 Gaedda i fod sefydlu fod rhywbeth nhw i edrych amser oant i gynghoriadau tel rail a i niferfer y ffermau fel ddewyr arall felly i gael a chi yn ei gael i gympas Holyrood y ffordd. The next item of business is a debate on motion 3281, in the name of Sandesh Gulhani, on preventing the collapse of NHS Dentistria in Scotland, and I would invite members who wish to speak in the debate to press their request to speak buttons or put R in the chat function. I call on Sandesh Gulhany to speak to and move the motion. We are here today to have a frank debate on the state of the NHS dentistry in Scotland in 2022. For sure, Covid-19 has hit dentistry hard, with practices closed during the early months of the pandemic. Once services resumed, infection control measures continue to limit the number of patients that dentists can see in a given hour. Those are, indeed, serious obstacles, which I will cover more later. However, we should recognise that, for over a decade, since well before the pandemic, the Scottish Government's model for engaging with dentists has been flawed. They are wedded to the old system. There is a lack of focus on prevention, with some regulations even based on outdated practice. Over the years, there has been little appetite by the Scottish Government to reform. In fact, and that is exactly and typical of how the Scottish Government works, it gave practices and the BDA one working day's notice before introducing free dentistry to those under 26. As things stand, it is bleak. The British Dental Association surveyed its members and found a third intent to leave the profession during the next 12 months. Do you recognise that removing and abolishing dental charges was in the SNP's manifesto? We had a whole section on dentistry. Why did he only have one mention of dentistry in his manifesto? I think the cabinet secretary needs to think about how businesses work. One working day's notice is absolutely not enough to allow them to work. There is indeed a risk of an exodus from the workforce, with families losing access to local NHS dentistry altogether, which will hit hardest those in the most deprived communities. We must send a clear message to dental practices and patients that this Parliament is serious about tackling a colossal backlog of unmet treatment and that we have clear ideas to ensure a future for NHS dentistry in Scotland for the benefit of the Scottish people. With dentists having to ventilate rooms for at least 10 minutes between appointments, which they are not paid for, that hourly rate has reduced considerably, to help the Scottish Government committed £5 million for ventilation improvements. However, if you read the small print, this support is limited to £1,500 per surgery, and dentists say that significant improvements to increased patient flow would cost at least six times that amount, but the Scottish Government are patting themselves on the back. Given the issues with schools, I cannot help wonder what ventilation measures the Government had in mind. The cost of everything is going up—disposables, utility bills, dental laboratory fees—so the Scottish Government may wish to speak about record high support, investment incentives in NHS dentistry, but is this spending effective? Is it actually solving anything? If you listen to the professionals who are actually delivering dental care or the Government's own stats, no. Over 3.5 million NHS dental appointments were lost during 2021, and this backlog will continue to grow unless the Scottish Government listens and opens to some fresh thinking. Patients are suffering. Families are not able to see their dentists. Kids are going without check-ups. We have twice the rate of oral cancer here in Scotland as the rest of the UK. This has remained silent for too long. Two years ago, at the start of the pandemic, the Scottish Government came up with an emergency funding package for NHS dentistry. It was a typical knee-jerk reaction, which, according to dental professionals, was not fit for purpose. However, it was a start. What is bitterly disappointing is that, two years later, there is not an interim package on offer that could pave the way for longer-term solutions. Patients need holistic oral healthcare. It has been known for years, of course. If the member believes that the emergency package that was brought in two years ago to support the dental sector throughout the pandemic is so flawed, why is he asking for it to be continued? I will come on to great detail of why. I am telling you if you care to listen, but it is because we need a root and branch reform of what is going on that we are not in a position where we are able to continue because NHS dentistry will be lost. It has been known for years that, in many ways, the current dental treatment and remuneration package is frankly ridiculous. I will go on to explain why. Let us consider cobalt chrome dentures. If you take the lab bill appointment times, dentists working for less than a minimum wage, then there are extractions. To take out teeth, maybe to prepare a teenager for braces, dentists are only paid for the first three extractions. There is more. The price code for composite white fillings on back teeth for children has no relation to what is required. In terms of time or complexity, taking overheads into account, dentists can make a loss. In Scotland, dentists are not allowed to place a white filling on the biting surface of a back tooth, only metal. Patients either pay or are disadvantaged with a mouth full of metal. Yet a white filling can be offered in England and Wales. There seems to be no reason for this other than that the Government's regulations are out of date. We are seeing lower patient participation in our most deprived areas. Oral health inequalities will translate into long-term, higher disease burden, as the chances of picking up early signs of decay and oral cancers at routing check-ups are reduced. Also, delays in treatment will mean higher costs to NHS and worse outcomes for patients. NHS dentistry in Scotland was in crisis before Covid hit. As we come out of the pandemic, we know that millions of our fellow Scots have missed out on important oral health checks. We also know that dentists are exhausted, demoralised and many are looking for the exit to either change careers, take on more private work or go overseas where demand is high and remuneration is fairer. Dentists and their staff are being abused by frustrated patients because of how long they have to wait. People think that dentists are rich. It is worth noting that between 2009 and 2019, taxable income of dentists in Scotland eroded by 35 per cent, the Scottish Government has failed to grasp that NHS dentistry needs to be adequately funded and retain a skilled workforce that includes dental nurses, technicians and support staff. If we do not help the profession, we risk losing NHS dentistry forever. The Scottish Conservatives want NHS dentistry to succeed, and that is why we are calling on emergency funding to remain as an interim solution, whilst we discuss with the British Dental Association a root and branch change. We believe that we also need a 30 per cent increase in tariffs as an interim measure. We need to ensure that dentistry is financially viable based on delivering holistic modern best practice services and on prevention rather than fee per item and drill and fill culture. Finally, by supporting our dentists and their practice, they have a fighting chance to work through the backlog and the goal to offer every Scott a dental check-up in 2022 and to stay on track in accordance with clinical guidance thereafter. I move the name in my amendment and we will support the Labour amendment. I will now call on Marie Todd to speak to and move amendment 3281.2 up to six minutes, please minister. Thank you, Presiding Officer. Thank you, Sandra Scalhani, for raising the important matter of patient access to NHS dental care. The dental sector, as we all know, has been disproportionately impacted by the nature of the pandemic. In order to protect patients and staff, dental practices are required to operate with specific infection prevention and control measures, including a fallow time between patients and full PPE protection. During the initial lockdown in March 2020, dental practices were closed to face-to-face patient care and NHS board centres largely focused on emergency and urgent dental care. Since that initial phase of lockdown, dental practices have slowly remobilised, offering increasing levels of care to their patients. While registration levels remain comparable with before the pandemic, those patients attending a dentist in the past two years has fallen from around 70 per cent to 53 per cent, and that is entirely due to the impact of the pandemic, which is why the Scottish Government has supported the NHS dental sector throughout the pandemic with an additional £50 million of financial support payments. I ask what assessment the minister or the Government has made of the impact of the decision to remove the financial top-up support from the 1st of April for NHS dentistry. I will go on to explain what we have done is carefully avoid a cliff edge. We are not simply removing it, we are replacing it with a system that rewards activity. We are aware that what we need to do is get more patients seen by dentists. We have given an additional £50 million of financial support payments, but we have also provided specific funding to mitigate the impact of the pandemic on dental activity. That includes £7.5 million funding for new dental drills, £5 million for ventilation improvements and £35 million of NHS PPE to date. The Scottish Government is determined to ensure that NHS dental services emerge well-placed to care for the oral health of the whole population. We have also committed, certainly, on the basis of the statement that the minister just made. What does the minister say to the British Dental Association, who says that her Government's approach to dentistry in Scotland could spell the end of NHS dentistry in Scotland? The Government is unashamedly putting patients first in our thinking about how the dental services are delivered in Scotland. In order to ensure that the people of Scotland have access to NHS dentistry free at the point of need, we are working really hard to support the dental sector. I would be interested to hear from any intervening Conservatives whether they actually support that commitment to NHS dentistry being free at the point of need. We have committed to tackling Dr Gunhut Gohani. It is interesting because there is a total lack of a financial package. I wonder if the minister has simply outlined right there a new support measure coming in April and how she continues to fund. NHS dentistry needs to be free at the point of care, but we need to have a financial package to actually have that, which you have not said. I am very pleased to hear that commitment from my Conservative colleagues. It is absolutely wonderful to have cross-party support for free NHS dental care for everyone in Scotland. Absolutely delighted. Let me continue and set out the financial package that we have put in place in order to support that. We have committed to tackling the backlog in care. We have announced an additional £20 million of increased fees this month to help to see them through more face-to-face patients, including those from our most deprived communities. I have let you intervene twice, Mr Gohani. Will you allow me to proceed and set out what financial support we are giving to our dentists? The funding announcement is part of a 9 per cent increase in the overall budget for NHS dental services in 2022-23 to support a return to more normal levels of activity. The additional money will deliver enhanced examinations for everyone, children and adults. Children are a key focus as we recover NHS dental care. We have taken steps to expand the funding of the child smile programme in dental practices, increasing it up to 17 years of age. The Scottish Government absolutely recognises the need to address oral health inequalities arising from the pandemic. We are making additional child smile interventions of £2 million over two years from April 22 to support the distribution of additional tooth brushing packs and recruitment of dental health support workers. Those initiatives will focus on families and children living in areas of disadvantage, especially those from minority ethnic backgrounds. The National Institute for Health and Care Excellence guidelines state that recall intervals for parent patients who have repeatedly demonstrated that they can maintain oral health who are not considered to be at risk of or from oral disease might be extended over time to an interval of 24 months. Our vision for NHS dental services is to ensure that all persons with the same clinical needs should be treated in the same way, and that special attention is paid to actions that might further disadvantage the already disadvantaged and vulnerable. As part of that, we will engage the sector in suitable reforms that allow dentists to practice modern dentistry, including the introduction of an oral risk health assessment. There are a number of vitally important processes that we are putting in place. What we must do is link financial support to dentistry to seeing patients. We must reward NHS dental teams for improving patient access. The focus needs to be on recovering the sector. Minister, could I just ask you to move the amendment? I now call on Jackie Baillie to speak to and move amendment 3281.1 up to five minutes, please. I never thought that I would stand here and say that the very existence of NHS dentistry in Scotland is currently under threat. The Government's complacency in light of that is genuinely deeply concerning, because NHS dentistry is in crisis. From the millions of lost appointments to the struggle to see an NHS dentist, plummeting staff morale and widening social inequalities, it is clear that urgent action is needed to pull our NHS dentist services back from the brink. Almost half of people in Scotland have been unable to see an NHS dentist for the past two years. I know that we have had a pandemic, but the path to recovery is far from clear. Figures from Public Health Scotland show the number of treatments up to March 2021 was down by something like 75 per cent. That equates to as many as 3.5 million appointments having been lost. That is a backlog that will take years to clear. Measures imposed on dentists by the Government due to the pandemic has meant that the number of patients that NHS dentists are able to see is still severely limited. The British Dental Association has told us that, despite the best efforts of dentists, returning to business as usual is still a distant prospect. It is important to note that those restrictions did not apply to private dental treatment, a surprising omission by the SNP Government. No wonder so many people were turning to private dental care because the Government has left them with no choice to get the essential care that they needed. The consequences of that are likely to be profound. What we are effectively seeing is the backdoor privatisation of the Scottish dental sector. It is not as simple as lifting the restrictions and everything will be fine because 80 per cent of Scottish dentists are planning to reduce their NHS commitment if the Government reverts to pre-pandemic arrangements. Let me translate that for the Government, because reducing NHS commitments means doing the same work but in a private setting. That will simply deepen inequalities. I am very conscious of time that I apologise to the people who want to intervene, but yesterday I was contacted by a woman who raised the issue of appointment deposits. That was new to me because to attend her free NHS check-up and receive a £13 basic dental clean, she is being charged a £20 deposit. At a time when the cost of living is skyrocketing, many families cannot afford to part with £20, especially for an appointment that should be routine. Let me turn to inequality. Public Health Scotland tells us that less than half of adults from the most deprived areas have seen an NHS dentist over the past two years. For the wealthiest areas, it is well over half. Those inequalities are only starker when it comes to children's dental care, with only 55 per cent of children from the most deprived areas being seen by a dentist in the past two years, but it is 20 per cent higher for those from the least deprived areas. It was, of course, Scottish Labour that introduced child smile. We did that to tackle inequalities in oral health and to ensure access to dental services for every child in Scotland, regardless of background. I am pleased that the Scottish Government has continued it. It is, however, depressing that the considerable progress made in child dental health is now going backwards. That coupled with the fact that those from poorer backgrounds are less likely to have received treatment is nothing short of a national disgrace. Dental care, under the SNP's watch, is fast becoming the privilege of the few who can afford to go private. That is why Scottish Labour's amendment calls for action to avoid a two-tier dental system. It is essential that emergency funding for dentists does not stop at the end of March. I do not understand how any Government could look at the current state of NHS dentistry and deem now to be in appropriate time to end support. Although I note the list of money that the minister has outlined, I welcome it. It is not just a case of more money. It is the current model of funding for dental services that needs to change. The current model is about as old as the NHS itself. That is older than me. It is no longer fit for purpose, a fact recognised by the chief dental officer. The current fee per item model is not sustainable. It relies on high-volume turnover and does not reflect the need to prioritise prevention or give dentists the time to care. It is not a question of more examinations. It is a question of better outcomes. However, the Government should really listen to the Scottish Dental Association, listen to the British Dental Association on this point. Consultation on changes were promised two years ago. They were promised again last year, but nothing has happened. Please stop promising to consult and actually do it. Do it before you stop the support of NHS dentistry or it will fall off a cliff-edge and end up being privatised, and that will happen on the SNP's watch. I move the amendment in my name. Thank you. I call Alex Cole-Hamilton. Thank you very much, Presiding Officer. I am very grateful to Dr Gilhane for securing time for this important matter in Parliament today. As we know, it is estimated that around 5 million people are registered with an NHS dentist here in Scotland, which represents 95 per cent of our population. We should all be able to expect check-ups, treatment and assistance wherever and whenever we may need it. It should be universal, regardless of where we live or what we can afford. That is the cornerstone of our healthcare system, of which dentistry is, of course, as we have heard this afternoon, a key service. However, of late, that reality is diminishing. I know that I am not alone in this chamber when I say that I have had many, many constituents contact me with being unable to access basic NHS dental services, with some having to wait months for so-called emergency appointments. As Jackie Baillie rightly raises the new spectre of deposits for appointments, that is not surprising if you look at the data from last summer, which revealed residents across Lothian waiting up to six months for routine dental care alone. Of course, I will. It is early clear that the practice of deposits in advance of NHS appointments is not loud. We have asked the private dental practices to follow NHS rules by healthcare improvements Scotland. Alex Cole-Hamilton I am very grateful that the minister and the Government are taking that seriously. People have especially got in touch about being unable to arrange appointments for their children. Many children across Scotland have not had a check-up in years. Of course, that is in part down to the pandemic, but it is also about availability. It is particularly worrying that children will not receive attention during such an important growth period in their lives when expert eyes are needed the most. That was the Government that used child dental health as a tool, and it was a metric for poverty when it first came to power in the national indicators. Instead of being provided with the care that it deserves, Scottish patients are instead being told to look for private care, with that being simply out of the question for so many families, yet another barrier is being placed before those who are struggling with the cost of living the most. According to the most recent data, only 55 per cent of children were able to get an appointment from the most deprived areas of Scotland compared to 73 per cent in the least deprived areas of our country. That is a health inequality. Dentists in Scotland have warned us that such disparity will contribute towards a healthcare inequality gap in which disease and long-term problems will become more and more commonplace among the most disadvantaged. That simply does not cut it. It is not just about dental check-ups. Mouth cancer can be missed from important screening appointments. There are many groups across society that need our attention regarding this issue. It was only on Monday that I spoke to a constituent who was also a veteran. He told me that a huge lack of co-ordination across services meant that veterans routinely struggled to access dental care on leaving the armed services. That needs to be noted in any changes in providing services going forward. It is not only our patients who are struggling, but our dentists, who are also under enormous pressure. Scottish dentist Dr Douglas Thane said recently that dentists have been repeatedly asked to provide an, I quote, a fine dining experience with McDonald's-like resources. This is leaving dentists having to sacrifice their own welfare for the sake of providing basic services. They should be given the resources to deliver. This is, sadly, another example of those who work in healthcare being burdened with poor mental health as a result of the job that they chose to do. That is why my party's burnout plan provides mental health services to dentists and other healthcare practitioners. All NHS staff are still so important. Not only does the current situation put an ordinate strain on our dentist, but it also causes a much deeper problem. Dentists within the NHS are being handed a severe lack of funding and slashed unit prices, which is being combined with an increased demand for dental services. It is a perfect storm. I will finish by saying that our dentistry system needs to be accessible to everyone whether a radical overhaul is needed. That is why the Scottish Liberal Democrats will be supporting Dr Gilhane's motion. We now move to the open debate and I call Finlay Carson to be followed by Christine Grahame. They often say that life is short and you should smile while you still have teeth. Sadly, there will be a lot of unhappy people right across Scotland unless dramatic action is taken to start tackling the enormous dental backlogs that are growing longer day by day. Tragically, one of the most serious legacies of the 15 years of this Government's failure—and there are plenty—is the worrying rise in dental inequalities, none more so than within rural and deprived communities across Scotland, that have already been the hardest hit during the last few years of Covid, with fewer than half of adults being able to see their dentist. Perhaps even more alarmingly, only 55 per cent of children were able to do likewise. To add further to this bleak outlook, dentists have already warned of a max exodus in the health sector that will leave many people with little or no access to dental care unless new funding and measures are urgently put in place. The British Dental Association has already revealed that four in five dentists will reduce their NHS commitment, leaving huge numbers of NHS patients with a stark dilemma. Either go private or simply do not go at all. In many cases, there is no other option. Just bite the bullet and excuse the pun. Having to pay into an expensive dental plan at a time when most households can all afford to take on extra expenses, or watch your smile disappear, that is the option. Like many of you, I am sure that my correspondence on dentistry issues has grown dramatically in recent weeks. One constituent in Stranraer, in my Gallyw and Western priests constituency, told me of the plight facing her children's access to dental treatment and care. She said that she was always of the opinion that all children got dental view and treatment free of charge within Scotland. However, this is no longer the case, she informed me. The majority of dentists in the region now refuse to take any children on to their lists unless their patients' appearance register privately and pay into an expensive monthly insurance scheme. There are few exceptions, but there is one dentist and de Fries who are still accepting NHS patients. However, that would involve her on a 150-mile round trip. Most dental practices state that they are full and unable to take on children, yet, if she paid, all of a sudden they can be seen. That discriminates against those from a less well-off background where parents cannot afford the schemes. Another constituent informed me that her children registered with a new dentist last October, an appointment was scheduled for January but cancelled. However, if she paid for them to go privately, she could be taken straight away. If I was able to pay private, I would go, but with a grown family and increasing living costs, there is no way that I can afford it. However, I feel that this is the way things are being forced. I am also reliably informed that not one dentist in Sonarra is now taking on new NHS patients. It begs the question of how many people are expected to afford private dentistry, even if they can find one. In Castle Douglas, there is another dentist not taking NHS patients, again leaving many families struggling to make arrangements. It is a little wonder then that the number of children registered with an NHS dentist is declining in my region, a situation that must surely be addressed as a matter of urgency. The warm words for the minister will be of little comfort to my constituents in Sonarra whose children have no access to NHS dentists other than having to travel for 150 miles. Can you imagine a cry if you are asking patients in Edinburgh or Glasgow to travel to Dundee to see their dentist? The Government thinks that an indicator of success is simply crowing about more equipment or increased funding and fail repeatedly to recognise that the indicator of success right across the health sector is better outcomes for patients. The SNP Government is giving us very little reason to be happy by urging the cabinet secretary to urgently move to address this growing crisis and to find the necessary resources that will at least let our children smile. Thank you very much. First, I want to register my thanks to all in the medical services, but focusing on this debate and dentists for endeavouring to deliver essential services in these unique and difficult two years, which are still continuing. It is obvious that dentists, in particular, with the necessary use of aerosol procedures, let alone the intimacy of dental contact with patients and the design of their facilities would find it particularly difficult to tend to their patients. People, too, would be avoiding treatment for fear of Covid. The backlog was therefore, as in other areas and not confined to the health service, unavoidable though none of us could protect how far it would go, but the case is picking up now in delivery of services. Our concern and our understanding of why we are here now should be agreed. However, the hyperbolic nature of the Conservative motion reminds me more of Dad's army. We are all doomed. We are all doomed. God bless, private Fraser. I have four minutes. Oh, I will take the intervention if you are going to say something interesting to me, Mr Gulhane. Would the member agree that the financial package that was announced just now by Minister Todd clearly does not allow free dentistry for all, as she said it would? That is a path that we are taking. It is not tomorrow. That is obvious from what the minister said. However, on your headline news, it is very good for the tabloids preventing the collapse of NHS dentistry in Scotland. What a headline. I will also come to this in a minute. An interesting point that Mr Gulhane made. Although, additionally, dentists received, along with other medical professions, a 3 per cent pay rise last year for recognition of their efforts during the pandemic and in line with the recommendation of the independent UK review body on doctors and dentists immunisation, Mr Gulhane reminded us that this is not a criticism of dentists but a fact that they are businesses. They are not services. They are in contract with the NHS and there is a conflict. There is a conflict. They are businesses just as many GP practices are. You use the term, Mr Gulhane. The member used the term, they are businesses. That is what I am reflecting on. It is not a criticism, it is that we have this hybrid situation where the NHS is contracted to provide services to professionals who also have to make profits to take in partners to run businesses. There is the same conflict in GP practices and that is something that we must be frank about and address. What the minister has already addressed is if you add together everything that the minister said in her statement, at the beginning, 112.5 million of public funding has already gone out to dentists. In reference to what the member said about Dumfries and Galloway in his constituency, where the provision of dentists is insufficient, as of the 7 of February this month, for example in Kellsin, Belch and not my patch but in the Borders and in parts of Dumfries and Galloway, I am subject to certain criteria to recruit and retain. There is an offer of 25,000 over two years to dentists to go into those areas where there is a difficulty in retention, which I accept there is but the Government is endeavouring to do. You see, in the real world that I live in, we have fixed budgets and every time I hear from there and from there calls for funding, I say to myself, where is your money tree that I do not have in my back garden and the Government does not have in its. If you collectively want those things, say where the money is coming from and have it in the budget. I am pleased to be speaking in this debate. I was thinking back to debates that I had in this chamber on this particular topic and there has always been inequality in dental care, as in other healthcare sectors. There are those who never get access to good oral hygiene and care. I remember being shocked at the number of children who do not even have a toothbrush, let alone understand good oral hygiene. The number of parents who do not know how to teach their children to brush their teeth and the steady increase in children having to have extractions, especially in the lower SIMD areas. A dentist friend of mine used to give me hundreds of toothbrushes and tubes of toothpaste to give out to a couple of third sector organisations in Ayrshire, such as Yip World and Centre Stage, who had taken it upon themselves to help with good oral hygiene with parents and young service users. This growing health inequality has only been significantly exacerbated during Covid. I do think that when we discuss health and health inequalities, we tend not to think of dentistry and access to treatment as much as we should. My dentist friend says that it demands just now or like nothing he has ever seen. More and more people are seeking private dentists because they cannot get access to NHS dentists. They are struggling to keep up with far longer waiting lists than they have ever been, and this is not good for swift care free at the point of need. Increasingly, there is frustration from patients on the waiting times, as my colleague Isander Scolhane said, and this has been passed on to dentists inevitably. This is driving that health inequality that I mentioned at the start of my contribution, because, of course, there are those who just cannot contemplate paying for their dentist. I did listen with interest in the minister's contribution and, quite frankly, I think that any dentist listening to her cannot help but be worried, because if that is the representative of the Scottish Government's understanding of the crisis in our dental surgeries, then their head is buried so far in the sand, all we can see is the soles of their feet. I would say to my dentist friend that I would highlight a couple of points that he wanted to make, and that is growing tension in waiting rooms. Masked exempt patients are accusing our dentists of any quality feeling that they have the right to use the waiting rooms causing difficult encounters. Vulnerable people are struggling as they want dental care but are fearful of the risk of exposure to Covid by sitting in waiting rooms. Masked wearing rules and healthcare settings in waiting rooms, he said, should continue regardless of role changes elsewhere to protect patients who remain or feel at risk. Vulnerable and at risk patients have the right to access healthcare and feel safe. I recognise that this flies in the face of the direction of travel that we are going in, but there are those who are vulnerable, whose needs should be considered as we hopefully come out of the other side of the pandemic. Perhaps there are situations that we need to consider where special cases can be made to ensure equal access to healthcare. I think that that is right after all. He said that it is harder to keep staff. The level of PPE has worked as he is not aware of any patient to dentist infection. That is great news, but it is really difficult to wear. Training a nurse, he said, for three months and has now handed in her notice as they are struggling to wear gear. There is a noticeable increase in headaches, and he suspects that that is due to PPE. He says that the PPE needs to continue, but we need to acknowledge and recognise that dentistry is now really, really struggling. As my colleague, Sandesh Gauhani, said in his contribution, there is an increasing backlog. There are concerns from the profession that the current settlement is going to prevent at financially viable sector. The Scottish Government needs to recognise that the pressures on NHS dentistry not only is driving patients towards the private sector, it is driving dentists towards the private sector. It is absolutely crucial, therefore, if the Scottish Government truly wants to tackle the significant and growing health inequalities that exist in access to dental treatment, they make the NHS dentistry as viable as they can possibly increase that system that encourages careers in NHS dentistry. I call Carol Muckin to be followed by Bob Doris. It is and, in fact, I think that we will leave here today having made it absolutely clear that there is a serious crisis in dentistry. It is a crisis caused by Government indecision and ineffectiveness. We all know and agree here in this chamber that the cost of living is a constant source of concern in our communities at the moment. However, also of concern is the anxiety and stress caused by uncertainty around health. For many people, that includes for their own and their loved ones oral health. Many parents have expressed to me the on-going worry of accessing a local NHS dentist for their children, and that is simply unacceptable. Of course, Covid is a serious contributing factor to this issue, currently facing dentistry, but we cannot always frame everything in this context. There were very many concerns and problems in the pressures on dentistry and dental surgeries and the availability of appointments before Covid. The truth is, if something is not done, the same problems will be around a lot longer than this episode. This is the stark reality that we face. Dentistry is one of the issues that I hear the most complaints about when speaking to constituents, yet it rarely receives the attention that other forms of healthcare get. Any assessment of the Scottish Government's stewardship over more than a decade would be far from positive. The record on delivering positive healthcare outcomes for the people of this country in dentistry and beyond is poor, and they cannot get away with this any longer. In fact, it often seems that when it comes to dentistry, we have an implied belief that it truly is a secondary concern, and that, really, if you are particularly concerned, you should simply go private, because this Scottish Government does not have the solutions—not at the moment, thank you—to the significant problems that we face. We have heard this in the chamber today. That is not good enough. There are thousands of people in Scotland who would have to choose between paying for such procedures and simply persevering, often in pain. We have all heard those stories, and it is not a thing of the past, as we might think. Sadly, I return to an issue that I raise in this chamber almost every day I attend, inequality. As the Scottish Labour amendment notes, thousands of Scots in the most deprived areas of our country have not seen a dentist in over two years, and only 55 per cent of the poorest young people have been able to see a dentist compared to some 73 per cent from welfare areas. That is a deficit that will increase mortality later in life, and we have to address it now. It is simply unacceptable. The worst-off in our society is being left open to serious decay and loss of teeth, and in some cases unidentified mouth cancers. That is not simply cosmetic, it is absolutely fundamental. In essence, we are being left with a two-tier dental system in which those with the ability to pay their way out of problems maintain their own health, while those with no means to do so are exposed to greater risk. Is that the legacy of this Government wants to leave? It is certainly something that those benches will fight against. As my colleagues have noted, the SNP administration is presiding over the near collapse of NHS dentistry, and it is near collapse of NHS dentistry, with over 3.5 million NHS dental appointments lost in Scotland since the first lockdown. Why the enormous is the Cabinet Secretary for Health announcing that the additional funding that she was given to dental practices during the pandemic is to be removed at the end of this financial year? Is this in an appropriate time? This is a serious health crisis, and this Government must change direction. I call Bob Dorris to be followed by Gillian Mackay. I am pleased to speak in this afternoon's debate. I will try my best to, believe it or not, make a consensual speech, because when you cut the hyperbole out of it, there is a lot to agree on, but there is also a lot of hyperbole, let's be honest. First of all, we all commend the work of all those dental practices during the pandemic and the most difficult and challenging of circumstances. We all agree that there is a need to work with dentists and dental practices to financially support them as much as possible as we emerge from Covid-19, including the need for reforms. Reforms, which the health secretary indicated, were actually in the SNP manifesto. The existence of a backlog is clear, no-one has denied that, and there is undoubted pressures. Again, no-one has denied that, there is consensus. What is not acknowledged in the Conservatives' motion is the significant and meaningful investment that has been from the Scottish Government to tackle some of those challenges. I will put them on the record again. Indeed, an additional £20 million only this month alone for fee enhancements. As the Scottish Government also makes clear, there has been £5 million for ventilation, £7.5 million for dental drills, £35 million for PPE and £50 million more generally for wider financial support and a 9 per cent increase in the coming financial year. That is simply factual. However, the most important aspect is in the Government amendment that there is on-going and active discussions between the Scottish Government and the British Dental Association. That is the most important thing to say here this afternoon, not the hyperbole. I thank the British Dental Association for their challenging briefing ahead of this afternoon's debate. I also welcome local dentists who have contacted me raising their concerns about financial challenges. I, in turn, have raised them with the Scottish Government. The chief dental officer has confirmed to me that discussions are indeed on-going with the sector to prioritise and maximise patient care as they move through to recovery. I am confident that the Scottish Government and the British Dental Association will find a constructive and long-term solution. However, the concerns raised with me were cash-related, but there were wider concerns, and I want some of those on the record as well. They wanted more emphasis to be placed on preventative care, something that the Scottish Government wants to see. Indeed, the £2 million mentioned here today, but the Scottish Government for a child smile, is part of that, as is the talk of the oral risk health assessments, to prioritise those most in need to see a dentist. Work is on-going. I would also mention that, in recent years, those similar discussions have happened with community pharmacy Scotland to move away from a model of community pharmacy that moves away from funding the prescribing of medicines, people are in well, to funding positive health messages in communities and direct intervention in communities to promote positive health. There is a lesson there for dentistry, perhaps, with the community pharmacy model, and I would like to mention that. Dentists also mention concerns in relation to bureaucracy and recompense for funding for emergency care, as well as recompense for clinical administration that they did not feel was adequately considered. Therefore, there are challenges that go beyond not just the money in the system but how that money is used in the system. There seems to be a consensus about inequalities in the system and how we use the money already in the system to address those inequalities. If the conclusions we reach as a Parliament are that the quantum of cash has to be focused away from some areas where dental health is very positive to other areas where it is not so, then all members in this Parliament have to be part of that agenda to redirect money from some areas of the country to some communities to others in order to tackle dental health inequalities, and perhaps we can come together as a Parliament to face that, and I support the Government amendment this afternoon. At the beginning of the pandemic, dentists had to quickly adapt to new ways of working. They were forced to close during the early months of the pandemic and then drastically reduced the services that they could offer due to the risk of Covid transmission during aerosol generating procedures. This has been an extremely challenging period for dentistry and the huge backlog of care that has built up during the past two years means that it will remain challenging for some time. Dentists continue to operate considerably below pre-Covid levels due to infection prevention and control measures, which mean longer waiting times. As we recover from Covid, it is right that people who are at higher risk are prioritised and that the frequency of dental appointments is based on clinical need. We need to trust dentists to make those assessments as they are the experts. However, we currently have a system of those who can afford to pay can access dental care more quickly. That inequality cannot continue or, as others have said, we will see a two-tier system established in Scotland. Dentists have a vital role to play in prevention and early detection of illnesses such as oral cancer. It is one of the best examples of how preventive healthcare can make a difference to lives, but that is undermined when patients cannot see dentists regularly. Figures published by Public Health Scotland last month revealed a sharp fall in the number of patients attending an NHS dentist as well as a widening gap in attendance between the most and least deprived areas. In Scotland, we have lifetime registration, which the Greens fully support, but we need people to actually go to the dentist. The pandemic will certainly have discouraged some people who may be less likely to attend. Others will have fallen out of the habit of going. Oral health inequalities existed before the pandemic and are continuing to widen, with data showing record gaps in participation rates. In 2008, the gap between the child participation rates for the most and least deprived areas was only three percentage points, but by September 2021, that increased to 18 percentage points. Every effort must be made to re-engage people with services, particularly those who are most at risk of developing tooth decay or other health conditions such as oral cancer. I would be keen to hear from the Cabinet Secretary what strategies could be used to reach those people who have fallen out of contact with dental services. As I have said, dentists have an important role to play in the detection of oral cancer. Since the early 1970s, oral cancer rates have been increasing and rates are significantly higher in Scotland than the UK average. According to the BDA Scotland, it remains unclear how the pandemic has impacted this. Deprivation is a risk factor for oral cancer and this underlines how important it is that we improve participation rates in deprived areas. Given the difficulties around access to dentistry caused by the pandemic, it is more important than ever that everyone is aware of the symptoms of oral cancer, which include red or white patches on the lining of your mouth or tongue, ulcers that do not heal or a lump in your neck. Your risk is also increased if you are a heavy smoker or drinker, and I would encourage anyone who has concerning symptoms to seek medical advice. I would like to conclude with a few words on the future of dental charges. The Scottish Greens believe that dentistry, like other parts of the NHS, should be free at the point of need. Access to healthcare should never be dependent on someone's ability to pay. We fully support the Government's intention to remove all dental charges to patients by the end of this Parliament, but in order for patients to feel the full benefit of this, issues around access must be addressed and the backlog of care must be worked through. That will be no small undertaking and the dental profession must be supported. The BDA Scotland has expressed concern about a lack of communication regarding the decision to extend free NHS dental care to 18 to 25-year-olds. I would be grateful to hear from the cabinet secretary about the Government's plans to engage with the dental profession while we move towards the removal of dental charges entirely. I now call Evelyn Tweed to the final speaker in the open debate. I am sorry that I cannot be in the chamber today for this important debate. I begin by thanking Dr Gohani for giving us the opportunity to compare and contrast dentistry services in Scotland with England and its attitude of the SNP with that of the Conservative Party. Let's not forget the impact of the pandemic on dental services, which is not unique to Scotland. I thank dentists and their staff for their service during those difficult times. Last year, Health Watch England found that people are expected to wait until 2024 for dental appointments while others are being removed on their practice list. It also found that many were being pressurised into going private. The situation is so bad that Tory MP Bob Sealy, speaking in the House of Commons, called on the UK Government to get dentists into England in the next year or two to help with the immediate crisis. The Mirror reported in November that a dozen Tory MPs, including Health Secretary Sadra Javins, benefit from links to private health firms. Despite Dr Gohani stating today his support for the NHS, his party at its heart supports private healthcare, and that is the core of the issue. If the 2019 prediction of political nostradamus Jackson-Carlo had come true and Baroness Davidson of London links had become First Minister, the Tories would probably be in the process of privatising parts of Scotland's NHS and its dentists. The Scottish Government, however, is totally committed to dentistry and an NHS free at the point of delivery, a point that Mary Todd has strongly emphasised today. Since the SNP came into office, the number of people registered with an NHS dentist has doubled to around £5 million. That can be attributed to record investment in dentistry that provided a 39 per cent increase in the number of high street dentists in Scotland since 2007. There are nearly 56 NHS dentists per 100,000 of the population in Scotland, compared to only 40 per 100,000 in England. Following the May 2021 election, the SNP's first 100 days commitment to deliver NHS free dental care for all—or under 26—has been met, and we are working hard to deliver free dental care for all by the end of this Parliament term. Remember that undergraduate medical and dental students in Scotland study free of charge, unlike in England, where tuition fees introduced by Labour have increased to an eye-watering £9,250 per year. Health spending in Scotland has increased by 70 per cent since the SNP came to power in 2007, and we abolish prescription fees, which are now £9.35 per item south of the border. As Marie Todd's amendment highlights, the Scottish Government is providing further funding of £20 million for dentistry from February and is increasing the budget for dental services in 2022. Ms Tweed, can I ask you just to pause for a moment, please? There is quite a lot of conversation across the chamber. I'd be pleased if we could hear Ms Tweed. I would just like to continue. Thanks, Presiding Officer. By 9 per cent to a record amount, given that the UK Government is failing to deal with a massive crisis in England, perhaps this Tory motion today should be thanking the Scottish Government for the steps that it has taken to support dentistry in Scotland, despite it lacking the full fiscal powers of an independent nation. I am confident that the Scottish Government is best placed to make the correct decisions necessary to continue to improve all NHS services in Scotland. It does not need to take lessons from a party that, at its core, does not support the NHS. I will be supporting the Government amendment this afternoon and the NHS is safe in our hands. We now move to winding up speeches. I call on Paul O'Kane up to four minutes, please. Thank you, Presiding Officer, and I thank Dr Gohani for bringing these important issues to the chamber for debate today. I think that what we have heard today about the state of dentistry in Scotland is deeply concerning. Jackie Baillie outlined that in her opening very starkly in terms of what she highlighted. As we have heard in Scotland, now over 3.5 million NHS dental appointments have been lost through the first lockdown alone. I have seen 239,000 fewer children and young people accessing dental care than we did two years ago. In my region of West Scotland, there have been reports that some people have not been able to see their dentist for 30 months now. I have heard that from colleagues across the chamber as well as Alex Cole-Hamilton and others referenced it in their remarks. Indeed, something perhaps more fundamental that my colleague Carol Mawkin illustrated today is that the decline in access to dentistry is deeply unequal. That was echoed in terms of the rural issues, as well as by Cymru Carson speaking about the inequalities that exist and are particularly acute in rural communities. Whilst the Scottish Government is singing the praises of the recent changes to access, the implementing of free dental care does not count for much when it is nearly impossible to access appointments in the first place. It is clear that the current model is not sustainable. On the current trajectory that the Government is proceeding with, the situation is only going to get worse. Because any NHS dentist started sounding the alarm long ago, we have been heading towards a two-tier system of dental care in Scotland. The BDA now projects that the Government's funding model will be the final blow to a sector that is already struggling so much. Morale within the profession is at an all-time low, with more than a third of dentists stating that they will leave the profession altogether in the next 12 months should the minister's current funding model go ahead. Without an immediate and comprehensive support plan in place, the Government risks the collapse of NHS dentistry in Scotland becoming their legacy. It is on that basis that we implore them to listen to the professionals and to rethink the current position and the wider implications for people across Scotland. The minister must surely know by now that those issues have persisted for years and that Covid cannot explain all of the issues away. When we have more and more people turning to and accessing private dental care, we know that NHS dentistry is not collapsing due to the level of aerosol generating procedures, but rather because it needs a fundamental overhaul of services to stop privatisation through the back door. To only cite Covid, I think undermines the hard work that NHS dentists have put in to mitigate years of problems and underfunding. I do want to support and welcome the commitment of the Scottish Government to further expand the child smile scheme. We on those benches are proud that the actions made by the last Scottish Labour Government in Scotland will continue to benefit all Scots. What the Scottish Labour's amendment does acknowledge is the very real concerns that colleagues have raised across the chamber today. Those are the concerns of our constituents and of professionals in the dental sector. Acknowledging the scale of the inequality that now exists is part of the steps that need to be taken before the Government can even begin to think about tackling them. It is clear that what we need to see from this Government is a sense of urgency to begin to truly make access to dentistry equal to all people, not just those who can afford to go private or those who live in urban communities. Scottish Labour knows that, in order to fix the system in Scotland, a comprehensive overhaul is required, but we know that, for some reason, this Government seems unwilling or incapable to write the issues in NHS dentistry that we have seen laid bare throughout the debates today. It is clear that the people of Scotland deserve so much better than what is currently being offered, and so do our dentists, and I support the motion in Jackie Baillie's name. I call on Humza Yousaf up to five minutes. Thank you very much, Presiding Officer. I start by thanking our hard-working dentists, but also all those who are involved in the dental sector. I know that there has been a lot of attention paid in this debate to dentists, but of course dental nurses, dental technicians, receptionists and all those who are involved in the dental sector, my thanks goes to every single one of them. I am not just saying that because four of my cousins are dentists themselves. Any suggestion that we have not provided financial support that I am afraid to dentistry during the pandemic is incorrect, so a number of contributions from the opposition have suggested that we have not provided... I am not talking about you, Ms Baillie, do not worry, but others have suggested that we have not provided substantial funding. I disagree. £20 million of additional money from this month, £50 million for financial support, I will in a second, £50 million for financial support for dental practices, £35 million for additional PPE, £7.5 million for dentist drills, which will help, of course, with those aerosol generating procedures and £5 million for ventilation. I am happy. I promised first to Dr Gilhane. I will give him... I thank the cabinet secretary. The £20 million that was announced in February was not discussed with the BDA. The Scottish Government has not explained its methodology as to how the sum was calculated. No consultation, no transparency. Will the minister show his workings, please? I completely disagree with the suggestion that the BDA does not welcome additional funding to the sector. Of course they do, but what I would say to Dr Gilhane, and that goes to the route of his amendment, is that he called the emergency payments flawed. I disagree with that characterisation, but he is asking us to continue them for the next financial year. At a time, of course, when his party often tells us that the pandemic itself is over, again, in assertion, I tend to disagree with. What we are doing, the funding that we are going to announce, and we are still in those discussions with the BDA, will be to link financial reward with activity so that more patients can be seen. I do not have much time, but of course I will give Mr Bailey... I genuinely think with all the greatest respect that you are arguing about the wrong thing. The issue is the outdated model of funding, and I would desperately encourage you to reform that. It is not about volume, it is about prevention. I will come to that. I do not necessarily disagree wholly with Ms Bailey, if she will be pleased to hear that. I am not suggesting that there is no room or no place for reform. I have never said that. In fact, in my discussions with the BDA, I have often said that I understand their desire for reform. What I am saying is that when we have the level of backlog that has been undoubtedly exacerbated by the past two years and the impact that IPC and infection prevention controls have had on dentistry, then the immediate priority has to be to work through that backlog. Yes, let us talk about the route and branch reform of the sector, but what we cannot do is to have a protracted discussion about reform, and in the meantime, patients are still waiting to be seen. Let me also take issue with... Let me just take issue... No, I won't, because I only have two minutes. Let me take issue with suggestions, and I think sensationalist suggestions, that the NHS dentistry was on the brink of collapse and that somehow there was not any progress being made pre-Covid. That is absolutely unfair and the statistics do not bear that out. P7 pupils, pre-pandemic pupils with no decay increased from 64 per cent in 2009 to 80 per cent under this Government. P1 pupils, 58 per cent to 74 per cent in 2020. No, I won't take an intervention. 5.2 million people registered with an NHS dentist in 2019 compared to 2.6 million in 2007 when Labour was last in power. Our record on dentistry and supporting dentists stands on its own. I think that anybody who is fair minded in this would see that there has been progress and improvement in the oral health of the country. Where there has not been improvement and where there is still a need for progress, then again, our model of linking financial reward to activity is absolutely the right way to go. We recognise that uncertainty does presently exist amongst NHS dental teams. That is a fair comment for the opposition to make, but that is why we are not suggesting a cliff edge. We are ensuring a soft transition as we fully recover the sector. In the meantime, I go back to this point on 1 April—before 1 April, the next month—being able to announce a package that I hope will incentivise dentists and dental practices to see more patients. That point about upselling was mentioned by a number of members, and I will conclude on that point. I have as much dismay as any other member about the practice of upselling private plans to the public. I raised this issue with the General Dental Council. Let me say to any member—and any dentist and dental practice watching—that, if members hear cases of dentists upselling private plans, please report that to your NHS board, because that is not allowed under the NHS regulations. Let me conclude by saying that this Government is proud of the record that we have in improving the dental and oral health of this country. As we get out of this pandemic, we will support that sector. I look forward to supporting the sector, but I move to motion in Marie Todd's name. I will call on Sue Webber to wind up the debate up to six minutes, please. Thank you, Presiding Officer. Today, we have heard that under the SNP, NHS dentistry is in crisis. Covid support is set to be withdrawn in two months' time, while even before the pandemic, the SNP was letting down NHS patients with its conveyor belt approach to dentistry. Moral in the profession is at an all-time low, with more than a third of dentists saying that they intend to leave the profession in the next 12 months. One of my constituents in Edinburgh spoke to their dentist yesterday, who said that they feel that they have been abandoned during the pandemic, and the dentists tuning into this this afternoon have messaged me to say that they are quite concerned and rightly furious with some of the comments from the Government today. Failure to act risks sparking an exodus from the workforce that will leave families across Scotland losing access to NHS dentistry for good. We, the Scottish Conservatives, acknowledge those concerns expressed by many in the profession and call upon the Scottish Government to come forward with a plan for ensuring the long-term sustainability of NHS dentistry. As Jackie Baillie rightly stated, the complacency that is shown today by the Scottish Government should be alarmed to us all. Over 3.5 million NHS dental appointments were lost in Scotland because of the pandemic, and this unprecedented backlog continues to grow. It will take years to clear. Despite the best efforts to restore patient care, dental practices continue to operate considerably below pre-Covid levels. Attendance rates have plummeted during the pandemic due to restrictions imposed on dental practices. Just over a half of registered patients saw an NHS dentist in the past two years, and this equates to over 850,000 fewer patients being seen by their NHS dentist compared to pre-pandemic levels. Dental inequalities are widening, and the participation gap between the least and most deprived communities is getting dramatically worse. I thank the member for taking an intervention. We all acknowledge that there is a challenge in recovering the dental sector over the entirety of the UK and ensuring that the capacity increases and that more patients are seen. Does the member agree with the Tory approach in England of penalising NHS dentists, or does he agree with our approach of providing additional funding? I, like the minister, have been elected to the Scottish Parliament, and I will be standing here today talking about Scottish issues. How can dentists, according to what Julie Mackay said earlier, assess clinical needs for their patients if the patients cannot even get an appointment to see them? As Brian Whittle highlighted, the health inequalities faced by our young people are awful. There has been a sharp increase in children having full extractions, and it should shock every one of us in this chamber that some children in Scotland today do not even own a toothbrush. Child dental health is going backwards. The SNP Government must do more to help to facilitate routine NHS dental care. As my colleague Dr Sandesh Gauhani said, the Scottish Government emergency funding package for NHS dentistry that was introduced at the start of the pandemic was not fit for purpose, but it was better than nothing. Yet, from 1 April, the SNP Government will cut this emergency funding while leaving all the infection control measures in place. We are now at the stage. Dentists are usually paid based on each individual item of treatment, however, during the pandemic, this funding mechanism has been superseded by the top-up financial support that recognised the additional infection control measures that severely reduced the number of patients that could be seen. The SNP Government is not planning to reduce or remove those measures despite withdrawing the financial support. We believe that the emergency Covid support cannot be withdrawn, while the strict infection control guidance remains in place. Top-up funding must be maintained for the upcoming financial year, while you decide on your long-term plan for the future. The British Dental Association has warned that, for the Government's plan to end Covid support payments from April, it will devastate dental services across the country. My colleague Finlay Carson also highlighted the stark inequalities faced by families across rural Scotland and rightly reinforces the negative impact that the funding removal will have on 1 April. The move means that the income of NHS dentists will be decimated as many have stressed that it will make their position financially unviable. NHS dentistry in Scotland was in crisis before Covid hit, let's not forget. 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. We are calling on the SNP Government to work with dentists to prevent the collapse of NHS dentistry. It doesn't matter if the treatment or enhanced examinations are free at the point of need if people can't get an appointment. The cabinet secretary must get a grip of the situation and bring forward a credible plan to restore routine dental care and tackle the enormous backlog. The SNP will always put independence obsession ahead of national interests. The Scottish Conservatives Scotland's real alternative is pushing for the full return of routine services and putting the people of Scotland first. That concludes the debate on preventing the collapse of NHS dentistry in Scotland. It's now time to move on to the next item of business before there will be a brief pause.