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Scotland: Putting dentistry on the political agenda

Blog Author Robert Donald

Blog Date 15/04/2021

​How our oral health manifesto is shaping election debate and what else the next Scottish Government needs to do to bridge oral health inequalities.


Ahead of next month’s elections, we have been making the case that in the face of an ever-growing backlog of unmet dental need and a system under immense pressure, it’s essential that the next Scottish Government takes action to bridge oral health inequality gaps and support dentistry.


Since the launch of our manifesto last week, extensive newspaper and broadcast coverage of our action plan, including a front page of The Herald, has finally pushed dentistry up the political agenda.


It’s been an unprecedented week, so here’s what you need to know:


A breakthrough?

In what could be a major breakthrough, the Scottish National Party has heeded our calls for action to increase access and deliver a new long-term funding model for dentistry. Their manifesto – published this morning – pledges to completely remove patient charges by the end of the next Parliament, and to work with the BDA to “shape a reformed funding arrangement for NHS dentists so that they are supported for the future”.


“The Scottish National Party has heeded our calls for action.”

We are of course ready to work with the SNP on these pledges, which could fundamentally change the way dentistry is delivered in Scotland, but we need to see detail. Practices are already struggling to deliver a fraction of pre-COVID activity and need support even to meet historic levels of demand. And of course we need assurances that any loss of Patient Charge Revenue would not lead to a reduction in overall funding for our service.


Following extensive conversations with us in the recent months, other parties are also making wide-ranging pledges on dentistry and oral health. Scottish Labour’s NHS Recovery Plan commits them to making capital spending available to improve dental surgeries to “repair the damage caused by real terms cuts over the past decade.” The Scottish Greens’ election manifesto contains a pledge to work with the profession to ensure the funding and workforce are available to address the backlog generated by the pandemic, and to invest in PDS.


Last night I attended a hustings event organised by the MDDUS and I was encouraged to hear an extensive discussion on oral health, with candidates quoting figures from our manifesto and speaking about the need for a long-term strategy on tackling inequalities and the backlog of care. Parliamentary candidates from all the big Scottish political parties have now pledged to work to ‘bridge the gap’ on oral health inequalities if elected, and we look forward to seeing oral health policies in the other parties’ manifestos when they are published in the coming days.


While I am heartened by our issues finally cutting through on the political arena, we must not stop making our case. The challenges we’re facing are immense and so we need truly transformational solutions.


A system at breaking point

Maybe I’m looking back with rose-tinted loupes, but I can’t help reminiscing about where we were before the pandemic, when a new model of care was being discussed and Childsmile was up and running. We knew much still needed to be done to tackle oral health inequalities and bring down GA lists, but, to me at least, it felt like the future of oral health was up for grabs and full of potential.


Now my practice is booked up for the next 6-7 weeks and every day as many as ten unregistered patients ring up begging for emergency appointments. There’s no end in sight to the backlog of care. We’re having to deprioritise patients because they’re considered low risk. But low risk doesn’t mean no risk. I’m deeply concerned about disease progression in patients who trust me with their care and by the oral cancer diagnoses that are likely being missed.


“The Government is conducting a survey on ventilation, but we need action.” 

Like our colleagues all over the country, we’re trying everything we possibly can to see and treat as many patients as safely as possible, but I estimate that we saw only 30% of our patients in the last year. Dentists cannot be left to stand alone, with new restrictions on care, but no funding for necessary ventilation improvements to minimise the risk from COVID and other infections.


The Government is conducting a survey on ventilation, but we need action, especially in light of today’s plans from the SNP. The Welsh and Northern Irish administrations have already committed capital funding for this purpose and dentists and patients in Scotland deserve no less. Every day we delay on this, dental disease progresses and the backlog of unmet dental need grows.


Prevention is crucial

The pandemic will have widened already stark and persistent oral health inequalities. We urgently need to get back to putting prevention at the heart of care. We must make NHS dentistry sustainable and improve access for vulnerable groups. And, in this context, I believe it would be foolish not to put water fluoridation – a safe, effective and money-saving intervention – back on the table.


It’s time for the influence on public health policy of old and unscientific claims about water fluoridation to be dismissed once and for all. Government may be wary of pushing for water fluoridation in this era of fake news and social media firestorms. But in the face of the widening oral health inequalities, it would be frankly negligent of them not to consider it.


“I’m calling on our political leaders for some courage to stand by the science.”

I’m calling on our political leaders for some courage and determination to examine and stand by the science. It is simply absurd that a case brought against Strathclyde regional council in 1978, which found that water fluoridation was safe, but that the council needed further legal powers to carry it out, completely stopped the roll-out of these schemes in Scotland.


I’ve been campaigning for prevention as long as I’ve been a dentist. I graduated almost 40 years ago now and so it would be wonderful if, towards the end of my career, we finally saw some movement on water fluoridation. It would be a real victory for science and compassion, over ignorance and political cowardice.


Action on water fluoridation should be a complement to, rather than a replacement for, Childsmile. It’s crucial our pioneering preventive programme is not just reintroduced as soon as possible, but also extended in areas with the worst rates of decay, so we can finally close the shameful gap in oral health outcomes between the rich and the poor.


What you can do

While we have already shared our manifesto with all political parties and candidates – and secured some welcome commitments – nothing makes the case more powerfully than hearing directly from you.


Candidates will be out on the streets, on your doorstep, and at hustings events. If you can, please explain to them the problems facing NHS dentistry and ask them – if elected – to speak up for dentists and the nation’s oral health in Parliament. Together we can get the next Scottish Government to consider dental health an essential part of public health as we emerge from this crisis.


You can also share the manifesto with local candidates on social media asking them to pledge to #bridgethegap on oral health inequality in Scotland. Please tag @theBDA when you do, so we can follow up any conversations with newly-elected MSPs and ensure our issues are not forgotten.


Robert Donald


Robert Donald
Chair of the BDA’s Scottish Council