Hansard

I welcome the debate and the publication of the research report, especially because in my region—the Highlands and Islands—access to dental care has been and remains an issue of great concern.

The weighty research report is primarily about dental services, rather than dental health, but it is reasonable for me to touch on our oral health record. Richard Baker has already quoted the following statement from the report, but I will do so again because it is so telling:

"the determinants of oral health extend far beyond access to dental services … Dental service utilisation alone does not necessarily enhance or maintain oral health".

I found the tables in the report fascinating. Scottish Borders, which clearly does best in the league table that relates to tooth decay in children, even allowing for all the variables that exist, and Dumfries and Galloway, which is about fifth in the table, are among the areas that have the lowest dentist to population ratios, the worst access to NHS dentists for new children and adults, the longest distances to travel to dentists and the longest waiting times. However, those areas have middle and low deprivation rates, respectively. That is a really important issue. Dental health in children—there does not seem to be much information held centrally about dental health in adults, to which I will return—correlates poorly with the level of services, but absolutely with the level of poverty. We will not improve the oral health of our population unless we eradicate poverty. It is as simple as that.

However, it would be wrong to say that provision of dental services is not important: of course it is, as is universal access to those services. I welcome the various initiatives and investments that the minister has announced. I welcome particularly the fact that the Executive is considering having a greater skills mix in dentistry in our communities in the future by introducing to surgeries professions that are complementary to dentistry, such as more dental hygienists and other people who could deliver services that dentists currently deliver.

Alex Fergusson said in his intervention that retaining dentists is not just a case of throwing money at the situation, but is also about job satisfaction. The report looked to some extent at what would make dentists more interested in treating more NHS patients. It was interesting that although 55 per cent of dentists agreed that they wanted increased fees for services, there were many other areas on which there was no agreement. I suspect that it would be an interesting exercise to go into more detail with individual dentists to find out what makes working for the NHS less satisfying.

That reminds me of a psychologist with whom I used to work. We used to ask each other the "miracle" question, which was, "If a miracle happened and you went to work tomorrow, what would be different?" It might be that for some dentists the miracle would be that they would carry on as normal but would get more money for treating patients. I suspect that for some, the miracle would be that they would arrive in the morning at splendid, up-to-date and purpose-built premises that were provided, maintained and equipped by the health board, staffed not only by receptionists and dental nurses, but by a range of professionals who are allied to dentistry and who would help them to deliver services. Job satisfaction and working conditions are perhaps more important and less easy to define than money, but they make the job more worth doing.

I mentioned the lack of information on adult oral health. I found it fascinating to read in the report that there is a distinct lack of data about dental health and dental health services held either at health board or Government level. The work that was done in preparing the report from the 1,800 returned questionnaires that the authors received provides some valuable information, but only on a snapshot basis. The information should and must be collated and monitored regularly over time. For example, the report mentions that no information on adult oral health is held by health boards. How can we plan to meet the needs of the population when we do not know what its needs are? No information is held at health board level about numbers of whole-time equivalent dentists. That is incredible—somebody pays them so surely we know how many of them there are.

No information is held at health board level about the number of dentists who are accepting new NHS patients—again, that is crucial information. There is no information about distances that are travelled by patients to see dentists, which is a big issue in my area. There is no information on demand for access to dental services, there is no information about the need for community dental services to treat some of the most vulnerable people and there are insufficient data on recruitment and retention. Now that the huge information gap has been recognised, I hope that we will hear how it will be plugged.

It will be difficult to meet our dental care needs and to keep up with meeting those needs as they change if we do not know what they are. I look forward to the day when our children's oral health is much better, when we have tackled poverty, when we have removed fizzy drinks from schools, when we have improved children's diet and when we have improved toothbrushing and dental health awareness in general. However, our population is living longer, people keep their teeth longer and the dental health needs of older people will increase. That has to be considered.

I have made the point about free dental checks in chamber debates before. I accept what other members have said about there being difficulty under the present system in delivering universal free dental check-ups, but there is also an ethical problem. In medicine, it is an ethical truism that one does not screen for a condition unless one can treat it if one finds it. My worry is this: even if we can deliver free dental checks, if they show up a need for treatment, will we be able to deliver that treatment? If we cannot, it is almost unethical to do the checks. We need to look not only at meeting the need for free dental checks, but at meeting the increased treatment needs that the checks will show up.