Chamber
Plenary, 30 Nov 2000
30 Nov 2000 · S1 · Plenary
Item of business
Dental Services (Grampian)
I am pleased to open this evening's debate, which is designed to highlight the problems of accessing NHS dental treatment, particularly in the Grampian area.
My attention was first drawn to the problem of accessing NHS dental treatment by the difficulties my local dental practitioner faced when he attempted to recruit a dentist to serve the people of Alford. For about 18 months, he tried to find someone who was willing to come to the rural north-east—but to no avail. The local health authority then tried to cover the area with a salaried dentist, so that NHS treatment could be provided. Six months down the line, the health authority could not recruit a dentist either.
I am concerned that people in rural areas are finding it increasingly difficult to get NHS dental treatment, either for routine work or for more specialist treatment from a consultant. I congratulate the Executive on taking NHS dental treatment much further up the political agenda. I also welcome its publication of "An Action Plan for Dental Services in Scotland".
I know that the Executive recognises that we have real problems with dental care provision in Scotland. Statistics from its document demonstrate that one third of our children are not registered with general dental practitioners and 25 per cent are left entirely without continuing dental care. However, the issues that I am raising this evening go much wider. Non-exempt individuals—for example those who are not children and who are not in receipt of benefits—are simply not able to access NHS dental provision.
After taking up the Alford case, I soon found that the health authority solution was to tell people that they could access NHS dental provision because an NHS salaried dentist was available in the city of Aberdeen, but anyone who knows the north-east will know that travelling such distances is not a practical solution, especially for people on a low income.
When I pressed health authorities to provide information on the level of NHS dental provision in the north-east, I was amazed to discover that no such information exists—no one could tell me how widespread the problem of accessing an NHS dentist in rural Aberdeenshire is. I conducted my own survey by asking the 10 dental practices in West Aberdeenshire and Kincardine whether they provide NHS access to new non-exempt patients. I found that only half do, so half the people in my constituency cannot register for a local NHS dental service. I cannot believe that the problem is confined to my constituency; it must be a wider problem in rural Scotland. Good schemes, such as the one for salaried dental practitioners that is identified in the action plan and is designed to address this problem, work only if a dentist can be recruited.
I will give some pertinent statistics that were provided to me by the Grampian local dental committee. Nationally, there is one dentist for every 2,500 people, but in Aberdeenshire there is one for every 4,500 people. That means that the problem is double for people in Aberdeenshire. In greater Glasgow, there is one dental consultant for every 100,000 people, but in Grampian and the Highlands and Islands there is only one consultant for restorative dentistry for every 900,000 people. Guidelines suggest that there should be one consultant for every 300,000 people, so the problem for people in the north-east and the Highlands is three times as bad. There is a waiting time of up to five years for restorative dentistry in Grampian.
I received a letter today from Alec Cumming of Grampian University Hospitals NHS Trust. He told me that
"the waiting time for a routine first appointment with the Consultant is indeed around 56 weeks at present. Following an initial appointment, some patients will have to wait up to four years for treatment."
There is no doubt that there is a shortage of dentists, in the north-east in particular. The problem is exacerbated by the fact that half the dentists working in rural Aberdeenshire do not take new NHS non-exempt patients. Those two issues need to be addressed. I will suggest two possible solutions, which I hope the minister will address.
First, the target of 120 graduates per year for the next five years should be increased. Scotland was producing up to 160 graduates before the Edinburgh dental school closed. The Grampian local dental committee has suggested that a link could be established with the Dundee dental hospital, building on the current expertise in the region. That would help to increase the provision of dentists and bring them into the region in the first place.
Secondly, there has been a reduction in NHS work because the level of fees for basic treatments is unrealistic. If there were a properly funded core service, with full funding for treatments such as check-ups, fillings, extractions and dentures, but more complex treatments were made private, more dentists could be attracted back to NHS work and the problem could be alleviated quite quickly. Of course, there is a shortage of cash—there always is—but the idea is to focus funding on a fully funded core service. That would enable more patients to find an NHS dentist closer to home, rather than have to search for practices providing NHS services.
The radical views of the Grampian local dental committee are worth examining. The fees that are associated with NHS dental services are outdated and provide little or no incentive for preventive dentistry in general practice—general practitioners want to focus on preventive dentistry.
Although the Executive's action plan is very welcome, the problems of accessing NHS dental services are real, especially for rural communities in the north-east. Perhaps we need more radical action to address them.
I will be very interested to hear the Executive's reaction to the ideas that I have outlined today. What about a training link between Aberdeen and Dundee to increase the number of trained dentists? What about incentives to promote access to NHS dentists in rural Aberdeenshire?
My attention was first drawn to the problem of accessing NHS dental treatment by the difficulties my local dental practitioner faced when he attempted to recruit a dentist to serve the people of Alford. For about 18 months, he tried to find someone who was willing to come to the rural north-east—but to no avail. The local health authority then tried to cover the area with a salaried dentist, so that NHS treatment could be provided. Six months down the line, the health authority could not recruit a dentist either.
I am concerned that people in rural areas are finding it increasingly difficult to get NHS dental treatment, either for routine work or for more specialist treatment from a consultant. I congratulate the Executive on taking NHS dental treatment much further up the political agenda. I also welcome its publication of "An Action Plan for Dental Services in Scotland".
I know that the Executive recognises that we have real problems with dental care provision in Scotland. Statistics from its document demonstrate that one third of our children are not registered with general dental practitioners and 25 per cent are left entirely without continuing dental care. However, the issues that I am raising this evening go much wider. Non-exempt individuals—for example those who are not children and who are not in receipt of benefits—are simply not able to access NHS dental provision.
After taking up the Alford case, I soon found that the health authority solution was to tell people that they could access NHS dental provision because an NHS salaried dentist was available in the city of Aberdeen, but anyone who knows the north-east will know that travelling such distances is not a practical solution, especially for people on a low income.
When I pressed health authorities to provide information on the level of NHS dental provision in the north-east, I was amazed to discover that no such information exists—no one could tell me how widespread the problem of accessing an NHS dentist in rural Aberdeenshire is. I conducted my own survey by asking the 10 dental practices in West Aberdeenshire and Kincardine whether they provide NHS access to new non-exempt patients. I found that only half do, so half the people in my constituency cannot register for a local NHS dental service. I cannot believe that the problem is confined to my constituency; it must be a wider problem in rural Scotland. Good schemes, such as the one for salaried dental practitioners that is identified in the action plan and is designed to address this problem, work only if a dentist can be recruited.
I will give some pertinent statistics that were provided to me by the Grampian local dental committee. Nationally, there is one dentist for every 2,500 people, but in Aberdeenshire there is one for every 4,500 people. That means that the problem is double for people in Aberdeenshire. In greater Glasgow, there is one dental consultant for every 100,000 people, but in Grampian and the Highlands and Islands there is only one consultant for restorative dentistry for every 900,000 people. Guidelines suggest that there should be one consultant for every 300,000 people, so the problem for people in the north-east and the Highlands is three times as bad. There is a waiting time of up to five years for restorative dentistry in Grampian.
I received a letter today from Alec Cumming of Grampian University Hospitals NHS Trust. He told me that
"the waiting time for a routine first appointment with the Consultant is indeed around 56 weeks at present. Following an initial appointment, some patients will have to wait up to four years for treatment."
There is no doubt that there is a shortage of dentists, in the north-east in particular. The problem is exacerbated by the fact that half the dentists working in rural Aberdeenshire do not take new NHS non-exempt patients. Those two issues need to be addressed. I will suggest two possible solutions, which I hope the minister will address.
First, the target of 120 graduates per year for the next five years should be increased. Scotland was producing up to 160 graduates before the Edinburgh dental school closed. The Grampian local dental committee has suggested that a link could be established with the Dundee dental hospital, building on the current expertise in the region. That would help to increase the provision of dentists and bring them into the region in the first place.
Secondly, there has been a reduction in NHS work because the level of fees for basic treatments is unrealistic. If there were a properly funded core service, with full funding for treatments such as check-ups, fillings, extractions and dentures, but more complex treatments were made private, more dentists could be attracted back to NHS work and the problem could be alleviated quite quickly. Of course, there is a shortage of cash—there always is—but the idea is to focus funding on a fully funded core service. That would enable more patients to find an NHS dentist closer to home, rather than have to search for practices providing NHS services.
The radical views of the Grampian local dental committee are worth examining. The fees that are associated with NHS dental services are outdated and provide little or no incentive for preventive dentistry in general practice—general practitioners want to focus on preventive dentistry.
Although the Executive's action plan is very welcome, the problems of accessing NHS dental services are real, especially for rural communities in the north-east. Perhaps we need more radical action to address them.
I will be very interested to hear the Executive's reaction to the ideas that I have outlined today. What about a training link between Aberdeen and Dundee to increase the number of trained dentists? What about incentives to promote access to NHS dentists in rural Aberdeenshire?
In the same item of business
The Presiding Officer (Sir David Steel):
NPA
We now come to the members' business debate on motion S1M-1347, in the name of Mike Rumbles, on access to national health service dental services in Grampian...
Motion debated,
That the Parliament recognises that improving access to NHS dental services is a public health priority, welcomes the publication by the Scottish Executive o...
Mr Mike Rumbles (West Aberdeenshire and Kincardine) (LD):
LD
I am pleased to open this evening's debate, which is designed to highlight the problems of accessing NHS dental treatment, particularly in the Grampian area....
The Deputy Presiding Officer (Mr George Reid):
SNP
Six members have asked to speak, so speeches should be around three minutes, please.
Lewis Macdonald (Aberdeen Central) (Lab):
Lab
I welcome the opportunity to debate this matter and the constructive approach of Mike Rumbles's motion. He is primarily concerned with access to dentistry in...
Richard Lochhead (North-East Scotland) (SNP):
SNP
I congratulate Mike Rumbles on securing this evening's debate and on sporting a Highland outfit. I think it is fair to say that the subject of the debate was...
Ben Wallace (North-East Scotland) (Con):
Con
I would like to thank Mike Rumbles for giving us the chance to highlight the continuing problems in Grampian. His outline of the situation and his proposals ...
Nora Radcliffe (Gordon) (LD):
LD
I would like to thank Mike Rumbles for this members' debate, which allows us to put on record our concerns about the provision of dental services in the nort...
Mary Scanlon (Highlands and Islands) (Con):
Con
I congratulate Mike Rumbles on securing today's debate and thank him for giving us an opportunity to discuss dentistry. I would also like to take the opportu...
The Deputy Minister for Health and Community Care (Malcolm Chisholm):
Lab
I congratulate Mike Rumbles on securing this debate, and I am grateful to all members who have contributed to it.During the debate on primary care dental ser...
Richard Lochhead:
SNP
I welcome the minister's comments on the need for more consultants which has been recognised in Grampian. Does the minister also accept that for every new co...
Malcolm Chisholm:
Lab
The discussion paper to which I referred earlier proposed significant increases in the number of professionals who are complementary to dentistry to enhance ...
Ben Wallace:
Con
Will the minister take on board the fact that members of Grampian Health Board have almost stopped advertising? Having spent so much money on trying to recru...
Malcolm Chisholm:
Lab
I hear what Ben Wallace is saying. I am told that an advertising campaign is going on and that, in January 2001, adverts will be placed, but I will check on ...
Meeting closed at 17:43.