3. What is the Welsh Government doing to improve access to dental provision in Mid and West Wales? OQ59370

I thank Cefin Campbell, Llywydd. Contract reform, financial incentives, additional investment and diversification of the profession are among the actions being taken to improve access for the people of the Member's region.

Thank you. Llandeilo, Haverfordwest, Fishguard—examples of dental practices in my area where NHS provision has come to an end over recent months. The dental situation in rural Wales is critical at the moment, and the change to contracts recently has caused real concern, as was expressed to me in recent correspondence from the Dyfed Powys dental committee. Even dentists who succeed in meeting the requirements of the new contracts have noted that they're doing so at the expense of treating their current patients, and these changes are causing real stress, which means that many dentists are now considering their future as NHS partners. In Powys alone, over 4,500 are on the waiting list for NHS dentists—10 per cent of those are children—and more and more families are facing difficult decisions, with many travelling abroad for dental treatment.

First Minister, do you agree with the sentiment expressed in the recent Government statement on dental reform that private dentistry is an acceptable alternative, or will we see a real commitment from Welsh Government to work with the profession to ensure a dental service that works for everyone in Wales?

Well, Llywydd, 20 per cent of dental practices in Wales are private practices; that is simply a fact of life, and it has been a fact of life since the NHS was established. There is nothing new in that at all. I see regularly from dental interests this theme that contracts are being handed back across Wales. I spoke to the Chief Dental Officer for Wales myself last night about this. He tells me that 20 contracts out of 400 have actually been handed back. Many of them are small contracts, and health boards, and health boards in rural parts of Wales, are succeeding when they put those contracts out for retendering. So, in the Member's own area, a major contract in Ammanford—a £1 million contract—has been successfully retendered. In Powys, to which he referred, a contract that was handed back in Newtown has been successfully retendered. It will provide NHS treatment for between 2,000 and 2,500 patients in that part of Wales.

Last year, Llywydd, just under 1 million people in Wales received NHS dental treatment. There were well over 1 million treatments on the NHS, and that included 155,000 additional NHS patients because of contract reform, 20,000 of those shared between Hywel Dda and Powys health board. So, while there are undoubtedly challenges in the field of dentistry, and a lot more ground that we need to gain, actually, it's fewer and fewer, not more and more, Welsh citizens who are needing to find treatment elsewhere. And as we move forward with the contract, in consultation and negotiation with the dental profession, we will be able to do even more, and that will include, Llywydd, the £5,000 salary uplift that we are offering to future dental trainees who are willing to complete their foundation year in dental practices in rural Wales rather than taking up opportunities in the more popular urban areas. That combination of contract reform, further financial investment, liberalisation of the profession—there is a way to go, but there is a formula in Wales that we have started to put in practice and is beginning to succeed.

Diolch, Prif Weinidog. I've previously raised the serious concern amongst local dentists in Carmarthen West and South Pembrokeshire about the Welsh Government's current policy direction. And like Cefin, a senior member of Dyfed Powys's local dental committee shared his views that the large financial penalties that were being threatened on dentists if they failed to meet what were described as 'unevidenced and unachievable contract reform targets'—quote—'were driving NHS dentistry provision in Wales towards a cliff edge'—another quote. But a possible solution to this, put to me by a local dentist and orthodontist in my constituency, is to reward the dentist when treatment starts, incentivising practices to see patients. So, would the Welsh Government explore this suggestion, which could help keep dentists in the NHS and support patients across Wales? Diolch.

Well, Llywydd, we're always willing to look at ideas that come forward from practitioners. The fact of the matter is that dentistry, uniquely of primary care professions, is paid for the work before they do it, not after it. At the end of the year, there always has been, under the previous contract as well as the current contract, a reconciliation, when you look to see what a practice has actually been able to achieve. If it has not been able to fulfil the terms of its contract, nobody can expect public money to be offered to somebody for a service that hasn't been provided.

Now, we have always had a pragmatic approach to that end-of-year reconciliation, and I know, from my discussions with the chief dental officer last night, that that is exactly the way in which it is being approached this year as well, and particularly because, with a new contract, some of the metrics that are being used are inevitably being used for the first time and need to be tested in practice. The system is not designed at all to penalise practices where there is a reasonable accommodation that can be reached with them. If there are other and better ideas as to how that can be navigated, then of course the system and the people who work in it will be very willing to think those through.

Good afternoon, First Minister. Today the Welsh Liberal Democrats published a report looking at dentistry, particularly focusing on our concern around two-tier dentistry—and I do make no apology in using that term. We have a system at the moment that means that, if you can pay for dentistry, then you don't have to wait; if you can't, then you do have to wait. And that is the basic truth.

I want to just focus my question, if I may, on children and young people. I'm sure we'd all agree that they should be able to access NHS dentistry. In Powys, as Cefin has mentioned, over 800 children are waiting for an NHS dentist, and, to be fair to Powys, they are one of only two health boards who keep data on children waiting for NHS dentistry. I just wonder if you could provide an update, an outline of the plan the Government has in order to help children who are waiting for NHS dentistry across Wales. Thank you, diolch yn fawr iawn.

Thank you to Jane Dodds for the additional question.

The Minister set out in her oral statement here on the floor of the Senedd practical action that is being taken to increase the provision of NHS dentistry for children, including the pilot that the Minister set out in secondary schools—a pilot being carried out in north Wales in the first instance, and we hope, if it is successful, to be able to do more of that elsewhere. In Powys, to which Jane Dodds referred directly, I think I was able to say in answering a question last week that the health board has been successful in recruiting a paediatric specialist dentist who can carry out more of the specialist treatment that is necessary without children needing to leave the county, and an additional dental therapist focusing exclusively on children. I understand that the figure of 800 to which Jane Dodds referred has already been reduced by more than 100 as a result of that additional resource that the health board has, and, when I spoke with the chief executive of Powys health board before questions last week, she said to me that she felt that the health board had been really successful in recruiting new staff in the dental profession, of a variety of contributions that they could make, to come to be able to make sure that adults, but children as well, are able to receive the sort of service that we would wish to see in that part of Wales.