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Meeting of the Parliament [Draft]

Meeting date: Wednesday, February 21, 2024


National Health Service Dentistry

The Presiding Officer (Alison Johnstone)

The next item of business is a debate on motion S6M-12215, in the name of Willie Rennie, on the crisis in NHS dentistry. I would be grateful if members who wish to speak in the debate would press their request-to-speak buttons.


Willie Rennie (North East Fife) (LD)

In case members have not had enough of me, I will speak in this debate, too. In preparation, I asked for people’s experiences of NHS dentistry. I had a tidal wave of responses: indeed, I am still receiving responses this very day. The stories are nothing short of extraordinary—apart from those of Scottish National Party supporters, who, it appears, are all registered with NHS dentists, get an appointment before they ask for one and even have the shiniest teeth on the whole planet.

It is certainly true that many people get a good NHS dental service experience, but so many people do not. Our job in Parliament is never to stop until everyone gets the service that they need and deserve.

The steps that people have taken are nothing short of extreme. Those steps have included DIY dentistry with tools that have been bought on Amazon; travelling hundreds of miles; sometimes paying a small fortune; and hunting for an NHS dentist for weeks on end without success.

Elaine Stewart could not find an NHS dentist in St Andrews, so she is still using her parents’ address on the west coast. She is not alone.

Naomi Kimber from Newburgh is a single mother with no support. She is on universal credit, she cannot work and does not drive. She told me:

“In one month, I spent almost £400 on X-rays, two fillings and cleaning. This left me short for food, which meant I skipped meals so that my son could eat.”

That is what NHS dentistry has brought for that young mother.

Alfie Cook could not get any treatment during the pandemic. He later paid £2,600 for private treatment because he could not get an NHS dentist.

Stephen Kelley from Tayport says that he has now been on a waiting list for four years. He told me:

“I have had to resort to ‘DIY dentistry’ with dental tools purchased on Amazon”.

He added, in brackets, that he was “not joking”.

Another constituent told me that he was going to Turkey for treatment, because it was cheaper to travel all the way there than it was to incur private costs here. So, as well as getting our ferries from Turkey, we are getting our teeth done in Turkey.

NHS dentistry is in crisis. It was in trouble before the pandemic. The British Dental Association says that the revised payment system that the Scottish Government introduced in November last year has made little to no difference.

No dentists in Fife are accepting new NHS patients. This month, Nanodent in Glenrothes said that it had no choice but to shut for “an extended period”. Redburn Dental in Kirkcaldy is going fully private due to on-going pressures. Last year, the Newburgh practice in my constituency went private and the Tayport practice closed altogether. A practice called Mydentist in Prestwick, Ayrshire, dropped 1,500 patients overnight, as it went private.

Almost 82 per cent of NHS dentists in Scotland no longer take new patients, and 83 per cent say that they will reduce their NHS numbers. Therefore, it is absolutely bogus to claim that, because a high percentage of people are registered with an NHS dentist, everything is fine.

Research that was carried out by my party last year found that almost half of people who are registered have not been seen by an NHS dentist in two years, 1.2 million have not had an examination or treatment in five years, and more than 10 per cent have not seen an NHS dentist in more than a decade. New statistics that were published yesterday by Public Health Scotland reveal that there was a 25 per cent drop in the number of NHS dental examinations that were paid for between December 2019 and December 2023—a drop of 50,000 from 195,000.

We should not forget that the SNP has abandoned its promise to abolish all NHS dental charges, but worse than that is that it has increased the charges rather than scrapping them. When the minister stands up next, her first words should be, “There’s a problem with NHS dentistry in Scotland.” If she does that, we can have a serious debate about how to fix it. It should include, I believe, a fee system that reflects the true cost of providing treatment and reverses the 35 per cent real-terms cut that has been made in recent years.

We should raise the cap on numbers of student dentists. Vocational dental training is the entrance to NHS dentistry. We should fund 70 more places, starting this August, and give NHS Education for Scotland the funds to act quickly. Come August, that would open NHS access across the country, with a very moderate financial outlay.

We also need to speed up the registration process for overseas dentists, which currently involves a three-year wait with the General Dental Council. We have the powers to do that in Scotland, so we should get on with it. I know of a dentist who is working as a pizza delivery driver because he simply cannot get registered. The Scottish Government must rewrite the failing NHS recovery plan.

I will finish with a final chilling anecdote; a dentist told me this. Someone with an early stage oral cancer has a five-year survival rate of 80 per cent and a late stage survival rate of only 20 per cent. One oral surgery department reports alarming increases in late presentations of oral cancers. That is something that should send shivers down all of our spines. It is not just about shiny teeth—it is a matter of life and death.

Can you confirm that the motion has been moved?

Willie Rennie

That was a rookie error.

I move,

That the Parliament believes that there is a crisis in NHS dentistry; considers that it is deeply concerning that people are finding it increasingly difficult to see an NHS dentist locally, if at all, and in some cases are resorting to DIY dentistry; notes concerns that changes to the payment system, which came into force on 1 November 2023, will do little to stop the exodus of NHS dentists; recalls that the Scottish Government committed in 2021 to abolishing all dentistry charges by the end of the current parliamentary session, but that charges for NHS patients have since increased substantially and been expanded to cover emergency appointments and denture repairs; believes that there must be decisive action to resolve this crisis, and calls, therefore, on the Scottish Government to rewrite the failing NHS Recovery Plan to prioritise workforce planning, boost the number of dentists taking on NHS patients and increase the number of appointments available.


The Cabinet Secretary for NHS Recovery, Health and Social Care (Neil Gray)

The previous debate focused on the importance of care being delivered in our communities through, and in partnership with, general practices.

This debate is equally important and it recognises dentistry as an essential linchpin of our primary care system. I would go further and say that it is a key driver in realising our commitment to delivering preventative and proactive healthcare, delivered by sustainable and effective public services, working in partnership with patients.

It is for that reason that the extension of free dental care to under-26s formed an integral part of this Administration’s first 100-day sprint, and why dental access remains a core tenet of the First Minister’s policy prospectus and my personal mandate from the First Minister.

Sue Webber (Lothian) (Con)

The cabinet secretary speaks about the preventative agenda being foremost in his thoughts, but how can dental treatment be preventative when there are two years between check-up appointments? Much can change in that time.

Neil Gray

I will come on to talk about some of the detail of the work that we are doing with the industry to provide greater capacity, so that Sue Webber can be reassured.

As I said earlier, even with the short time that we have for them, I welcome such debates as an opportunity to talk in greater detail about the essential nature of community-based healthcare. I am therefore grateful to Willie Rennie and the Liberal Democrats for bringing the debate to the chamber.

In talking about dentistry, it would be remiss of me not to set out, as necessary context for the debate, the impact that the pandemic had on dentistry—for practitioners and for the public who, overnight, lost access to that vital service. It is not hyperbolic to say that the pandemic had, and continues to have, a seismic impact on the dentistry sector—possibly more than on many other health services—because of the nature of dental care and its high reliance on aerosol-generating procedures, and the stringent infection prevention and control measures that were put in place, which effectively stopped activity overnight.

Can the cabinet secretary explain why private sector dentistry is not facing the same pressure as NHS dentistry, post-pandemic?

Neil Gray

There are pressures across the dentistry sector. I do not think that it would be fair to say that any one part is facing the pressures alone. That is why we have developed the reform, which I will go on to talk about shortly.

Although controls were relaxed, they were still a significant barrier to full productivity in the sector and thus to dental-contractor incomes. The Scottish Government responded with more than £150 million of additional emergency financial support to sustain and, ultimately, to preserve the sector. We recognised then, and continue to recognise now, how important dental care is.

Although the immediate impacts of the pandemic on activity are now behind us, the dentistry sector continues to feel the impact of the pandemic in relation to access and the available workforce. Parliament will recall that all undergraduate and vocational training was suspended for a year at the height of the pandemic, due to the IPC restrictions, and that loss of an entire cohort of 160 dentists is undeniably still being felt today and is recognised by members across the chamber, I am sure.

I want to address Willie Rennie’s opening comments and the awful examples that he gave of people seeking NHS dentistry and the lengths that some people have gone to in the absence of access to it. I recognise that there are challenges—of course I do—and I recognise the difficulties that have been faced by people of late.

I recognise, as well, that the Liberal Democrats have set out their own action plan for dentistry and I thank them for that plan. People who are paying attention will see that the plan is, in many areas, a direct copy of the actions that this Government is already taking. Their proposed plan outlines the intention to reform the funding structure for NHS dentistry—something that the Scottish Government has already delivered through significant root-and-branch payment reform on 1 November last year.

The reformed payment system comprises a completely new fee structure, which is designed to attract dentists to provision of NHS care and, ultimately, to improve patient access.

That builds on the commitments that we set out in our 2018 “Oral Health Improvement Plan”. It follows one of the biggest consultations with the dental sector in recent times, and it is the most substantial reform of NHS dental services since the introduction of the NHS in 1948, backed by a recurring investment from this Government of almost half a billion pounds. The data that was published yesterday shows almost 400,000 unique patient contacts in NHS primary care dentistry in November 2023 alone. That does not reflect a system that is “in crisis”, as has been suggested.

That said, although I am encouraged by how the sector has engaged with payment reform, I am not complacent. We recognise that payment reform is not a remedy for all the ills, and we know that in some areas local access problems remain, driven in part by the same workforce problems that I alluded to earlier.

Again, aligned to the action plan, we are already actively consulting the sector on ways to strengthen the NHS dental workforce, including greater utilisation of highly skilled dental therapists. The Minister for Public Health and Women’s Health has also initiated and led discussions with her counterparts in the other UK nations regarding ways in which we can increase the number of overseas dentists coming to the United Kingdom. I am pleased to see that, as a result of those discussions, the Department of Health and Social Care has already moved to consult on reform of that vital pipeline.

I am under no illusions—I know that the NHS dental sector has faced, and continues to face, significant challenges, so I give my heartfelt thanks to dentists working in the NHS for their resilience and dedication. The shadow of the pandemic and other external factors remain, not just in Scotland but across the UK. I am, however, proud that Scotland is the only nation in the UK to actively tackle those challenges head-on through significant generational reforms. That is despite our already being in a relatively stronger position.

Thank you, cabinet secretary, you must conclude.

Neil Gray

I move amendment S6M-12215.2, to leave out from first “believes” to end and insert:

“recognises the significant challenges in dental services, compounded by the impacts of the COVID-19 pandemic, high inflation, and Brexit on public services, dentistry and the available dental workforce across the UK; welcomes that the Scottish Government has confirmed the sustainment and improvement of access to NHS dentistry as a strategic priority; acknowledges that payment reform, as introduced on 1 November 2023, is the most significant change to NHS dentistry since its inception and the most meaningful intervention to realise the Scottish Government’s ambition at this time; recognises that payment reform correctly prioritises public resources on securing access to NHS dentistry by incentivising delivery of NHS care through improved fees; is confident that the changes are the appropriate basis for further reforms to NHS dentistry, which will be focused on improvements in workforce and access to services across Scotland, and thanks NHS dentists and all staff working across Scotland for their continued commitment to the sector and provision of a vital service to the people of Scotland.”

I should say that we are very tight for time this afternoon—we have no time in hand. I call Sandesh Gulhane to speak to and move amendment S6M-12215.3. You have up to five minutes.


Sandesh Gulhane (Glasgow) (Con)

I refer members to my entry in the register of members’ interests—I am a practising NHS general practitioner.

There we have it from the cabinet secretary: everything is perfect. The SNP’s plans are perfect. Mr Rennie, why bother having this debate? Well, members and the public at large may recall the SNP promise at the last election to make NHS dentistry free at the point of care to everyone in Scotland by the end of this parliamentary session. Three cabinet secretaries, two First Ministers and nearly three years later, this SNP Government still has no plan for how to make that possible. The reality is that, no matter how big the headline or how many Scots are registered with a dentist, too many patients cannot get an appointment to see a dentist and access full NHS dental services in the first place.

This is not rocket science. A shortage of dental nurses, a lack of dentists and rising costs, including for materials and lab works, have left many practices providing NHS services at a loss, so it is no surprise that practices are folding. The situation is unsustainable and the SNP Government has been warned, time and again, that this would happen. In fact, the SNP’s shortage of dentists is even holding back Scotland’s space industry, as engineers are reluctant to relocate to Sutherland because of a lack of dental care. Holyrood—we have a problem.

I remember being at a conference of local dental committees last April, when a delegate reminded the minister Jenni Minto that NHS dentistry in Scotland is broken and that the SNP Government had broken it. Yesterday’s “NHS Dental Data Modelling Report” for November and December is telling. In December 2023, the number of people who saw an NHS dentist had fallen by more than a third, which begs the question what patients are doing if they cannot see a dentist.

Under the SNP and its botched management, patients are opting for an alternative model of dentistry—the SNP-DIY model. The British Dental Association says that 83 per cent of Scottish respondents to its survey said that they had treated patients who had performed DIY on their own teeth since lockdown. Desperate patients are taking desperate measures and are literally taking matters into their own hands by ripping out teeth, supergluing crowns and even using repair kits ordered from Amazon. That is gruesome.

More and more patients are heading overseas for dental care, as Willie Rennie mentioned. In fact, patients are travelling to central Europe and even India for standard treatment. Refugees from Ukraine are returning to a war zone for care, but the cabinet secretary thinks that that is just unfortunate. That is not medical tourism—it is desperation.

The SNP Government, like Corporal Jones, cries “Don’t panic!” and points to its reformed payment system for NHS dentistry, which was introduced in November last year and which aims to incentivise dentists to stay in the NHS system. It includes changes to fees for many treatments and reduces the number of treatments available from 400 to 45. Although it is too early to measure the real impact of the reform, we know that the SNP has just been tinkering with the problem. The BDA warns that

“the fundamentals of a broken system remain”.

That is because the SNP Government decided to stick with the drill-and-fill model.

All of us who work in primary care understand the importance of preventative healthcare, and we know that it delivers better outcomes for patients. It is also important to understand that oral health can tell us a lot about our overall general health. Regular monitoring identifies and deals early with problems such as oral cancer and bacterial fungal infections that can cause sepsis. In fact, gum disease is linked to a higher risk of heart disease and dementia.

As the Scottish Conservatives argue in our NHS reform policy paper, we support incentivising preventative healthcare, as it is good for patients and cost effective. That is what dentists want and what they believe in. When it comes to prevention, we want to go further than just regular check-ups. Good oral health relies on healthy lifestyles. We need to be effective in tackling unhealthy behaviours including vaping, smoking, consuming alcohol and consuming high-sugar foods and beverages. That is very different from the SNP’s approach to dentistry, which is geared towards saving the Scottish Government money in the short term and is clearly not geared towards long-term dental health.

Cabinet secretary, please go back to the drawing board. We need a root-and-branch reform of the statement of dental remuneration so that dentists are valued and supported and so that patients are helped to stay healthy and not just to queue to be fixed when things go wrong.

I move amendment S6M-12215.3, to insert after “resolve this crisis”:

“; notes with great concern that the number of people able to see an NHS dentist in Scotland fell by over a third in just one month in December 2023, as dental practices abandoned NHS work in droves; stresses that registration rates with dentists in no way indicate satisfactory dental service provision if registered patients are unable to get an appointment; regrets that the Scottish Government has failed to do what is necessary to restore NHS dentistry activity levels to at least pre-COVID-19-pandemic activity levels; expresses concern that people in rural and more deprived areas will likely suffer disproportionately negative oral health consequences from these failures”.


Paul Sweeney (Glasgow) (Lab)

I take this opportunity to welcome the new cabinet secretary to his place. It was remiss of me not to do so during the previous debate, but I do so now. I also congratulate the new member, Tim Eagle, on his excellent maiden speech.

The decline in NHS dentistry in Scotland under the SNP is, frankly, scandalous. The Government is driving NHS dental services into the ground. Oral health is consistently a second thought, and there are people across the country who are unable to sign up to a dentist and who are relying on emergency dental phone lines instead. In 2022, the number of NHS 24 calls about dental health exceeded 60,000, which was an increase of 40,000 compared to four years prior. That is not good enough. Scots should be able to access the care that they need in their local area and should not have to wait until a minor dental issue becomes an emergency to see a dentist.

Labour research shows that, in recent years, waits for dental surgery have soared. Each of the 14 territorial health boards has seen an increase in the average waiting time for dental surgery. In some parts of Scotland, people are waiting close to a year, in excruciating pain, for the surgery that they desperately need.

The Government’s failure to get to grips with NHS dentistry issues is—as is far too often the case—compounding health inequalities. In 2022, children and adults from the most deprived areas in Scotland were less likely to have seen their dentist compared to those in the least deprived areas. The gap between child participation rates in dental care was 20 percentage points between the most and least deprived, which is completely unacceptable. Shockingly, only 68 per cent of 10 to 11-year-olds in the 10 most deprived areas in Scotland are decay free compared to 90 per cent in the 10 least deprived areas. That is a stark contrast. Patients and dentists deserve better.

I can furnish members with a personal anecdote. For the past 20 years, I have been registered with an NHS dentist in one of the most deprived communities in Scotland—north Glasgow—and, for the first time in my life, from childhood to the present, I have been unable to get a routine check-up because the permanent dentist has left, locums continually fail to appear and dental appointments have routinely been cancelled. I have not been able to get a dental check-up for eight months, despite repeatedly attempting to book one. That is just one personal example.

In 2006, the last Labour-led Scottish Government introduced the world-leading and ambitious childsmile programme, which gives young people free toothbrushes and toothpaste as well as two fluoride varnishes a year. The programme has vastly improved prevention of the signs of tooth decay in primary school-aged children. Childsmile is an example of spending to save down the line and improving through-life costs. It is about prevention and is a good example of what the Government could do much more of. It was also a targeted intervention to close the oral health gap. That is why I mention it in my amendment. That foresight and long-termism is missing from the Scottish Government’s sticking-plaster approach to dentistry.

Last year, Labour members welcomed the news that the Scottish Government was in conversation with dentists regarding a new payment reform plan to ensure that dentists continue to offer NHS services in the light of swathes of dental practices turning away from NHS provision. Often, once they go, they will not come back in a hurry. However, what the Government offered fell short of the mark, and, as the British Dental Association has said,

“the fundamentals of a broken system remain”.

Dentists regularly tell me that they have witnessed a huge increase in the number of patients presenting with signs of DIY dentistry, and I am sure that they have said the same to ministers. We only have to look at the explosion of adverts for self-dental scaling kits that are available on social media as an indication of what is going on out there. A British Dental Association survey showed that 83 per cent of Scottish dentists have treated patients who performed DIY dentistry during lockdown. That is simply outrageous.

Significant change to the NHS recovery plan is needed to reverse the decline in NHS dentistry so that Scots have access to dental healthcare when and where they need it.

I move amendment S6M-12215.1, to insert at end:

“and recognises that the world-leading Childsmile programme, which was implemented by the last Scottish Labour Party-led administration in 2006, has been widely recognised as one of the most effective public health interventions of the devolved era and has transformed child dental health.”

We move to the open debate. I call Liam McArthur, to be followed by David Torrance.


Liam McArthur (Orkney Islands) (LD)

A year ago, in a similar Scottish Liberal Democrat debate, I suggested that any objective analysis of NHS dentistry across Scotland could only conclude that the sector was in crisis. At the time, the then health secretary—now the First Minister—was writing to dentists, telling them how pleased he was about how well the sector was performing. It was the sort of tone deaf ministerial complacency that had dentists around the country clutching their drills more tightly and possibly even dreaming of the emergency extraction work that they would love to perform.

Twelve months on, and despite changes that were introduced by the Government last November, the BDA insists that NHS dentistry has been

“in crisis for a generation”

and that the action taken by ministers falls short of the root-and-branch change that is needed. Willie Rennie vividly highlighted the painful consequences of that failure by Government to get to grips with the scale of the challenge that the sector faces. I will use my time to illustrate how the crisis in dentistry is playing out in the islands that I represent.

As the BDA briefing for the debate makes clear, the registration rate for adult patients in Orkney stands at 50 per cent, which is the lowest rate in the country. That is no great surprise, despite the Herculean efforts of local dentists and staff. It reflects what I have been seeing in my casework over recent years. That figure needs to be considered in the context of the participation rate—contact with a dentist in the past two years—which, last summer, stood at 50 per cent of all those who are registered. The fact that that figure is lower than the figure in 2021, when we were in the midst of a pandemic, should flush out any residual complacency in St Andrew’s house.

NHS Orkney’s dental lead, Steven Johnston, has confirmed to me that, between 2020 and 2022, the participation rate among children plummeted from 87 per cent to 57 per cent. Although overall dental hygiene among children in Orkney remains good, there must be a serious risk of problems being stored up in the longer term. Mr Johnston has also spoken about a concerning shift in activity from the NHS to the private sector. Again, that trend is borne out by my mailbag and it undermines any claim that the Government might make that even basic dental provision in Scotland is free for all at the point of delivery.

Addressing that will require the wider reforms that were set out by Willie Rennie, as well as a sustainable funding model. Changes to date may have stemmed the exodus of dentists from NHS practices, but, as one local dentist told me this week, it will not reopen lists to new registrations. The low-margin, high-volume funding system does not work in island and rural settings. Certain treatments are, de facto, loss making unless they are delivered in high numbers, which simply cannot be achieved in places such as Orkney.

On recruitment and retention—where, again, specific challenges exist in island and rural areas—there is a lack of clarity on the support that is available. I previously raised the issue in Parliament with the minister and was told that support is being provided where it is most needed. However, NHS Orkney and the remote and rural directors of dentistry group still appear to be awaiting details of the financial allowances. In the meantime, the loss of the fully-funded remote and rural fellowship is being keenly felt. In the past, that scheme was well used by dentists in Orkney, even allowing one dentist to go on to provide orthodontic services prior to 2021. There is now no provider of orthodontics locally, which is leading constituents to contact me to highlight the impact on their children, for whom there are mental health as well as oral health implications. A replacement for the fellowship scheme to improve recruitment and retention in island and rural areas is urgently needed.

The crisis in dentistry persists, and more urgent and concerted action is needed by the Government. I urge the Parliament to support the motion in the name of Willie Rennie.


David Torrance (Kirkcaldy) (SNP)

We all know that Opposition parties do not like talking about Brexit, but given that approximately 60 per cent of the dental workforce is European, to simply ignore it or pretend that it has played no part in the situation in which we find ourselves is beyond disingenuous. It simply cannot be ignored. It is utterly undeniable that Brexit, which all the main parties at Westminster are now signed up to, has had a huge impact on recruitment. Eight long years after the referendum, Brexit has had a devastating impact on the UK labour market, and it has hit the recruitment of professionals in the health and social care sector especially hard. The number of EU and European Free Trade Association dentists who have joined the register has halved since the referendum. That is backed up by a Nuffield Trust report on health and Brexit, which states:

“Before the EU referendum, consistently well over 500 dentists trained in the EU and EFTA registered in the UK each year. They made up around a quarter of the additions to the workforce. This dropped sharply around the time of the referendum to around half its previous level, and has never recovered.”

Brexit has brought nothing but harm to people, communities and businesses all across Scotland. This debate gives yet another example of its devastating impact. Scotland needs a migration system that is humane and meets our social and economic needs. We will certainly not get that while we take part in the broken Westminster system.

However, in the face of that challenge, the Scottish Government remains firmly committed to sustaining and improving patient access to NHS dental services. Despite the challenges presented to the profession by the global pandemic and a disastrous Brexit, the Government has maintained a strong track record in growing the NHS dental workforce in Scotland, with 57 dentists per 100,000 population. It continues to work closely with the British Dental Association and others on the recruitment and retention of dentists, particularly in areas where the problem is known to be most acute.

It is worth noting that Scotland continues to outperform England when it comes to the number of dentists per head of population. Compared with England’s 4.3 dentists per 10,000 population and Northern Ireland’s 6, Scotland had 5.9 and Wales had 4.6 in 2021-22. In England, the number carrying out NHS work per head of population has not risen in a decade.

Will the member give way?

I am short of time.

I will be very brief.

David Torrance

No, thank you.

It is fair to say that the rate of NHS registration is also significantly higher in Scotland than in the rest of the United Kingdom, with more than 95 per cent of our population registered with an NHS dentist.

The work by the Scottish Government, alongside the British Dental Association Scotland and the wider sector, on payment reform is the most significant change to NHS dentistry in generations. It provides practitioners with a new suite of fees that are designed to provide a full range of care and treatment to NHS patients. The reform will provide long-term sustainability to the dental sector and encourage dentists to continue to provide NHS care, helping to mitigate some of the access challenges that we are seeing.

The payment reform will improve the system for both dental teams and patients, and it is the first step in the process to make the services that are available on the NHS reflect the changing oral health needs of the population. It also reaffirms the Scottish Government’s commitment to the sector and to all NHS patients in Scotland.

The modernised system will increase clinical freedom for dentists, provide long-term sustainability to the sector and encourage dentists to continue to provide NHS care. Scotland is the only part of the UK where free examinations are available to NHS patients, and that will continue. All patients will receive free NHS dental examinations, with those who are exempt, including children, young people under 26 and those on certain benefits, continuing to receive free care and treatment.

I believe that people in Scotland recognise and appreciate the Government’s commitment to sustaining and improving patient access to NHS dental services. Earlier this week, I received a call from a constituent who wanted to reach out after hearing about the debate that was planned for this afternoon. The gentleman wanted to highlight his recent experience of accessing emergency treatment. He was of the firm belief that he would not get the quality of care that he had received anywhere but in Scotland.

It is an improving picture in NHS dentistry, and building on that progress is an absolute priority for the Scottish Government.


Sue Webber (Lothian) (Con)

Two years ago, the Scottish Conservatives held a debate called “Preventing the Collapse of NHS Dentistry in Scotland”. Two years on from that debate, NHS outcomes in Scotland have worsened, waiting times for all sorts of NHS treatment have increased, and here we are explaining that dentistry has got no better in that time.

It is clear that the SNP Government has failed to do what is necessary to restore NHS dentistry activity levels to pre-pandemic rates. That raises further concerns that rural and more deprived areas are likely to suffer disproportionately from negative oral health as a result. Indeed, 90 per cent of respondents to a recent BDA survey said that they believe that oral health inequalities in Scotland are on the rise.

Oral health can tell us a lot about our general health. Regular monitoring identifies and deals with problems early—not just oral issues but oral cancers. We heard from Willie Rennie about the catastrophic effect that late presentations can have on survival. There are also bacterial and fungal infections that can cause sepsis, and gum disease is linked to a higher risk of heart disease and dementia, both of which cause a disproportionate number of deaths in Scotland.

However, dentistry is becoming harder to access, with waiting times increasing. The 2023 BDA survey of general dental practitioners showed that nearly 60 per cent had reduced the amount of NHS work that they undertook since lockdown, and four in five said that they plan to reduce their commitment further in the year ahead. All the while, patient numbers are increasing. Dental practices are abandoning the NHS in droves for private practice, leaving many Scots without an NHS dentist. Failure to act risks sparking an exodus from the workforce that will leave families across Scotland losing access to NHS dentistry for good.

Many Scots are not having dental treatment, with almost half of the people registered with an NHS dentist in Scotland not having seen a dentist in the past two years and 1.2 million people not having had a dental examination or treatment in five years. The crisis in access to NHS dentistry in Scotland has resulted in many desperate patients taking matters into their own hands with DIY dentistry, or heading overseas for care, as we have heard from many members. Hearing that people are resorting to putting Super Glue on their dentures should be a wake-up call to all of us.

It is worrying that, on the number of children who have seen a dentist in the past two years, the gap between the most deprived and the least deprived children has widened. In 2021, 55 per cent of the most deprived children had seen a dentist, compared with 73 per cent of the least deprived children; in September 2022, that percentage had risen, and 56 per cent of children from the most deprived backgrounds had seen a dentist in the past two years, compared with 76 per cent of the least deprived children.

Let us remember that NHS dentistry in Scotland was in crisis long before Covid hit, so the SNP must get a grip on the situation and bring forward a credible plan to restore routine dental care and tackle the enormous backlog. I said earlier that Robert Donald, who is the chair of the BDA’s Scottish council, has warned that there could be a “wholesale exodus” of the profession from the NHS if ministers fail to make a “serious long-term commitment” to the sector.

For too long now, people have gone without access to full NHS dental services. To tackle that unprecedented challenge, dental practices need support from the Scottish Government. The new cabinet secretary, Mr Gray, and the SNP must offer more solutions. Healthcare staff and patients have been repeatedly let down.

The recovery plan is not fit for purpose. We want a plan that is clear to deliver a modern and efficient local NHS. For dentistry specifically, that means an end to drill and fill; it means the prioritisation of prevention, and a plan that reflects modern dentistry.


Claire Baker (Mid Scotland and Fife) (Lab)

As Willie Rennie highlighted, we are seeing more people struggling to get access to NHS dentistry in Fife. David Torrance can defend the Scottish Government if that is what he wishes to do, but he must also recognise that constituents in Kirkcaldy have recently been told that Redburn Dental is going fully private and that he will have constituents who will not be able to access an NHS dentist.

The Scottish Government points to 95 per cent of Scots being registered with an NHS dentist. However, following the introduction of lifetime registration in 2010, that figure actually tells us little. Far more relevant is the percentage of people who have seen an NHS dentist in the past two years, which is only around half of those who are registered. The dental statistics that were published this week unfortunately do not give an update to that figure. I hope that future publications will assess any impact of the changes on access to NHS care.

We need more information on registration. Registration numbers do not show that a third of children who are registered have not seen a dentist in the past two years; they do not include the fact that people who are registered with a practice but are currently without a dentist within it are unable to access routine treatment; and they do not include patients who are currently at practices that will close in the next couple of months and who, in the meantime, cannot get an appointment. Registration without access to dentistry is meaningless.

Recruitment and retention are clear challenges. The overall increase in the number of dentists since 2010 has evaporated since the pandemic, and issues with the supply of dentists from training or from other countries are a major pressure on the system. In evidence on dentistry to the COVID-19 Recovery Committee, it was noted that private practice was not experiencing the same difficulties.

We know that dentists are leaving NHS practice and that practices are struggling to recruit new dentists. Practices are closing, leaving patients without access to care. In Fife, Nanodent in Glenrothes will close in April due to a lack of staffing. One dentist is moving to another practice, but all adult patients with other dentists will be deregistered. Patients have been struggling to get appointments for the past two years due to low staffing, and that struggle will now continue as they try to find somewhere else in Fife that offers NHS care. Another practice in Glenrothes is to relocate many of its patients to a dentist 14 miles away in Cowdenbeath. For those who rely on public transport, real issues exist around accessibility.

Letters that advise of closures tell patients that it proved impossible to recruit dentists. The letters also recognise the difficulties in finding a dental practice that is willing to accept NHS patients. More than 80 per cent of NHS practices in Scotland are no longer taking on new patients, with a similar number reducing their lists. As of this morning—as has been the case for some time—zero NHS dentists in Fife are taking on new patients, whether people are under 26 or not. Patients who are looking to register with a dentist can do nothing but wait, and out of more than 50 listed NHS dentists, only two practices in Fife are even operating waiting lists.

The BDA is clear that lower attendance at dentists will result in a higher dental disease burden down the line, with health inequalities expected to widen further. The organisation is also clear that the changes that were brought in late last year were not the “root and branch reform” that those in the profession sought. Instead of shifting to a more prevention-based system, the Scottish Government has merely tinkered with the drill-and-fill model, and it is not clear how that will make NHS dentistry a more attractive place to be for practitioners or how that will improve access for patients.

The promise of free dental care for all was not made before the pandemic; it was made at a point when dental services had been heavily impacted and we knew that there would be on-going consequences. However, the majority of Scots are not only still paying for dental treatment; since November, they are now paying even more than they used to.

I am concerned that, rather than providing free, quality dental care, we are in a situation in which people are being pushed into using private dentistry with no other option available to them. The changes that were made in November must be only the beginnings of much more comprehensive reform if NHS dentistry is to have a future.


Gillian Mackay (Central Scotland) (Green)

As I did in the previous debate, I thank all the professionals working in the sector for their hard work. I also thank the BDA for its briefing ahead of the debate.

I met the BDA on Monday and had a good discussion with it about several of the issues that have been covered so far. It raised issues, particularly those relating to the backlog that has been created by the pandemic, that practices across the country are working hard to overcome.

With regular check-ups not happening during the pandemic, many changes or problems that would have been picked up early have surfaced only when patients have experienced pain and disease has been much further advanced. We have heard many stories of people being unable to access treatment and the potential risks of that.

The pandemic has undoubtedly had an impact on the delivery of the childsmile programme, with children missing out on that for a time. The education on good brushing and oral hygiene habits that the programme produced are incredible, as are the preventative measures that were mentioned earlier. I would be grateful for an update from the minister about the status of the programme and on whether those who may have missed some of the programme due to the pandemic have the opportunity to catch up.

In our conversation, the BDA acknowledged the difference in administrative burden that the reformed payment structure gives, but it said that the outcome and effect of that structure cannot be known as yet. Its briefing to us for today’s debate said the same. Some patients may still be on a course of treatment that was started under a code on the previous fee structure, so the full effects may not be seen for some time. I asked the BDA about what the measure of success of the new payment structure looks like. It would be useful if the BDA and the Government laid that out clearly. No two practices are the same in terms of size, structure and services, and rural and urban practices have their own differences and challenges, too. Given that it is so difficult to compare practices, it would be useful to define what the measure of success is for the new payment structure and when we might see that coming to fruition.

There is a widening gap in registration levels between the least and most deprived areas, especially in the registration of children. More needs to be done to ensure that parents register where they can and that, where there are difficulties, parents are given support to find care. Some of the causes behind the dip in registrations are complex. We need to fully understand the dip and address it urgently.

In my conversation with the BDA, it also raised the issue of access to general anaesthetics for dentistry in hospitals and the number of cancellations. The greatest number of general anaesthetics that are administered to children is for dental issues. That can be for a multitude of reasons, but it is often to reduce the trauma for invasive procedures where children cannot tolerate the same level of treatment as adults may be able to.

Access to general anaesthetics is also relevant for adults who have a disability or a particular medical condition that requires enhanced treatment. Waiting times for such treatment is often overlooked. In the interests of making a helpful suggestion somewhere in the debate, I hope that the cabinet secretary or the minister may raise the issue with health board, to ensure that people are getting the treatment that they need in the manner that they need it.

We need to closely monitor the changes that have been made recently to dentistry and ensure that they are achieving everything that they need to, while promoting good oral health and hygiene and reinforcing programmes such as childsmile, in order to ensure good oral health for all.


Fergus Ewing (Inverness and Nairn) (SNP)

Like the offices of all other members in this debate, my constituency office receives a huge number of contacts from people who present with very serious problems because of lack of access to NHS dentistry. For a while, the nearest place for people in my constituency to access an NHS dentist was Invergordon, where they had to go instead of Inverness. I see no point in using the short time that I have to repeat those stories, but they are toe curling, as Willie Rennie’s stories were at the beginning of the debate.

I raised those concerns with the minister, Jenny Minto, and she pointed to a range of actions. I was extremely impressed with the minister’s demeanour, the obvious care and time that she had devoted to the matter and the follow-up response, which outlined a number of those measures. I would be grateful if she could say how progress has been made on the access initiative, the recruitment and retention allowance, and the remote areas allowance. I praise the minister for her work. As members may have noticed, I do not tend characteristically to sprinkle praise on ministers—perhaps that is a failing on my part, but that is for others to judge.

In this debate, I want to make the wider case for what I suggested in the previous debate, because it applies—as the lawyers say—mutatis mutandis. Just as we see a flood of young people leaving Scotland to practise their medical profession elsewhere in the world, we are seeing nurses, teachers and dentists doing likewise. I do not know the number of those people. I was heartened that the new cabinet secretary said that he would get that data, and I think that that is very important to have.

Alex Cole-Hamilton (Edinburgh Western) (LD)

Fergus Ewing is right to talk about the issue of potential bonds on new dental graduates, but is he also interested, as the Liberal Democrats are, in how easy it is to register overseas dentists to come and work in Scotland? Right now, that process is glacial. We heard the example of Willie Rennie’s constituent who is working as a pizza delivery driver but wants to practise dentistry in this country.

Fergus Ewing

I totally agree with that point. Unnecessary bureaucratic imposts are one of the things that are really holding Scotland back across the range. Incidentally, I was heartened that the new cabinet secretary undertook, in his first statement, that he would seek reform. That is why I am making this speech—because I am trying to be helpful.

The idea of a bond is not new, and it is not mine—I am a practised plagiarist. I suppose that our job is to garner ideas from the public and people who approach us. I was accosted in the street by a somewhat elderly lady who told me of her plans. She kindly sent me a very detailed note, although she is not my constituent, so I cannot take the matter up for her. She described her experience as a teacher in New South Wales in Australia, where teachers who left Australia were required to pay back some of their training costs. I believe that she mentioned other countries that do something similar, but I am no expert on that—the cabinet secretary can get his hordes of civil servants to do the necessary research, I am quite sure.

There were also provisions requiring that the teachers had to go to the outback—to the rural parts of the country. That meant that the schools and the hospitals in rural states in Australia had sufficient provision of personnel. If what I am advocating were to happen, the biggest beneficiaries would be the Highlands and Islands—Beatrice Wishart’s constituents, Mr Eagle’s new constituents and mine. That is why I felt it was appropriate to put forward this case.

I hope that I have made my point. I hope that the Government and the cabinet secretary, with the enthusiasm of a newbie, will adopt the policy. I think that the public would very much welcome it.

We move to winding-up speeches.


Carol Mochan (South Scotland) (Lab)

I am pleased to close the second debate for Scottish Labour. As before, I thank the Liberal Democrats for bringing this important debate to the chamber in their own time.

Having listened to the debate, I think that it is fair to say that NHS dentistry in Scotland is in crisis. Patients cannot get an appointment, dentists are leaving NHS practices, and our constituents and communities are suffering. I note, however, as Willie Rennie acknowledged, that when services are available, they are of high quality. Dentists are doing the best job that they can for their patients.

Despite what some members on the back benches think, this is a crisis and much of it is of the Government’s making. It should worry the Government that I do not think that a single member of the public really trusts it to be able to fix the situation, so it needs to demonstrate that it can take action that will fix it.

In the amendment, the cabinet secretary again goes for the blame everyone approach, rather than talk about the Government’s involvement. It is quite remarkable how often we have to go over that. To be honest, it is not surprising but, given that we have all talked about the information that we get in our inboxes from constituents, it is an insult to dentists and patients not to acknowledge some of the things that the Government has not put in place.

It is fair to say that it is a self-congratulatory SNP amendment that calls for Parliament to welcome the Government strategically prioritising dentistry access—after 17 years in power—and to thank dentists for their “continued commitment”. We all know from our inboxes that dentists stay in the NHS because of their commitment to it. It is little wonder that patients feel that they are being forced out of NHS dentistry and that they are unable to get an NHS dentist.

Of course, it is right that we acknowledge the impact of the pandemic on dentistry because of its face-to-face nature. We know that dentists have by no means recovered, but it would be entirely disingenuous to suggest that the problem is only a post-Covid one. Other members have mentioned the words of the chair of the British Dental Association’s Scottish dental practice committee, which made me think, so I will quote them again. He said:

“the fundamentals of a broken system remain unchanged.

The Scottish Government have stuck with a drill and fill model designed in the 20th century.”

I know from what we have heard from the dental profession that it tried to help the Scottish Government to get this right. David Torrance, who is in the back row of the chamber, probably needs to listen to the dentists themselves, who say that there have been no changes to the model of care and that, despite recent changes in the payment system, NHS dentistry remains in dire straits, with a two-tier system becoming an increasing reality for patients. It feels like sticking plasters and will not cut it. That is what we are hearing from the dentists and the dentist professions.

I want to mention the oral cancer statistics that Willie Rennie gave, which are important facts that show why we must resolve the issue. I am running out of time, but I want to say that Claire Baker gave us excellent statistics that the members on the Government front benches should really look at. There is evidence from the COVID-19 Recovery Committee that private dentistry is not experiencing the same exit issues as NHS dentists. That is an important part of the inequalities that are happening.


Tess White (North East Scotland) (Con)

Shocking new figures that were released yesterday have revealed the scale of the crisis in Scottish dentistry. In December last year, the number of patients who were able to see an NHS dentist fell by an astonishing 38 per cent. Gillian Mackay talked about regular check-ups not happening since the pandemic and mainly because of the pandemic. Mr Sweeney said that he was fine during the pandemic and afterwards but has now been waiting for nine months to be seen. I have a constituent in Angus who is in complete despair and significant pain and who cannot find an NHS dentist. That has happened recently and it is happening now.

The number of NHS dental procedures fell by as much as 200,000. The cabinet secretary proudly states that his Government provides free dental care to the under-26s, but the sad reality is that they cannot find an NHS dentist to treat them. Eighty per cent of NHS dentists are no longer taking on new patients, and 83 per cent say that they will reduce their NHS numbers. Is it any wonder that people in Scotland are having to travel thousands of miles for dental treatment? As we have heard today from Willie Rennie, as well as the fact that we have ferries coming from Turkey, people are having to go to Turkey to have their teeth fixed. As Dr Sandesh Gulhane said, people are going to India, and refugees are going from Scotland back to war zones to have their teeth fixed.

Keith Brown said that Neil Gray is one of his most capable colleagues, and Neil Gray said that he recognises the challenges. The SNP Government has decimated NHS dentistry, and patients are paying the price. As Dr Gulhane said, the SNP is tinkering with the problem with an outdated drill-and-fill model.

Sue Webber talked about the fact that oral health is a good indicator of general health. We hear harrowing stories again and again of DIY dentistry, with people resorting to Amazon to purchase tools for self-treatment. [Interruption.] Those are not isolated incidents. According to the BDA, 83 per cent of dentist respondents to a recent survey—

Ms White, I will stop you for a second. I am aware of several conversations going on across the chamber. I would be grateful if they would cease.

Tess White

Thank you, Presiding Officer. SNP members might not want to hear from the British Dental Association. For colleagues who were standing chatting to one another at the back of the chamber, I will repeat that, according to the British Dental Association, 83 per cent of dentist respondents to a recent survey reported treating patients who had performed some form of DIY dentistry since lockdown, such as using Super Glue to fix a crown or pliers to remove teeth. That is Dickensian dentistry. No one should have to pull out their own teeth or use glue to repair their dentures. It is disgraceful.

For so long—too long—the public have been told that prevention is better than cure, but 1.2 million people have not had a dental examination or dental treatment in five years. As Carol Mochan said, the SNP-Green Government blames everyone other than itself and has a track record of 17 years of managed decline. In our latest health paper, the Scottish Conservatives have committed to root-and-branch reform of the statement of remuneration so that dentistry is financially viable and delivers modern best practice that is focused on prevention. Neil Gray said that he is not complacent, but he must heed the warnings of the experts.


The Minister for Public Health and Women’s Health (Jenni Minto)

I pass on my thanks to all those in the dental profession for their work in maintaining the dental health of the people of Scotland.

This has been an interesting and helpful debate. I am clear that the introduction of payment reform on 1 November 2023 has been a key intervention to improve patient access to NHS dental care. The changes were made in close collaboration and partnership with dentists. The Scottish Government has acted with a significant intervention by introducing major NHS dental payment reform. We have substantially improved fee-per-item payments to provide pricing that better reflects the increased cost of modern dentistry. In addition, we pay a premium on fees to dentists who work in our more deprived communities. When I introduced payment reform, I recognised that it was not a magic bullet, but it is part of a comprehensive plan of reform.

Will the minister take an intervention?

Jenni Minto

I would like to continue.

I am working on that plan with my officials and with directors of dentistry across NHS health boards.

As the cabinet secretary and others have highlighted, the necessary interruption in the training of undergraduate and newly qualified dentists during the pandemic had a significant impact on the introduction of home-grown talent into the sector. We are working on that. Training has now resumed. In August 2023, we had about 160 vocational trainees, and we anticipate having about 170 from August 2024.

Sue Webber made a point about frequent dental examinations. We have not reduced the number of dental examinations; we have followed the National Institute for Health and Care Excellence guidelines, which will allow dentists to have better conversations with people with poorer oral health, who will potentially be seen more often than they would have been under previous arrangements. That is incredibly important as part of dentists’ key work on prevention.

Before Brexit, around one in 10 dentists working in Scotland was from the EU. In some rural board areas, the percentage was much higher. As a result, I personally initiated and led discussions on exploring ways in which we could improve the registration process for international dentists across the four UK nations, as regulation of health professionals is a reserved function. I welcome the outcome of that meeting with my counterparts, as I do the consultation that the UK Government’s Department of Health and Social Care published last week, to consider provisional registration of international dentists by the General Dental Council. I clarify that the Scottish Government will work alongside health boards and NHS Education for Scotland to design any required regulations and framework to support international dentists who come to practise in Scotland, so that they can safely follow that journey. That is incredibly important.

In addition to the full resumption of Scottish training programmes and improvements in overseas pipelines, the Scottish Government is clear that further short-term actions are required to boost the available dental workforce. I have met the directors of dentistry in the health boards to discuss those matters. We are actively considering whether we can better utilise our highly skilled dental therapists to provide dental care without the assistance of dentists, as is currently required. I am pleased to say that a short-life working group, comprising NHS dentists and dental care professionals, working alongside officials, has been convened to make recommendations on the best way to implement such a system.

I thank Fergus Ewing for his comments, although, to be honest, I was waiting for him to add a “but”. In the vein of Mr Ewing’s suggestion, I offer to hold a round-table meeting with members who have taken part in the debate.

I want to be clear that the Scottish Government continues to work closely with NHS boards to support them in identifying tailored solutions to local access problems. For example, the Scottish dental access initiative provides grants of up to £100,000 for opening a new practice or extending an existing one in a health board area. We also offer golden hello payments of up to £37,500 for new trainee dentists practising in such an area. I note that the UK Government has just announced a similar idea for England. In the meantime, I have been assured that unregistered patients will continue to be able to access emergency and urgent dental care via public dental service clinics.

Childsmile, which Paul Sweeney mentioned, does great and important work. This year’s statistics showed that, in October 2023, 82 per cent of primary 7 children had no obvious decay, compared with 53 per cent in 2005. That shows that a policy that was introduced by a Labour Government, but which has been continued, invested in and expanded by the current SNP Government, is a real success story.

Please conclude, minister.

I would also make the point that England has copied Scotland in yet another idea. I believe that the only way to protect our NHS dental services is through independence. Until that is achieved—

Thank you, minister. I must ask you to conclude.

—the Scottish Government will continue to work with partners to address the challenges of NHS dentistry and deliver sustainable services for people.

I call Alex Cole-Hamilton to wind up the debate.


Alex Cole-Hamilton (Edinburgh Western) (LD)

I am rather dismayed that the Presiding Officer cut the minister off, because I wanted to hear how the bombshell of independence was going to in any way improve any aspect of healthcare in this country.

A whole year ago, the Liberal Democrats used our one day of Opposition debate time to raise the crisis in NHS dentistry. During that debate, Maree Todd said:

“NHS dental services are on the road to recovery.”—[Official Report, 8 February 2023; c 40.]

We are a year on and, in large tracts of Scotland, NHS dentistry is dead on arrival—there is no question about that.

As we have heard in today’s debate, there is a crisis in NHS dental care in this country. My party warned the Government about it last February but, in the interim, the Government has done very little to stop the rot. I do not remember an occasion when we have debated the subject in Government time.

The fundamental flaw to the Government’s rebuttal in the debate is that, once again, it leans on the global pandemic as an excuse for the problems that we see in NHS dental care. While that may be true for the delays in treatment that people suffered as a result of the hard stop on aerosol-generating procedures during the months of lockdown, it does not explain why so many of our dental practitioners are leaving the NHS profession and leaving the delivery of NHS care. That has nothing to do with the pandemic.

In truth, the SNP has abandoned NHS dentistry. Although changes have been made to the payment structure for NHS dentists—as Government members were quick to talk about today—it is not enough. We should listen to the British Dental Association, which says that that is tinkering with a structure whose fundamentals are structurally unsound.

I say to Government back benchers that they should look at their casework bags—I do not believe that they are not getting what I am getting. Like Willie Rennie and others, I have heard testimony from my constituents, unbidden and unrequested, that is awash with human pain. I hear more and more every day from constituents who are struggling to get an appointment, including one with a 14-month-old baby who cannot get registered. Another constituent, who was unable to get an appointment after several attempts, said:

“it saddens me that the NHS dentistry service is so much worse now than it was when I was a young child in the 1960s and 1970s”.

Willie Rennie gave us a litany of human suffering from his casework bag in North East Fife. He is not alone. This is not a case of dentists leaving the profession or NHS dental care because of some rush to capitalism or profiteering; it is symptomatic of a fee structure model that is fundamentally no longer fit for purpose, and which the British Dental Association has been crying out for the Government to address for a long time.

As Willie Rennie rightly said, far from NHS dental charges being scrapped in their entirety, people who can still access NHS dental treatment are seeing an increase in charges. Shame on the Government.

We have produced solutions in our motion. First, we must engage with the dental profession on a fundamental redesign of the fee structure. We should also look to registration. The minister was quite quick to address Willie Rennie’s point and say that that is a reserved matter. However, it is not only the General Dental Council that deals with registration; the Royal College of Physicians and Surgeons of Glasgow and the similar body in Edinburgh are also empowered to deal with it. Let us work with them to make it easier for foreign workers to come and deliver dental care.

Fundamentally, we need to reform the recovery plan not only for dentistry but for primary care. As we heard in the earlier debate this afternoon, the recovery plan is no longer worth the paper that it is written on, and clinicians across the board are crying out for the Government to change it. The cabinet secretary made his protestations that he had taken on board our plan, but that will be cold comfort to the constituents whom we have heard about today.

Sandesh Gulhane was right to expand on the extreme measures that people are being driven to. When our Ukrainian refugee guests, who have sought safe harbour in Scotland, are prepared to brave the Shahed drones and Iskander missiles of downtown Kyiv to access dental care for want of an NHS dentist in this country, something is fundamentally wrong.

We heard several times about the important early warning system that dental care can offer. If oral cancer is caught early, it is eminently survivable, but the time that we are asking our patients to wait between appointments means that the early warning signals and vital clinical signs are being missed.

Paul Sweeney’s speech was excellent. He was absolutely right to point to the fact that we know the empirical measurement of how extreme things are in communities, when 83 per cent of our dentists are telling us that they have patients in their practice for whom they are having to deliver remedial work for botched DIY dental work that patients have tried to undertake on themselves. Things are Dickensian—it is terrible and it is extreme.

Liam McArthur was right to say that lists will not open to registration. Any tinkering around the edges might have changed things or stopped the exodus, but lists will not be opened to registration for new patients.

For those in our casework examples—the constituents whom we all know of—who have been jettisoned from NHS care or have moved into an area, the damage is already done. They are out in the wilderness and nobody is looking after their teeth.

In a typically refreshing speech, Fergus Ewing gave the lie to all the Government back benchers who are clearly not attending to their casework in-trays. David Torrance was the most extreme example of that, given that he was not even aware that his own surgery was closing to new patients.

I am aware that you want me to close, Presiding Officer. [Interruption.] It is emblematic of the rot that has set in—[Interruption.]

Let us hear Mr Cole-Hamilton.

Alex Cole-Hamilton

—because of 17 years of SNP incompetence and, yes, ministerial disinterest. I make no apology for saying that—that is exactly what this is.

One of my constituents put it best when she wrote:

“Is the situation only going to get worse? Dental treatment only if you can afford it? Why is nobody in authority concerned about talking about this?”

Why, indeed; why, indeed.