Chamber
Plenary, 25 Oct 2000
25 Oct 2000 · S1 · Plenary
Item of business
Primary Dental Care
I welcome today's debate and the fact that the improvement of dental and oral health is being prioritised by the Scottish Executive. As the minister has outlined, good dental health is vital to people's general health and well-being. That is why effective public education about how to minimise the effects of dental disease and the availability of high-quality NHS dental services for everyone in Scotland, regardless of where in the country they live, is so important.
However, it is three and a half years since Labour came to power at Westminster and 18 months since Susan Deacon took office as the Scottish Minister for Health and Community Care, and we are entitled to ask why Scotland still has the worst dental health record in the United Kingdom—indeed, one of the worst in the whole of Europe. We are also entitled to ask why—as I will go on to show—things appear to be getting worse rather than better.
The statistics that tell the story of Scotland's dental health, some of which Iain Gray quoted in his speech, are shocking. People listening to this debate would have appreciated rather more frankness about the scale of the problems with which we are dealing than the minister showed in his speech. It should be a matter of shame that more than half of all five-year-olds in Scotland show signs of dental disease. The figure is 56 per cent, compared with 57 per cent in 1988. In other words, we have witnessed an improvement of only 1 percentage point in 12 years. In six health board areas—Greater Glasgow, Fife, Grampian, Highland, Tayside and the Western Isles—the situation has actually deteriorated. In each of those areas more five-year-olds suffer dental disease today than was the case 10 years ago. The Minister for Health and Community Care is shaking her head, but that is a fact. I dare say that she will reflect on it when she winds up the debate.
The statistics demonstrate the failure of past policies, not just of the Labour Government but of the Conservatives before it. Although the dental health of our children appears in many respects to be deteriorating, the problem is compounded by the fact that fewer and fewer children are registered with a dentist. Sixty-four per cent of children are registered with a general dental practitioner—that is 2 per cent fewer than a year ago and it is down on the level that existed when Labour took office.
Only three health boards in Scotland employ paediatric dentists. Most of the health boards in whose areas child dental statistics are deteriorating have no paediatric dentists. Labour's headline response to that has been to set one of its many targets; a promise that, by 2010, 60 per cent of all five-year-olds should have no experience of dental disease. That sounds grand until we read a document that was published by the Conservative Government in 1991, in which there was a promise to do the same thing—the only difference being that the Conservatives promised to achieve that target by 2000. All new Labour has done is take the old Tory target and give itself an extra 10 years to achieve it.
The position of adults is even worse. Under Labour, the proportion of adults who are registered with a dentist has fallen to below 50 per cent of the adult population. I concede that there has been a slight increase in the average number of dentists per thousand people in Scotland, but the number of dentists has dropped in a third of health board areas in Scotland. The reality on which Iain Gray has reflected is that, in some areas of Scotland, people have genuine difficulties accessing any dental services.
Dental hospital waiting lists are increasing. An anxious patient who is referred to Glasgow dental hospital will wait more than 40 weeks for a first appointment. Against that background, the need for dental services has never been greater. Dental health is getting worse in some areas. The incidence of oral cancer is on the increase and we have an aging population that includes many more people who retain their natural teeth. Those are the real challenges that we face. I make those points not simply to be political and to denigrate the work of the Executive, but to paint a genuine and true picture of the challenge that we face. We should be prepared to own up to that challenge, openly and fully.
The SNP welcomes the action plan for dental services, but we retain some scepticism about fluoridation. We remain unconvinced that local communities are being and will be properly consulted and that alternatives to putting fluoride in our water are being properly and thoroughly pursued. However, we welcome the action plan on the whole—which is why we are happy to accept the Executive's motion, as far as it goes.
We must, however, continue to ask whether more could reasonably be done to tackle the fundamental reasons why our nation's health is so bad. Let us take the example of public health. I will return for a moment to the question that was raised by Dorothy-Grace Elder and which, I have to say, the minister did not answer. That question related to the promotion of good dental health among our young people.
Commendably, the action plan talks about co-ordinated community programmes that could be used to encourage, among other things, the consumption of low-sugar food and drinks. It is a fact, however, that in increasing numbers of schools throughout Scotland—for example, in about a third of secondary schools in Glasgow—there are vending machines that have been installed commercially for profit by the schools. Those machines peddle high-sugar fizzy drinks and sweets. Susan Deacon shakes her head, but that is a perfect example of a lack of effective co-ordination and an example of why we need to get the rhetoric of joined up working and thinking off the page and into the reality of the ways in which our health boards and local authorities conduct their business.
However, it is three and a half years since Labour came to power at Westminster and 18 months since Susan Deacon took office as the Scottish Minister for Health and Community Care, and we are entitled to ask why Scotland still has the worst dental health record in the United Kingdom—indeed, one of the worst in the whole of Europe. We are also entitled to ask why—as I will go on to show—things appear to be getting worse rather than better.
The statistics that tell the story of Scotland's dental health, some of which Iain Gray quoted in his speech, are shocking. People listening to this debate would have appreciated rather more frankness about the scale of the problems with which we are dealing than the minister showed in his speech. It should be a matter of shame that more than half of all five-year-olds in Scotland show signs of dental disease. The figure is 56 per cent, compared with 57 per cent in 1988. In other words, we have witnessed an improvement of only 1 percentage point in 12 years. In six health board areas—Greater Glasgow, Fife, Grampian, Highland, Tayside and the Western Isles—the situation has actually deteriorated. In each of those areas more five-year-olds suffer dental disease today than was the case 10 years ago. The Minister for Health and Community Care is shaking her head, but that is a fact. I dare say that she will reflect on it when she winds up the debate.
The statistics demonstrate the failure of past policies, not just of the Labour Government but of the Conservatives before it. Although the dental health of our children appears in many respects to be deteriorating, the problem is compounded by the fact that fewer and fewer children are registered with a dentist. Sixty-four per cent of children are registered with a general dental practitioner—that is 2 per cent fewer than a year ago and it is down on the level that existed when Labour took office.
Only three health boards in Scotland employ paediatric dentists. Most of the health boards in whose areas child dental statistics are deteriorating have no paediatric dentists. Labour's headline response to that has been to set one of its many targets; a promise that, by 2010, 60 per cent of all five-year-olds should have no experience of dental disease. That sounds grand until we read a document that was published by the Conservative Government in 1991, in which there was a promise to do the same thing—the only difference being that the Conservatives promised to achieve that target by 2000. All new Labour has done is take the old Tory target and give itself an extra 10 years to achieve it.
The position of adults is even worse. Under Labour, the proportion of adults who are registered with a dentist has fallen to below 50 per cent of the adult population. I concede that there has been a slight increase in the average number of dentists per thousand people in Scotland, but the number of dentists has dropped in a third of health board areas in Scotland. The reality on which Iain Gray has reflected is that, in some areas of Scotland, people have genuine difficulties accessing any dental services.
Dental hospital waiting lists are increasing. An anxious patient who is referred to Glasgow dental hospital will wait more than 40 weeks for a first appointment. Against that background, the need for dental services has never been greater. Dental health is getting worse in some areas. The incidence of oral cancer is on the increase and we have an aging population that includes many more people who retain their natural teeth. Those are the real challenges that we face. I make those points not simply to be political and to denigrate the work of the Executive, but to paint a genuine and true picture of the challenge that we face. We should be prepared to own up to that challenge, openly and fully.
The SNP welcomes the action plan for dental services, but we retain some scepticism about fluoridation. We remain unconvinced that local communities are being and will be properly consulted and that alternatives to putting fluoride in our water are being properly and thoroughly pursued. However, we welcome the action plan on the whole—which is why we are happy to accept the Executive's motion, as far as it goes.
We must, however, continue to ask whether more could reasonably be done to tackle the fundamental reasons why our nation's health is so bad. Let us take the example of public health. I will return for a moment to the question that was raised by Dorothy-Grace Elder and which, I have to say, the minister did not answer. That question related to the promotion of good dental health among our young people.
Commendably, the action plan talks about co-ordinated community programmes that could be used to encourage, among other things, the consumption of low-sugar food and drinks. It is a fact, however, that in increasing numbers of schools throughout Scotland—for example, in about a third of secondary schools in Glasgow—there are vending machines that have been installed commercially for profit by the schools. Those machines peddle high-sugar fizzy drinks and sweets. Susan Deacon shakes her head, but that is a perfect example of a lack of effective co-ordination and an example of why we need to get the rhetoric of joined up working and thinking off the page and into the reality of the ways in which our health boards and local authorities conduct their business.
In the same item of business
The Presiding Officer (Sir David Steel):
NPA
The main business of the afternoon is the debate on motion S1M-1271, in the name of Susan Deacon, on primary dental care services. I have selected two amendm...
The Deputy Minister for Community Care (Iain Gray):
Lab
In the debate on public health on 5 October, Susan Deacon made it clear that oral and dental health are priorities for the Executive. In that debate, several...
Mrs Margaret Ewing (Moray) (SNP):
SNP
Is it not also the case that the York study indicated that further research had to be done on fluoridation?
Iain Gray:
Lab
That is the case, and the study commented on the methodologies of the studies that it considered. However, if Mrs Ewing will bear with me, I will say somethi...
Phil Gallie (South of Scotland) (Con):
Con
Is the minister aware of the proposal, made by dentists in Ayrshire, to establish an emergency call-out system in line with the extremely successful out-of-h...
Iain Gray:
Lab
We are aware of the initiative and we will pursue an interest in that. The action plan that I referred to includes, in the long term, an examination of how w...
Elaine Smith (Coatbridge and Chryston) (Lab):
Lab
Where does the funding for those dentists come from? Do health boards have to find the funding?
Iain Gray:
Lab
The funding comes through the health board and the approval to appoint a salaried dentist is given by Scottish ministers, but of course health boards have fu...
Dorothy-Grace Elder (Glasgow) (SNP):
SNP
Can I take it that the minister does not approve of the installation of confectionery and soft-drink vending machines in school halls, which seems to oppose ...
Iain Gray:
Lab
I want to move on to talk about effects on health, on which there has been some debate. I think that Dorothy-Grace Elder is thinking in particular about the ...
Mr Mike Rumbles (West Aberdeenshire and Kincardine) (LD):
LD
So far, the minister has not mentioned that one of the main ways to improve dental health would be to increase the number of dental graduates. He referred to...
Iain Gray:
Lab
If Mr Rumbles will bear with me, the next section of my speech will address some of the issues that he raises.We need our general dental practitioners to pla...
Nicola Sturgeon (Glasgow) (SNP):
SNP
I welcome today's debate and the fact that the improvement of dental and oral health is being prioritised by the Scottish Executive. As the minister has outl...
Mr Brian Monteith (Mid Scotland and Fife) (Con):
Con
I admit that it is a long time since I was at school, but when I was there I ran the tuck shop, which sold Mars bars—
Mr Rumbles:
LD
We can see that.
Mr Monteith:
Con
We sold Mars bars, Polos and crisps, and the financial benefits went to buy snooker tables, books and so on for pupils. Does Nicola Sturgeon advocate that th...
Nicola Sturgeon:
SNP
I advocate implementation of a national strategy—as there is—to encourage good dental health among young people and to encourage them to consume low-sugar pr...
Iain Gray:
Lab
Is the member aware that dental fees are set by a body that is independent of the Government and that it recommends each year the percentage increase in fees?
Nicola Sturgeon:
SNP
I am fully aware of that fact, but if MSPs are to have a reasoned and rational debate on the future of dental services in Scotland, we cannot ignore the real...
The Deputy Presiding Officer (Mr George Reid):
SNP
Before I call Robin Harper, I advise members of a purely editorial change in the last line of his amendment—S1M-1271.2. The phrase "NHS Centre for Research a...
Robin Harper (Lothians) (Green):
Green
I am pleased that the workings of the Scottish Parliament have allowed a small party to contribute to the debate through an amendment.I have no problem with ...
Phil Gallie:
Con
I understand that fluoride exists naturally in some water supplies. If Mr Harper is really concerned about the harmful effects, does he believe that those su...
Robin Harper:
Green
Mr Gallie is talking about one small area of Scotland, around Burghead. It would be nice to have good-quality research on that area. I have tried to find som...
Mary Scanlon (Highlands and Islands) (Con):
Con
I, too, welcome the opportunity to debate the important subject of primary dental care services, including the plans for early registration schemes, fissure ...
Nora Radcliffe (Gordon) (LD):
LD
No one would disagree that oral health is important, that we do not want our children to have fillings or extractions, and that all of us should retain a hea...
Nicola Sturgeon:
SNP
Will the Liberal Democrats vote in line with last year's manifesto commitment?
Nora Radcliffe:
LD
I will deal with that when I come to it. I will not duck the question.Nicola Sturgeon has made me lose my place.Three dental schools were closed. It is right...
Mary Scanlon:
Con
The recommended number of dental graduates each year in Scotland is 120; Glasgow produces 70 graduates and Dundee produces 50. Dundee is allowed to fund 59 g...
Nora Radcliffe:
LD
Whether or not we are training enough dentists, we do not seem to have enough on the ground. That points up the fact that we need more. We also need more anc...
The Deputy Presiding Officer:
SNP
We will have speakers from the floor until 4.29 pm. I suspect that more members want to speak than time will allow, but if members keep speeches to four minu...