We'll move on to item 6, a statement by the Minister for Health and Social Services on dental reform. I call on the Minister to make the statement—Eluned Morgan.

Diolch yn fawr, Dirprwy Lywydd. The oral health response to 'A Healthier Wales' set out how oral health and dental services in Wales would continue to develop in line with the changing needs of the population. Our vision for dentistry builds on the philosophy of prudent healthcare and fully recognises that system change is required. Dentistry has been one of the more difficult services to recover following the COVID-19 pandemic and this explains, in part, why people experience difficulty accessing NHS dental care. But dental reform is progressing at pace, and I’d like to take the opportunity today to set out how this Government is increasing access to NHS dental care for those that most need it.

I turn first to access for people who have not been able to get a place at an NHS dental practice. I have heard statements recently saying that NHS dentistry is now a two- or three-tiered system. The fact is that there has always been a private dental system, available to those who choose to use it and can afford it. Private healthcare is an established alternative, and whilst we might aspire to provide NHS dental care for everyone, in reality some will prefer to go private, creating a divided market.

Access for people who have not regularly attended the dentist has always been a problem since registration was removed with the inception of the UDA contract in 2006. We have recognised that this is a problem, and have implemented a contract variation for this year, which has been adopted by 80 per cent of Welsh dental practices, with a requirement to give access to new patients. Around 140,000 new patients have now been seen since April 2022, significantly more than we had anticipated. So, we are not presiding over the creation of a tiered system. Instead, we are actively increasing access for the people that were excluded under the previous UDA contract model. We recognise there is more to do, and we will continue with this approach in the next financial year.

There are claims that this change has meant that people who have visited the dentist regularly are being disadvantaged as they can no longer get their twice-yearly check-ups. Members will be interested to know that the NICE guidelines published in 2004—18 years ago—recommended that people with healthy mouths could safely go as long as 24 months between check-ups. The unit of dental activity contract does nothing to enforce these guidelines, and effectively rewards dental practices for seeing patients more often than they need to. Again, this is being addressed through the variation offer, where practices are now remunerated for seeing patients based on a patient's individual risk and needs basis.

Fundamentally, we need to reimagine NHS dental services along that risk and needs-based approach, using our much-strained financial resource to provide care and treatment for those that need it most. And that's why we're doing a reform of the dental contract. It's a fundamental change for both patients and the dental profession, where we can, and will, do more to ensure that the change is acceptable and understood by all.

Another narrative circulating is that many, many dentists are handing back their contracts and turning to private dentistry only. There are some examples of this, but the reality is that there were 413 contracts in operation on 1 April 2022, and during this year, fewer than 20 have been handed back, for reasons such as retirement, practice sale or to go private. In monetary terms, this equates to around 3 per cent of annual expenditure on GDS. It’s important to remember that this funding is not lost but remains with the health board for it to consider how best to replace the services lost. I realise it can be disconcerting for patients when a practice closes or turns to private only, but I can assure them that those services will be replaced. But there will inevitably be a gap in provision during reprocurement. It's encouraging that the vast majority of contract handbacks, particularly the larger ones, are being successfully recommissioned, so this shows that there's an appetite for dentists to take on new NHS dental contracts.

I'd also like to update Members on how we're working on the unique challenge that rurality creates for our dental services. One issue is the workforce. Sometimes, it's difficult to recruit people into rural areas, and we know that people are more likely to settle where they complete their training. Using the ‘Train. Work. Live.’ dental campaign this year, which is launching next week, HEIW have put together an enhanced offer that aims to encourage future dental trainees to complete their foundation year in dental practices in rural Wales rather than towns and cities. Dentists who accept this offer will receive a £5,000 salary uplift. They will also receive additional academic and well-being support for the duration of the programme. This will help to increase access to NHS care for local people in rural Wales.

Finally, in terms of children, I am committed to ensuring that they can access dental services, particularly in those areas where it's more difficult to access a dental appointment. We have the Designed to Smile scheme for children up to seven years of age, and we know that this has had a very positive effect since its inception 13 years ago. This programme normalises the habit of tooth brushing and provides direct fluoride application for children.

But the age group of children I really want to focus on next is secondary school age, because this is the formative age when children start to make more independent choices around what they eat and drink. During the spring, we will be trialling the use of a mobile dental unit on the site of Ysgol Y Moelwyn in Blaenau Ffestiniog. Over a number of weeks, all children at the school will have an opportunity to see a dentist and receive any treatment they may need to take care of their oral health. I think this is a really exciting development, and if it is successful, it could be a cost-effective way of delivering dental care directly into schools in our most deprived areas. It would also reduce demand on general dental services and community dental services. But, more importantly, it would provide much-needed care and treatment without impacting on children's schoolwork or requiring parents to take time off work.

In closing, and to reassure Members that dentistry is one of my top priorities, I want to develop an NHS dental service that is fair for dentists and that meets the needs of the population, one that is based on preventative principles, and provides everybody with an opportunity to take responsibility for their own oral health. Thank you very much, Dirprwy Lywydd. 

I thank the Minister for her statement today. Quite early on in your statement, Minister, you talked about the fact that you've heard some people saying that there is now a two or three-tiered system. Well, I'm one of those people who have made that comment, and we've made that comment in our report from the Health and Social Care Committee. I'm just wondering whether you've perhaps misunderstood, or what is behind that statement. And you also say that, in reality, some people will prefer to go private, creating a market divide. I would suggest—and I want to check if you think this is fair—that it's not so much that people prefer to go private, it's that people have to go private, because there's no other alternative for them because they can't access an NHS dentist.

So, perhaps just to gauge your assessment on that, but perhaps to explain the three-tiered system from my perspective. Some people can access an NHS dentist; some people will go private, but there'll be some people who can't afford an NHS dentist and they cannot also access an NHS dentist either. Therefore, there is a potential three-tiered system. So, I just want to ask: do you recognise what is meant by a potential three-tiered system? 

I think, today, if you don't answer all my questions, answer this one: from a patient's perspective, when will we get to a position where every person in Wales, every resident in Wales, will be able to access an NHS dentist without having to make up to a three-hour round trip? Because that's what we once had; when I first got elected, that's what we had. But when will we get to that position? Give us a date when that will be achieved by, so I can answer constituents who raise these issues with me. 

Now, the British Dental Association have warned that the very concept of NHS dentistry could cease to exist, and they have warned that dentists have described being on the brink of handing back NHS contracts due to stress and concerns about patients' aftercare. That's not me saying that—that's the British Dental Association. And they said in their—. The chair of the British Dental Association wrote to me shortly before the statement was originally scheduled, and what he said, quite frankly, startled me. What he said then was, or what they said, was that the messages have been deeply buried whenever Government answers are given to questions in the Senedd Plenary debates, and that the tone of the Government's replies have been growing noticeably colder towards dentists over the last year. So, I think my question is: why do you think, Minister, that you have alienated a key stakeholder and representative group like this? You no doubt disagree with what they say—perhaps you can tell us that—but tell me why you think that there's been such a divide with the BDA. How many times have you met with the BDA, it'd be interesting to know, since you've come into post? And, how do you respond to their claims, backed up by testimony as well—testimony that I've also heard myself—that the reforms make NHS dentistry a financial risk for professionals? 

Now, it is, of course, totally understandable from my perspective, Minister, that you want to orientate policy towards widening access to patients—that's what we all want; I agree with that, of course. And, after all, we are in a position in Wales where we have the least accessible dentistry in the UK. But the BDA's recent survey of high-street dentists tells us that more than a third would reduce their NHS contracts this year, while 13 per cent said that they would hand back their contracts entirely. Now, to finish, I've heard what you've said, Minister; you've talked about it being a very different picture, and about relatively few contracts being handed back. And you’ve talked about there being an appetite for dentists to obtain new NHS contracts, but that doesn’t feel like reality to me, because in my own health board area—not only in my own constituency, but in the entirety of Powys—not one dentist offers entry for a new NHS patient. My colleague Sam Rowlands has done similar research in north Wales. So, what you’re saying in your statement today doesn’t match reality, and I want to try and understand why that is.

Finally, perhaps you could give us an initial assessment of some of the recommendations and the work and report from the Health and Social Care Committee as well. I’m hoping to extract some initial views on the work of our committee.

Thanks very much, Russell. I think what I tried to make clear in my opening statement is that, actually, there is—we’ve acknowledged that there is—a multitier system. I mean, this is not something new. It has always been the case, that there has been an NHS system and there’s been a private system. So I absolutely recognise that; I wasn’t trying to deny that that’s the case. And whilst I accept that some people say that they can’t afford an NHS dentist, and I completely understand that, in reality, about 50 per cent of people in Wales are eligible for free dental care. That’s the situation as it is at the moment. [Interruption.] It’s 50 per cent of—

Let the Minister answer, because I have many people who wish to speak, and the longer people intervene—well, you can’t intervene, but the longer people speak from sedentary positions, someone’s not going to be able to ask their question.

So, about 45 per cent of the patients who receive NHS dental treatment at the moment are exempt from patient charges as it is, and then, when patients are charged, if you look at how much they’re charged in Wales compared to England, on band 1, people are charged £14.70 in Wales while, in England, it’s £23.80; on band 2, it's £47 in Wales, £65.20 in England. So, we recognise that, actually, also, we do need to make sure that there’s an ability for those who are not eligible for free treatment, especially during a cost-of-living crisis, that we’ve frozen the amount that people have to pay.

I think dentists, we’ve got to understand, are private contractors. We can’t force them to work for the NHS. So, whilst I’d love to say to you, Russell, ‘Of course we want to offer this to everybody’, I simply don’t have the power to do that, because they have to decide whether they want to pick up this option or not. Now, what we have to do is to work with them to see how far we can go with this, and the reality is that, actually, certainly this year, 80 per cent of them have picked up that new contract. What we’ve found is that when we’ve put out those contracts, they have been returned, and actually there’s an appetite to take them up. So, it may be that it’ll be different next year, but our current experience is telling us that, actually, the appetite is there. And whilst they did suggest, for example, that they were a bit upset, that they needed more time to consider the contract, I think we’ve learnt from that last year, which is why the contract variation offer this year was issued before Christmas. So, they’ve had more time to do that.

Obviously, I’m meeting with the British Dental Association in the next couple of weeks, and let me tell you that in Powys, 3,392 new patients have been seen this year.

Thank you for the statement and for giving us prior sight of it. But I have to say that it’s an astonishing statement in many ways, and I’m afraid that it doesn’t seem to reflect the reality of the dental service or patient experience at any level. It’s another one of these statements that gives the impression either that everything is fine or that there are problems, but those problems are in hand—when all of the evidence before us demonstrates that that isn’t the case. The signs were poor early on in the statement when the Minister said:

‘Dentistry has been one of the more difficult services to recover following the COVID-19 pandemic and explains, in part, why people experience difficulty accessing NHS dental care.’

That’s completely disingenuous, I’m afraid. Of course COVID brought huge challenges to dentistry, as was the case with all health and care services. But the issues in dentistry were very serious indeed before COVID hit. And things are getting worse; I am going to quote once again.

I have heard statements recently saying that NHS dentistry is now a two or three-tiered system, and the fact is that there has always been a private dental system—an established alternative. I think that many people will find it staggering to hear a Labour Minister referring so casually to that very real divide between the haves and have-nots. The Minister refers there to just the two-tier system: the haves and have-nots. She can include me on that list of people who have been describing a three-tier system, which she chose not to address.

Perhaps I can explain what we mean by that third tier. It’s not around the affordability of NHS treatment. There are people who can afford to go private. There are people who can’t afford to go private and have NHS treatment. And then there are people who can’t access NHS treatment at all. That is the third tier. A lot of what is driving that lack of access is the growth that there has been in the private sector. People are going private and increasing that private sector precisely because they cannot get access to NHS dental care. This is a vicious cycle and it is getting worse.

When I hear dentists saying that there will not be an NHS dental service in Wales in a few years, do you know what? It’s not hard to believe when you look at the trajectory that we are currently on. We are not creating a tiered system, the Minister says. Well, this Government is presiding over a broken three-tiered system, and entrenching it day by day.   

Now, the Minister refers to contractual changes, which were intended to enhance access to NHS services. She says that 140,000 new patients had been seen. On the face of it, of course, that sounds positive, but it's entirely clear that this is not sustainable. I was speaking yesterday to a dentist who is entirely committed to the NHS, who had succeeded in hitting that target and registered hundreds of new patients. But the process had been so onerous—and had placed so much strain on staff—and it still didn't provide them with the incentive to work in a preventative way, as they would want that they have decided to hand a third of their NHS contract back for next year, exacerbating the problem.

The Minister later says that few contracts have been handed back to the health service. That's one that the Minister isn't aware of. My constituency has lost one in three NHS dentists in a year. The Minister suggests, when that's happening, that there's no problem in having new providers, I can tell the Minister that Betsi Cadwaladr health board, and I will quote them—they are not confident that they can find new providers.

I will use all my time here. There is so much that I could be saying. The Minister constantly repeats that the answer is to see people less often, suggesting that the problem that we have is that people are opposing that. Now, I don't see any opposition to that. I see people who are more than happy to follow the new guidance and to see patients less often. The problem that we have is a lack of sustainability. There is hardly any talk here of training more dentists. We need that for sustainability. We need more private dentists to return to the NHS. 

I am going to refer in my very last seconds, Deputy Presiding Officer, to the last statement from the Minister.

'In closing, to reassure Members that dentistry is one of my top priorities, I want to develop an NHS dental service in Wales that is fair for dentists'— it clearly isn't; they are leaving in droves—

'delivers for the risk and needs of the population'— clearly, it's not doing that—

'underpinned by prevention principles'— dentists are screaming to be able to work in a preventative way—

'which will enable everyone to take responsibility for their own oral health.'

Well, I agree with the Minister on that, because that's all that people can do currently.

Look, I accept that everything is not perfect. I accept that there is a huge way to go in this very difficult area. But, as I reiterate, we do not employ these people directly. They are independent practitioners, and we have to convince them to come with us on the journey.

Now, it is true to say that COVID has impacted the work that they were able to do before. They're not back to what they were doing pre pandemic, and that's because they have to take account of the extra issues in relation to the potential for COVID to carry. So, there are more restrictions than there were pre pandemic.

Our contract does shift people from the haves to the have-nots. That's precisely what we're trying to do. There are people who haven't been able to see dentists for years on end, and now 140,000 of them have had access for the first time. So, that's not something that's happening in England. We've changed this contract, and England are looking at our model now to see what they can learn from us. But, of course, we need to go further.

So, I think it's important for us to understand that it's not just about supply as well, it's also about affordability and transport issues and all of these other things. One of the things that I am a bit concerned about is we are seeing pockets where we're seeing concentrations where dentists have handed back the contracts. That is something that concerns me. Certainly, in the area that I represent, that is a concern, which is why, for example, in rural areas, we've put this £5,000 additional funding on the table. In Betsi, we've got these 26,000 extra appointments that have been given, and, crucially, as the First Minister mentioned this morning, we're developing this new dental school in north Wales.

Key to what we're trying to do here is to broaden the dental skill mix. You asked me about training—well, we've got now 67 new dental trainees, we've got 50 dental care trainees, we've got new hygienists and new therapists. All of these people will, we hope, contribute to that dental mix, and, obviously, we're speaking to the UK Government to make sure that they change the rules so that some of these people can not just open a dental appointment, but close it as well. That's been part of the problem—legally, that's not been possible within the rules currently.

I would reject that they are leaving in droves. They are not leaving in droves. There is no evidence to suggest they're leaving in droves. We've got 80 per cent of people who've signed up to the new contracts. I gave you the figures: over 420 or so who we had pre pandemic, and only 20 have handed back. Those are the figures, those are the facts. You might not like the facts, you might—[Interruption.] Well, they haven't handed it back yet, and, as I'm saying, let's keep the conversation going, which is why I'm very keen to make sure that I have a real understanding of the concerns of the dental workforce and why I'm meeting them very soon.

I have many Members who wish to speak, understandably, on this issue, because it affects all of our constituencies, including mine. But if you please keep to your one minute, we can get everybody in to ask their question. John Griffiths.

Diolch, Dirprwy Lywydd. Minister, I wonder if you could address a situation that occurred in my constituency in Caldicot, where, in October last year, an NHS dentist wrote out to their 10,000 NHS patients telling them they were reducing the number to 2,500 effective from 1 January this year, and all of those 10,000 would have to reapply for an NHS place if they wanted one. So, that led to a situation of great concern amongst the local community, and the position now is that most of the people affected who haven't remained as NHS patients with that practice have to travel several miles to access NHS dentistry, or they have registered as private patients. Some will now have unmet dental need because they are not in a position, as vulnerable people, to travel the distance required for NHS treatment and, of course, they can't pay privately.

One other matter, Minister, which is that I have a 13-year-old girl who has been told she will have to wait three years to have braces fitted, and I wonder if you could say something about that situation. Thank you.

Thanks very much. I recognise that there are individual circumstances, and there are 20 of those that we have to consider, and that's why they've gone. But, as I say, what happens is that you don't lose the NHS dental appointments there; they are re-tendered, they go to somebody else. Now, what I recognise is that that may mean that people aren’t able to access what used to be in their community and they have to go further afield. And that creates another barrier to access, and I do think that is something that I’m particularly concerned with, and I’m particularly concerned around children—as you’ve mentioned; you’ve got that one case. But what I’m interested in now is to see, look, actually, can we think about creating a new kind of model here. In particular, let’s have a look at children.

So, through this pilot that we’re running in north Wales, a mobile unit goes into the school, sees every child in the school. We don’t necessarily need a dentist; we can use dental therapists to do this work. And I think it’ll be really interesting to see how that works out, and, if that does work out, I think that is a model that I’d like to seriously consider rolling out across the whole of Wales.

I do think—. Listen, it’s really difficult—orthodontic procedures, that’s always a challenge, and I think there are some real challenges around that in terms of the costs and all kinds of things. We all have to consider, I think, in future, where we’re going to be in terms of costs in future, because there are some real challenges ahead of us. There are massive restrictions on the budget coming down the line, and we need to consider very carefully what our priorities are going to be in future.

I’m not going to go over what other people have said, Minister, but I want to pick something out of your statement that I think is very positive and I think it’s around children and the pilot that you’re doing in Blaenau Ffestiniog of bringing the mobile dentist unit actually into schools. What I’d like to know is some questions around that. How long is that trial going to last in Blaenau Ffestiniog? How long is the Welsh Government going to take to do the evaluation around that, and when can we see that being rolled out right across Wales? Because there are certain parts of my constituency where this is needed, and the sooner it can come, the better.

Thanks very much. Well, I’m on a mission with this, so I’m really keen to see this. This is something that I’ve very much tried to drive forward. What I’m keen to do is to make sure that we have at least a six-month roll-out of the programme and see how that goes, and then, obviously, we’ll have to look at the evaluation. But what was beneficial in Blaenau Ffestiniog is that, actually, we knew that Betsi had these mobile units that we could use, and also we’ve had to check that the school has access to the right power supplies and water supplies and all of those other things. So, there are some technical and practical things that we have to consider before we’re able to roll it out to every school in Wales. And obviously, there’ll be a price on this, but, actually, what, effectively, we will be doing is shifting resources into schools, rather than seeing people being seen in the community.

Thank you, Dirprwy Lywydd. I’m afraid the content of your statement doesn’t correspond in the very least with what I hear from patients and dentists in the Arfon constituency. According to a survey of dentists across the north of Wales, 88 per cent believe that they don’t have the capacity to see the new patients expected under the new contract. Ninety-six per cent say that the patients that they already have give negative feedback and complain about the lack of access to dental care. It appears to me that dentists are drowning in the workload that they face as a result of targets that cannot be met. Can I ask you therefore whether the new contracts set far too high an ambition for dentists? And you say that you will be having discussions on contracts for 2024-25 and onwards from then, but, as a result of all of the concerns that we do hear about, will you make a commitment this afternoon to review these contracts without delay, please?

Thank you. Well, the fact is that these dentists have already delivered to a great extent. What I asked was that they shift from seeing people who have healthy mouths and seeing them regularly, as was the case in the past—. Around 60 per cent people have healthy teeth, and they, according to NICE, don’t need to see a dentist more than once every two years. Now, that's what the NICE guidelines say—they're not our guidelines. So, we've worked on the basis that, even if 20 per cent of those see a dentist less often, you do reach a point where you can provide opportunities for new people to see dentists for the first time. So, I do think that we're moving in the right direction, and, of course, in north Wales, what we will see with the new academy, which will open for six days a week from the autumn onwards—they will have an opportunity to see 12,000 to 15,000 patients annually. 

I am guilty as charged; I am one of those who've used the phrase 'two-tier system', and let me tell you why, because I think it's really important. I do acknowledge that NICE guidelines have changed—I think we all do; we all hear that. I know there needs to be a skill mix in dentistry, and I think that's accepted. There have always been dental charges for adults in the past. I remember that a while ago. I know there has been a private health system in dentistry, just as there is in any health system. But what I don't understand is how that matches with what I am, and it seems others are, hearing day after day, time after time. And I think, Minister, part of that is that there just seems to be a resistance to seeing the reality. The reality is what we're hearing: it's people going to dentists, like the one that John Griffiths said, and them saying, 'I'm sorry, you have to de-register and then register again, in a queue'; the reality that families are told, 'I'm really sorry, but we're now a private healthcare practice.' I really think that one of the things that would be really valuable is that we look at how we can bring together everything across the board and not have that two-tier system. Thank you. Diolch yn fawr iawn.

Diolch yn fawr, Jane. I acknowledge there's a two-tier system. I've made that absolutely clear. There always has been. And in an ideal world, I would love it if we could get to a system where everybody was able to access an NHS dentist. But, actually, it's very difficult to find dentists. That's the first thing. We're about to start a new campaign to see if we can attract more dentists from abroad. But, actually, I think we've got to rethink the model. I think we've got to think about how we use the skill mix in a very different way. And I also think that some of the figures that I've stated today, that's the reality. I'm giving you facts. Now, there's a lot of noise—I get that there's a lot of noise—but we're talking about 20 out of 420 practices handing back contracts. Now, it may be that more of them will say, 'Well, we didn't like that, so we're moving next year', but, as it stands currently, which is why I think we do need those conversations with dentists to make sure that we are landing in the right place on this—. But, this year, the fact is, we had a target of 114,000 new NHS dental appointments, and we've got 140,000. So, we've gone way beyond what we had as an ambition. 

I just want to pay tribute to Jane for the work that you are doing, constantly and tirelessly, on dentistry, and I know one of the things that you've been pushing for is a dental registry, a national dental registry, and I just want to make it clear that we do hope that that will be something that we will be able to deliver in future, subject, obviously, to money, which is going to be a constant restraint on us in future. 

Minister, thank you for the statement, and I'm heartened that you state that dentistry is one of your top priorities. And even before COVID, it has had a long and chequered past since deregistration. I think we all realise that. For many of my constituents, NHS dentistry, though, still remains incomprehensible at times. I do welcome the many new initiatives in dentistry that you and Welsh Government have introduced, and those bearing fruit. That is welcomed, as are the new 140,000 patients now seen. I have, though, listened carefully to the concerns expressed by some dentists that, under the UDA model and the new model called 'metrics', the Government is still emphasising the number of different patients seen, and that there seems to be no credit for the specific course of treatment undertaken, i.e. no differentiation between either a complex bridge or a simple filling, and it's stated that the only credit given is that the individual patient was seen and has had a course of treatment. So, how would the Welsh Government respond to that observation, that this is still a rather crude form of analysis that does not concentrate the focus on the expertise of dentists and the skilled personalised work that they undertake? And what consultation, Minister, has been undertaken with the dentistry profession on this new and innovative model of working?

Thanks very much. Well, you'll be aware that in Aneurin Bevan we've seen 24,500 new NHS patients being seen as a result of the new contract. The course of treatment undertaken, obviously, is something that I think we just need to make sure we've got that in the right place, and in terms of consultation, there has been very significant consultation. As I say, they've seen a copy of what is being proposed for next year before Christmas, so I hope that has given them enough time to consider it, and obviously we will be carrying on those conversations with the dental authorities.

Thank you, Minister, for bringing forward today's statement. As I highlighted to you last week, Minister, I recently contacted 69 NHS dentists in north Wales. I spoke to 57 of those practices last week, and it was just four who were taking on, but those four had huge waiting lists. What that highlighted to me is the significant challenge that my residents face in accessing an NHS dentist in north Wales.

Minister, I do welcome efforts being made to recruit more dentists. I certainly welcome those efforts being made, along with the trials of the use of the mobile dental units at schools, which, as my colleagues mentioned, could be cost-effective and certainly help reduce those waiting lists. But like others in the Chamber here today, I take particular exception to parts of your statement, and I quote, where you say,

'Private healthcare is an established and acceptable alternative,' and you go on to say,

'in reality some will prefer to go private, creating a divided market.'

Just to be really clear from my side, and my residents, this is not something that most of my residents would prefer to do; it's something that they have to do because they cannot access those NHS dentists. What my residents would prefer is to be able to access NHS dentists, because they pay their national insurance, they pay their income tax, they pay their taxes, and they expect to get healthcare free at the point of service as a result of that. So, in light of this, Minister, and in light of your statement here today, do you think the measures you've highlighted here today will go far enough to address the concerns that my residents have in being able to access an NHS dentist?

Thanks very much. Well, we are making efforts to recruit new dentists, and to be honest, Brexit didn't help the situation, and certainly I know a lot of eastern European dentists went home, following Brexit.

Just in terms of the issue about paying for dental treatment, I think it's really important to note that there are exemptions for people who can't afford to pay, and I can set out what those exemptions are if you'd like, but the fact is that everybody—. If you're not exempt, you do pay these charges. I think it's really important that people understand. This is not free, and it's really important that people understand that there is an expectation, in Wales, in England, in Scotland, in Northern Ireland, that actually you do have to pay for treatment.

In response to an FOI that I submitted a few weeks ago, I was told that 11,000 people are waiting on a waiting list to register with an NHS dentist in the region that the two of us represent. Last year, the BBC conducted a survey across the UK, including our region, which showed that no NHS dentist had capacity to take on additional patients. So, whatever this statement might say about contracts, there is a great deal of discontent that exists. My dentist in Llandeilo—and I've been with an NHS dentist for several years—told me about three weeks ago that he is giving back his contract and he's going private. I looked to see whether there was any way that I could go to another NHS dentist. In Carmarthenshire there are over 3,500 on the waiting list. There's no hope for me. So, does the Minister agree with me, for families on a low income, is going private an 'acceptable alternative'?

Well, one of the things we're seeking to do, and Cefin will be aware of just how difficult it is to recruit people to rural Wales in the field of dentistry, and that does create greater issues in rural areas than it does in some of our more urban areas, perhaps, and that's why there are additional problems, I think, that we see in our region. I am certainly aware that Llandeilo is one of those places where they have handed the contract back—they're one of the 20. Others have done so in Haverfordwest, in Cardigan and in Fishguard. So, there is a cluster there, more or less, that are quite close together, and that does create additional difficulties, and that's why we've provided the additional £5,000 to try and tempt people to undertake their training in rural Wales.

May I just emphasise therefore, we're talking—? In terms of our constituents who contact us, many do qualify for free treatment, but they can't find a dentist to do the work. That's the category we're talking about. And I haven't seen any clarity on that at all.

If I look at South Wales Central, here are some of the facts that have been provided by the British Dental Association: 18 per cent of dentists are likely to cease providing NHS services and go private only; 39 per cent to reduce the amount of work that they do for the NHS. May I ask specifically, therefore? You said that the data you have now may not reflect that, but this is what we're hearing and this is what's likely to happen, apparently.

So, can you give us some clarity as to how many have reduced their contractual requirements—not handed them back, but reduced them? We haven't had any clarity on that. I'm hearing more and more in my region about the complexities that dentists see because of the nature and the density of the problems that they treat. And some of the comments made by dentists are very cutting indeed. They need more time with these patients, and they are concerned that all of these changes will be prejudiced against areas with high levels of health needs.

Can I also ask whether your message today to the people of Wales is that everyone who can afford to go private for dental treatment should do so? Because that's what I'm hearing.

Thank you, Heledd. Well, I think it is clear that those amongst the 140,000 who received an opportunity to have treatment for the first time in a long time, and those opportunities are available—we're paying for those. So, the contract ensures that there is an opportunity for them to receive the help that they need. So, if they are eligible for dentistry free of charge, then they will receive that service free of charge.

What we are seeing now is a situation where dentists have been treating people who need just a check-up—60 per cent of them need a check-up—and that's easy to do. Obviously, if you're seeing someone who hasn't been to the dentist for a while, for years, then you're bound to see more complications, and I understand, therefore, why that would create more difficulties for the dentists, and this is a strategy of ours that's quite clear. That's what we want to see. We want to see people who haven't had the opportunity to see a dentist in a long time get the chance, and those who don't need to see a dentist, because their mouths are healthy, that they don't see the dentist as often as they did, because the NICE guidelines say it's not necessary.

And finally, Jenny Rathbone.

Thank you very much. Congratulations on the work you're doing to increase the number of people who are actually getting to see a dentist. That's really good news. I just wanted to go back to the mobile dental unit as the way of ensuring that all children get seen by somebody who’s appropriately qualified, because we know that the number of missing, filled or decayed teeth is a really good indicator of deprivation. We used to have a mobile dental unit in Llanedeyrn on the site of what is now the well-being centre in the Maelfa, which I know the Minister is familiar with. I just wondered whether we have more dental units. I haven't seen it since the pandemic; does it still exist, and, if so, how is it being deployed? Can it therefore be used to offer services to people in super-output areas of deprivation, where we know there are likely to be more missed decayed teeth?

Thanks, Jenny. Well, I'm really excited about this new approach. I think this is something that I hope will work in Blaenau Ffestiniog. If we find that it does work, then obviously what we'll try and do is to target those areas of deprivation as a priority, to make sure that those people, perhaps, who haven't been in a situation where they've been able to access dentistry for a long time, and to get children into that situation where they understand that, actually, you do need to take responsibility for your own oral health. So, what we'll do is to see how this pilot turns out in north Wales and in the meantime look around to see where these other mobile dental units exist. So, Betsi had more than one available. So, we're just trying to map out where they exist, and then obviously we will need some money to make this happen, and obviously the money will need to be spent on staff, and we need to make sure that the staff are available. But what we're talking about here, as I say, are not necessarily dentists, but dental therapists and dental technicians, and it's precisely that approach of dental mix. If there is a complication, then you refer up to the dentist rather than see the dentist refer down, so it's turning the model on its head.

I thank the Minister.