Hansard

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.

There is also wide variation in the proportion of time that dentists in different health board areas spend providing NHS services, ranging from 99.5 per cent in the Western Isles to 64.5 per cent in the Highlands. In the recent past, 26 per cent of dentists have decreased their NHS time. Significantly, that proportion was greater in general dental practice. Members might think that that is stating the obvious, but the research report states:

"Registration rates were significantly higher in areas where there were more GDS dentists available, suggesting that increasing the dentist to population ratio in an area is a way of improving the utilisation of services in that area."

That means that the more dentists there are, the more likely people are to go to the dentist. Given the appalling state of Scotland's dental health, that has to be an immediate area of concern.

Scotland has a slightly higher dentist to population ratio than the United Kingdom as a whole, but that has to be seen in the context of our far higher levels of remoteness and rurality. When we compare ourselves with other European countries, there is no need to adjust the figures to take those factors into account. In Denmark and Norway—the two countries in Europe that are most comparable to Scotland in terms of population and geography—the dentist to population ratios are more than twice that in Scotland. We have a long way to go to catch up.

When we turn to accessibility issues, we find that 58 per cent of primary care dentists are offering appointments to new child patients. That is all well and good, but it means that 42 per cent are not. Moreover, only 37 per cent are accepting all categories of adults as new NHS patients. Again, that varies throughout the country, with Orkney dentists accepting the highest proportion and Borders dentists accepting the lowest proportion of new NHS patients. More than 80 per cent of Borders dentists are either not accepting new patients or have a waiting list.

There are problems with access to NHS specialist services in rural and urban areas, with long waiting times for some specialties in Lothian, greater Glasgow, the Borders and Dumfries and Galloway. More than half of specialist practitioners are not accepting new patients or are using a waiting list. The point must be made that the public are prepared to travel for specialist services, but they are not prepared to wait for them. As I said, only 3.5 per cent of primary care dentists intend to increase the amount of time that they spend treating NHS patients in the next two years. It is worth thinking about that in the current context.

No single incentive to increase NHS commitment from dentists was favoured by an overwhelming majority of practitioners. The most frequently endorsed incentive was a significant increase in the fee per item of treatment. Moves to a salaried contract or a capitation arrangement are less popular and there seems little likelihood of retired dentists being attracted back into work. That means that the significant increase in NHS provision that is required to meet pledges to make free NHS check-ups available to all by 2007 is unlikely to be achieved with the range of incentives that are currently available.

The report provides a summary of the performance of each health board in relation to NHS dental services, in terms of availability, accessibility and accommodation. I have no doubt that members went straight to that information as they tried to figure out how provision in their constituencies compares with provision in the rest of the country. If members have not found that information, I can tell them that it is on pages 6 and 7, just before the brightly coloured map that will help to orientate them.

Of course, everything is relative, as Mike Rumbles suggested. Tayside, where my particular interest lies, appears on paper to be better served than some areas. However, I will give an example of what can happen in one of the so-called better-served areas. I have a constituent who needed to have a front crown replaced. She cannot afford to go private. Because she works in Stirling, she called dentists in Stirling, Dunblane, Bridge of Allan and Perth, with no success. She managed to get her family placed on the waiting list of a practice in Perth, but she was told that she would have to wait at least until August before anything came up.

Eventually, a week after her tooth had fallen out, she called the dental hospital in Dundee but, because the crown pin had fractured, the hospital advised her—wait for it—to get a dentist. She sat outside the dental hospital calling dentists in Dundee until she finally found one who was taking NHS patients. She had her crown fixed at a third of the private price. She is relieved about that, but now faces a long round trip to take herself or her children to the dentist. Given that she works in Stirling, she will presumably have to take most of a day off work. Simply put, the best that there is—Tayside is one of the better-served areas—is just not good enough.

On 17 March, the Executive published its "An Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland". In a letter to me on 4 April, the Deputy Minister for Health and Community Care welcomed the research report and provided the Executive's response to its findings. I have three questions arising from that, which I hope that the minister will address either during the debate or afterwards.

First, the minister acknowledged that better information is required at a local level to address supply and demand issues for NHS dental services. The Executive's action plan gives NHS boards responsibility for planning and securing the provision of NHS dental services, including improved information. The main focus is to be on those people with the greatest need—that is, children and older people. My question to the Executive is: how is greatest need to be assessed, in the absence of adequate information?

Secondly, the minister indicated that the availability and access issues that are raised in the report will be addressed in the national workforce plan to be published in June 2005. Would she care to give an indication of how quickly she believes the plan can be expected to have an impact on dental services in Scotland?

Thirdly, on recruitment and retention, the Executive has indicated that it plans to increase Scottish dental schools' output of dentists and to offer dentists incentives to return to Scotland. The minister also wants to recruit from outwith Scotland and intends to increase the remote areas allowance from £6,000 to £9,000. Once again, I ask whether the minister can give us a timetable for when those plans will begin to have a real impact, because that will be important to people's perceptions of what is happening throughout Scotland.

The research that the Health Committee commissioned offers a comprehensive snapshot of the views and experiences of NHS dentists in Scotland. Ministers and members would do well to reflect on what it tells them, particularly about incentives. I highlight a comment from one respondent on incentives:

"Stop access money for young dentists to allow them to set up a new practice around the corner from the retiring practitioners desperate to sell."

There must be logic in the way in which the incentives are applied.

The Health Committee recognises that, through the development and publication of the action plan, the Executive has begun to take action on the issues that are identified in the report. However, I am concerned that that action is not enough to tackle the depressing picture that is painted in the final summary of the report. As the report says, the Executive's pledge of free check-ups for all by 2007

"is going to be difficult to fulfil".

Plans to use retired dentists are

"unlikely to be successful".

Moreover, the significant increase in NHS Scotland provision that is required to meet the Executive's pledges is

"unlikely to be achieved with the type of incentives currently available".

Finally,

"a broader national strategy is required to ensure that the majority of practitioners receive adequate incentives to commit to NHSScotland".

We are all aware of the problems with access to NHS dental services. By commissioning the research and sponsoring today's debate, the Health Committee hopes to highlight the issues that require to be addressed and to make a positive contribution to the solutions. We will continue to monitor progress.

I move,

That the Parliament commends to the Scottish Executive the research report, Access to Dental Health Services in Scotland (SP Paper 277), commissioned by the Health Committee; draws the Executive's attention to the problems of access to services that the report identifies and their implications for the introduction of free dental checks, and urges the Executive to use the report to inform the implementation of its dental strategy.