Hansard

I, too, welcome the opportunity to debate the important subject of primary dental care services, including the plans for early registration schemes, fissure sealing and other proposals. I am pleased that my son and daughter, aged 26 and 27, have no fillings and I think that that is because they had fissure sealing at the appropriate time.

I welcome Robin Harper's speech. I hope that when the time comes we will have a full debate on fluoridation, from the environmental as well as the health point of view. I hope that the decision on fluoridation does not go through the Parliament added on to dental treatment, as the issues are wider. In the Conservative party, we would have a free vote on fluoridation because many people have strong feelings for and against it.

I regard "An Action Plan for Dental Services in Scotland" as the kind of vision that Bishop Devine spoke of earlier and "Workforce Planning for Dentistry in Scotland" as the real plan for action. Today, therefore, I will consider the outline of the latter document, its aims and objectives and how it addresses concerns about current practice; I am pleased to say that it goes a long way towards doing that.

Page 4 of the document lists seven areas of increased demand and 12 factors that illustrate the reduction in supply. That variance produces a huge gap, which the document largely deals with. There is not only a training gap, but an action gap and a major funding gap. I am pleased that we will consider dentistry again in the new year, as we have made a professional and responsible start in dealing with that important subject.

The proposals will mean a significant increase in the number of patients who are seen by dentists. To allow that to happen, we will need more dentists and many more dental personnel. Figures in the document outline that in the European Union, the average number of inhabitants for each practising dentist is 1,634. In the United Kingdom, the average is 2,645—1,000 above the European average.

The recommendation for the number of dental graduates in Scotland—120 a year—has been accepted by the two major dental schools. I was pleased to hear that the dental college in Dundee recruits more than 50 students to allow for a drop-out rate and to ensure that 50 students graduate each year.

As Nicola Sturgeon mentioned, serious problems exist in our system, even before we consider the implementation of the proposals. At Glasgow dental hospital, waiting times are 71 weeks for oral medicine; 69 weeks for anxiety treatment and hypnosis; 34 weeks for oral surgery; 11 months for prosthodontics; 30 weeks for dental conservation; and 22 weeks for children's dental health. We have a lot of work to do in facing those problems.

Similarly, Dundee dental school is not without its problems. It faces a £250,000 deficit and has to work under the constraints on investment and expenditure that result from Tayside University Hospitals NHS Trust's £19 million deficit. Will the Executive ensure that the expenditure for the dental hospital in Dundee is ring-fenced to ensure that the hospital is given the opportunity to rise to the challenges in the action plan and the work force planning review?

The minister mentioned the need for adequate funding and incentives. I am pleased that funding and incentives will be further examined for general dental practitioners.

The recent case of John Evans-Appiah—who has had 44 jobs in 22 years—gives rise to concern over the 1,701 new entrants to the dentists register in 1999. Of those new entrants, 54.2 per cent qualified overseas. Can we be sure that those dentists have undergone the rigorous and extensive training that Scottish dental graduates have undergone? We want to ensure that there is no repeat of the exceptionally bad working practices that occurred with John Evans-Appiah and that led to such tragic events.

The cost of educating a dental student is accepted to be far greater than that of educating any other undergraduate. The supervision of dental students is much more intensive than on other courses. That gives rise to a serious issue of underfunding. Will the Executive consider ways of providing funding to allow all dentists to fulfil the obligations for continuing professional education that are outlined in both documents?

The General Dental Council has approved the concept of continuing professional development and lifelong learning for dentists and of linking a proportion of that training to attendance at verifiable courses. On that point, we must ask whether our dental schools have the funding, the resources and the facilities to meet those demands. The dental schools are already stretched, so resources must be made available to recruit more staff to allow the new courses to be run without an adverse affect on clinical activity and clinical university teaching.

Training must be given and posts created for speciality practice, in addition to more facilities being made available. I have praised the work force planning document, which is excellent. None the less, little is said in the document about specialities—for example, surgical restorative orthodontics and prosthodontics—although such disciplines are essential to achieve the continuing professional development that is outlined, the aims and objectives that are contained in the action plan, and equality of access throughout Scotland.

I refer members to page 29 of the work force planning document, which states:

"The lack of significant expansion of the consultant grade in the dental specialities in comparison with medical and surgical specialities is of some concern to those involved with training and improving clinical practice."

I hope that Scotland can continue to work towards being a centre of excellence for dentistry. To achieve that and the levels of training that are outlined, we must address the personnel issues. However, the recent announcement that all dental general anaesthesia outside hospitals will end by January 2002 offered no positive suggestions for the proper resourcing of alternative methods of anxiety management, or increased training for general dental practitioners.

Morale in the dental profession is a matter of serious concern. When an NHS plan devotes 144 pages to the medical profession and only eight lines to dentistry, dentists do not get a sense that their contribution to NHS care is valued. I hope that when we produce our Scottish health plan in November, we will devote more attention to dental needs. It is time for the minister to put her money where her mouth is and commit fully the resources that are required to benefit oral health in Scotland.