Meeting of the Parliament 21 February 2024
A year ago, in a similar Scottish Liberal Democrat debate, I suggested that any objective analysis of NHS dentistry across Scotland could only conclude that the sector was in crisis. At the time, the then health secretary—now the First Minister—was writing to dentists, telling them how pleased he was about how well the sector was performing. It was the sort of tone deaf ministerial complacency that had dentists around the country clutching their drills more tightly and possibly even dreaming of the emergency extraction work that they would love to perform.
Twelve months on, and despite changes that were introduced by the Government last November, the BDA insists that NHS dentistry has been
“in crisis for a generation”
and that the action taken by ministers falls short of the root-and-branch change that is needed. Willie Rennie vividly highlighted the painful consequences of that failure by Government to get to grips with the scale of the challenge that the sector faces. I will use my time to illustrate how the crisis in dentistry is playing out in the islands that I represent.
As the BDA briefing for the debate makes clear, the registration rate for adult patients in Orkney stands at 50 per cent, which is the lowest rate in the country. That is no great surprise, despite the Herculean efforts of local dentists and staff. It reflects what I have been seeing in my casework over recent years. That figure needs to be considered in the context of the participation rate—contact with a dentist in the past two years—which, last summer, stood at 50 per cent of all those who are registered. The fact that that figure is lower than the figure in 2021, when we were in the midst of a pandemic, should flush out any residual complacency in St Andrew’s house.
NHS Orkney’s dental lead, Steven Johnston, has confirmed to me that, between 2020 and 2022, the participation rate among children plummeted from 87 per cent to 57 per cent. Although overall dental hygiene among children in Orkney remains good, there must be a serious risk of problems being stored up in the longer term. Mr Johnston has also spoken about a concerning shift in activity from the NHS to the private sector. Again, that trend is borne out by my mailbag and it undermines any claim that the Government might make that even basic dental provision in Scotland is free for all at the point of delivery.
Addressing that will require the wider reforms that were set out by Willie Rennie, as well as a sustainable funding model. Changes to date may have stemmed the exodus of dentists from NHS practices, but, as one local dentist told me this week, it will not reopen lists to new registrations. The low-margin, high-volume funding system does not work in island and rural settings. Certain treatments are, de facto, loss making unless they are delivered in high numbers, which simply cannot be achieved in places such as Orkney.
On recruitment and retention—where, again, specific challenges exist in island and rural areas—there is a lack of clarity on the support that is available. I previously raised the issue in Parliament with the minister and was told that support is being provided where it is most needed. However, NHS Orkney and the remote and rural directors of dentistry group still appear to be awaiting details of the financial allowances. In the meantime, the loss of the fully-funded remote and rural fellowship is being keenly felt. In the past, that scheme was well used by dentists in Orkney, even allowing one dentist to go on to provide orthodontic services prior to 2021. There is now no provider of orthodontics locally, which is leading constituents to contact me to highlight the impact on their children, for whom there are mental health as well as oral health implications. A replacement for the fellowship scheme to improve recruitment and retention in island and rural areas is urgently needed.
The crisis in dentistry persists, and more urgent and concerted action is needed by the Government. I urge the Parliament to support the motion in the name of Willie Rennie.
16:32