Hansard

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 it were to change, getting dentists into the NHS would be even more difficult.

The report that was commissioned by the Health Committee revealed an astonishing lack of data at health board level on adult oral health, the recruitment and retention of staff, the demand for general, community and hospital dental services and other matters. Without such basic information, it is hard to see how supply and demand issues for NHS dental services—particularly for general dental services—can be properly addressed.

The report confirmed that there are particular problems with accessing NHS dentistry in rural areas; that only 3.5 per cent of primary care dentists intend to increase their NHS commitment over the next two years; that there is a problem with retaining dental nurses; and that 62 per cent of retired dentists—many of whom have retired early—could see no incentive that would induce them to return to providing NHS Scotland dental services. Furthermore, the rising proportion of women in the profession, with their desire for career breaks and shorter working hours, is an increasingly important consideration in service planning and delivery.

On top of an increasingly female workforce and the pressures of early retirement, too many dental graduates still leave Scotland once their training is complete. In addition, the current complex system of charging certainly needs to be replaced by a new system that is easy to operate, transparent, easy to understand and less bureaucratic. The short-term measures that the Executive has introduced recently to try to alleviate the current crisis have not solved the problem. Urgent measures are needed if NHS dentistry is to survive in Scotland.

The Executive's pledge to provide free dental checks for everyone by 2007 sounds attractive, but it is generally accepted that the pledge is unlikely to be met by the dental workforce that is currently available. Modern dentistry—which goes far beyond the identification and repair of holes in teeth to include lifestyle and preventive advice and the needs of the patient as a whole—is time consuming, and that time has not been funded by the NHS.

The aims of the dental action plan, which were announced by the minister in March, are admirable and try to address issues that are raised in the report. By March 2008, every child in Scotland is to have access to dental care when they start nursery—that means an extra 50,000 children every year. The aim is to have the largest supervised toothbrushing programme in Europe, which is fair enough; 200 more dentists by 2008; and 400,000 more people—that is, nearly half a million people—registered with an NHS dentist by March 2008. Red tape is to be slashed in general practice, with hugely simplified item-of-service fees for dentists. There should be more professionals complementary to dentistry, a new form of remuneration for dentists and improved practice allowances.

Some £150 million of extra funding over three years for NHS dentistry in Scotland has been promised. That is a large sum of money, but I say to the minister that it is just around half of what the profession considers to be necessary to put things right. The action plan was described by Dr Lamb of the British Dental Association as

"a patchwork of measures which lacks clarity".

He also said that

"it is difficult to see at this stage how the Executive's admirable aims will be achieved."

Many other dentists have said that there has been too little, too late and that what has been done will not resolve the crisis in the service. Dr Lamb has requested answers from the Executive with regard to concerns about funding for training dentists and about how the immediate shortage of dentists will be solved.

Are enough trained staff available in the colleges to provide the training for the significantly greater number of dentists and professionals complementary to dentistry that the Executive has identified as required? I asked that question on the day that the minister announced her action plan and Mary Scanlon repeated it. Why did we not receive an answer? Furthermore, given the recently identified lack of sufficient patients for current dental students to train with, where will the Executive find patients for the extra dental students and therapists that it has promised? Will they be found through the promised outreach centres? Will there be enough? Is there an assumption that all the extra students will make the grade, or will there be pressure to pass students in order to meet the Executive's targets at the risk of compromising quality? Those questions are important and they need positive answers if the Executive's aspirations are to become reality.

Only time will tell whether the action plan is effective in averting the crisis in NHS dentistry. Initial reactions suggest that, at the very least, its aspirations are over-ambitious given the resources that are available. I hope that the plan will attract new recruits into the NHS, but I am afraid that I do not think it will bring back those who have already left the service, either through retiring early or for the rewards and independence of private practice.