Hansard

The purpose of my statement today is to advise of the Executive's intention to undertake a consultation on the future arrangements for primary care dental services in Scotland. Consultation is required to deliver the undertaking in the Executive's white paper "Partnership for Care" that we would take forward, in discussions with the dental professions and the general public, proposals for changes to the system for rewarding primary care dentistry, in order to promote prevention, improve access to services, and improve recruitment and retention.

I recognise the growing concerns of patients, practitioners, national health service boards and MSPs about the current system. It is clear to me that we need to take a fundamental look at how dental services are provided in Scotland. The dental health of the people of Scotland is poor, and is strongly related to deprivation. In national surveys, a small minority of children—often the poorest—were found to experience the majority of dental decay. For example, in 5 year olds, 50 per cent of decayed surfaces were found in just 9 per cent of children. Currently, only 45 per cent of children have no experience of tooth decay on starting school at 5 years of age. Adult dental health also remains poor. Forty one per cent of dentate adults in Scotland reported having some dental pain in the previous 12 months.

Although the number of dentists has been increasing incrementally in Scotland, there is evidence that we have an inadequate supply for NHS services. Fifty-one per cent of adults and 35 per cent of children are not registered with a dentist, although some of those do still access NHS services on an occasional basis. NHS boards have reported that an increasing number of dentists are deregistering patients from continuing care and capitation arrangements and increasing their percentage of private work. The hospital dental service is under pressure, as it is picking up a number of patients on an emergency basis who were previously seen by general dental practitioners. The community dental service is facing increased pressures from reduced availability of NHS dentistry, either as a result of failure to recruit dentists to a particular area or the reducing commitment to the NHS of existing practitioners. Problems of access to NHS dentistry in certain areas have been the subject of legitimate public and media interest, and I have received representations on the subject from many MSPs.

The remuneration system for dentists and the consequent charging system, which patients find opaque, have remained largely unchanged since the establishment of the NHS. In conjunction with the dental professions, we have already introduced a number of measures in Scotland in the past two to three years, aimed at addressing access and recruitment issues. While those measures have had some effect, I have concluded that the present delivery system is unlikely to be sustainable in the longer term and that a different form or forms of provision will be necessary to sustain an acceptable level of service and secure the improvements in oral health that we so badly need.

In the partnership agreement, we have undertaken systematically to introduce free dental checks for all by 2007. We also recognise the need to increase the number of dentists and dental graduates in Scotland and we will expand the capacity of dental training facilities in Scotland by establishing an outreach training centre in Aberdeen.

Notwithstanding those commitments, I consider that it would be appropriate to consult interested parties on the future form of primary care dental services in Scotland. To take forward the process, the Executive is today launching a consultation on possible options for the future. The consultation document, "Modernising NHS Dental Services in Scotland", sets out the background to oral health and dental services in Scotland, provides a summary of what has already been put in place to support NHS dental services, describes the pressures and the need for further change, and puts forward options for changing the current system, including patient charges. The consultation process will include discussions with interested parties, including representatives of the NHS, the professions and the public. We will undertake in the new year a number of consultation meetings around Scotland. It is recognised that any substantial change to the current system will require legislative change. Following consultation, we will consider bringing forward legislation at a suitable opportunity.

Substantial changes may take some time to implement and it is important that we continue to develop short-term measures to address the current problems. In that regard I am pleased to announce some changes to existing Scottish initiatives and the introduction of several new measures. Some of those measures will contribute to the recruitment of dentists from the European Union. With regard to existing initiatives, we will double the remote area allowance from £3,000 to £6,000, we will double the allowance for vocational trainees in designated areas to £6,000, and we will double the allowance to recent graduates entering general dental services to £10,000, and double it again to £20,000 for designated areas. We will double the access grant for new NHS practices to £100,000 and double the grant for extending existing practices to £50,000.

In addition I am happy to announce a new range of Scottish initiatives: a new allowance for vocational trainees in non-designated areas of £3,000; a new allowance of £5,000 for joining a dental list for the first time or for re-entry after a five-year break—that allowance will double to £10,000 for designated areas; a new allowance of £10,000 for salaried dentists employed within three months of completion of training—that allowance will double to £20,000 for designated areas; and a new allowance of £5,000 for dentists who join the salaried dental service for the first time—that allowance doubles to £10,000 for designated areas. The increases to existing allowances and the introduction of new allowances will take effect from 1 April 2004.

So far I have announced our plans for the medium term, via the consultation process; and for the short term, via the new and enhanced initiatives. However, I recognise the urgency required in some areas. Consequently, I am pleased to announce, with immediate effect, £1.5 million to establish new emergency dental services provided by NHS boards and to support existing ones. That emergency capacity will minimise the risk that anyone will experience pain for an unacceptable time. That new money is in addition to the funding for such services that is available under the general dental services budget.

Substantial change will not happen overnight and it will be a challenge—because of the complexity of the issues and the importance of making dental service delivery more effective. I hope that we will be able to work together to achieve what I have set out and that, in doing so, we will produce a high-quality NHS dental service that delivers on the needs of patients and the aspirations of the dental professions and which makes a substantial impact by improving the health of the people of Scotland.