is simply crowing about more equipment or increased funding and it repeatedly fails to recognise that the indicator for success right across the health sector is better outcomes for patients. The Government has given us very little reason to be happy. I urge the cabinet secretary to urgently address this growing crisis and find the necessary resources that will at least let our children smile.

15:24  

I thank all those in the medical services, but I will focus on dentists, who have been endeavouring to deliver essential services in the unique and difficult situation of the past two years, which continues. It is obvious that dentists, in particular, with their necessary use of aerosol procedures, as well as the intimacy of dental contact with patients and the design of their facilities, have found it particularly difficult to tend to their patients. People are also avoiding treatment, for fear of Covid.

As in other areas—this is not confined to the health service—the backlog has been unavoidable, although none of us could have predicted how far it would go. However, the pace is picking up in delivery of services. Our concern about and understanding of why we are here now should be agreed. However, the hyperbolic nature of the Conservative motion reminds me more of “We’re all doomed! We’re all doomed!” from “Dad’s Army”. God bless Private Frazer.

Will the member take an intervention?

I have only four minutes but, if you are going to say something interesting, I will take your intervention.

Does Ms Grahame agree that the financial package that the minister just announced clearly does not allow free dentistry for all, although Maree Todd said that it would?

This is a path that we are taking; we will not get there tomorrow, which is obvious from what the minister said.

Your headline news is very good for the tabloids. “Preventing the collapse of NHS dentistry in Scotland”—what a headline. [Interruption.] I will come to that in a minute.

Mr Gulhane made an interesting point. Although, along with other medical professions, dentists received a 3 per cent pay rise last year—in recognition of their efforts during the pandemic and in line with the recommendation of the independent United Kingdom review body on doctors and dentists remuneration—as Mr Gulhane reminded us, their practices are businesses, not services. That is not a criticism of dentists but a fact. They are in contracts with the NHS and there is a conflict—[Interruption.]

They are businesses, just as many general practices are. You used the term, Mr Gulhane.

Ms Grahame—

I beg your pardon. The member used the term “businesses” to describe dental practices. That is what I am reflecting on; it is not a criticism. We have a hybrid situation, where the NHS is contracting to provide services through professionals who also have to make profits, take on partners and run businesses. There is the same conflict in GP practices, and we must be frank about that and address it.

The minister addressed the fact that, if we add together everything that she said at the beginning of her speech, £112.5 million of public funding has already gone out to dentists. Finlay Carson talked about his constituency, which is in Dumfries and Galloway. Where the provision of dentists is insufficient, from 7 February, there has been an offer of £25,000 over two years for dentists to go into areas where there is a difficulty with retention, such as Kelso and Berwickshire—not my patch, but in the Borders—and parts of Dumfries and Galloway. That offer is subject to certain criteria around recruitment and retention. I accept that there is a difficulty, but the Government is endeavouring to address that.

In the real world, which I live in, we have fixed budgets. Every time I hear Conservative and Labour members call for funding, I ask myself, “Where is your money tree that neither I nor the Government have in our back gardens?” If, collectively, those parties want such things, they should say where the money is coming from and have it in their budgets.

15:28  

I am pleased to speak in the debate. I was thinking back to debates that we have had in the chamber on the topic. There has always been inequality in dental care, as in other healthcare sectors. There are those who never get good access to good oral hygiene and care. I remember being shocked at the number of children who do not even have a toothbrush—let alone an understanding of good oral hygiene—as well as at the number of parents who do not know how to teach their children to brush their teeth and at the steady increase in children who need extractions, especially in the lower Scottish index of multiple deprivation areas. A dentist friend of mine used to give me hundreds of toothbrushes and tubes of toothpaste to hand out to third sector organisations in Ayrshire, such as Yipworld and CentreStage, which had taken it on themselves to help with good oral hygiene for parents and young service users.

The growing health inequality has been significantly exacerbated during Covid. When we discuss health inequalities, we tend not to think of dentistry and access to treatment as much as we should. My dentist friend says that the demand now is like nothing he has ever seen. More and more people are seeking private dentists because they cannot get access to NHS dentists. NHS dentists are struggling to keep up with waiting lists, which are far longer than they have ever been. That is not good for providing swift care that is free at the point of need.

Increasingly, patients are frustrated about waiting times, as my colleague Sandesh Gulhane said, and that frustration is being passed on to dentists. Inevitably, that is driving the health inequality that I mentioned, because there are people who cannot contemplate paying for their dentist.

I listened with interest to the minister’s contribution. Frankly, any dentist who was listening to her cannot help but be worried. If her contribution is representative of the Scottish Government’s understanding of the crisis in our dental surgeries, the Government’s head is buried so far in the sand that all that we can see is the soles of its feet.

I told my dentist friend that I would highlight a couple of issues for him, one of which is the growing tension in waiting rooms. Mask-exempt patients are accusing our dentists of inequality, because they feel that they have the right to use waiting rooms, which can cause difficult encounters. Vulnerable people are struggling because they want dental care but fear the risk of exposure to Covid from sitting in waiting rooms.

My friend said that mask-wearing rules in healthcare settings and waiting rooms should continue regardless of rule changes elsewhere, in order to protect patients who are or feel at risk. Vulnerable and at-risk patients have the right to access healthcare and to feel safe. I recognise that that goes against the direction of travel that we are going in, but the needs of vulnerable people should be considered as we—hopefully—come out of the other side of the pandemic. There are perhaps situations in which we need to consider whether special cases can be made to ensure equal access to healthcare—which is, after all, a right.

My friend also said that it is harder to keep staff. The use of PPE has worked, and he is not aware of any patient-to-dentist infection. That is great news, but PPE is difficult to wear. A nurse whom he trained for nearly three months has now handed in her notice because she is struggling to wear the gear. There has also been a noticeable increase in headaches, and he suspects that that is because of PPE. He said that the wearing of PPE needs to continue, but we need to acknowledge that dentistry is struggling.

As my colleague Sandesh Gulhane said, the backlog is increasing, and there are concerns in the profession that the current settlement will prevent the sector from being financially viable. The Scottish Government needs to recognise that the pressures on NHS dentistry are driving not only patients but dentists to the private sector. If the Scottish Government truly wants to tackle the significant and growing health inequalities that exist in access to dental treatment, it is crucial that it makes NHS dentistry as viable as possible. The Scottish Government must create a system that encourages careers in NHS dentistry.

15:33  

I think that we will leave here today having made it absolutely clear that there is a serious crisis in dentistry, which has been caused by Government indecision and ineffectiveness. All of us in the chamber know and agree that the cost of living is a constant source of concern in our communities. However, also of concern are the anxiety and stress that are caused by the uncertainty about health. For many people, that includes their own and their loved ones’ oral health.

Many parents have expressed to me on-going worry about accessing a local NHS dentist for their children. That is simply unacceptable. Covid is a serious contributing factor to the issue that dentistry faces, but we cannot frame everything in that context. Before Covid, there were many concerns about the pressures on dentistry and dental surgeries and about the availability of appointments. The truth is that, if something is not done, the same problems will be around for a lot longer. That is the stark reality that we face.

When I speak to constituents, dentistry is one of the issues about which I hear the most complaints, yet it rarely receives the attention that other forms of healthcare get. Any assessment of the Government’s stewardship over more than a decade would be far from positive. Its record on delivering positive healthcare outcomes for the people of this country in dentistry and beyond is poor, and it cannot get away with that any longer. It often seems that we have an implied belief that dentistry truly is a secondary concern and that, if people are particularly concerned, they should go private.

Will the member take an intervention?

Not at the moment, thank you. The Government does not have the solutions to the significant problems that we face, as we have heard today. That is not good enough. Thousands of people would have to choose between paying for such procedures and simply persevering, often in pain. We have all heard such stories, which are not a thing of the past, as we might have thought.

I am sad to say that I will return to an issue that I raise in the chamber almost every day that I attend—inequality. As the Scottish Labour amendment notes, thousands of Scots

“in the most deprived areas have not seen a dentist in over two years”.

Only 55 per cent of the poorest young people have been able to see a dentist, compared with 73 per cent from wealthier areas. That deficit will increase mortality later in life, and we must address that now. The situation is simply unacceptable. The worst-off in our society are being left open to serious decay, loss of teeth and, in some cases, unidentified mouth cancers. That is not simply cosmetic; that is fundamental.

In essence, we are being left with a two-tier dental system in which those with the ability to pay their way out of problems maintain their oral health, while those with no means to do so are exposed to greater risk. Is that the legacy that the Government wants to leave? Labour will fight against that.

As my colleagues have noted, the SNP Administration is presiding over the near collapse of NHS dentistry—[Interruption.] It is the near collapse; more than 3.5 million NHS dental appointments have been lost since the first lockdown. Amid all that, why is the Cabinet Secretary for Health and Social Care announcing that the additional funding that was given to dental practices during the pandemic is to conclude at the end of this financial year? Is this an appropriate time to do that? This is a serious health crisis, and the Government must change direction.

15:37  

I am pleased to speak in the debate. Believe it or not, I will try my best to make a consensual speech. When we cut out the hyperbole, there is much to agree on. However, let us be honest about the fact that there is a lot of hyperbole.

We all commend those who have worked in dental practices during the pandemic in the most difficult and challenging of circumstances. We all agree that there is a need to work with dentists and dental practices to financially support them as much as possible as we emerge from Covid-19. There is also a need for reforms. As the health secretary has indicated, such reforms were in the SNP’s manifesto. The existence of a backlog is clear—no one has denied that. Undoubtedly, there are pressures—again, no one has denied that. There is consensus about that. However, the Conservatives’ motion does not acknowledge the Government’s significant and meaningful investment to tackle some of the challenges. I will put those on the record.

Will the member take an intervention?

I have only four minutes, so I am afraid that I cannot.

Only this month, an additional £20 million was announced for fee enhancements. As the Government has also made clear, it has provided £5 million for ventilation improvements, £7.5 million for dental drills, £35 million for PPE and £50 million in wider financial support. There is a 9 per cent increase in funding for the coming financial year. That is simply factual. However, the most important aspect, which is also in the Government’s amendment, is that there are on-going discussions between the Government and the British Dental Association. That is the most important thing to say this afternoon, not the hyperbole.

I thank the British Dental Association for the challenging briefing that it provided ahead of the debate. I also welcome the fact that local dentists contacted me to raise their concerns about financial challenges. In turn, I have raised those concerns with the Scottish Government. The chief dental officer has confirmed to me that discussions are continuing with the sector to prioritise and maximise patient care as we move through to recovery. I am confident that the Scottish Government and the British Dental Association will find a constructive and long-term solution.

Some of the concerns that were raised with me were cash related, but there are also wider concerns, not just those that are on the record. The dentists who contacted me wanted more emphasis to be placed on preventative care, which the Scottish Government wants to happen. Indeed, the £2 million for the childsmile programme that the Government mentioned is part of that, as is using oral health risk assessments to prioritise the people who are most in need of seeing a dentist. Work on that is continuing.

In recent years, similar discussions have taken place with Community Pharmacy Scotland about moving away from a model of community pharmacy that funds the prescribing of medicine for people who are unwell to one that funds positive health messages and direct intervention in communities to promote positive health. There is, perhaps, a lesson for dentistry in that model.

The dentists also mentioned concerns about bureaucracy and did not feel that recompense funding for emergency care and clinical administration is adequate.

There are challenges that go beyond the money that is in the system to how it is used. There seems to be a consensus about the inequalities in the system and how we can use the money that is already in it to address them. If the conclusion that the Parliament reaches is that the quantum of cash must be focused away from areas where dental health is positive to areas where it is not so positive, all members in the Parliament must be part of redirecting money from some areas of the country to other communities in order to tackle dental health inequalities. Perhaps we can come together as a Parliament to face that.

I will support the Government’s amendment at decision time.

15:41  

At the beginning of the pandemic, dentists had to adapt quickly to new ways of working. They were forced to close during the early months of the pandemic and then drastically reduce the services that they could offer due to the risk of Covid transmission during aerosol-generating procedures. It has been an extremely challenging period for dentistry, and the huge backlog of care that has built up over the past two years means that it will remain challenging for some time. Dentists continue to operate considerably below pre-Covid levels due to infection prevention and control measures, which mean longer waiting times.

As we recover from Covid, it is right that people who are at higher risk be prioritised and that the frequency of dental appointments be based on clinical need. We need to trust dentists to make those assessments, because they are the experts. However, we currently have a system in which people who can afford to pay can access dental care more quickly. That inequality cannot continue; otherwise, as other members have said, a two-tier system will be established in Scotland.

Dentists have a vital role to play in the prevention and early detection of illnesses such as oral cancer. That is one of the best examples of how preventative healthcare can make a difference to lives, but it is undermined when patients cannot see dentists regularly. Figures that were published last month by Public Health Scotland revealed a sharp fall in the number of patients attending an NHS dentist, as well as a widening gap in attendance between the most and least deprived areas. In Scotland, we have lifetime registration, which the Greens fully support, but we need people to go to the dentist. The pandemic will certainly have discouraged some people who might be less likely to attend; others will have fallen out of the habit of going.

Oral health inequalities existed before the pandemic and the gaps continue to widen. The data show record gaps in participation rates. In 2008, the gap in the participation rates between the most and least deprived areas was only three percentage points, but, by September 2021, it had increased to 18 percentage points. Every effort must be made to re-engage people with services, particularly those who are most at risk of developing tooth decay or other health conditions, such as oral cancer. I am keen to hear from the cabinet secretary what strategies could be used to reach people who have fallen out of contact with dental services.

As I said, dentists have an important role to play in the detection of oral cancer. Since the early 1970s, oral cancer rates have been increasing, and the rate in Scotland is significantly higher than the UK average. According to the BDA Scotland, it remains unclear how the pandemic has impacted on that. Deprivation is a risk factor for oral cancer, which underlines the importance of improving participation rates in deprived areas. Given the difficulties with access to dentistry that have been caused by the pandemic, it is more important than ever that everyone is aware of the symptoms of oral cancer. Those include red or white patches on the lining of your mouth or tongue, ulcers that do not heal, or a lump in your neck. A person’s risk is also increased if they are a heavy smoker or drinker. I encourage anyone who has concerning symptoms to seek medical advice.

I will conclude with a few words on the future of dental charges. The Scottish Greens believe that dentistry, like other parts of the NHS, should be free at the point of need.

Will the member take an intervention?

I am sorry, but I am in my last minute. I need to conclude.

Access to healthcare should never be dependent on someone’s ability to pay. We fully support the Government’s intention to remove all dental charges to patients by the end of this session of Parliament. However, for patients to feel the full benefit, issues with access must be addressed and the backlog of care must be worked through. That will be no small undertaking, and the dental profession must be supported.

The BDA Scotland has expressed concern about a lack of communication regarding the decision to extend free NHS dental care to 18 to 25-year-olds. I would be grateful to hear from the cabinet secretary about the Government’s plans to engage with the dental profession while we move towards the removal of dental charges entirely.

I call Evelyn Tweed, who will be the final speaker in the open debate.

15:46  

Thank you, Presiding Officer. I am sorry that I cannot be in the chamber today for this important debate.

I begin by thanking Dr Gulhane for giving us the opportunity to compare and contrast dentistry services in Scotland with those in England and to compare the attitude of the SNP with that of the Conservative Party. Let us not forget the impact of the pandemic on dental services, which is not unique to Scotland. I thank dentists and their staff for their service during these difficult times.

Last year, Healthwatch England found that some people are expected to wait until 2024 for dental appointments while others are being removed from practice lists. Healthwatch also found that many people are being pressurised into going private. The situation is so bad that Tory MP Bob Seely, speaking in the House of Commons, called on the UK Government

“to get dentists into this country”—

that is, England—

“in the next year or two to help with the immediate crisis”.—[Official Report, House of Commons, 7 February 2022; Vol 708, c 779.]

In November, The Mirror reported that a dozen Tory MPs, including health secretary Sajid Javid, benefit from links to private health firms. Therefore, despite Dr Gulhane stating his support for the NHS, his party at its heart supports private healthcare. That is the core of the issue. If the 2019 prediction of political Nostradamus Jackson Carlaw had come true and Baroness Davidson of Lundin Links had become First Minister, the Tories would probably be in the process of privatising parts of Scotland’s NHS and its dentists.

However, the Scottish Government is totally committed to dentistry and an NHS that is free at the point of delivery, as Maree Todd has strongly emphasised today. Since the SNP came into office, the number of people registered with an NHS dentist has doubled to around 5 million. That can be attributed to record investment in dentistry that has provided a 39 per cent increase in the number of high-street dentists in Scotland since 2007. There are nearly 56 NHS dentists per 100,000 of the population in Scotland, compared to only 40 per 100,000 in England.

Following the May 2021 election, the SNP’s commitment to deliver, in its first 100 days, free NHS dental care for all those under 26 has been met, and we are working hard to deliver free dental care for all by the end of this session of Parliament. We should remember that undergraduate medical and dental students in Scotland study free of charge, unlike in England, where tuition fees, which were introduced by Labour, have increased to an eye-watering £9,250 per year.

Health spending in Scotland has increased by 70 per cent since the SNP came to power in 2007, and we have abolished prescription fees, which are now £9.35 per item south of the border. As Maree Todd’s amendment highlights, the Scottish Government is providing further funding of £20 million for dentistry from February and is increasing the budget for dental services in 2022-23 by 9 per cent to a record amount.

Ms Tweed, I ask you to pause for a moment, please. There is quite a lot of conversation across the chamber. I would be pleased if we could hear Ms Tweed. Please continue, Ms Tweed.

Thank you, Presiding Officer.

Given that the UK Government is failing to deal with a massive crisis in England, perhaps today’s Tory motion should be thanking the Scottish Government for the steps that it has taken to support dentistry in Scotland, despite the fact that it lacks the full fiscal powers of an independent nation.

I am confident that the Scottish Government is best placed to make the correct decisions that are necessary to continue to improve all NHS services in Scotland. It does not need to take lessons from a party that, at its core, does not support the NHS.

I will support the Government’s amendment. The NHS is safe in our hands.

15:50  

I thank Dr Gulhane for bringing these important issues to the chamber for debate. What we have heard about the state of dentistry is deeply concerning. Jackie Baillie highlighted those concerns starkly in her opening speech.

As we have heard, more than 3.5 million NHS appointments in Scotland were lost during the first lockdown alone and 239,000 fewer children and young people are accessing dental care than was the case two years ago. In my West Scotland region, there have been reports that some people have not been able to see their dentist for 30 months. Alex Cole-Hamilton and other members across the chamber referred to that.

A more fundamental point is that, as my colleague Carol Mochan illustrated, the decline in access to dentistry is deeply unequal. Finlay Carson echoed that when he talked about particularly acute inequalities in rural communities.

Although the Scottish Government sings the praises of its recent changes to access, the implementation of free dental care does not count for much when it is nearly impossible to access appointments in the first place. It is clear that the current model is not sustainable.

If the Government proceeds on its current trajectory, the situation will only get worse. NHS dentists started sounding the alarm long ago. We have been heading towards a two-tier system of dental care in Scotland and the BDA believes that the Government’s funding model will be the final blow to a sector that is already struggling so much. Morale in the profession is at an all-time low, with more than a third of dentists stating that they will leave the profession altogether in the next 12 months, should the minister’s current funding model go ahead.

Without an immediate and comprehensive support plan being put in place, the Government risks the collapse of NHS dentistry in Scotland becoming its legacy. It is on that basis that we implore the Government to listen to the professionals and to rethink the current position and the wider implications for people across Scotland.

The minister must surely know by now that these issues have persisted for years and that Covid cannot be the explanation for them all. When we have more and more people turning to, and accessing, private dental care, we know that NHS dentistry is not collapsing due to the level of aerosol-generating procedures; rather, a fundamental overhaul of services is needed to stop privatisation through the back door. To cite only Covid undermines the hard work that NHS dentists have put in to mitigate years of problems and underfunding.

I support and welcome the Scottish Government’s commitment to further expand the childsmile scheme. We are proud that the actions that were taken by the previous Scottish Labour Government will continue to benefit all Scots.

Scottish Labour’s amendment acknowledges the concerns raised by colleagues across the chamber. Those are the concerns of our constituents and of professionals in the dental sector. Acknowledging the scale of the inequality that now exists is one step that needs to be taken before the Government can even begin to think about tackling it.

It is clear that we need a sense of urgency from the Government to make access to dentistry truly equal to all people, not just those who can afford to go private or those who live in urban communities. Scottish Labour knows that, in order to fix the system in Scotland, a comprehensive overhaul is required. However, we know that, for some reason, the Government seems unwilling to right the issues in NHS dentistry, or is incapable of doing so. We have seen those issues laid bare throughout the debate.

It is clear that the people of Scotland deserve much better than what is being offered and so do our dentists. I support the amendment in Jackie Baillie’s name.

15:54  

I start by thanking our hard-working dentists and all the others who are involved in the dental sector. In the debate, a lot of attention has rightly been paid to dentists, but my thanks also go to dental nurses, dental technicians, receptionists and all those who are involved in the dental sector. I thank every single one of them, and I am not just saying that because four of my cousins are dentists.

Any suggestion that we have not provided financial support for dentistry during the pandemic is incorrect. A number of contributions from the Opposition have suggested that we have not provided—[Interruption.]. I am not talking about you, Ms Baillie, do not worry; but others have suggested that we have not provided substantial money, and I disagree. There will be £20 million of additional money from this month—

Will the cabinet secretary take an intervention?

I will in a second. We have provided £50 million of financial support for dental practices, £35 million for additional PPE, £7.5 million for dentists’ drills, which will help with those aerosol-generating procedures, and £5 million for ventilation.

Will the cabinet secretary take an intervention?

I promised to give way to Dr Gulhane first.

The £20 million that was announced in February was not discussed with the BDA and the Scottish Government has not explained its methodology for calculating that sum. There was no consultation and no transparency. Would the cabinet secretary show his workings, please?

I completely disagree with the suggestion that the BDA does not welcome additional funding for the sector—of course it does.

Dr Gulhane—and this goes to the root of his motion—called the emergency payments “flawed”. I disagree with that characterisation, but he asks us to continue making them for the next financial year, at a time when his party often tells us that the pandemic is over. That is, again, an assertion that I tend to disagree with.

The funding that we are going to announce—we are still in discussions with the BDA—will be to link financial reward with activity, so that more patients can be seen.

Will the cabinet secretary take an intervention?

I do not have much time, but of course I will give way.

I genuinely think, with the greatest respect, that the cabinet secretary is arguing about the wrong thing. The issue is the outdated funding model and I desperately encourage the cabinet secretary to reform it. It is not about volume; it is about prevention.

I will come to that. I do not necessarily wholly disagree with Ms Baillie, she will be pleased to hear. I am not suggesting that there is no room or place for reform. I have never said that, and in fact in my discussions with the BDA, I have often said that I understand the desire for reform.

I am saying that when we have the level of backlog that we have, which has undoubtedly been exacerbated by the past two years and the impact that infection prevention controls have had on dentistry, the immediate priority has to be to work through that backlog. Let us talk about root-and-branch reform of the sector, but we cannot have a protracted discussion about reform while in the meantime patients are still waiting to be seen.

Will the cabinet secretary give way?

No, I will not, because I have only two minutes left.

I take issue with suggestions, which I think are sensationalist, that NHS dentistry is on the brink of collapse and that somehow there was no progress being made pre-Covid. That is absolutely unfair and the statistics do not bear that out. Pre-pandemic, the proportion of primary 7 pupils with no decay increased from 64 per cent in 2009 to 80 per cent—under this Government. For P1 pupils, it went from 58 per cent in 2009 to 74 per cent in 2020.

Will the cabinet secretary take an intervention?

No, I will not take an intervention.

Some 5.2 million people registered with an NHS dentist in 2019, compared with 2.6 million in 2007, when Labour was last in power. Our record on dentistry and supporting dentists stands on its own. I think that anybody who is fair minded will see that there has been progress and improvement in the oral health of the country. Where there has not been improvement and there is still a need for progress, our model of linking financial reward to activity is absolutely the right way to go.

We recognise that uncertainty presently exists among NHS dental teams; that is a fair comment for the Opposition to make. However, that is why they are not getting a cliff edge. We are ensuring a soft transition as the sector fully recovers. In the meantime, I go back to the point that, before 1 April, in the next month, we will be able to announce a package that I hope will incentivise dentists and dental practices to see more patients.

I will conclude on this point. A number of members mentioned upselling. I am as dismayed as any other member by the practice of upselling private plans to the public. I raised the issue with the General Dental Council and I say to any member of a dental practice who might be watching that if they hear about cases of dentists upselling private plans, they should report it to their NHS board. That is not allowed under NHS regulations.

I will conclude—

I must ask you to.

—by saying that the Government is proud of its record in improving the oral health of this country. As we get out of the pandemic, we will support that sector and I look forward to supporting the amendment in Maree Todd’s name.

16:00  

We have heard that, under the SNP, NHS dentistry is in crisis. Covid support is set to be withdrawn in two months’ time, while even before the pandemic the SNP was letting down NHS patients with its conveyor belt approach to dentistry.

Morale in the profession is at an all-time low, with more than a third of dentists saying that they intend to leave the profession in the next 12 months. One of my constituents in Edinburgh spoke to their dentist yesterday, who said that dentists feel as though they were abandoned during the pandemic. Dentists who are tuning in to the debate this afternoon have messaged me to say that they are quite concerned about and rightly furious with some of the Government’s comments.

Failure to act risks sparking an exodus from the workforce that will mean families across Scotland losing access to NHS dentistry for good. We, the Scottish Conservatives, acknowledge the concerns expressed by many in the profession and call upon the Scottish Government to come forward with a plan for ensuring the long-term sustainability of NHS dentistry. As Jackie Baillie rightly stated, the complacency that the Scottish Government has shown today should alarm us all.

More than 3.5 million NHS dental appointments were lost in Scotland because of the pandemic, and that unprecedented backlog continues to grow. It will take years to clear. Despite their best efforts to restore patient care, dental practices continue to operate considerably below pre-Covid levels. Attendance rates plummeted during the pandemic due to restrictions imposed on dental practices.

Just over half of registered patients have seen an NHS dentist in the past two years, which equates to more than 850,000 fewer patients being seen by NHS dentists compared to pre-pandemic levels. Dental inequalities are widening and the participation gap between the least and most deprived communities has widened dramatically.

We all acknowledge that we face a challenge in recovering the dental sector in the entirety of the UK, and ensuring that capacity increases so that more patients are seen. Does the member agree with the Tory approach in England of penalising NHS dentists, or does the member agree with our approach of providing additional funding? Would she please clarify?

Like the minister, I have been elected to the Scottish Parliament and I will talk about Scottish issues.

As Gillian Mackay said earlier, how can dentists assess their patients’ clinical need if their patients cannot get an appointment to see them?

Brian Whittle highlighted the awful health inequalities faced by young people. There has been a sharp increase in the number of children having full extractions, and it should shock every one of us in the chamber to hear that some children in Scotland today do not even own a toothbrush. Child dental health is going backwards.

The SNP Government must do more to facilitate routine NHS dental care. As my colleague Dr Sandesh Gulhane said, the Scottish Government emergency funding package for NHS dentistry that was introduced at the start of the pandemic was not fit for purpose, but it was better than nothing. However, from 1 April, the SNP Government will cut that emergency funding while leaving all the infection control measures in place.

Will the member give way?

No, not at this stage, Mr Doris.

Dentists are usually paid based on each individual item of treatment that they provide but, during the pandemic, that funding mechanism has been superseded by top-up financial support that recognises that the additional infection control measures severely reduce the number of patients who can be seen. The SNP Government is not planning to reduce or remove those measures, even though it is withdrawing financial support.

We believe that the emergency Covid support cannot be withdrawn while strict infection control guidance remains in place. Top-up funding must be maintained for the upcoming financial year, while the Government decides on its long-term plan for the future. The British Dental Association has warned that the Government’s plan to end Covid support payments from April will devastate dental services across the country.

My colleague Finlay Carson highlighted the stark inequalities that are faced by families across rural Scotland and rightly reinforced the negative impact that the removal of funding on 1 April will have. That move means that the income of NHS dentists will be decimated, and many have stressed that it will make their position financially unviable.

Let us not forget that NHS dentistry in Scotland was in crisis before Covid hit. For too long now, people have gone without access to full NHS dental services. To tackle the unprecedented challenge, dental practices need support from the Scottish Government. We are calling on the SNP Government to work with dentists to prevent the collapse of NHS dentistry. It does not matter that treatment or enhanced examinations are free at the point of need, if people cannot get an appointment.

The cabinet secretary must get a grip of the situation and bring forward a credible plan to restore routine dental care and tackle the enormous backlog. The SNP will always put its independence obsession ahead of the national interest. The Scottish Conservatives—Scotland’s real alternative—are pushing for the full return of routine services and putting the people of Scotland first.