 Name of debate is a debate on motion 7.8.1.2. In the name of Alex Cole-Hamilton, on addressing the crisis in NHS Dentistry. I would invite those members who would wish to speak in the debate to please press request to speak buttons and I call on Alex Cole-Hamilton to speak too and to move the motion up to seven minutes please. Thank you very much indeed Deputy Presiding Officer. I'm very pleased to rise for my party to speak in this debate i ddweud i gydwun i ddwygen i gennym ni. Rydw i ddwygen i'n cymdeithasol eich cymaint oedd byd yn cymaint, erbyn hyn mae'n gydag i'n allan o'r tyn fawr teidl a'r ymdÕr oedd ti'n ei adnoddau i ddigon i dda i ddagiddor, a sut mae'n ddweud i'n ddweud teidl eich ddwyg i ddweud ar y blyneddol a oedd y ddefnyddio. Mae'n gydag yna, o hyd gweld o'r ffordd ydyniad Felly, we have come well to know from this Government with its head in the sand and the dead hand of ministerial disinterest on things that matter to real people. Indeed, I think that it was a show of astonishing timing that the Government published a letter last night where it obviously evidenced a paltry effort to kick down the road with promises of jam tomorrow to our hardworking dentist because, Deputy Presiding Officer, far too many Scots are facing huge obstacles in accessing NHS dental check-ups, and the number of NHS treatments being conducted is dramatically below pre-pandemic levels. Whilst the world democrat research has also revealed that soaring waits for dental treatment with some patients waiting more than three years for help, imagine the pain, dental pain, having to deal with that for three years. It's astonishing. The situation is dire right across this country, with 11 health boards recording patients having to wait more than a year for treatment, while the FOI on health boards for January to November last year showed that dentists submitted around 3.2 million claims for NHS work. That sounds like quite a lot, but if you compare it to the 5.6 million claims for NHS dental work in 2019, you start to understand the quantum of the problem around us, the fall away in dental work. Put simply, many people are either forced to wait months for NHS dental treatment or are unable to access that care on the NHS at all. In rural communities, the situation is even more acute. In Orkney and Shetland, NHS dental claims have fallen by more than 50 per cent, while in Dumfries and Galloway many practices have closed their doors to NHS work entirely. The warning lights are well and truly on and they are blinking, but the response from this Government has been achingly slow. Let's think about how we got here. The business model for dentistry is straightforward. It has always been balanced between NHS and private work, but over time, stagnation in payment for NHS work has seen that balance shift inexorably toward private work. Now, this is not the fault of dentists. They have people to employ, they have lights to keep on, they have bills to pay at home as well. This is a result, as I say, of that ministerial disinterest in the funding model. We know from senior dentist that this Government has, in their words, had its head in the sand. I note once again, Deputy Presiding Officer, that the Government has referenced the impact of the pandemic. Of course, that has had an impact. We know that that is one of the large part down to why there has been a backlog of procedures. Again, as NHS former chief executive Paul Gray said, this crisis in our NHS, including in dentistry, was always coming. Covid has just hastened the date. This Government talks in lofty tones about protecting our NHS from privatisation. It rightly speaks of prescription charges, for example, being the tax on the sick. Yet, under this SNP Green Government, thousands of people are denied the dental treatment that they desperately need. Why are they denied it? Because they simply cannot afford to pay for private treatment, the only other option available to them. Of those responding to a UK-wide poll conducted by my party last year, a quarter of the respondents said that they were forced to pay for private dental treatment. Many people say that they delayed seeing a dentist despite suffering pain. When the pain got too bad, many of those who could not afford to go private turned instead to DIY dentistry. That means they carried out dental work on themselves or asked somebody equally unqualified to do it for them. A staggering one in five people who failed to get an NHS dentist appointment last year resorted to this. We are not living in the dark ages. This is 21st century Scotland. Many people are being forced to take this sort of measure as a national scandal and an absolute indictment. I will take innovation from Dr Gilhane. I wonder if Alex Cole-Hamilton agrees with me that since Scottish Conservatives did a debate on dentistry, things have actually got worse. Alex Cole-Hamilton? Things are getting worse. Dr Gilhane is absolutely right. I sometimes feel that we are becoming sadly enured to the level of crisis in our dentistry profession. If the cabinet secretary wants to intervene on me, I am quite happy to take one. Will Alex Cole-Hamilton recognise that Brexit is one of the other impacts as well as the pandemic on dental workforce and does he then disagree with his leadership who want to keep us out of Europe? Wow. I think that I have turned up to the wrong debate. Nevertheless, I invite the cabinet secretary to explain that to senior dentists who have told us that his Government has his head in the sand. Brexit has obviously played its part. My party opposed Brexit and is still opposed to Brexit. Nevertheless, he cannot once again shirk on either blaming the pandemic or Brexit for his Government's own inadequacies and his own ministerial disinterest. I wish that it were just hyperbole, but when healthcare in this country is in such dire straits that people are literally being forced to pull out their own teeth, the word crisis feels far too modest. I cannot believe that this Government has sought to remove that from this motion. It should go without saying that tooth care, like any other form of healthcare, should be universally accessible and free at the point of delivery. Scottish Liberal Democrats were instrumental in bringing forward free dental checks in Scotland in coalition with Labour and impressing for a new dental school to address our shortages in the dentistry workforce. However, over the past 15 years, Scottish Dentistry has been left to rot in the incapable hands of the Scottish National Party. We find ourselves in this situation because our NHS has been starved of funding. The money that dentists are being given every time they carry out an NHS procedure is not going far enough to make the work sustainable, with some dentists even running a loss in treatment. Unsurprisingly, more and more dentists are becoming fully private, with only 18 per cent of practices taking on new NHS patients. I will close by saying this, Deputy Presiding Officer. Liberal Democrats have solutions. We want the Government to reform the existing funding structures for dentistry so that dentists are incentivised to take on NHS patients, rewrite the NHS recovery plan so that it includes dentists in more comprehensive ways and properly recognise the importance of dentists in the course of NHS recovery. People are suffering. It is time that the Government woke up to that. Thank you, Mr Cole-Hamilton. I now call on Marie Todd Minister to speak to and move amendment 7.812.3 up to six minutes, please minister. Thank you, Presiding Officer, and I'm happy to move to our amendment. I'm grateful for the opportunity to debate the important matter of access to NHS dental care, given the unprecedented impact of the pandemic and the uncertainty that it has caused. I am also pleased with the progress that we are making, and I am glad that we were able to confirm that we are maintaining the current bridging payment until the 31st of October this year, incentivising NHS work. I am sure that everyone in the chamber will recognise that NHS dental services have undergone a significant and prolonged period of recovery. Members will recall that patient access to NHS dental services was severely reduced during the pandemic, as sensible public health precautions were required to mitigate the possible transmission of Covid-19 and dental surgeries. We are seeing encouraging signs of improving patient access to care. The Scottish Government supported dental practices throughout the pandemic, including providing an additional £150 million to maintain the sector. That includes vital financial support payments that are made to contractors to secure continued NHS dental service provision. NHS dental services are on the road to recovery, and I am sure that members will wish to share my admiration for NHS dental services as the sector recovery continues. That is highlighted by more than 1.6 million NHS examination appointments that were completed between April and October 2022. In 2022-23, an average of 300,000 courses of treatment per month have taken place, highlighting an improvement on the 2021 figures. Far from the picture that Alec Cole-Hamilton paints, that means that we are on course for an increase of 40 per cent in NHS dental activity compared to 2021-22, and that means that we have made considerable progress towards the pre-pandemic levels. Additional support payments have been provided in each quarter of the current financial year at one moment, on top of an item of service claims to support contractor incomes and crucially to enable patient care to be delivered, if you are brief. Alec Cole-Hamilton? I am grateful to the minister for giving away. She talked about the uplift in dental work on 2021-22, but I remind her that non-aerosol generating procedures were not allowed in 2021-22, so an uplift of 40 per cent is hardly something to be congratulated for. We are making progress. It is undeniable that we are making progress. We are making really good progress towards pre-pandemic levels, and we are still in the midst of a global pandemic. Give me one moment to make some progress. There is now a clear necessity to provide continued support to the sector as we move to payment system reform. The improving picture on patient access to care underpins the need for longer-term sustainable payment reform to provide surety of NHS provision. The development of NHS payment reform has been built in the spirit of clear engagement with the sector. I am really pleased to report to members that the chief dental officer's advisory group, containing practising NHS dentists and members of the dental team, has been absolutely prominent in developing the clinical requirements of those reforms, building on our oral health improvement plan approach. In discussion and engagement with BDA Scotland, there has been further development of the payment system reform programme, informing us of the correct course to take to seek agreement on the overall package of reform. Members will welcome the open approach to the development of reform with a focus on preventative care. The payment system reform supports enhanced clinical discretion and will support clinicians to deliver effective, high-quality care to patients. I welcome the minister's contribution outlining reform, but can she give us a timetable, please? Certainly, I think that the timetable is very clear in the commitment to maintain the bridging payments to the end of October this year. We would expect the new system of reform payments to be in place by then. The Scottish Government has ensured that NHS dental services are well placed to recover from the impacts of the pandemic to deliver care for the oral health of the whole population. We are committed to tackling the pandemic-related backlog in routine dental care, and we have supported the sector continuously. The improved position reflects well on the commitment of NHS dental contractors and their wider clinical teams. The minister mentioned improvements. I wonder whether she could point out to any improvements in Dumfries and Galloway. She also pointed out that dentists are not leaving Dumfries and Galloway, they are leaving the NHS because we have seen a huge increase in private dental care. Where are the improvements in Dumfries and Galloway? The member is well aware of the particular conditions in Dumfries and Galloway that have contributed to the situation that we are in now. We have an area that is particularly impacted by Brexit, so I think that more than 60 per cent of the dental workforce. If the member would please, if you want to make another intervention... Absolutely, well, and I appreciate you doing that. I appreciate that, because the minister should be bringing her remarks to close. Find the person. The Brexit remark was going to come and we were just waiting for it, it's like bingo. Dumfries and Galloway dentists are not leaving dentistry, they are leaving the NHS to go private. Minister. Can I just say in response to that point, I know that you don't like us talking about Brexit, but over 60 per cent of the dental workforce were European. I think that it's undeniable that Brexit is a factor in the situation, which has arisen up there. Here we see an absolute head in the sand about the situation that his party has brought on his local area. Now, the early intervention to support enhanced examinations in February 2022, including providing a fee for child examinations, is reflected in official statistics that show considerable progress in the delivery of patient care and treatment coming out of the pandemic period. I am absolutely clear that our support of the sector has ensured its recovery. As well as the impact of Brexit on the workforce, we have a number, a whole year of dental students who haven't qualified, but despite the challenges, we have seen a 23 per cent increase in dentists providing NHS dental services for the period that the SNP has been in power from 2007 to 2022. Minister, you really do your over-your-time need to conclude. Thank you. Over 95 per cent of the Scottish population continues to be registered with a dental and NHS dentist as a situation that we are determined to progress and improve. Thank you. To speak to a move amendment 7812.2 up to five minutes, please, Dr Gohanny. NHS dentistry is in crisis, and this is on the SNP's watch. Yet, when we listen to the minister, the message seems to be, well, aren't we just doing well? But this doesn't wash. It's really not time for the tiresome self-congratulatory spin for no matter how many Scots have registered Yes, I will. Minister, I'm very clear in acknowledging the absolute challenges that the sector faces at the moment, but would the member join me in recognising that there has been a 23 per cent increase in the workforce in NHS dentistry in the time of the SNP Government, and that is a very welcome statistic. Dr Gohanny. You'll hear in the rest of my speech how badly you've been doing when it comes to NHS dentistry, so do listen. For no matter how many Scots are registered with a dentist. Dr Gohanny, please resume a second. I just say that it's a very important issue, but we really need to just listen to everybody and extend the courtesy and respect that we would all hope to have extended to us as individuals. Dr Gohanny, please resume. For no matter how many Scots are registered with a dentist or what age groups are entitled to free NHS dental care, it's missing the point if patients can't actually access NHS dental services or if dental practices are going to the wall, the SNP Green Government must get a grip and bring forward a credible plan to both restore routine dental care and tackle the enormous backlog, and this plan should not include moving the goalposts. What do I mean by this? Well, we understand that the latest draft of a revised statement of dental remuneration proposes to create capacity by changing the frequency of NHS oral check-ups from once every six months to once every 12, 18 or even 24 months. In other words, a cut to patient care and further privatisation by the back door as patients who want checked out sooner need to pay so much for preventative healthcare and consider this against a backdrop of particularly worrying reports from dentists of poor oral children's hygiene and health, especially in areas of higher deprivation and a growing requirement for early tooth extractions. The Scottish Government must act on the dire warnings from the British Dental Association that the system is broken. This is not simply about hearing the words of professionals but heeding them as well. Without a new sustainable NHS dentistry model in place by October 2023, the decision to extend this 1.1 multiplier, which must remember has fallen sharply as a bridging payment will lead to inevitable collapse. The traditional high-volume low-margin model is unsustainable. Without reform, practices would be pushed into bankruptcy or forced to drop NHS services altogether. Practices are already facing the risk of providing NHS care at a loss with the laboratory work that they point out. Let me give you an example. Practices, when they do dentures, receive £153.34 for each full set of dentures, either upper or lower. This includes the 1.1 multiplier, and the average lab bill is £90. The margin is £63.34, and this is split between the practicing dentist and the practice owner, who in turn must pay at least two members of staff over five or six appointments. A single extraction, as another example, is £20.30 gross. Many dentures book a 30-minute appointment for such treatments, and rushing them helps neither staff nor the patient. The above system is now geared towards saving the Scottish Government money and not towards patient's dental health. Can the Scottish Government reasonably argue that practice owners can afford to support any of those treatments or that experienced associate dentist will continue to accept NHS dentistry going forwards? Motivation is genuinely at an all-time low. Material and lab fees have risen 20 to 40 per cent across all practices, and this can only be supported through a greater emphasis on private treatment and putting many deserving but non-urgent NHS patients on an indefinite waiting list until something gives. There is also a lack of dental nurses and a lack of dentists, which means that practices are unsustainable and will fold. Recent data indicates that claims submitted by NHS dentists for dental work are 43 per cent down on 2019 levels and suggest a growing exodus of the NHS workforce. Across health and social care, the cabinet secretary-responsible has multiple failures across his brief. It is time to work with dentists and prevent a collapse of NHS dentistry and provide the sector with adequate financial support to continue offering NHS dentistry. Heed the words of professionals deliver the care. I declare my interest as a practicing NHS GP and I move the amendment in my name. I now call on Paul Sweeney to speak to and to move amendment 7.812.1 up to four minutes, please, Mr Sweeney. Thank you, Deputy Presiding Officer. I start by moving the amendment in my name. Labour agrees with the Liberal Democrat motion and will support it if unamended. Our amendment adds a request that the Government provides an update on the progress of his oral health improvement plan, and I hope that there is something everyone in the chamber can agree with. I thank the member for Edinburgh western for bringing this motion for debate in Parliament today. NHS dentistry and dental services are often overlooked and tend not to generate the headlines that we see in relation to acute NHS services or indeed mental health services, but that does not mean that it is any less important. After all, in the same way that we will all need some form of medical treatment during our lives, we will all need dental treatment too. Therefore, it is vitally important that people can rely on dental services and are confident that they will be able to receive treatment in a speedy manner when the time comes. That takes us to the very heart of the issue, because it is present in a postcode lottery when it comes to the availability of dental services in Scotland. In August last year, the British Dental Association and the BBC identified over 8,500 dental practices across the United Kingdom that they believed held NHS contracts. As part of their research, they contacted almost 7,000 practices to see whether they were able to offer appointments to new, adult or child NHS patients. In Scotland, a staggering 82 per cent were not accepting new patients. Even more shockingly, they were unable to find a single practice in Dundee, Midlodie and Dumfries and Galloway, Murray, Orkney, South Ayrshire or the Western Isles that were taking on new, adult or child NHS patients. That is a crisis that is creating a two-tier dental system in Scotland with patients who are unable to afford private dental care for going services entirely, and a crisis that risks collapsing NHS dentistry in Scotland in the long term to a basic extraction service getting a tooth yanked out if you needed to be in pain. We are already seeing the beginning of that demise. In 2022, more than 2 million fewer patients were seen by NHS dentists compared with 2019. When it comes to participation rates, things are even worse until a tale of widening oral health inequalities in children and adults. In September 2008, the gap between child participation rates for the most and least-deprived quintiles in Scottish society was 3 per cent points. In September last year, it was 20 per cent points. The highest difference ever reported, shocking. In the same period, in September 2008 to September last year, the gap between adult participation rates for the most and least-deprived quintiles grew from 3 per cent points to 11 per cent points. Again, the highest difference ever reported. Why does this all matter, Deputy Presiding Officer? It matters because these cold, hard facts are illustrative of a bigger problem. Inertia, in this Government, when it comes to our healthcare system and particularly inequality in our healthcare system, we know the problems facing our NHS, one of which is the problem of staff retention, a problem that exists in dental services, too. Just last week, the British Dental Association issued a start warning that, in two months' time, bridging payments to NHS practices in Scotland will cease, and to date, there is no real clarity on what support will take its place. That is a terrifying prospect that I am happy to give away. I think that Alex Cole-Hamilton might have referenced this, that we have agreed to extend bridging payments to October, which I am sure he will welcome. I accept that that is the case, but, as my own dentist has just told me yesterday, those will not offset the multiplier effects that were previously in place. It does not address the financial detriment faced by dentists. There is no reason for them to engage. That is not sufficient, Minister, to address that problem. It is compounded by the fact that many dentists are simply leaving the profession, particularly young dentists. They go on to warn that an exodus from the workforce appears to be in motion and that dentists are reconsidering their futures working in a broken system, as we are seeing with junior doctors. That should be a huge concern, because, without a highly skilled, trained workforce able to provide NHS dental services to adult and child patients, a fundamental cornerstone of our public dental system will collapse. When it does, it will be those from the most deprived backgrounds who will suffer. My plea to the minister and the cabinet secretary is simple. Listen to these warnings, sincere warnings from professionals in the field, harness their expertise and bring a plan to this Parliament that can command support from across the chamber before it is all too late. Thank you, Deputy Presiding Officer. The Liberal Democrats seem to have spooked the health secretary. On the eve of this very debate, he rushed out a letter to NHS dentists across the country. In that letter, he promised an extension to the interim bridging payments to October, when they were supposed to be sorted in April, something that the minister referred to. He also said in the letter that he was pleased and grateful, but I don't know that there are many dentists across the country who are pleased and grateful for the performance of this Government. Under the current funding system, dentists are losing money with every practice that they undertake. Sandish Dohani gave some excellent examples earlier, but take dentures. Lab costs are estimated to have gone up by around 50 per cent. One dentist told me that I have made dentures recently and it lost me £6 on every single job. Like so many other sectors, the SNP Government is expecting private work to subsidise public work. It is happening with nurseries, it is also happening with higher education. I want to mention that my dentist told me that one of the biggest increases in costs is dental equipment and supplies that have come from the EU. That has made a big difference to the margins there. It reinforces the case for a Government that reflects the real cost that dentists are facing or that we are going to be driving more into the private sector, which has a direct impact on those who are seeking NHS treatment. It is increasingly difficult to get NHS dentists. That is pretty clear. The numbers are quite transparent, despite the increases from the pandemic period, which was at record lows. It has increased modestly since then. We have heard that since 2019 there has been a fall of 20 per cent dentists performing NHS procedures. Around a quarter of people seeking a dentist could not get an appointment. That is really stark. That forces more into private treatment. Those people are not only expected to pay for their own treatment but also the SNP underfunding of NHS treatment. I do not think that that is particularly fair that people who are desperate to get NHS treatment have to go private and then are also having to subsidise NHS treatment as well. They are killing NHS dentistry by stealth. Patients from my constituency are hunting from practice to practice to get access to treatment. It is therefore, I have to say, an utter farce that the SNP are continuing to promise that they are going to abolish all NHS dental charges. They are worthy go, not unreasonable, but in its sense it misses the whole point of the crisis in NHS dentistry. You might be able to get free not to have to pay for your treatment if you are getting treated under the NHS but to try to get an NHS dentist under those conditions. It will not be free for everyone, it will only be free for those who can get through the door of an NHS dentist, yet the SNP get their headline. That comes at a time following the pandemic that people know that people who need dentistry are most slowly to come forward. As Paul Sweeney has rightly identified, that is exacerbating inequalities and that is particularly the case with children. We are posing a significant risk to the population who may be at risk of diabetes, HIV and cancer. It is no surprise that there has been an increase in those resorting to treating themselves. The minister needs to accept that there is a crisis in NHS dentistry and if he does not do something about it soon, it will get a whole lot worse. I am glad that the Liberal Democrats are using their parliamentary debate today to address NHS dentistry in Scotland. After reading the 2021 Scottish Liberal Democrat manifesto to learn a bit more about the party's plans and ambitions for dentistry in Scotland, I am afraid to say that the Lib Dems did not mention dentistry once. Back in 2021, Covid was still very real and the SNP on the other hand dedicated a whole section in our manifesto on how we can improve dentistry services and action has already been taken. It goes without saying that there are significant challenges facing dentistry in Scotland and our health service, but we need to recognise the impact of the global pandemic. It has been the biggest shock to our NHS in its 74-year history and the NHS is not going to recover in a few weeks as all the opposition parties demand. It is going to take years. Will I be able to get the time back? Let's dive into some of the facts. Right now, more than 95 per cent of people in Scotland are registered with their NHS dentists. I was shocked to learn that only 44.3 per cent of people were registered with their dentists back in 2007. The progress is down to the work of the SNP Government and represents a massive uptake following years of decline under Labour and Lib Dem Governments. Examinations and appointments are once again up following the massive backlog caused as a result of the global pandemic. To date, the SNP Government has provided more than £150 million of financial support to maintain capacity and capability of NHS dentistry. I am not sure if my colleague Alex Cole-Hamilton is aware, but being proactive after the pandemic last April, we saw the system of fee per item payment incentivised versus NHS dental teams to see patients being reintroduced. Public Health Scotland statistics show how those measures have increased patient examination appointments back to the pre-pandemic levels, allowing more patients to be seen as dental practises to register more patients as they work through the pandemic backlog. Historically, since the SNP has committed to office, we have made considerable progress on dental services and oral health improvement. Under the Scottish Government has already removed dental charges for all patients under 26, and that is around 600,000 young Scots. That is the first step in scrapping it for the whole of Scotland. Partly because of this policy, our children's oral health, particularly deprived communities, is improving dramatically, with primary seven groups seeing better results than ever. The child smile programme that has been introduced into nurseries and schools, and I witnessed this in practice last week on a visit to Trun, has a lot of great work being done. We also have more dentists per head of population. In Scotland we have 59 dentists per 100,000, in comparison to 43 dentists per 100,000. Do we want more dentists? Yes. However, due to the pandemic, we have had a whole year where there have been no dentists students qualifying. However, I believe that immigration can play a key role in tackling this backlog. I will await the growings from the Tory benches. It is not Brexit bingo, and this is not a game. It is a hard cold fact that Brexit has had a significant detrimental impact on recruitment on health and social care staff. One such fact is that dentists joining the register have hathed since the EU referendum, and the Not Feel report, which was a health and Brexit six years on, which was published last December, describes a UK dentist workforce as being a particular concern. The report states, and I quote, that, before the EU referendum, consistently well over 500 dentists trained in the EU and the after-registered in the UK each year. That made up to a quarter of additions to the workforce. That dropped sharply around the time of the referendum, and it is about a half of the previous level, and it has never recovered. I am sorry for everyone at a time, Presiding Officer, so I will go to conclude. I thank the Liberal Democrats for using their debating time to bring this hugely important issue to the chamber. The members will be aware of my long-standing interest in the preventable health agenda. I think that dentistry sits quite firmly in that category. Further more when we discuss health inequalities, we cannot avoid the fact that the most deprived areas are suffering far worse than the least deprived areas. I had hoped that the minister, given her experience, would be prepared to accept that there is a long-standing issue with access to dental care, and that there is a disparity in legal oral hygiene between the most and least deprived areas. I had hoped to be able to discuss the issue without politics getting in the way, because it is far too important an issue to play politics. However, the reality bears no resemblance to the Government's amendments. Covid makes its usual appearance—I can make a little bit of progress, first of all, please minister. Covid makes its usual appearance in the Government's list of excuses when we discuss anything health related. For the record, I have looked at the trends in the percentage of registered patients participating in NHS general dentistry services from 2006 until now. The minister should be aware that the percentage in Scotland has been consistently falling from a higher of 96.7 per cent in 2006 to now 65.7 per cent. All Covid did was accelerate an already chronic problem. Furthermore, the number of dentists working within the NHS has been steadily declining over the past six years, with the biggest decline in the last two. We can already extrapolate those results to conclude that an already declining state of oral health in hygiene in Scotland has been accelerated. It is entirely reasonable to conclude that the most deprived will suffer the worst consequences. I convene the CPG on health inequalities and have done so for nearly seven years. Our frustration is that the issues that we discussed way back then are the same issues that we discussed now, but they are much worse. Our amendment, which I hope will get the support from across the chamber, is born out of continual reports from dentists who increasingly worry about poor child oral hygiene with their patients, especially in areas of higher deprivation and a growing requirement for early tooth extractions, and it believes that the Scottish Government's lack of dentistry recovery plan will only exacerbate this growing health inequality. Those ones may be in our amendment, but they are also a direct quote from a senior dentist. Good oral hygiene is the epitome of the preventable health agenda. I am absolutely sure that the member will welcome the enhanced child examination fee that has been in place since 2022, but does he also welcome that, since 2003, where we saw 45 per cent of primary 1 children, less than half of primary 1 children had no obvious decay, that number has increased to 73 per cent this year in 2021-22. It does not quite fit with the narrative that you are progressing around the SNP's management and preventative health in children. Minister, what you have just said does not fit the narrative that we are hearing from dentists day in and day out. It is about time that the SNP Government is listening to the people who are working on the front line, because those words, as I have said, are the direct quote from a senior dentist. Good oral hygiene is the epitome of the preventable health agenda. By investing in early intervention, the Scottish Government would avoid much more costly and invasive treatments further down the line. That is not just about cost, it is about investment, it is about being able to continually reinvest in the dentistry profession to the betterment of the profession, its patients and, ultimately, tackling that growing health inequality. It is no good that the Scottish Government is creating ambitious targets with no route to related outcomes of its policies. I had hoped, Presiding Officer, that we could have an honest and open debate today on the very serious and escalating health crisis, and, unfortunately, we are not getting that from the Scottish Government today. The everything will be fine and there is nothing to see here policy will just not wash. It is time that the Scottish Government accepted the severity of the situation, and its policies to date have not worked. We had a complete route and branch review of dentistry, Presiding Officer. Thank you very much, Presiding Officer. I also thank the Liberal Democrats for bringing this important debate to the chamber. Today, our NHS dentistry services are experiencing unprecedented levels of pressure. Not for the first time in our health sector, the Scottish Government has taken its eye off the ball. The mismanagement of NHS dentistry has left the sector fighting for its survival. Since the onset of the pandemic, over 6 million NHS dental appointments in Scotland have been lost. That includes essential annual check-ups, which are a cornerstone for maintaining good oral health as any potential issues can be identified early, properly assessed and that boosts the likelihood of a positive outcome. Since coming to power, the SNP Green Government has not only presided over privatisation of dentistry services in Scotland, it has actually accelerated that process of privatisation. In response to any criticism or scrutiny, as we have again seen today in the chamber, the Scottish Government gives their response and their excuses. One is which to state that 95 per cent of Scots are registered with a dentist. However, being registered with a dentist is meaningless if you cannot access an appointment for several weeks or if you cannot afford the expense of going private, particularly in our most deprived communities, where such access to appointments we know is crucial. The impact of the widespread privatisation of dentistry services is a marked increase in health inequalities, most prominently among children. New research from the British Dental Association has found that in total the proportion of people who have visited their dentist in the past two years has fallen from 65 per cent in 2020 to only 50 per cent in 2022. Three in every four children in the most affluent areas have visited their dentist in the last two years compared to just over one in two in the most deprived communities. When the SNP came to power, as we have heard already from my colleague Paul Sweeney, the difference in dental participation rates among children from the most affluent areas and the most deprived communities was only 3 per cent. It is now 20 per cent. That is a shameful statistic, which is indicative of the SNP's shambolic management of NHS dentistry and a lack of targeted action over 15 years to reduce health inequalities. We are faced with the reality of dental care being a privilege, which can only be accessed by those who have enough disposable income to seek private treatment. I would like to say that I was pleased to hear the minister confirm that the Scottish Government has extended the bridging payments, which update the NHS fees to help dental practices to deal with rising costs. That is what the minister said would happen. However, I do not think that we have had any acknowledgement of the multiplier effect or the systemic issues with the current funding model that is completely broken and that it is celebrating the shift away from NHS dentistry and into private practice. I am in my last minute. I will take a very brief if I can. Thank you. Would Paul O'Kane agree with me and dentists that holistic oral health is a priority not to continue the Drill and Fill model that the Scottish Government is pursuing? In my speech, I have outlined the importance of that relationship with a dentist and ensuring that your appointment is the gateway into the services that you require for good oral health. What is needed now is real reform to a broken system. There can be no more kicking the can down the road. A sustainable model must come in place in October. Those are not my words, Presiding Officer. They are the words of the chair of the British Dental Association's Scottish Dental Practice Committee, David McCall. As a matter of urgency, the Scottish Government must fix the systemic issues with the current funding model if it is serious about maintaining a universal NHS dentistry service across Scotland. We need to shift the debate away from the proportion of the public who are registered with a dentist and focus on who is able to access a dental appointment. In concluding, Presiding Officer, if action is not taken, we will see the end of dentistry, as we know it in Scotland, with a two-tier system of care, one for the rest and one for the rest, which will only exacerbate and further entrench existing health inequalities in oral health. I call Jolene Mackay to be followed by Jolene Martin. Thank you, Presiding Officer. I, too, am pleased that we have time today to discuss dentistry. Dentistry is a part of the health service that often gets lost when we are discussing wider health issues. It is a hugely effective preventative health measure, looking not only at teeth and gum health, but finding other potential issues and conditions as well. Like all parts of our health service, Covid has placed unprecedented pressure on dentistry, and I commend all the dentist, therapists, hygienists, nurses and technicians who put their wellbeing and sometimes their lives at risk to continue delivering essential healthcare during the pandemic. It is only right, though, that we look at this in the context of how dentistry is delivered in Scotland, which is fundamentally different to general practice and other healthcare services. As such, a response to Covid recovery for dentistry needs to be different to other parts of healthcare. The mixed model of private dentistry, general practice and the public dental service creates a complex system that the public is not always confident in negotiating. It also opens the real risks of an uneven and unequitable delivery of dental services across the country. We should also be looking at expanding the role of the public dental service in which healthcare boards fully deliver dental services. Historically, this has been reserved for communities who are unable to access dentists such as people living in care homes, but in more recent years it has successfully delivered a full dental service in remote and rural areas such as the Western Isles, which have been badly serviced by general practice. The public dental service provides an existing model that could be expanded to cover more communities, especially those where private and general practices are closing or where growing populations are not adequately served by the existing practices. Although the model of delivery may be different, there are clearly lessons that can be learned from the way that GPs have adapted to deliver primary healthcare, not least in the successful use of allied health professionals as part of wider health teams in surgeries. The wider category of dental care professionals includes dental therapists, hygienists, technicians and extended duty dental nurses and can operate a wide range of services from extractions to preventative care. They are already used extensively across Scotland but currently have to work in a referred-down model where patients must see a dentist before being referred on for further treatment to a dental care professional. This is the opposite to how GP practices work, where it is now common to see a nurse before being referred to further treatment elsewhere and indeed is not the way dental care professionals work in other parts of the UK. Reviewing the model and changing it to a referred-up system could significantly ease current pressures on dental services and ensure that we are making full use of our well-trained and highly skilled dental care professionals. I welcome the removal of dental care charges for under-26s and hope that we can look at how to roll this out to groups for whom paying for dental care is a barrier quickly before extending it to the rest of the population. There are some groups that we know who are already exempt from charges, for example those who are pregnant or in receipt of different benefits, but I do not think, especially in the current economic climate, that this is capturing all those for whom dental treatment may be a luxury that they cannot afford. I hope that we may be able to devise a targeted approach that addresses both the availability of dentists in some areas and the affordability. We need to look closely at why some may not be attending dental appointments too and look to see how we can remove some of those barriers. Some people I have spoken to over the pandemic have simply gotten out of the habit of going and don't get round to booking a check-up and we need to address that. Dentistry is one of the greatest examples we have of preventative care and we need to ensure that everyone who may need it has access. We need to look at where and how this is delivered and make sure that it is not too long before the abolition of dental care charges. I have, for some time, been concerned about the recruitment of dentists in 2018, local and rural NHS dentists, Naveen Aziz, came to see me claiming that, because of the Brexit vote, he was already saying that we are already seeing in the profession a 90 per cent drop in applicants for dentist vacancies. That was in the period before the actual withdrawal. Of course, now EU dentists need a work visa to come here, a visa that is very difficult to get. Mr Aziz was right, applicants from the EU have all but ceased, but he also runs a couple of practices in the Highlands. He was looking to recruit dentists from outwith the EU under the sponsor licence scheme, but they required the dentist to be earning £50,000, and that was not within the pay scale that he could afford. I do not have time. Therefore, they could not apply through the other visa routes. At that point, Amber Rudd was the home secretary. I called on Ms Rudd, I wrote to her, and I called on her to have a contingency visa arrangements that we put in place to take into account Brexit's impacts on dentists. I referenced another pressure that was highlighted in the survey at the time by the British Dental Association, which found that more than 50 per cent of NHS dentists across the UK were considering leaving the profession within the next five years, and that third of members over the age of 55 were looking to take early retirement. Unfortunately, I did not hear back, but that is maybe because of umpteen reshuffles at that point. Since then, Mr Aziz is in the fortunate position of having an SNP MP to take his case on with the current home secretary, but sadly he is coming up against the same brick wall. Mr Aziz continues to be unable to fill vacancies that he has willing applicants for. Incidentally, I just want to mention that he is my parents dentist and they never have a problem getting an appointment despite his recruitment challenges. My colleague Jackie Dunbar is not speaking in today's debate, but she was telling me earlier of a similar case that she has, and she was happy for me to relay it, because it mirrors Mr Aziz's issue. She is a constituent who runs a dental practice in Aberdeen. He wanted to give a job to a dentist from Afghanistan to fill a vacancy that he had, so he wrote to the home secretary to ask of dentists who are on the occupation shortage list in the UK. If specific schemes are in place to resettle dental graduates from Afghanistan given the issues over there, well, I have to. Now don't ask. Jackie Dunbar. I thank the member for taking the intervention and I apologise in advance for hijacking our speech, but since my NHS dentist was mentioned I just wanted to give them a shout out and say thank you very much and all the NHS dentistry team. I broke a tooth last Thursday, I called my dentist, it wasn't an emergency because it's not sore, so I got the appointment for next Wednesday. I got a call this afternoon to say there was a cancellation that I wanted to come in this afternoon, but obviously I couldn't. So I just wanted to say thank you and just say that we can't get appointments from the dentist's team. Julian Martin. I thank Jackie Dunbar. I've mentioned my own dentist as well since we're all mentioning her own dentist, but I already mentioned it to Willie Rennie about the issues that he was having with the costs and the time it took to get dental supplies, so that's also an issue that's a result of Brexit. The Tories are terrified of us calling out Brexit, but it's a massive problem, not just for this sector but for so many sectors, because we cannot magic qualify dentists out of thin air. The minister and other members from my own benches have outlined the actions that have been taken to try to improve things. We've introduced new incentives for recruitment and attention in the NHS dentist, which include certain areas within grampian health boards such as golden hello arrangements and means that NHS dentists can receive up to £25,000 over a two-year period, but we have to be able to also take overseas dentists who want to come here. Until that happens, we really are running to stand still, Presiding Officer. Almost exactly a year ago, I spoke in this chamber about my concerns that the very existence of NHS dentistry in Scotland was under threat. In February 2022, the outlook was bleak, and I regret to say that the SNP has presided over the near collapse of NHS dentistry. We know that over 6 million NHS dental appointments have been lost since the first lockdown, and statistics published just last month showed that 2 million fewer patients were seen from January to November 2022, which is compared to the same period in 2019. Just 50 per cent of Scots who are registered with a dentist have seen one in the past two years. Dentists tell us that the SNP Government is presiding over the backdoor privatisation of NHS dentistry, which is directly as a result of the lack of funding and incentive for dentists to offer NHS services. At the very time that NHS dentistry needs support, ministers appeared to be intent on withdrawing bridging payments from April, so I am delighted that this will continue to October. If we are being honest, the statement of dental remuneration, which is about as old as the NHS itself, is no longer viable. However, you need to recognise that the multiplier has been substantially cut, so urgency is still required. I accept the minister's comments, and I will take that as a commitment that reform will be in place by October, because, to be honest, pre-pandemic levels of clinical activity are not possible, and there are serious concerns about staff recruitment and retention that we have heard from a number of members. However, the Government has not acted fast enough, so we will probably end up with fewer NHS dentists as a result. I thank Jackie Baill for taking intervention. All seriousness, I have listened to her members and members across the chamber who are calling for rightly reform. Does she have an idea of what that reform should look like? Does she agree, for example, with the fee per item model? Does she think that that should be scrapped? If so, therefore, what should it be replaced with? I have engaged with the minister before on this very subject. More than a year ago, he suggested that the way to do it is to bring dentists in and discuss these things. However, there is no urgency to it. I talked about this a year ago and you have presided over more dentists leaving the NHS. Dental care in Scotland is becoming the privilege of those with the deepest pockets who can afford to go private. What a shameful indictment of the SNP's approach to healthcare. Let me illustrate part of the problem, because David McCall, chair of the BDA Scottish Dental Practice Committee, told us about the fee's dentist pay to the lab for denture repair. That is £2640. The fee that the Scottish Government will provide for the repair is just £24. NHS dentists are being asked to run services at a loss and subsidise the NHS with barely enough funding coming in to pay staff. The cuts are set to get worse. High Street NHS dentists in Scotland have fallen by over 5 per cent since the pandemic. Patients are often forced to turn up at A&E with excruciating mouth pain because they can't get an appointment with an NHS dentist. The situation is in danger of getting worse. The growing inequality that is becoming synonymous with the SNP's governance of Scotland is growing in dental provision at an alarming rate. September 2022, children and adults from the most deprived areas were less likely to have seen their dentists compared to those in the least deprived areas within the last two years, and that gap is widening. Scottish Labour introduced child smile when we were in government because we were determined to tackle inequalities in oral health and to ensure access to dental services for every child in Scotland regardless of their background. It is heartbreaking to see that the considerable progress that has been made in child dental health is now going backwards. The SNP's failure is creating a two-tier dental system where those with the money to spend go private and those who do not have the money go without. Shame on them. Today we have heard the scale of the crisis in NHS dentistry in Scotland. It is a profession on its knees, a system that is broken. Words we are hearing all too often in this chamber under this SNP green government. Millions of dental appointments lost since the start of the pandemic, millions of missed opportunities to treat early tooth decay, prevent dental disease and detect the early stages of oral cancer, and certainty over future funding in a system that is already chronically underfunded, an exodus from the workforce according to the British Dental Association. All of that against the background of the SNP's 2021 manifesto, it was their commitment to scrap NHS dental charges for everyone in Scotland. The Minister Mary Todd talked about reform but she was unable to give any timetable and once again this SNP government blamed Brexit and once again they blamed the pandemic. It is deflection and it is denial and again in terms of deflection and denial they also took the credit for child smile from Labour. That was interesting. I do agree with Willie Rennie this is an utter farce just like Gillian Martin refusing to take an intervention from my colleague but took a seemingly staged intervention from her colleague Jackie Dunbar. Alex Cole-Hamilton shone the light that the Scottish Government want to delete reality and their heads are in the sand. Dr Gullhane raised serious issues of so many dental practices going to the war because they're running at a loss. He gave example upon example upon example. Paul Sweeney talked about the postcode lottery and Brian Whittle said this government operates and everything is fine and there's nothing to see model. The Scottish Conservatives amendment highlights widening oral healthcare inequalities something that was glaringly absent from the Lib Dem motion sadly. It is patients in Scotland's poorest communities who are paying the price for the crisis in dentistry according to David McColl, chair of the BDA's Scottish Dental Practice Committee and presiding officer make no mistake SNP ministers cannot peg widening inequalities in oral health outcomes on the pandemic alone. Like so much with this SNP government it's a problem that has been years in the making. For example the national dental inspection programme 2018 revealed that while 86% of children in Scotland's least deprived areas had good dental health that figure was only 56% for children in the most deprived areas. Of course as we've heard today the SNP likes to trumpet the number of people registered with an NHS dentist in Scotland. That's so typical of the SNP's smoke and mirrors approach to policy and political PR but it is the participation rate. It is the participation rate. Contact with a dentist in the past 24 hours, 24 months that matters most. So let's take a look at it. The participation rate has fallen by almost 15 percentage points between 2020 and 2022, with adults and children from the most deprived parts of Scotland less likely to attend than those in the least deprived areas. Excuse me, can we please hear Ms White without interruption? Thank you, Presiding Officer. The cabinet secretary obviously doesn't like what I'm saying. The reality is that we are seeing a decline in dentistry under this SNP green government. Dentistry in Scotland is on a cliff edge. Humza Yousaf announced today that the bridging payment will remain in place until 31 October this year, after months of uncertainty for dental practices who fear they might collapse. Finally, Presiding Officer, Humza Yousaf and the SNP government must urgently get a grip of the situation and bring forward a credible plan with a timescale to restore routine dental care and the confidence of the profession. Thank you. I call on Humza Yousaf up to five minutes, cabinet secretary. Thank you, Presiding Officer, and I thank Liberal Democrats for bringing this important debate to the chamber. I will try to address a number of the points that have been made in the key themes that have come up. I say from the offset that nobody in the Scottish Government is suggesting that everything is rosy in the park. In fact, a very first line of our amendment acknowledges the impacts that the pandemic has had on NHS dentistry. Of course, we acknowledge that there were challenges even pre-pandemic as well. I agree with those across the chamber who are saying that there are challenges to access to NHS dentistry. No doubt, some of those issues are more acute in some localities such as Dumfries and Galloway and Shetland islands that have been raised in this chamber with me directly. I acknowledge, too, that there is a challenge around the current payment system and that is why we are engaged in reform and doing that at pace. It was really telling, Presiding Officer, in fact, in Jackie Baillie's response to my intervention, that, for all the talk of reform, nobody in this debate has given any detail of what that reform should look like. In fact, I will give way shortly, but what I will say to Jackie Baillie is that, when I asked her what that reform should look like, she gave a completely incoherent answer, no substance whatsoever. On that point, Jackie Baillie may want to give more detail. I am sorry, but I had an hour-long discussion with your minister and the chief dental officer a year ago, and that discussion has not been acted on. If you want me to take an hour of your time just now to give you that detail, I would be happy to, but perhaps the cabinet secretary would answer a question, because I acknowledge his acceptance of the impact of Covid, so has he estimated the cost of how much it will take to clear the current backlog and how much time it will take to do so? Of course, all that depends on what the payment per item is, what the fee is for that item, and that is a conversation that we are very much engaged with. However, all that I asked for was just one bit of detail from Jackie Baillie, and in fairness, it is not just Jackie Baillie. I have managed to, I would ask the question of everybody genuinely, quite seriously, that if there is some detail, shortly I will, if there is some detail around the form that you think we should be bringing forward, please do bring that to our attention, because if you do not agree with the fee per item model and you agree with a salaried model, then please just make that clear. I give way to Gillian Mackay, who was first. I thank the cabinet secretary for giving way and apologised to everybody else. Would the cabinet secretary reflect on my suggestion of changing to that refer-up model so that we can make the best use of dental therapists and dental hygienists rather than always having to put people to a dentist in the first instance? I thought it was a point that was very well made. I was going to come to it later on. In fact, Gillian Mackay being one of the few that was able to give some detail of what reform we should see. What I would say to the Conservatives and others who suggest that there hasn't been any progress in recovery is to just look at the facts and the figures. 1.6 million NHS examination appointments were completed between April and October, with an average of more than 300,000 courses of treatment per month. That means that we are on-course, not quite there yet, but on-course for over 3.5 million courses of treatment in 2022-23. That compares with 1.5 million in 2021-22 and 2.6 million in 2021-22. I will very, very flay, if you may. I really appreciate you giving way. You are saying that there are solutions there and there are specific issues in Dumfries and Galloway. What are the interventions that you are going to take? To stop NHS dentists from stopping providing NHS services and moving into the private sector, that is happening right across Dumfries and Galloway. What can you do to address that? For the sake of brevity, I may well write to Finlay Carson the details of what specifically has been done in Dumfries and Galloway. There have been a number of interventions that have been tried and tested. There has been some return for those investments, but not much, except that I know that the board has assembled a local dental task force and we expect detail imminently on what the next steps that they are going to propose in Dumfries and Galloway. I will write to Finlay Carson with some more of that detail, given that I have vastly running out of time. To suggest that the SNP Government has not supported the dental sector, I am afraid is incorrect, £150 million of funding for the sector throughout the course of the pandemic. The issue of privatisation and people feeling that they have no choice but to go to private, is that we are incentivising NHS dentistry through the multiplier. If some have said, why are you reducing the multiplier from 1.3 to 1.1? Of course, the multiplier was set at that level during the course of the pandemic when the majority of aerosol generating procedures could not be done and there were severe IPC restrictions. Those IPC restrictions have loosened, so it is right that we begin through them, because of the importance of making sure that we get value for the public purse. We are reducing the multiplier in a phased manner. I must ask you to conclude, cabinet secretary. I am afraid not. The cabinet secretary has been on this time. I will say that we will continue to make sure that we resource and fund this sector and make sure that NHS dentistry is available for all my population. I now call on Liam McArthur to wind up up to six minutes, please. Thank you, Presiding Officer. The Government is often accused in this chamber of lodging motions or amendments that smack of complacency of ministers being quick to pat themselves on the back or believing that any concerns, however serious, can be brushed aside with an expression of ministerial gratitude to those working in the sector. Indeed, today's debate, despite what the cabinet secretary said in his closing remarks, has provided text but examples of those three character traits. I must say that complacency, self-satisfaction and patronising dismissiveness of the letter that was sent out yesterday by the cabinet secretary to dental practitioners around Scotland takes the biscuit. As Willie Rennie observed, he could almost hear the grinding of teeth in dental practices from Shetland to Stranraer, as Mr Yousaf has pleasantly declared in that letter that he is pleased to see how well the dental sector has been performing. The lack of self-awareness or understanding about what NHS industry is crying out for led the cabinet secretary to insist that the bridging payment has supported the sector to provide significant levels of NHS patient care during this difficult time. Will have had dentists reaching for the drills with dark thoughts on their minds. Fundamentally, it reflects a failure on the part of the cabinet secretary and his chief dental officer to listen and respond to what those in and representing the sector have been saying for months. I will give way to Bob Doris. I thank the member for giving way. I have written to the Government about pressure with NHS dentistry in Mary Helen's bring-burning, particularly recruitment and retention issues in the drifted private sector. I know that remote and rural areas are recruitment and retention allowance and incentive for newly qualified dentists. I wonder if that could be enhanced and extended to urban areas. Is there a specific suggestion for Government to take forward? I thank Bob Doris for prior sight of his intervention, if not in the detail, and I certainly agree with the point that he makes. As Alex Cole-Hamilton said in opening the debate, the term crisis is often overused in the face of what we have seen happening in A and E to mental health. It is perhaps unsurprising that other aspects of the broader crisis have dominated the headlines in this chamber's attention. Yet any objective analysis of NHS dentistry across Scotland right now can only lead to one single conclusion. The sector is in crisis. Dental check-ups and treatment remain dramatically below pre-pandemic levels. 11 health boards record weights of over a year for treatment. The BDA has confirmed that dentistry in Scotland is still, quote, light years away from business as usual. The number of dentists doing NHS work has fallen while the chair of the BDA, the Scottish Council, warns of a wholesale exodus for NHS work. As one dentist told me last night upon receiving Mr Ysaf's letter, the current system is the cause of the exodus, and I suspect that this announcement sounds the death now for this era of NHS dentistry added. There will be a lot of practices making some tough decisions over the coming days. It's a position that's reflected around the country. I'll take a brief intervention. I'll be very brief, because I just wonder if he has an answer to the question that I've asked others. What is the detail of the reform that he would like to see? Do you agree with the fee per item model? If not, is there a different model that he would propose? I'd be very keen to hear. I think that the point that's been made by dentists is that they're being involved in committees and consultations where they're feeding in their views that have been routinely ignored. I think that that communication breakdown between the Government and the sector itself is of more concern than the ideas coming forward from other political parties. As others have said, Sandish Gohani has made the point. Let's hear Mr MacArthur, please. About the lack of the impact on preventative healthcare, he, Paul Sweeney, Brian Whittle all talked about the yawning gap and the expanding gap in health inequalities. Siobhan Brown was perhaps right to talk about free dental checks, but as Willie Rennie pointed out— Mr MacArthur, if I could just ask you to stop for a second. There is a discussion going on down here that I would be grateful if it could cease, and we can hear Mr MacArthur. Siobhan Brown talked about free dental checks, but as Willie Rennie pointed out, the free dental checks only work if there's a door through which to go to be seen by somebody who can carry out those checks. Gillian Martin talked about the impact of Brexit and being unable to magic into existing dentists. That's absolutely true, but it means that we should be doing all that we can to discourage those from leaving NHS dentistry in the numbers that it's currently happening. Gillian Mackay was absolutely right to make the point about a referral up programme. It's certainly something that's been referred to me, and I think that the role of therapists could be expanded more. They have the training already. They just need to be allowed to be able to deploy those skills. Alex Cole-Hamilton was right to point out the particular challenges in rural and island areas. Just this week, I've been contacted by constituents highlighting their own experience. One father explained how the absence of a registered orthodontist in Orkney has left his daughters unable to access important orthodontic work at a key stage in their teenage years. The implications of that are potentially far-reaching, not just the costs of future work but the emotional toll as well. I know another constituent who recently forked out around £6,000 for orthodontic work desperately needed by her daughter. Another constituent was in touch to explain that he'd moved to Orkney two and a half years ago, and they and their family were still unable to register with an NHS practice. They've explored private dental care, but the costs are prohibitive, and they're also far cry from the First Minister's promise of NHS free at the point of delivery. Even getting children registered has proved impossible, leaving many with no experience of going to the dentist, increasing the risks of poor habits or even phobias developing. The fact that the public dental service hasn't fallen over completely at this point is due to the commitment of dentists and dental practices across Scotland, yet that commitment has been rewarded by disorganisation and disrespect from this Government. The Government may be able to remove the word crisis from this motion, would the ministers expended just as much effort in trying to address the crisis in reality?