Chamber
Plenary, 21 Apr 2005
21 Apr 2005 · S2 · Plenary
Item of business
Dental Health Services
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 access to national health service dentistry services. The committee thought it appropriate to have a more objective assessment of the situation than was available, so in April 2004 it commissioned researchers from the Guy's, King's and St Thomas' dental institute in London to conduct a survey of Scottish dentists. Their remit was to identify the contribution of dentists to the provision of NHS dental services in Scotland and to identify areas where the availability of services is insufficient to meet need or demand. The report and conclusions were published on 1 February 2005.
On behalf of the Health Committee, I thank Professor Tim Newton, Professor Alison Williams and Dr Elizabeth Bower for their comprehensive piece of work, which I hope will form the basis of a serious examination of some of the real difficulties and shortcomings facing NHS dental provision throughout Scotland. I also thank the clerks to the committee for all their assistance and hard work.
The research is extremely thorough. I will take some time to present the main findings of the report to the chamber, with a detour here and there, as members might expect, into my experience as a constituency MSP who receives complaints from constituents who are unable to access dental services.
The purpose of the exercise was to find the facts behind what we knew to be the reality of some of our constituents' experiences. Stories abound of queues down the street when a dentist announces that he or she is taking on NHS patients or, worse, restricting his or her NHS list on a first-come, first-served basis. There was just such a story in The Herald on Tuesday. The sole remaining NHS dental practice in Stranraer announced that it was going private and would be offering NHS treatment only to children and existing NHS patients. That dentist had nearly 3,500 patients, a great many of whom queued outside the surgery to join the private scheme, which has been restricted to only 1,000 members, leaving 2,500 people disappointed. The question is where those people are to go. Of course, Stranraer is not alone in experiencing such a situation.
The report identifies a number of problems in relation to access to dental services and flags up the difficulties that could arise with the implementation of the Executive's policy on free oral health checks unless dentists can be encouraged to increase the amount of time that they spend treating NHS Scotland patients over the next two years. Frankly, there is little sign of that happening, either from past performance or from indications for the future. In the past two years, just over one in 10 dentists in Scotland have increased the number of NHS hours that they work, while more than a quarter have decreased their NHS hours. Only 3.5 per cent of primary care dentists have stated that they intend to increase the amount of time that they spend treating NHS patients in the next two years.
It may come as a surprise to members that insufficient information is available at health board level on a whole range of indicators, such as numbers of dentists; the number of dentists who are accepting new NHS patients; distances travelled by patients for primary and secondary dental care, which is pretty fundamental, especially in rural areas; the availability of evening and weekend appointments; access for groups with special needs; demand for dental services; and recruitment and retention of all dental staff. That is all basic information, yet it is not readily available.
We know some things, however. The researchers established that the dentist to population ratio for Scotland as a whole was 5.57 NHS dentists per 10,000 population, although when part-time provision and the provision of private services were taken into account the figure fell to 3.52 NHS dentists per 10,000 population. However, there are significant variations. Surprisingly—I say that because most committee members were surprised—the highest dentist to population ration was in greater Glasgow and the lowest was in Dumfries and Galloway. Presumably, the news from Stranraer means that the figures there have got even worse.
On behalf of the Health Committee, I thank Professor Tim Newton, Professor Alison Williams and Dr Elizabeth Bower for their comprehensive piece of work, which I hope will form the basis of a serious examination of some of the real difficulties and shortcomings facing NHS dental provision throughout Scotland. I also thank the clerks to the committee for all their assistance and hard work.
The research is extremely thorough. I will take some time to present the main findings of the report to the chamber, with a detour here and there, as members might expect, into my experience as a constituency MSP who receives complaints from constituents who are unable to access dental services.
The purpose of the exercise was to find the facts behind what we knew to be the reality of some of our constituents' experiences. Stories abound of queues down the street when a dentist announces that he or she is taking on NHS patients or, worse, restricting his or her NHS list on a first-come, first-served basis. There was just such a story in The Herald on Tuesday. The sole remaining NHS dental practice in Stranraer announced that it was going private and would be offering NHS treatment only to children and existing NHS patients. That dentist had nearly 3,500 patients, a great many of whom queued outside the surgery to join the private scheme, which has been restricted to only 1,000 members, leaving 2,500 people disappointed. The question is where those people are to go. Of course, Stranraer is not alone in experiencing such a situation.
The report identifies a number of problems in relation to access to dental services and flags up the difficulties that could arise with the implementation of the Executive's policy on free oral health checks unless dentists can be encouraged to increase the amount of time that they spend treating NHS Scotland patients over the next two years. Frankly, there is little sign of that happening, either from past performance or from indications for the future. In the past two years, just over one in 10 dentists in Scotland have increased the number of NHS hours that they work, while more than a quarter have decreased their NHS hours. Only 3.5 per cent of primary care dentists have stated that they intend to increase the amount of time that they spend treating NHS patients in the next two years.
It may come as a surprise to members that insufficient information is available at health board level on a whole range of indicators, such as numbers of dentists; the number of dentists who are accepting new NHS patients; distances travelled by patients for primary and secondary dental care, which is pretty fundamental, especially in rural areas; the availability of evening and weekend appointments; access for groups with special needs; demand for dental services; and recruitment and retention of all dental staff. That is all basic information, yet it is not readily available.
We know some things, however. The researchers established that the dentist to population ratio for Scotland as a whole was 5.57 NHS dentists per 10,000 population, although when part-time provision and the provision of private services were taken into account the figure fell to 3.52 NHS dentists per 10,000 population. However, there are significant variations. Surprisingly—I say that because most committee members were surprised—the highest dentist to population ration was in greater Glasgow and the lowest was in Dumfries and Galloway. Presumably, the news from Stranraer means that the figures there have got even worse.
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 ...