Chamber
Plenary, 21 Apr 2005
21 Apr 2005 · S2 · Plenary
Item of business
Dental Health Services
I welcome the debate and the publication of the research report, especially because in my region—the Highlands and Islands—access to dental care has been and remains an issue of great concern.
The weighty research report is primarily about dental services, rather than dental health, but it is reasonable for me to touch on our oral health record. Richard Baker has already quoted the following statement from the report, but I will do so again because it is so telling:
"the determinants of oral health extend far beyond access to dental services … Dental service utilisation alone does not necessarily enhance or maintain oral health".
I found the tables in the report fascinating. Scottish Borders, which clearly does best in the league table that relates to tooth decay in children, even allowing for all the variables that exist, and Dumfries and Galloway, which is about fifth in the table, are among the areas that have the lowest dentist to population ratios, the worst access to NHS dentists for new children and adults, the longest distances to travel to dentists and the longest waiting times. However, those areas have middle and low deprivation rates, respectively. That is a really important issue. Dental health in children—there does not seem to be much information held centrally about dental health in adults, to which I will return—correlates poorly with the level of services, but absolutely with the level of poverty. We will not improve the oral health of our population unless we eradicate poverty. It is as simple as that.
However, it would be wrong to say that provision of dental services is not important: of course it is, as is universal access to those services. I welcome the various initiatives and investments that the minister has announced. I welcome particularly the fact that the Executive is considering having a greater skills mix in dentistry in our communities in the future by introducing to surgeries professions that are complementary to dentistry, such as more dental hygienists and other people who could deliver services that dentists currently deliver.
Alex Fergusson said in his intervention that retaining dentists is not just a case of throwing money at the situation, but is also about job satisfaction. The report looked to some extent at what would make dentists more interested in treating more NHS patients. It was interesting that although 55 per cent of dentists agreed that they wanted increased fees for services, there were many other areas on which there was no agreement. I suspect that it would be an interesting exercise to go into more detail with individual dentists to find out what makes working for the NHS less satisfying.
That reminds me of a psychologist with whom I used to work. We used to ask each other the "miracle" question, which was, "If a miracle happened and you went to work tomorrow, what would be different?" It might be that for some dentists the miracle would be that they would carry on as normal but would get more money for treating patients. I suspect that for some, the miracle would be that they would arrive in the morning at splendid, up-to-date and purpose-built premises that were provided, maintained and equipped by the health board, staffed not only by receptionists and dental nurses, but by a range of professionals who are allied to dentistry and who would help them to deliver services. Job satisfaction and working conditions are perhaps more important and less easy to define than money, but they make the job more worth doing.
I mentioned the lack of information on adult oral health. I found it fascinating to read in the report that there is a distinct lack of data about dental health and dental health services held either at health board or Government level. The work that was done in preparing the report from the 1,800 returned questionnaires that the authors received provides some valuable information, but only on a snapshot basis. The information should and must be collated and monitored regularly over time. For example, the report mentions that no information on adult oral health is held by health boards. How can we plan to meet the needs of the population when we do not know what its needs are? No information is held at health board level about numbers of whole-time equivalent dentists. That is incredible—somebody pays them so surely we know how many of them there are.
No information is held at health board level about the number of dentists who are accepting new NHS patients—again, that is crucial information. There is no information about distances that are travelled by patients to see dentists, which is a big issue in my area. There is no information on demand for access to dental services, there is no information about the need for community dental services to treat some of the most vulnerable people and there are insufficient data on recruitment and retention. Now that the huge information gap has been recognised, I hope that we will hear how it will be plugged.
It will be difficult to meet our dental care needs and to keep up with meeting those needs as they change if we do not know what they are. I look forward to the day when our children's oral health is much better, when we have tackled poverty, when we have removed fizzy drinks from schools, when we have improved children's diet and when we have improved toothbrushing and dental health awareness in general. However, our population is living longer, people keep their teeth longer and the dental health needs of older people will increase. That has to be considered.
I have made the point about free dental checks in chamber debates before. I accept what other members have said about there being difficulty under the present system in delivering universal free dental check-ups, but there is also an ethical problem. In medicine, it is an ethical truism that one does not screen for a condition unless one can treat it if one finds it. My worry is this: even if we can deliver free dental checks, if they show up a need for treatment, will we be able to deliver that treatment? If we cannot, it is almost unethical to do the checks. We need to look not only at meeting the need for free dental checks, but at meeting the increased treatment needs that the checks will show up.
The weighty research report is primarily about dental services, rather than dental health, but it is reasonable for me to touch on our oral health record. Richard Baker has already quoted the following statement from the report, but I will do so again because it is so telling:
"the determinants of oral health extend far beyond access to dental services … Dental service utilisation alone does not necessarily enhance or maintain oral health".
I found the tables in the report fascinating. Scottish Borders, which clearly does best in the league table that relates to tooth decay in children, even allowing for all the variables that exist, and Dumfries and Galloway, which is about fifth in the table, are among the areas that have the lowest dentist to population ratios, the worst access to NHS dentists for new children and adults, the longest distances to travel to dentists and the longest waiting times. However, those areas have middle and low deprivation rates, respectively. That is a really important issue. Dental health in children—there does not seem to be much information held centrally about dental health in adults, to which I will return—correlates poorly with the level of services, but absolutely with the level of poverty. We will not improve the oral health of our population unless we eradicate poverty. It is as simple as that.
However, it would be wrong to say that provision of dental services is not important: of course it is, as is universal access to those services. I welcome the various initiatives and investments that the minister has announced. I welcome particularly the fact that the Executive is considering having a greater skills mix in dentistry in our communities in the future by introducing to surgeries professions that are complementary to dentistry, such as more dental hygienists and other people who could deliver services that dentists currently deliver.
Alex Fergusson said in his intervention that retaining dentists is not just a case of throwing money at the situation, but is also about job satisfaction. The report looked to some extent at what would make dentists more interested in treating more NHS patients. It was interesting that although 55 per cent of dentists agreed that they wanted increased fees for services, there were many other areas on which there was no agreement. I suspect that it would be an interesting exercise to go into more detail with individual dentists to find out what makes working for the NHS less satisfying.
That reminds me of a psychologist with whom I used to work. We used to ask each other the "miracle" question, which was, "If a miracle happened and you went to work tomorrow, what would be different?" It might be that for some dentists the miracle would be that they would carry on as normal but would get more money for treating patients. I suspect that for some, the miracle would be that they would arrive in the morning at splendid, up-to-date and purpose-built premises that were provided, maintained and equipped by the health board, staffed not only by receptionists and dental nurses, but by a range of professionals who are allied to dentistry and who would help them to deliver services. Job satisfaction and working conditions are perhaps more important and less easy to define than money, but they make the job more worth doing.
I mentioned the lack of information on adult oral health. I found it fascinating to read in the report that there is a distinct lack of data about dental health and dental health services held either at health board or Government level. The work that was done in preparing the report from the 1,800 returned questionnaires that the authors received provides some valuable information, but only on a snapshot basis. The information should and must be collated and monitored regularly over time. For example, the report mentions that no information on adult oral health is held by health boards. How can we plan to meet the needs of the population when we do not know what its needs are? No information is held at health board level about numbers of whole-time equivalent dentists. That is incredible—somebody pays them so surely we know how many of them there are.
No information is held at health board level about the number of dentists who are accepting new NHS patients—again, that is crucial information. There is no information about distances that are travelled by patients to see dentists, which is a big issue in my area. There is no information on demand for access to dental services, there is no information about the need for community dental services to treat some of the most vulnerable people and there are insufficient data on recruitment and retention. Now that the huge information gap has been recognised, I hope that we will hear how it will be plugged.
It will be difficult to meet our dental care needs and to keep up with meeting those needs as they change if we do not know what they are. I look forward to the day when our children's oral health is much better, when we have tackled poverty, when we have removed fizzy drinks from schools, when we have improved children's diet and when we have improved toothbrushing and dental health awareness in general. However, our population is living longer, people keep their teeth longer and the dental health needs of older people will increase. That has to be considered.
I have made the point about free dental checks in chamber debates before. I accept what other members have said about there being difficulty under the present system in delivering universal free dental check-ups, but there is also an ethical problem. In medicine, it is an ethical truism that one does not screen for a condition unless one can treat it if one finds it. My worry is this: even if we can deliver free dental checks, if they show up a need for treatment, will we be able to deliver that treatment? If we cannot, it is almost unethical to do the checks. We need to look not only at meeting the need for free dental checks, but at meeting the increased treatment needs that the checks will show up.
In the same item of business
The Presiding Officer (Mr George Reid):
NPA
The next item of business is a debate on motion S2M-2708, in the name of Roseanna Cunningham, on behalf of the Health Committee, on access to dental health s...
Roseanna Cunningham (Perth) (SNP):
SNP
Members of the Health Committee, like members throughout the chamber, have been concerned by the extent of the anecdotal evidence of a perceived decline in a...
Mike Rumbles (West Aberdeenshire and Kincardine) (LD):
LD
Roseanna Cunningham will remember that those statistics relate to health board areas and that in committee I made the point that, on a local authority basis,...
Roseanna Cunningham:
SNP
Yes. There is an issue with how the figures operate, because they relate to health board areas, not local authority areas or, indeed, constituency areas.Ther...
The Deputy Minister for Health and Community Care (Rhona Brankin):
Lab
We all agree that Scotland has a continuing need to improve oral health, especially among children and in deprived communities. Indeed, in deprived areas of ...
Alex Fergusson (Galloway and Upper Nithsdale) (Con):
Con
In countries such as Denmark and Sweden, specialised dental health educators supervise children's toothbrushing sessions. Will the minister expand on the pla...
Rhona Brankin:
Lab
That is a good point. At the moment, there is a variety of ways of supervising toothbrushing. In some schools, dental hygienists supervise it, but we are con...
Alasdair Morgan (South of Scotland) (SNP):
SNP
The minister was due to visit that dentist but she cancelled the visit. Would it not be appropriate for her to go ahead with it, if necessary to talk to the ...
Rhona Brankin:
Lab
I will be absolutely frank with the member. I thought that it was important, on my visit to Dumfries and Galloway, to meet dentists who are committed to the ...
Mary Scanlon (Highlands and Islands) (Con):
Con
How can the Executive ensure that the £150 million of resources that have been allocated will meet the priorities, given the distinct lack of information tha...
Rhona Brankin:
Lab
There is no doubt that we need to get better at acquiring information, but we have enough information at the moment to be able to plan with NHS boards. We ar...
Shona Robison (Dundee East) (SNP):
SNP
I pay tribute to those who worked on the report and to the committee clerks for their input. The report is an excellent piece of research, which has informed...
Mr Duncan McNeil (Greenock and Inverclyde) (Lab):
Lab
Does the member approve of the actions of the dentist in Stranraer last weekend? Does she approve of the ultimatum that he gave to loyal patients, who had to...
Shona Robison:
SNP
That is not the point. If we are to persuade dentists to stay in the NHS and persuade dentists who have left the NHS to come back, it is not helpful to casti...
Rhona Brankin:
Lab
The minister has announced £150 million of additional funding, which is the biggest-ever investment in NHS dentistry. Within a few weeks of that announcement...
Shona Robison:
SNP
The minister misses the point. The individual dentist is not the issue. The issue is those who have gone before and those who may come after and make the dec...
Alex Fergusson:
Con
I agree with Shona Robison's comment about the language that has been used. I will address that in my speech. Does she agree that the endless stream of denti...
Shona Robison:
SNP
The two go together. Those dentists do not have quality time with their patients and they are run off their feet. If dentists can do less work for more money...
Rhona Brankin:
Lab
Will the member take an intervention?
Shona Robison:
SNP
No. I am running out of time.The SNP believes that more needs to be done to expand the workforce and therefore supports the development of a third full denta...
Mrs Nanette Milne (North East Scotland) (Con):
Con
I joined the Health Committee as the report was being published. I commend the committee for commissioning the report, which gives a clear snapshot of curren...
Rhona Brankin:
Lab
What is the Conservative party's policy on private dentistry?
Mrs Milne:
Con
Dentists are contracted to the health service. It is up to them whether to work for the NHS or opt to go private—that has been a long-standing situation. If ...
Mike Rumbles (West Aberdeenshire and Kincardine) (LD):
LD
This is a welcome debate on the problems that NHS dentistry in Scotland faces. The failure over many years to ensure that everyone in Scotland—regardless of ...
Mary Scanlon:
Con
Will the minister give way?
Mike Rumbles:
LD
I am not a minister, but I will certainly give way.
Mary Scanlon:
Con
Mike Rumbles mentioned the Edinburgh dental school. Does he acknowledge that the Conservatives recommended the postgraduate dental institute in Edinburgh, wh...
Mike Rumbles:
LD
It would be wiser for the Conservatives not to push the issue, because they have done a lot of damage. They set in train the damage to the NHS dental service...
Christine Grahame (South of Scotland) (SNP):
SNP
I am interested in Liberal Democrat support for what we might term golden handcuffs for dentists who are going into training and education. Does Mr Rumbles h...
Mike Rumbles:
LD
It is not appropriate to refer to golden handcuffs. However, I am certainly in favour of this concept for dentists and I think that it could be expanded for ...