Chamber
Plenary, 17 Mar 2005
17 Mar 2005 · S2 · Plenary
Item of business
Dentistry
The purpose of my statement is to provide the Executive's response to the consultation documents "Towards Better Oral Health in Children: A Consultation Document on Children's Oral Health in Scotland" and "Modernising NHS dental services in Scotland". In the action plan that we are publishing today in response to those consultations, we outline measures that represent the most substantial programme of work that has ever been undertaken to address Scotland's poor oral health record and to provide better access for patients and an attractive package for the professional staff whom we wish to recruit to, and retain within, the national health service.
On fluoridation, I can confirm that the Executive will not change the current legislation in this Parliament. By maintaining the current position, we will still retain powers to allow national health service boards to consider whether, in the light of local consultations, they wish to make an application to Scottish Water to increase the fluoride content of the public water supply in their areas. Our decision recognises the case for, and the benefits of, fluoridation. In the absence of popular consensus in Scotland as a whole, we will retain the existing legislation.
On the two consultations, I do not need to remind colleagues that Scotland has an appalling oral health record. Our children have some of the worst teeth in Europe. Currently, only 45 per cent of children are free from dental decay, but the problem is even more prevalent in areas of high deprivation and poverty. In some parts of Glasgow, more than 60 per cent of children have dental disease before they reach the age of three and five-year-olds have average levels of dental decay that are six times greater than is experienced in other parts of the United Kingdom. By the time that they reach the age of 14, two thirds of all Scottish children have dental disease. On average, people in their parents' generation have 10 fillings and have had eight teeth removed. Over half of all 65-year-olds have lost all their teeth.
In addition, access to NHS dental services has been a problem and in some parts of Scotland it has become a major problem. I recognise the justified concerns that many people have about the current system. Today, dentistry has become increasingly complex and we continue to feel the effects of the closure of the Edinburgh dental school by the Conservative Government in 1996. We inherited a system that was in difficulties. We have taken action already, but it is now time for more radical measures.
Our main, but not exclusive, focus will be on those whose need is greatest and on whom the greatest potential impact could be had: children and older people. Having learned the lessons from some of our European neighbours, we will make much better use of the talents and potential of the whole dental team. We will invest unprecedented levels of resources in public health programmes that will target those most in need.
Given the size of our nation, the children's toothbrushing programme that we will implement will be one of the largest in Europe. The Scottish programme currently involves more than 1,400 nurseries and 60,000 children in daily toothbrushing and provides free toothpaste and toothbrushes to the children. The number of children involved will be doubled, as the programme will be offered to all children in nursery and to those children in primary schools with the highest levels of dental disease. Our longer-term aim is to roll out the programme to all primary schools.
The potential significance of our action plan can be highlighted by the results of a pilot in Dundee, where a supervised fluoride toothbrushing programme in primary schools that had high levels of dental disease helped to reduce dental decay by almost half among children by the age of nine.
The implementation of our school meals policy, "Hungry for Success", is under way in all schools and we are working with local authorities to ensure that fizzy drinks have no place in primary schools and are replaced by water and milk in all our schools and nurseries. We will give responsibility to community health partnerships to achieve a more co-ordinated approach to oral health across community-based services, building on parenting programmes such as sure start and starting well.
Scotland's parents have a responsibility for the oral health of their children. As with diet and exercise, instilling a culture of toothbrushing and mouth care early on is a task for the family and the home. We will support parents in that task. We will promote oral health and prevent dental disease in our children from birth through to the teenage years. We will offer dental care to all children from the earliest stages and will implement new schemes to promote registration and preventive activity from birth. Our goal is that, on starting nursery, all children will have access to dental care and advice from a member of the expanded dental team. We will aim for an increase in the number of children aged three to five years who are under dental supervision from 66 per cent to 80 per cent. Our goal is for every child to be registered with a dentist and we will monitor progress closely. We will introduce a new programme that is targeted on those children in greatest need. It will include new, enhanced services for those with extensive caries, including mobile dental units working in our most deprived communities.
We will also provide better preventive services for older people and disadvantaged groups. The first phase will be implemented by introducing, later this year, free oral health assessments for people aged 60 and over. That will include an examination of the soft tissues for oral cancer and it will underpin the move towards a preventive service for all.
The consultation on modernising NHS dental services produced a consensus on the need for substantial change to meet the expectations of patients and dental professionals. We have already started along that path, uniquely in the UK, by introducing a number of measures that are aimed at improving the recruitment and retention of dentists and by introducing support for practices, including practice improvement funding and practice allowances. There are encouraging signs that those Scottish allowances are starting to pay dividends, particularly in respect of the increased numbers of new dentists joining the dental lists in Scotland, but we need to do much more.
We already have more dentists per head of population than the UK has. We will further increase the number of dentists in Scotland by more than 200 by 2008. To do that, we will increase dentist output from our dental schools, offer dentists incentives to return to Scotland and recruit from outwith Scotland. We will also increase the number of dental therapists in training by 33 per cent. Dental therapists can provide a wide range of dental treatments as part of the dental team. We will introduce better training for all members of the team, from dental nurses to practice managers, and help to reduce the administrative burden on clinical time.
However, we also need to ensure that those independent-contractor dentists who have been, and continue to be, committed to the NHS are suitably rewarded and that they increase the amount of time that they devote to the NHS. That means giving them better support for their premises, information technology, staff, and health and safety needs, in return for their commitment to the NHS. The more work they do for the NHS, the more support they will get. We also need to strengthen our salaried services, particularly in areas where there are insufficient independent-contractor dentists to meet the needs of patients.
To resource this radical overhaul of dental services, we will be providing unprecedented financial support—an additional £150 million over three years—to achieve our goals in oral health and NHS dentistry. That is the biggest-ever investment to support NHS dentistry in Scotland. In the first year, we will be providing an extra £45 million to improve oral health and support NHS dental services. That will rise to £100 million the year after and will build up to £150 million of additional funding by 2008.
The action plan, which we are publishing today, contains a radical list of actions that we are determined to implement in the next three years, and we will make a substantial start from next month. In addition to the doubling of the practice allowance, which I announced last week, we will provide a further £5 million to help dentists to improve their practices. We will give NHS boards authority to appoint directly salaried dentists to meet local needs. In addition, we will increase the remote areas allowance for NHS dentists to £9,000 per year.
We will provide further infrastructure support for premises by introducing a rent reimbursement scheme and we will modify our existing dental access scheme to provide funding for dentists who wish to take over practices while maintaining NHS services. We will also begin an IT programme to support dentistry by providing and maintaining a connection to NHSnet for all NHS dentists.
We will modify the commitment payments scheme to recognise the contribution of part-time dentists who are committed to the NHS. We will provide £1 million to support emergency dental services further.
We will cut red tape in surgeries by radically simplifying the system of dental remuneration: we will reduce the current 450 items to around 45 to 50 items. We will introduce a financial support package for professionals complementary to dentistry and we plan to introduce a bursary scheme for dental students who commit to NHS dentistry on graduation.
Those are only the first steps and our action plan outlines the further work that will be undertaken over the following two years.
No one on the partnership benches underestimates the challenges. Many members have been quick to highlight unacceptable cases and to proffer solutions, but it is the Executive that has devised and costed the plan and which will deliver the plan. We will deliver better oral health for Scotland's children, provide access to dental services wherever people are in Scotland and deliver an NHS dental service that people will want to use and will be proud to work for.
On fluoridation, I can confirm that the Executive will not change the current legislation in this Parliament. By maintaining the current position, we will still retain powers to allow national health service boards to consider whether, in the light of local consultations, they wish to make an application to Scottish Water to increase the fluoride content of the public water supply in their areas. Our decision recognises the case for, and the benefits of, fluoridation. In the absence of popular consensus in Scotland as a whole, we will retain the existing legislation.
On the two consultations, I do not need to remind colleagues that Scotland has an appalling oral health record. Our children have some of the worst teeth in Europe. Currently, only 45 per cent of children are free from dental decay, but the problem is even more prevalent in areas of high deprivation and poverty. In some parts of Glasgow, more than 60 per cent of children have dental disease before they reach the age of three and five-year-olds have average levels of dental decay that are six times greater than is experienced in other parts of the United Kingdom. By the time that they reach the age of 14, two thirds of all Scottish children have dental disease. On average, people in their parents' generation have 10 fillings and have had eight teeth removed. Over half of all 65-year-olds have lost all their teeth.
In addition, access to NHS dental services has been a problem and in some parts of Scotland it has become a major problem. I recognise the justified concerns that many people have about the current system. Today, dentistry has become increasingly complex and we continue to feel the effects of the closure of the Edinburgh dental school by the Conservative Government in 1996. We inherited a system that was in difficulties. We have taken action already, but it is now time for more radical measures.
Our main, but not exclusive, focus will be on those whose need is greatest and on whom the greatest potential impact could be had: children and older people. Having learned the lessons from some of our European neighbours, we will make much better use of the talents and potential of the whole dental team. We will invest unprecedented levels of resources in public health programmes that will target those most in need.
Given the size of our nation, the children's toothbrushing programme that we will implement will be one of the largest in Europe. The Scottish programme currently involves more than 1,400 nurseries and 60,000 children in daily toothbrushing and provides free toothpaste and toothbrushes to the children. The number of children involved will be doubled, as the programme will be offered to all children in nursery and to those children in primary schools with the highest levels of dental disease. Our longer-term aim is to roll out the programme to all primary schools.
The potential significance of our action plan can be highlighted by the results of a pilot in Dundee, where a supervised fluoride toothbrushing programme in primary schools that had high levels of dental disease helped to reduce dental decay by almost half among children by the age of nine.
The implementation of our school meals policy, "Hungry for Success", is under way in all schools and we are working with local authorities to ensure that fizzy drinks have no place in primary schools and are replaced by water and milk in all our schools and nurseries. We will give responsibility to community health partnerships to achieve a more co-ordinated approach to oral health across community-based services, building on parenting programmes such as sure start and starting well.
Scotland's parents have a responsibility for the oral health of their children. As with diet and exercise, instilling a culture of toothbrushing and mouth care early on is a task for the family and the home. We will support parents in that task. We will promote oral health and prevent dental disease in our children from birth through to the teenage years. We will offer dental care to all children from the earliest stages and will implement new schemes to promote registration and preventive activity from birth. Our goal is that, on starting nursery, all children will have access to dental care and advice from a member of the expanded dental team. We will aim for an increase in the number of children aged three to five years who are under dental supervision from 66 per cent to 80 per cent. Our goal is for every child to be registered with a dentist and we will monitor progress closely. We will introduce a new programme that is targeted on those children in greatest need. It will include new, enhanced services for those with extensive caries, including mobile dental units working in our most deprived communities.
We will also provide better preventive services for older people and disadvantaged groups. The first phase will be implemented by introducing, later this year, free oral health assessments for people aged 60 and over. That will include an examination of the soft tissues for oral cancer and it will underpin the move towards a preventive service for all.
The consultation on modernising NHS dental services produced a consensus on the need for substantial change to meet the expectations of patients and dental professionals. We have already started along that path, uniquely in the UK, by introducing a number of measures that are aimed at improving the recruitment and retention of dentists and by introducing support for practices, including practice improvement funding and practice allowances. There are encouraging signs that those Scottish allowances are starting to pay dividends, particularly in respect of the increased numbers of new dentists joining the dental lists in Scotland, but we need to do much more.
We already have more dentists per head of population than the UK has. We will further increase the number of dentists in Scotland by more than 200 by 2008. To do that, we will increase dentist output from our dental schools, offer dentists incentives to return to Scotland and recruit from outwith Scotland. We will also increase the number of dental therapists in training by 33 per cent. Dental therapists can provide a wide range of dental treatments as part of the dental team. We will introduce better training for all members of the team, from dental nurses to practice managers, and help to reduce the administrative burden on clinical time.
However, we also need to ensure that those independent-contractor dentists who have been, and continue to be, committed to the NHS are suitably rewarded and that they increase the amount of time that they devote to the NHS. That means giving them better support for their premises, information technology, staff, and health and safety needs, in return for their commitment to the NHS. The more work they do for the NHS, the more support they will get. We also need to strengthen our salaried services, particularly in areas where there are insufficient independent-contractor dentists to meet the needs of patients.
To resource this radical overhaul of dental services, we will be providing unprecedented financial support—an additional £150 million over three years—to achieve our goals in oral health and NHS dentistry. That is the biggest-ever investment to support NHS dentistry in Scotland. In the first year, we will be providing an extra £45 million to improve oral health and support NHS dental services. That will rise to £100 million the year after and will build up to £150 million of additional funding by 2008.
The action plan, which we are publishing today, contains a radical list of actions that we are determined to implement in the next three years, and we will make a substantial start from next month. In addition to the doubling of the practice allowance, which I announced last week, we will provide a further £5 million to help dentists to improve their practices. We will give NHS boards authority to appoint directly salaried dentists to meet local needs. In addition, we will increase the remote areas allowance for NHS dentists to £9,000 per year.
We will provide further infrastructure support for premises by introducing a rent reimbursement scheme and we will modify our existing dental access scheme to provide funding for dentists who wish to take over practices while maintaining NHS services. We will also begin an IT programme to support dentistry by providing and maintaining a connection to NHSnet for all NHS dentists.
We will modify the commitment payments scheme to recognise the contribution of part-time dentists who are committed to the NHS. We will provide £1 million to support emergency dental services further.
We will cut red tape in surgeries by radically simplifying the system of dental remuneration: we will reduce the current 450 items to around 45 to 50 items. We will introduce a financial support package for professionals complementary to dentistry and we plan to introduce a bursary scheme for dental students who commit to NHS dentistry on graduation.
Those are only the first steps and our action plan outlines the further work that will be undertaken over the following two years.
No one on the partnership benches underestimates the challenges. Many members have been quick to highlight unacceptable cases and to proffer solutions, but it is the Executive that has devised and costed the plan and which will deliver the plan. We will deliver better oral health for Scotland's children, provide access to dental services wherever people are in Scotland and deliver an NHS dental service that people will want to use and will be proud to work for.
In the same item of business
The Deputy Presiding Officer (Murray Tosh):
Con
The next item of business is a statement by Rhona Brankin on dentistry. As is normal on such occasions, the minister will take questions at the end of her st...
The Deputy Minister for Health and Community Care (Rhona Brankin):
Lab
The purpose of my statement is to provide the Executive's response to the consultation documents "Towards Better Oral Health in Children: A Consultation Docu...
The Deputy Presiding Officer:
Con
Because there are 20 minutes into which to fit questions and my screen shows that 18 members want to speak, I will allow the first three members two question...
Shona Robison (Dundee East) (SNP):
SNP
I thank the minister for the advance copy of the statement and welcome the £50 million a year—that is exactly the estimate that the SNP gave last week of the...
Rhona Brankin:
Lab
I think that Shona Robison has selective amnesia. She said last week that she thought that additional funding should be between £40 million and £50 million.
The Minister for Health and Community Care (Mr Andy Kerr):
Lab
In total.
Rhona Brankin:
Lab
Absolutely. That was in total. We are providing £150 million of new money. It is important to make that distinction.We are committed to providing free dental...
Mrs Nanette Milne (North East Scotland) (Con):
Con
I, too, thank the minister for the advance copy of her statement, which contained a lot of warm words and a number of welcome things. However, I do not think...
Rhona Brankin:
Lab
I make it clear again for the benefit of the Conservatives that we are making available £150 million of new money.Conservatives have asked in the past about ...
Mike Rumbles (West Aberdeenshire and Kincardine) (LD):
LD
The Liberal Democrats very much welcome the biggest-ever shake-up of NHS dentistry since the NHS was formed more than half a century ago. There is no doubt t...
Rhona Brankin:
Lab
Absolutely. It is important to make the point that, in total, we will be spending £350 million by 2008. I am grateful for Mike Rumbles's support. I know that...
Dr Elaine Murray (Dumfries) (Lab):
Lab
I, too, welcome the minister's long-awaited statement on this substantial investment. The minister and her predecessors will be aware from my correspondence ...
Rhona Brankin:
Lab
As I said in my statement, NHS boards will now be able to access directly and employ salaried dentists. That will be hugely important in some of the more rem...
Chris Ballance (South of Scotland) (Green):
Green
At a recent meeting with Dumfries and Galloway NHS Board, I was told that it would take five years for lists to open to NHS patients. Can the minister give a...
Rhona Brankin:
Lab
The figure that Chris Ballance quotes was given before today's announcement. We estimate that, by March 2008, an additional 400,000 people will be registered...
Janis Hughes (Glasgow Rutherglen) (Lab):
Lab
I thank the minister for her statement and welcome the unprecedented levels of spending on dental health. She talked about the expanded dental team. How does...
Rhona Brankin:
Lab
We have said that we will increase the number of dental therapists by 33 per cent. It is hugely important that we have a complete dental team. There are jobs...
Richard Lochhead (North East Scotland) (SNP):
SNP
I thank the minister for her statement and welcome many of the measures that are contained therein, which will also be welcomed by constituents in the Grampi...
Rhona Brankin:
Lab
I am confident that the attractiveness of the package that I have announced this afternoon will encourage dentists to return to the NHS. It is hugely importa...
Elaine Smith (Coatbridge and Chryston) (Lab):
Lab
I welcome the minister's excellent statement. I am sure that it will be welcomed throughout Scotland. Given the fact that the Breastfeeding etc (Scotland) Ac...
Rhona Brankin:
Lab
We supported the Breastfeeding etc (Scotland) Bill, and believe that breastfeeding is very important in developing calcium in babies' teeth and in giving the...
Mary Scanlon (Highlands and Islands) (Con):
Con
Will the new fees for oral assessment and other dental work take account of the six-minute infection control period between each patient? I also remind the m...
Rhona Brankin:
Lab
The new fee structure recognises the increasing need to take infection control into consideration and the additional administration and practice running cost...
Susan Deacon (Edinburgh East and Musselburgh) (Lab):
Lab
I warmly welcome the minister's statement, in particular its emphasis on prevention. Does she agree that the foundations for good dental health are laid in t...
Rhona Brankin:
Lab
Yes. I agree fundamentally with Susan Deacon, which is why women who become pregnant will receive an oral health pack that explains the importance of looking...
Mr Jamie Stone (Caithness, Sutherland and Easter Ross) (LD):
LD
Although the statement is most welcome, we should acknowledge the fact that a large number of people out there who are perhaps among the poorest and most dis...
Rhona Brankin:
Lab
Absolutely. My statement is underpinned by the need to improve the oral health of all people in Scotland. However, that need is clearly much greater in some ...
Des McNulty (Clydebank and Milngavie) (Lab):
Lab
I am sure that the simplified fee structure will be welcomed, but will the minister say any more about the level of fees, particularly for oral inspection, b...
Rhona Brankin:
Lab
I am unable to give the member more information about specific fees at the moment because the matter is still subject to negotiation with our dentist colleag...
Stewart Stevenson (Banff and Buchan) (SNP):
SNP
What was the fee on which the increase to £355 million was based?