 That concludes the debate on proving access to primary care. It's time to move on to the next item of business, which is a debate on motion 12215, in the name of Willie Rennie, on crisis in NHS dentistry. I'd be grateful if members wished to speak in the debate where to press their request to speak buttons. I call on Willie Rennie to speak to and move the motion up to seven minutes, please. Just in case you've not had enough of me. In preparation for this debate, I asked for people's experiences of NHS dentistry. I had a tidal wave of responses and they are still being sent to me this very day. The stories are nothing short of extraordinary. This is apart from SNP supporters who are partly all registered with NHS dentists, get an appointment before they even ask for it and even have the shiniest teeth in the whole planet. However, it is certainly true that many people do get a good NHS dental service experience, but so many don't. Our job in this Parliament is to never stop until everyone gets the service that they need and that they deserve. The steps that people have taken are nothing short of extreme. Those have included DIY dentistry with tools bought on Amazon, travelling hundreds of miles, paying a small fortune sometimes, 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. On universal credit, she cannot work, she does not drive. She told me this. In one month, I spent almost £400 on x-rays, two fillings and cleaning. That left me short for food, which meant that I skipped meals so that my son could eat. That is what NHS dentistry has brought to this 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 Kelly from Taipor says that he has been on a waiting list for four years now. He told me this. I have had to resort to DIY dentistry with dental tools purchased on Amazon, and he puts in brackets. I am 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 incur private costs here. So, not only are we getting our ferries from Turkey, but we are getting our teeth done in Turkey as well. NHS dentistry is in crisis. It was in trouble before the pandemic. The British Dental Association says that the Scottish Government's revised payment system from November last year has made little to no difference. In Fife, there are no dentists accepting new NHS patients. This month, Nanodent and Glenrothes said that they have no choice but to shut for an extended period. Redburn dental in Cercodi is going fully private due to on-going pressures. Last year, the Nubara practice in my constituency went private, and the Taipor practice closed altogether. A practice called My Dentist in Prestwick, Ayrshire, dropped 1,500 patients overnight going private. Almost 82 per cent of NHS dentists in Scotland no longer take new patients, and 83 per cent are saying that they will reduce their NHS numbers. So, it is bogus, absolutely bogus to claim that because a high percentage are registered with an NHS dentist, means that everything is fine. Research by my party last year found that almost half of those registered have not been seen at an NHS dentist in two years. 1.2 million have not had an examination or treatment in five years, and more than 10 percent have not seen an NHS dentist in over a decade. New statistics published yesterday by Public Health Scotland reveal that there has been a 25 per cent drop in the number of NHS dental examinations paid between December 23 and December 2019. That is a drop from 195,000 down 50,000. We should not forget that the SNP has abandoned its promise to abolish all NHS dental charges, but it is worse than that. It has increased the charges rather than scrapping them. When the minister stands up next, her first words should be that there is a problem with NHS dentistry in Scotland. If she does that, then we can have a serious debate about how to fix it. That includes, I believe, a fee system that reflects the true cost of providing treatment, reversing the 35 per cent real-terms cut in recent years. Raise the cap on student dentists. Vocational dental training is the entry door to NHS dentistry. We should fund 70 more places to commence this August and give NHS Education Scotland the funds to act quickly. That will open NHS access across the country, come August, with a very moderate financial outlay. We need to speed up the registration process for overseas dentists, which currently has a three-year wait with the General Dental Council. We have the powers to do it 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. Let me leave you with this final chilling anecdote. This is a dentist, Toby this. An early oral cancer has a five-year survival of 80 per cent. A late stage 1, only 20 per cent. One oral surgery department reports alarming increases in late presentations of oral cancers. That is something that should shivders down all of our spines. That is not, therefore, just about shiny teeth. It is a matter of life and death. Can I confirm, Mr Rennie, that the motion was moved? Thank you, Presiding Officer, and I move the amendment in my name. The previous debate focused on the importance of care that is delivered in our communities through and in partnership with general practice. The debate is equally as important and recognises dentistry as an essential instrument of our primary care system. I will go further and say that it is a key driver in realising our commitment to deliver preventative and proactive healthcare, delivered by sustainable and effective public services working in partnership with patients. It is for this reason that the extension of free dental care to under-26s form an integral part of this administration's first 100-day sprint, and why dental access remains a core tenant of the First Minister's policy perspectives and my own personal mandate from the First Minister. I will briefly. You speak about the preventative agenda being foremost at your thoughts, but how can you be preventative in your treatment for dental when it is two years between appointments to check things up? Much can change in that period of time. I will come on to some of the detail about the work that we are doing with the industry to provide greater capacity to ensure that the member is reassured. As I said in my earlier remarks, I welcome these debates as an opportunity to talk in greater detail, even with the short time that we have, about the essential nature of community-based healthcare. I am grateful to Willie Rennie and Liberal Democrats for doing so. In talking about dentistry, it would be remiss of me not to set out as necessary context for the debate where about to enter the impact that the pandemic has had on dentistry, both for practitioners and for the public who overnight lost access to this vital service, because it is not hyperbolic to say that the pandemic had and continues to have a seismic impact on the dental sector, possibly more so than many other aspects of our health services, due to the nature of dental care and the high reliance on aerosol generating procedures, stringent infection, prevention and control measures that were put in place effectively stopping activity overnight. Could the cabinet secretary then explain why the private sector in dentistry is not facing the same pressures post-pandemic as NHS dentistry? I think that there are pressures across the dental sector. I do not think that it would be fair to say that any one element is facing those pressures alone. That is why we have come forward with the reform that we have that I will go into talk about shortly. 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 over £150 million of additional emergency financial support to sustain and ultimately preserve the sector. We recognise then and continue to recognise now how important dental care is. While the immediate impacts of the pandemic are on activity are now behind us in dentistry, the sector continues to feel the impact of the pandemic on access and on available workforce. The Parliament will recall that all undergraduate and vocational training was suspended for a year at the height of the pandemic due to those same IPC restrictions. That loss of an entire cohort of 160 dentists is undeniably still felt today and recognised across the chamber, I am sure. I also want to address the comments that Willie Rennie made in opening the debate and the awful examples that he gave of people seeking NHS dentistry and the length that some people have gone to in absence of being able to do. I recognise that there are challenges, of course I do, and 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. I thank colleagues for that plan. Those paying attention will see that in many areas is a direct copy of the very actions that this Government is already taking. Their proposed plan outlines intentions to reform the funding structure for NHS dentistry, something that the Scottish Government has already delivered through significant route and branch payment reform on 1 November last year. The reformed payment system comprises a completely new fee structure designed to attract dentists to provide NHS care and ultimately improve patient access and building 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 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 that almost 400,000 unique patient contacts in NHS primary care dentistry in November 23 alone does not reflect a system that has been suggested as being in crisis. That said, while I am encouraged by the way the sector has engaged with the payment reform, I am not complacent. We recognise that payment reform is not a remedy to all of the ills and we know that the local access problems do remain in some areas driven in part by those same workforce problems that I alluded to earlier. Again, aligned to the member's action plan, we are already actively consulting with the sector on ways to strengthen the NHS dental workforce, including at greater utilisation of highly skilled dental therapists. The Public Health Minister has also initiated and led discussions with her counterparts in other UK nations regarding ways in which we can improve the number of overseas dentists coming to the UK. In that connection, I am pleased to see that, as a result of those discussions, the Department for Health and Social Care has already been moved to consult on reform of this vital pipeline. I am under no illusions that the NHS dental sector has faced significant challenges to continue to face. I give my heartfelt thanks to those dentists who are working in the NHS for their resilience and dedication. The shadow of the pandemic and other external factors are not just in Scotland but across the UK. However, I am proud that Scotland is the only nation in the UK to actively tackle those challenges head on through significant generational reforms, and that is despite already being relatively strong. I should say that we are very tight for time this afternoon. We have no time in hand. I now call on Sandesh Gulhani to speak to and move amendment 12215.3 up to five minutes, please. Thank you. I wish to refer members to my register of interests as a practicing NHS GP. Well, there you have it from the cabinet secretary. Everything is perfect. S&P plans are perfect. Mr Rennie, why bother having this debate? Members in the public at large may well recall the S&P 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 S&P government still has no plan on how to make this possible. The reality is, no matter how big the headline or indeed how many Scots are registered with a dentist, too many patients can't actually get an appointment to see and access full NHS dental services in the first place. This isn't rocket science. A shortage of dental nurses, a lack of dentists, rising costs, including materials and lab works, have left many practices providing NHS services at a loss. It's no surprise that practices are folding. This is unsustainable, and the S&P government has been warned time and time again that this would happen. In fact, the S&P shortage of dentists is even holding back Scotland's space industry as engineers are reluctant to relocate to southern because of our 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 Minister Jenny Minto that NHS dentistry in Scotland is broken and that the S&P government had broken it. Yesterday's NHS dental data modelling report is telling the number of people to see an NHS dentist fell by over a third in December 2023, and it begs the question, what are patients doing if they can't see a dentist? Under the S&P and its botched management, patients are opting for an alternative model, the SNP-DIY model for dentistry. The British Dental Association says that 83% of Scottish respondents to their survey said that they treated patients who performed DIY on their own teeth since lockdown, desperate patients taking desperate measures and taking matters into their own hands literally, ripping out teeth, superglowing crowns, even using repair kits ordered off Amazon. This is gruesome. We also know that more and more patients are heading overseas for dental care, as Willie Rennie has mentioned. In fact, though patients are travelling to Central Europe, even India for standard treatment, refugees from Ukraine are returning to a war zone for care, but the cabinet secretary thinks that this is just unfortunate. Presiding Officer, this is not medical tourism. It is desperation. Of course, the SNP Government, like Corporal Jones, will cry, don't panic and point to its reformed payment system for NHS dentistry. Introduced in November last year, this aims to incentivise dentists to stay in the NHS system. It includes changes to fees for many treatments and reduce the number of treatments available from 400 to 45. While it is too early to measure the real impact of this reform, what we do know is that the SNP have just been tinkering with the problem. The BDA warns that the fundamentals of a broken system remained, and it is because the SNP Government decided to stick with the drill-and-fill model. All of us working in primary care understand the importance of preventative healthcare, and we know that this 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 with problems early, such as oral cancer, bacterial fungal infections and sepsis. Gum disease is also 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, but also cost-effective. This is what dentists want—it is what they believe in. When we talk about prevention, we want to go further than just regular check-ups. Good health, good oral health, relies on healthy lifestyles. We need to be effective in tackling unhealthy behaviours, including vaping, smoking, alcohol consumption, consuming high sugar, foods and beverage. This is so different to the SNP's approach to dentistry, which is geared towards saving the Scottish Government money in the short-term and clearly not towards long-term dental health. Cabinet Secretary, back to the drawing board, please. We need a root and branch reform of the statement of dental remuneration, so dentists are valued and supported and patients are helped to stay healthy and not just queued in a fixed when things go wrong. I move the motion in my name. I now call on Paul Sweeney to speak to and move amendment 12215.1 up to four minutes, please. Thank you, Presiding Officer. I would like to take the opportunity to welcome the new Cabinet Secretary to his place. I was missing me in the last debate not to do so. I congratulate the new member on his excellent maiden speech. The decline in NHS dentistry under Scotland in the SNP, as far as I am concerned, is, frankly, scandalous. The Government is driving NHS dental services into the ground. Oral health is consistently a second thought, and we have people across this country who are unable to sign up to a dentist and rely on emergency dental phone lines instead. NHS 24 calls about dental health exceeded 60,000 in 2022. That is an increase of 40,000 compared to four years prior. That is not good enough. Scotland should be able to access the care that it needs in its local area and 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 have seen an increase in the average waiting time for dental surgery. People are waiting close to a year in some parts of Scotland's urgent and excruciating pain for the surgery that they desperately need. The Government's failure to get to grip with the NHS dentistry issues is, far too often the case, compounding health inequalities, too. In 2022, children and adults from the most deprived areas in Scotland were less likely to have seen their dentists compared to those in the least deprived areas. The gap between child participation rates with dental care was 20 per cent of the points between the most and least deprived, completely unacceptable. Shockingly, just 68 per cent of 10 to 11-year-olds in the 10th most deprived areas in Scotland are decay free compared to 90 per cent in the 10th least deprived area. A stark contrast, patients and dentists deserve better. I can certainly furnish that with a personal anecdote. I have been registered with an NHS dentist for the last 20 years in one of the most deprived communities in Scotland and North Glasgow. For the first time in my life, from a childhood age up to present, I have been unable to get a routine check-up because the permanent dentist has left and locums continually fail to appear and dental appointments have been routinely cancelled. I have not been able to get a dental check-up for eight months. That is just one personal example, despite repeatedly attempting to book it. In 2006, the last Labour-led Scottish Government introduced the world-leading and ambitious child smile programme, giving young people free toothbrushes and toothpaste, as well as two fluoride varnishes a year, vastly improved signs of tooth decay in primary school-aged children. Child smile is an example of spending to save down the line and improving through life costs. It is about prevention. It is a good example of what the Government could do much more of in this country. It was also a targeted intervention to close the oral health gap, and that is why I have mentioned it in the amendment to the Liberal Democrat motion today. That foresight in long-termism is missing from the Scottish Government's sticking plaster approach to dentistry, Presiding Officer. Last year, those benches welcomed the news that the Scottish Government were in conversation with dentists regarding a new payment reform plan to ensure that dentists continue to offer NHS services in light of swathes of dental practices turning away from NHS provision. Often, once they go, they will not be coming back in a hurry. However, what the Government offered fell short of the mark. As the British Dental Association has said, the fundamentals of a broken system remain. Dentists regularly come to me to tell me that they have witnessed a huge increase in the numbers of patients presenting signs of DIY dentistry. I am sure that they have to the ministers too. You will have to look at the explosion of adverts for self-dental scaling kits 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 have performed DIY dentists just on lockdown. That is simply outrageous. Significant change is needed to the NHS recovery plan to reverse the decline in NHS dentistry so that Scots have access to dental healthcare when and where they need it. I move the amendment in my name. 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 of the then health secretary, First Minister, he was writing out to dentists telling them, quote, how pleased he was at 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 an emergency extraction work they would love to perform. Twelve months on, and despite changes introduced by the Government last November, the BDA insists that NHS dentistry has been, quote, in crisis for a generation and the action taken by ministers falls short of the root and variance change needed. Willie Rennie has already vividly highlighted the painful consequences of that failure by Government to get to grips with the scale of challenge facing the sector. I want to use my time this afternoon to illustrate how this crisis in dentistry is playing out in the islands that I represent. As the BDA briefing for this debate makes clear, registration rates for adult patients in Orkney stands at 50 per cent, the lowest in the country. This is no great surprise and comes despite the herculean efforts of local dentists and staff, but reflects what I have been seeing in my own case work over recent years. These figures need to be considered in the context of participation rates, contact with a dentist in the last two years, which last summer stood at 50 per cent of all those registered. The fact that this is down on the figure from 2021, the midst of the pandemic, should flush out any residual complacency in St Andrew's house. In terms of children's participation rates, NHS Orkney's dental lead Stephen Johnson has confirmed to me that between 2020 and 2022, this plummeted from 87 per cent to 57 per cent. While overall dental hygiene among children in Orkney remains good, there must be a serious risk of problems being stored up over the longer term. Mr Johnson has spoken too of a concerning shift in activity over to the private sector. Again, a trend borne out by my own mailbag and one that I think undermines any claim this Government might have, that even basic dental provision in Scotland is free for all at the point of delivery. Addressing this will require the wider reform set out earlier by Willie Rennie, including a sustainable funding model. Changes to date may have stemmed the exodus of dentists from NHS practice, but, as one local dentist told me earlier this week, it won't reopen lists to new registrations. The low-margin, high-volume funding system doesn't work in island and rural settings. Certain treatments are de facto loss making unless delivered in high numbers, which simply can't be achieved in places like Orkney. On recruitment and retention, where again specific challenges exist in island and rural areas, there is a lack of clarity on the support available. I raised this with the Minister in Parliament previously and was told that support is being provided where it is most needed, but NHS Orkney and the remote and rural directors of dentistry group still appear to be awaiting details of the financial allowances. Meantime, the loss of the fully funded remote and rural fellowship is also being keenly felt. In the past, this scheme was well used by dentists in Orkney, even allowing one to go on to provide orthodontic services prior to 2021. There is now no provider of orthodontics locally, leading constituents to contact me, highlighting the impact on their children, for whom there are mental health as well as oral health implications. Replacing the fellowship scheme to improve the recruitment and retention in island and rural areas is urgently needed. The crisis in dentistry persists. More urgent and concerted action is needed by the Government and the Irish Parliament to support the motion in the name of Willie Rennie. We all know that opposition parties do not like to talk about Brexit, but in the context of the debate here today, approximately 60 per cent of the dental workforce is European. To simply ignore it or pretend that it is played no part in where we find ourselves today is beyond disingenuous. It simply cannot be ignored. It is utterly undeniable that Brexit, which all the main parties in Westminster are now signed up for, has had a huge impact on recruitment. Eight long years after Brexit, it has had a devastating impact on the UK labour market, with recruitment of professions within the health and social care sector. It is especially hard, with the rate of EU and European free trade association dentists joining the register halfings since the referendum. This is backed by a nutfield report on health and Brexit, which states that, before the EU referendum, constituents of well over 500 dentists trained in EU and European free trade association registered in the UK each year. We made up of around a quarter of additions to a workforce. This dropped sharply around the time of the referendum to around half its previous levels and has never recovered. Brexit has brought nothing but harm to people, communities and businesses across Scotland. The debate today is just yet another example of its devastating impact. Scotland needs a migration system that is both humane and meets our social economic needs. We are certainly not going to get it why we take part in the broken Westminster system. However, in the face of those challenges, the Scottish Government remains firmly committed to sustaining and improving patient access to NHS dental services. Despite the challenges presented to the profession because of global perdenic and the disastrous restrict, the Government has maintained a strong track record in growing NHS dental workforce in Scotland, with 57 dentists per 100,000 of the population that continues to work closely with the BDA and others on recruitment and retention of dentists, particularly in the area where it is known that the problem is most acute. It is worth noting that, in respect, Scotland continues to help to perform England when it comes to a number of dentists per head, compared to England's 4.3 dentists. Northern Ireland 6, Scotland has 5.9, and Wales has 4.6. In England, the number carrying out NHS work per head of population has not risen in a decade. It is fair to say that 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 of 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 generation and provides practitioners with a whole new suit of fees that are designed to provide a full range of care and treatment to NHS patients. That reform will provide a long term sustainability to a dental sector and will encourage dentists to continue to provide NHS care, helping to further mitigate some of the access challenges that we are seeing. Payment reform improvements system for both dental teams and patients in the first step in the process to make services available on NHS effect that are changing oral health needs of the population. It also reaffirms the Scottish Government's commitment to sector and to all NHS patients in Scotland. This modernised system will increase clinical freedom for dentists, will provide long term sustainability to the sector and encourage dentists to continue to provide NHS care. Scotland is an only part of the United Kingdom where free examinations are available to NHS patients and this will continue. All patients will receive free NHS dental examinations with those who are exempt, including children and young people under 26. Those uncertain benefits continue to receive free care and treatment. In conclusion, I believe that people in Scotland do recognise and appreciate this Government's commitment to sustaining and proving patient access to NHS dental services. An early last week, I received a call from a constituent who wanted to reach out after hearing about the debate planned for this afternoon. The general man wanted to highlight his recent experience and access to emergency treatment. He was of firm belief that he would not get the level of quality of care that he received anywhere else but in Scotland. Presiding Officer, it is an improving picture in the NHS dentistry and building on his progress is an absolute priority for the Scottish Government. I call Sue Webber to be followed by Claire Baker. Two years ago, the Scottish Conservatives held a debate that was called preventing the collapse of NHS dentistry in Scotland. Two years on from the debate, here we are, with NHS outcomes in Scotland worsened, waiting times for all sorts of NHS treatments have increased. 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 the pre-pandemic rates. That raises concerns further that rural and more deprived areas are likely to suffer even more disproportionately with negative oral health as a result of that. Indeed, 90 per cent of respondents to recent BDA survey say that they believe that oral health inequalities in Scotland are on the rise. Oral health can tell us a lot about our general health. Regularly monitoring identifies and deals with problems early, not just oral issues but oral cancers. We have heard from Willie Rennie about the impact of late presentations and the catastrophic effects that it can have on survival, but there are also bacterial and fungal infections that cause sepsis. Gum disease is also linked to higher risk of heart disease and dementia. Both are diseases that cause a disproportionate number of deaths in Scotland. However, dentistry is becoming harder to access with waiting times increasing. The 2023 British Dental Association survey of general dental practitioners showed that nearly 60 per cent had reduced the amount of NHS work that they undertook since lockdown. Four in five say 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 was 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 the people registered with an NHS dentist in Scotland not having seen a dentist in the past two years, where 1.2 million people have not had a dental examination or treatment in five years. The crisis and access to NHS dentry in Scotland has resulted in many desperate patients taking matters into their own hands with DIY dentistry or heading overseas for care, which we have heard from many members and resorting to putting superglue on their dentures should really be a wake-up call to all of us. Worrying the gap between the most deprived and least deprived children who have seen a dentist when the last two years has widened, in 2021 55 per cent of the most deprived children had seen a dentist compared to 73 per cent for the least deprived children. In September 2022, that had risen to 56 per cent of children from the most deprived backgrounds, had not seen a dentist in the last two years or had, sorry, I'm getting myself a bit tongue-tied, it's hot in here, compared to 76 per cent for the least deprived children. Let's remember 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. Robert Donald, the chair of the BDA's Scottish Council, has warned that there could be a wholesale exodus, as I've mentioned earlier, of the provision 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 this unprecedented challenge. Dental practices need support from the Scottish Government, so Mr Gray, the new cabinet secretary and the SNP must offer more solutions. Healthcare, staff and patients have been completely let down. The recovery plan is not fit for purpose. We want a plan that is clear to deliver modern and efficient local NHS, and for dentistry specifically, this means an end to drill and fill and prioritisation of prevention and one that reflects modern dentistry. As Willie Rennie has highlighted in Fife, we are seeing more people struggling to get access to NHS dentistry. David Torrance can make a defence of the Scottish Government if that is what he wishes to do, but he must also recognise that constituents in Carcody have recently been told that redburn dental practice is going fully private, and he will have constituents who will not be able now to access NHS dentists. The Scottish Government points to 95 per cent of Scots registered with NHS dentists, but following the introduction of lifetime registration in 2010, there is little this figure tells us that far more relevant is the percentage of people who have seen NHS dentists in the past two years, and that is only around half of those who are registered. The dental statistics published this week, unfortunately, do not give an update to this. I hope that further future publications will assess any impact on the changes of access to NHS care. We need more information on registration, because registration numbers do not show that a third of children 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, which will close in the next couple of months, when the meantime cannot get an appointment. Registration without access to dentistry is meaningless. Recruitment and retention are clear challenges. The overall increase in dentists since 2010 has evaporated since the pandemic, and issues with supply of dentists from training or from other countries is a major pressure on the system. In evidence to the Covid-19 Committee on Dentistry, it was noted that private practice was not experienced in the same difficulties. However, we know that dentists are leaving NHS practice and that practices are struggling to recruit new dentists. Practices are closing, and they are leaving patients without access to care. In 5, nano-dent 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 are struggling to get appointments for the past two years due to low staffing, and that struggle will continue as they try to find somewhere else in 5 offering NHS care. Another practice in Glenrothes is to educate many of its patients to a dentist 14 miles away in Cowdenbeath. For those who rely on public transport, there are then real issues around accessibility. In letters advising of closures, patients are being told that it proved impossible to recruit dentists. The letter also recognises 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—there are zero NHS dentists in 5 taking on new patients, whether they are under 26 or not. For those patients looking to register with a dentist, there is nothing they can do but wait. Out of over 50 listed NHS dentists, only two practices in 5 are even operating waiting lists. The BDA is clear that lower attendants 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 brought in last year were not the routine branch reform that those in the profession sought. Instead of shifting to a more preventative-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 improve access for patients. The promise of free dental care for all was not made pre-pandemic. It was made at a point where dental services had been heavily impacted, and we know that there would be on-going consequences. Not only are the majority of Scots still paying for dental treatment, since November, they are now paying even more than they used to. I am concerned at rather than providing quality free dental care when a situation where people are being pushed into using private dentistry with no other option available to them. The changes made in November must only be the beginning of a much more comprehensive reform if we are to see a future for NHS dentistry. As with the previous debate, I wanted to start by thanking all the professionals working within dentistry for their hard work and the BDA for their briefing ahead of the debate. I met with the BDA on Monday and had a good discussion about several of the issues that have been covered so far in the debate today. The raised issues, particularly relating to the backlog created by the pandemic, practice 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 only surfaced when patients experienced pain and disease was much further advanced. We have heard many stories of people not being able to get access and the potential risks of that. The pandemic has undoubtedly had an impact on the delivery of the child smile programme, with children missing out on the programme for a time. The good brushing education on oral hygiene habits that the programme produced are incredible, as well as the preventative measures that were mentioned earlier in the debate. I would be grateful for an update from the minister about the status of the programme at the moment and whether there is an opportunity for those who may have missed some of the programme due to the pandemic to be caught up. In our conversation on Monday, the BDA acknowledged the difference in administrative burden that the reformed payment structure gave, but that the outcome and the effect of that structure cannot be known as yet. Their briefing to us today said the same. Some patients may still be on a course of treatment, which was started under a code on the previous fee structure, so the full effect may not be seen for some time. I asked the BDA about what the measure of success of the new payment structure looked like, and I think that it would be useful to have that clearly laid out from both the BDA and the Government. 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. When 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 may be able to see some of that coming to fruition. There is also a widening gap in the registration levels between the least and most deprived areas, especially in children. More needs to be done to ensure that parents take up registration where they can and that, where there are difficulties, parents are given the support to find care. Some of the causes behind a dip in registrations are complex, and I believe that we need to fully understand the dip in registrations and address it urgently. In my conversation with the BDA earlier this week, it also raised issues with access to general anesthetics for dentistry in hospitals and the number of cancellations. The greatest number of general anesthetics 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 treatments as adults may be able to. However, it is also relevant for adults who have a disability or a particular medical condition that requires that enhanced treatment. It is a waiting time that is often overlooked and in the interests of making a helpful suggestion somewhere in this debate. I hope that the cabinet secretary or the minister may raise that with health boards 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 Child Smile to ensure good oral health for all. All the members in this debate, my constituency office receives a huge number of people who present with various serious problems. Because of the lack of access to NHS dentistry for a while, people had to go to Invergordon, the nearest place to access one instead of Inverness. I see no point in using the short time that I have to repeating those stories, but they are so curling as Willie Rennie's were to begin with. I did the result, of course, raise those concerns with Jenny Minto, the minister, and she pointed out to a suite of a range of actions. I was extremely impressed with the minister's demeanour, the obvious care and time that she had devoted to this matter, and the follow-up response, which outlined a number of those measures. I would be grateful if she might say how progress is being made on the access initiative, the recruitment and retention allowance and the remote areas allowance. I praise the minister for that. As members may have noticed, I do tend not to sprinkle praise around ministers characteristically. Perhaps that is a failing in my part, of course, but that is for others to judge. However, what I really wanted to say today was really to make the wider case that I put in the last debate, because it applies, as the lawyers say, mutatus and mutandus. Just as we see a flood of young people leaving Scotland to practice their medical profession elsewhere in the world, we are seeing nurses, teachers and dentists doing likewise. I do not know how many numbers there are. I was heartened that the new cabinet secretary said that he would get the data, and I think that it is very important. I am very grateful to Fergus Ewing for accepting my intervention. Fergus Ewing is rightly talking about the issue of potential bonds on new dental graduates, but is he also interested, as we are, in how easy it is to register overseas dentists coming to 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 practice dentistry in this country. Fergus Ewing? I totally agree with that. Unnecessary bureaucratic imposter is one of the real things that is holding Scotland back across the range. Incidentally, I was heartened to see that the new cabinet secretary undertook in his first statement that he would be seeking reform, and that is why I am making this speech, because I am trying to be helpful. The ideas of a bond are not new, and they are not mine. I am a practised plagiarist, and our job, I suppose, is to garner ideas from the public from people who approach us. I was accosted in the street by a lady, a somewhat elderly lady, who told me of her plans, and she kindly sent me a very detailed note. She is not my constituent, so I cannot take matter up from her. She did describe 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 in the world, but I am no expert in that. The cabinet secretary can get his hordes of civil servants to do the necessary research, I am quite sure. However, there were also provisions that the teachers had to go up to the rural parts, and that meant that the schools and the hospitals in rural states in Australia had sufficient provision of personnel. The biggest beneficiary of what I am advocating would be the Highlands and Islands. It would be Beatrice Wishart's constituents, and it would be Mr Eagle's new constituents. It would be mine. Therefore, that is why I felt that it was appropriate to put forward this case. I hope that the Government and the cabinet secretary with his enthusiasm of a newbie will adopt this policy, and I think that the public would very much welcome it. We move to winding up speeches. I call on Carol Mock and up to four minutes, please. I am pleased to close this second debate for Scottish Labour, and again, thank the Liberal Democrats for bringing this important debate forward in their own time. Listening to the debate, it is fair to say that NHS dentistry in Scotland is in crisis. Patients cannot get an appointment, dentists are leaving NHS practices, and it is our constituents in communities that are suffering. I want to note, though, that Willie Rennie acknowledged that when services are available, they are, of course, of a high provision, and dentists are doing the best job that they can for their patients. Despite what perhaps some in the back benches think, this is a crisis that comes under much of the Government's making. It should worry them that I do not think that a single member of the public really trusts them to be able to fix it, so they need to demonstrate that they can take action that will fix it. In the amendment today, the cabinet secretary again goes for this blame everyone factor, other than to talk about what the Government's involvement is. It is quite remarkable how often we have to go over this. However, if I am honest, it is not surprising, but we have all talked about the information that we get in our inboxes from constituents. It is an insult to dentists and to patients not to acknowledge some of the things that the Government itself has not put in place. It is fair to say that it is a very self-congratulatory SNP amendment that calls for Parliament to welcome the Government's strategically prioritising dentistry access after 17 years in power. The SNP thank dentists for their continued commitment. We all know from our inboxes that dentists stay in the NHS because of their commitment to the NHS. For patients, it is little wonder that they 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 do acknowledge the impact of the pandemic on dentistry due to the face-to-face nature of dentistry. We know that dentists are by no means recovered, but it would be entirely disingenuous to suggest that this is only a post-Covid problem. The words that have been mentioned by other members of the chair of the BDA Scottish Dental Practice Committee have really made me think—I just quote them again—that the fundamentals of a broken system remain unchanged. The Government has stuck with a drill and fill model that was designed in the 20th century. I know from what we have heard from the dental profession that they tried to help the Scottish Government to get that right. Probably David Torrance in the back row needs to listen that the dentists themselves are saying that there have been no changes to the model of care. Despite recent changes in the payment system, NHS dentistry remains in dire straits with a two-tier system and increasing reality for patients. It feels like sticking plaster in it and it will not cut it. That is from the dentists and the dentists' professions. I also want to mention the oral cancer stats that were given by Willie Rennie and the important fact that that is why we have to get this resolved. I know that I am running out of time, but I thought that Clare Baker gave us some excellent statistics. The front benches should really look at them. There is evidence in the Covid-19 committee that private dentistry is not experiencing the same exit of dentists. That is an important part of the inequalities that are happening. Shocking new figures released yesterday have revealed the scale of the crisis in Scottish dentistry. In December last year, the number of patients able to see an NHS dentist fell by an astonishing 38%. Today, Gillian Mackay talked about regular check-ups not happening since the pandemic and mainly because of the pandemic, but Mr Sweeney was fine during the pandemic and afterwards, but he has said that today he has been waiting nine months to be seen and I have a constituent in angus in complete despair and significant pain that he cannot find an NHS dentist and that is recent and that is now. The number of NHS dental procedures fell by as much as 200,000. The Cabinet Secretary proudly states his government has a free dental care to the under 26, but the sad reality presiding officer is that they cannot find an NHS dentist to treat them. 80% of NHS dentists are no longer taking on new patients and 83% say they will reduce their NHS numbers. Is it any wonder in Scotland that people are having to travel thousands of miles for dental treatment and as we've heard today from Willie Rennie, it's not just ferries that come from Turkey but people are having to go to Turkey for their teeth to be fixed and as Dr Gant Sandesh Gulhane said they're going to India and refugees are going from Scotland back to war zones to have their teeth fixed. Keith Brown said today that Neil Gray was one of his most capable colleagues. Neil Gray says he recognises the challenges. Cabinet Secretary, this SNP government has decimated NHS dentistry and patients are paying the price and as Dr Gulhane said, SNP is tinkering with a problem with an outdated drill and fill model. Sue Weber today talked about the fact that oral health is a good indicator of general health. We're hearing harrowing stories again and again of DIY dentistry with people resorting to Amazon to purchase their own tools for self-treatment. These aren't isolated incidents. According to the BDA, 83% of dentists' respondents to a recent survey— Ms White, if I might just stop you for a second. I am aware of several conversations going on across the chamber. I'd be grateful if they could cease. Thank you, Presiding Officer. Maybe the SNP don't want to hear the British Dental Association. Will I say again for those colleagues who are talking and who are standing chatting to one another at the back of the chamber? According to the British Dental Association, 83% of dentists' respondents to a recent survey reported treating patients that had performed some form of DIY dentistry since lockdown, such as using superglue to fix a crown or pliers, as many of us know, to remove teeth. This is Dickensian dentistry. No one should have to pull their own teeth out or use superglue to repair their dentures. It's disgraceful. For so long, for too long, the public has been told that prevention is better than cure, but 1.2 million people have not had a dental examination or treatment in five years. Carol Mocken said today that the SNP Green Government blames everyone rather than themselves, and they have a track record of 17 years managing decline. In our latest health paper, the Scottish Conservatives have committed to a route and branch reform of the statement of remuneration, so dentistry is financially viable and delivers a modern best practice focused on prevention. Finally, Neil Gray says that he is not complacent, but he must heed the warnings of the experts. I would like to pass on my thanks to all those in the dental profession for the work that they do to maintain the dental health of the people of Scotland. That has been a really interesting and helpful debate. I want to be clear that the introduction of payment reform on 1 November 2023 has been a key intervention to improve patient access to NHS dental care. Those changes were made and were done 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 working in our more deprived communities. I recognise when I introduced payment reform that it is not the magic bullet, it is part of a comprehensive plan of reform. That is what I am working on. I would like to continue, Mr Rennie. That is what I am working on with my officials and directors of dentistry across the NHS health boards. As the cabinet secretary highlighted and others have mentioned, the necessary interruption in the training of undergraduate newly qualified dentists during the pandemic led to a significant impact on the introduction of homegrown talent to the sector. We are working to look at that. Training has now resumed and, in August 2023, we have around 160 vocational trainees and anticipate around 170 from August 2024. We have also raised the point about frequent dental examinations. We have not reduced the number of dental examinations, but we have followed nice guidelines. That will allow dentists to have better conversations with those with poorer oral health to potentially be seen more often than under previous arrangements. That is incredibly important as part of the preventative side of the key work that dentists do. Before Brexit, around one in 10 dentists working in Scotland were from the EU, and in some rural board areas, the percentage was much higher. As a result of that, I personally initiated and led discussions on exploring ways in which we could improve the registration process for international dentists on a four-nation basis, as regulation of health professionals is reserved. I welcome the outcome of that meeting with my counterparts and the consultation that was published last week by the UK Department of Health and Social Care to consider provisional registration with the General Dentals Council for international dentists. I want to be clear that the Scottish Government will design any regulations and framework alongside health boards in NHS Education Scotland to support any international dentists who come to Scotland to practice 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 available dental workforce. I have met the directors of dentistry in the health boards to discuss those. We are actively considering whether we can better utilise our highly skilled dental therapists to provide dental care without the assistance of a dentist, as is currently the case. I am pleased to say that a short-life working group comprising of NHS dentists and dental care professionals working alongside officials has been convened to make recommendations as to how the best way to implement this is. I would like to thank Fergus Ewing for his comments. If I am honest, I was waiting for a but, but thank you very much. In the vein of what Fergus Ewing has suggested, I would like to offer a round table with MSPs that have taken part in this 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 those local access problems and by providing grants, for example the SDAI, up to 100,000 for opening a new or extending an existing practice in an area. We have also got golden hello payments of up to 37,500 for new trainee dentists practising in the area. That is an idea that I note that the UK Government has just announced 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. Child Smile, as Paul Sweeney mentioned, is a great, important piece. The statistics that we got this year—82 per cent of primary seven children in October 2023, having no obvious decay compared to 53 per cent in 2005—shows that a policy that was introduced by the Labour Government but has been continued and invested in and expanded by that this SNP Government is a real success story. I would also like to point out yet another idea that England has copied Scotland in. I believe that the only way to protect our NHS dental services is through independence. Until that is achieved, this Scottish Government will continue to work with Scotland to deliver sustainable services to the people. I now call on Alex Cole-Hamilton to wind up the debate. Thank you very much. I am rather dismayed that you 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 this crisis in NHS dentistry. Marie Todd said at the conclusion of that debate, in her words, that NHS dentistry was well on the road to recovery. Well, a year on, and in large tracts of Scotland, NHS dentistry is dead on arrival. There is no question about it. As we have heard over the course of today's debate, there is a crisis in NHS dental care in this country. My party warned the Government about it last February, and in the interim, it has done very little to stop the rush. I cannot remember an occasion, Presiding Officer, when we have debated this in Government time. There is a fundamental point, a fundamental flaw to the Government's rebuttal in this debate, where once again they lean 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. It has nothing to do with the pandemic. In truth, the SNP has abandoned NHS dentistry. While changes have been made to the payment structure for NHS dentists, as the Government benches were quick to talk about today, it is not enough. Listen to the BDA. They say that this is tinkering with a structure for which the fundamentals are structurally unsound. I say to the Government-backed benches, look at your casework bags, look at your casework bags. I cannot believe that you are not getting this as well. Like Willie Rennie, like others, I have heard testimony, unbidden and requested from my constituents, who tell me a wash with human pain. I am hearing more and more every day from constituents struggling to get an appointment, including one with a 14-month-old baby who just cannot get registered, and another constituent, who was unable to get an appointment after several attempts, said that it saddens me that the NHS dentistry service is so much worse now than when I was a young child in the 1960s and 1970s. Willie Rennie gave us a listening of human suffering from his casework bag in North East Fife. He is not alone. This is not a case of dentists leaving the professional, leaving NHS dental care because of some rush to capitalism or profiteering. However, as a symptomatic of a model of a free fee structure, it is just fundamentally no longer fit for purpose that the British Dental Association has been crying out to this Government to address for a very long time. As Willie Rennie rightly said, far from scrapping NHS dental charges in their entirety, the ones that remain—the ones for people who can still access NHS dental treatment—are seeing those charges increase. Shame on them. We have produced solutions in our motion today. First, we must engage with the dental profession on a fundamental redesign of the free structure. We should look to registration. The minister was quite quick to address Willie Rennie and say that this was a reserved matter. It is not just the general dental council that deals with registration, but the Royal College of Surgeons in Glasgow and Edinburgh is so empowered to deal with it, so let's work with them to make it easier to have foreign workers come and deliver dental care in this recovery. Fundamentally, we need to reform the recovery plan, not just for dentistry but for primary care as well in the earlier debate this afternoon. The recovery plan is no longer worth the paper it has written on and clinicians across the board are crying out for this Government to change it. Cabinet Secretary made his protestations that he had taken on board our plan, but that will be a cold comfort to the constituents that we have heard about today. Sandesh Gilhane was right to expand on the extreme measures that people are being driven to. When our Ukrainian refugee guests to this country who have sought safe harbour in Scotland are prepared to brave the Shahad drones and escander missiles of downtown Kiev to access dental care for want of an NHS dentist in this country, then something is fundamentally wrong. We have heard several times about the very important early warning system that dental care can offer, that oral cancer, if it is caught early, is eminently survivable, but the amount of time that we are asking our patients to wait between appointments, those early warning signals and vital clinical signs are being missed. Paul Sweeney was excellent and absolutely right to point to the fact that 83 per cent—we know the empirical measurement—of how extreme things are in our community. 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 on for botched DIY dental work that they have tried to undertake on themselves, things are Dickensian. It is terrible and it is extreme. Liam was quite right when he said that they will not open lists to registration. Any tinkering around the edges may have changed things or stopped the exodus, but they will not open lists to registration for new patients. For those casework examples, the constituents that we all know of who have been jettisoned from NHS care or have moved into the area, the damage is already done, they are out in the wilderness, and nobody is looking after their teeth. Fergus Ewing, in a typically refreshing speech, gave the lie to all those Government backbenches who clearly are not attending to their casework entries. David Torrance is the extremist example of that, because he was not even aware that his own surgery was closing to new patients. I am aware that he wants me to close. It is emblematic of the rot that has set in due to the 17 years of SNP incompetence. Yes, ministerial disinterest, I make no apology for that. That is exactly what this is. One of my constituents put it best—I will say this in closing—when she wrote, is this 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, Presiding Officer? Thank you. That concludes the debate on crisis in NHS dentistry, and it is now time to move on to the next item of business, which is consideration of business motion 12233, in the name of George Adam, on behalf of the parliamentary bureau setting out a business programme. I call on George Adam to move the motion. No member has asked to speak on the motion, and the question is that motion 12233 be agreed. Are we all agreed? The motion is therefore agreed. The next item of business is consideration of business motion 12234, in the name of George Adam, on behalf of the parliamentary bureau on timetabling of a bill at stage 2. Any member who wishes to speak against the motion should press their request-to-speak button now. I call on George Adam to move the motion. No member has asked to speak against the motion. Therefore, the question is that motion 12234 be agreed. Are we all agreed? The motion is therefore agreed. The next item of business is consideration of parliamentary bureau motion 12235, on designation of a lead committee. I ask George Adam on behalf of the parliamentary bureau to move the motion. Minister, the question on this motion will be put at decision time. There are nine questions to be put as a result of today's business. Can I remind members that if the amendment in the name of Neil Gray is agreed to, the amendment in the name of Sandish Gilhaney will fall? The first question is that amendment 12214.2, in the name of Neil Gray, which seeks to amend motion 12214, in the name of Alex Cole-Hamilton, on improving access to primary care, be agreed. Are we all agreed? The Parliament is not agreed. Therefore, we will move to a vote and there will be a short suspension until our access to digital voting system.