Scottish Parliament, 10 March 2005

461 contributions from 79 members. The official report.

Official Report 10 March 2005

Dentistry

George Reid (None, Ochil)

Good morning. The first item of business is a debate on motion S2M-2549, in the name of Shona Robison, on dentistry.

Shona Robison (Scottish National Party, Dundee East)

The state of our nation's teeth is one of the biggest public health challenges facing Scotland, with 55 per cent of children having dental disease by the age of five. For many people in Scotland, getting access to a national health service dentist has become an impossible quest. Hardly a day goes by when there is not a story in the press about another dental practice closing its doors to NHS patients. We know that 40,000 dental patients have been taken off NHS lists in the past two years and that dozens of dental practices have closed. This is an opportunity for the Parliament to have its say on what the Minister for Health and Community Care must include in his statement next week if we are to rectify the situation and ensure that NHS dentistry has a future in Scotland.

The power of Scottish National Party debates is clear for everyone to see this morning, with the minister's announcement in the press that

"Every child in Scotland is to be guaranteed access to an NHS dentist".

That is an excellent result for a morning's work, as I am sure all members will agree. The question for the Deputy Minister for Health and Community Care, however, is where the Executive is going to find the dentists to carry out that work.

A report recently commissioned by the Scottish Parliament's Health Committee found that, among primary care dentists, 42 per cent of those

"currently treating children were not accepting new children for NHSScotland dental care or were using a waiting list."

With respect to adults, it was reported that

"only 37% of Scottish dentists are prepared to accept all categories of adults as new NHS patients.

One-quarter admit to scaling down their NHS commitment and only 3.5% of primary care dentists say they intend to increase the amount of time spent treating NHS patients over the next two years.

The study ... concludes that the Executive's flagship

pledge to give"

free oral health assessments

"to everyone by 2007 will be difficult to meet without a significant increase in NHS dentists."

The report made it clear that

"ministers' plans to lure retired dentists back to work in the NHS with incentives were unlikely to be successful."

The report also stated:

"A significant increase in NHS Scotland provision required to meet pledges to improve access to dental services is unlikely to be achieved with the type of incentives currently available".

That all comes at a time when our chief dental officer is allowed to go part-time. That is just not good enough.

The key problem has been the chronic underinvestment in NHS dental services over the years, which has led to NHS work becoming less and less attractive to dentists, both financially and in terms of the quality of service that they can offer their patients. The pledge to introduce free dental checks—or oral health assessments, as they should be known—by 2007 must involve more than a cursory look in the mouth. Dentists must have time to spend with patients to carry out a proper assessment of their needs.

The British Dental Association has made it clear that, without major changes to remuneration, there will not be enough dentists prepared to carry out oral health assessments for the current princely sum of £7.05, which does not even cover their cost. If we are serious about shifting the focus of NHS dentistry to preventive work, there must be financial incentives for carrying out that work. The Health Committee's report states that nearly 56 per cent of dentists said that an increase in the fee level for such work was required to get them to treat more NHS patients. That is the reality that we are faced with, whether members like it or not.

Consideration must be given to linking oral health assessments with a screening programme to ensure that those who are less likely to access oral health assessments for themselves or for their children are targeted. Many of those who live in our most deprived communities are already entitled to free dental checks, but they do not take them up. We must address that problem if we are to deal with the horrendous dental health record in those communities. A screening programme can help to achieve that.

Another mechanism to encourage dentists to remain and to do more within the NHS is the provision of assistance with infrastructure costs. Many premises urgently require to be improved. For many of them, the overhead costs do not make doing more NHS work financially viable. That must be addressed. Such support would help to improve the quality of service provided; it would also improve the level of commitment that a practice gives to the NHS. We need to reduce bureaucracy and simplify the fee scale, which currently contains more than 400 items of service.

We must also increase the dental workforce if such an approach is to work. The dental workforce has never recovered since the Tories closed the Edinburgh dental school in 1996. Other small European countries, including Denmark and Norway, have double the dentist-to-population ratio of Scotland and, of course, a much better dental health record to go with it.

The British Dental Association has estimated that at least 215 additional dentists will be required if the Executive is to keep its free oral health assessment pledge. We need to increase the number of salaried dentists from the 90 posts that are currently filled. Such posts must be targeted at places where lack of access to NHS dentists is most acute. We also need to expand the workforce further by increasing the number of undergraduates on training places and, crucially, by expanding the number and role of professionals complementary to dentistry. A lot more work could be carried out by dental nurses, hygienists and technicians to free up dentists to carry out more of the complex work. That would require a bigger investment in training and education.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

The member is aware that the BDA wants three times as much investment. What is the SNP arguing for? What can the SNP come up with by way of an investment package?

Shona Robison (Scottish National Party, Dundee East)

As a minimum, we require £40 million to £50 million of funding in addition to the money that is already going into dental services. The oral health assessment will not be carried out for £7.05; it requires at least £20, plus investment in infrastructure and more money towards salaried dentists. A minimum of £40 million is required.

I hope that the minister will listen to the views of members across the Parliament on the best way to address the dental crisis in Scotland. As many dentists have told me, next week's statement provides a one-off opportunity to get it right for NHS dentistry. The challenge for the minister is to get it right, for the sake of Scotland's oral health.

I move,

That the Parliament is concerned about Scotland's poor dental health record; notes that only 3.5% of dentists anticipate increasing their NHS provision in the foreseeable future; recognises that if access to NHS dentistry is not improved, then the commitment to provide universal free oral health assessments by 2007 may not be met, and therefore believes that, in order to meet this pledge and safeguard the future of NHS dentistry, the Scottish Executive must provide incentives for dentists to undertake more preventive work including a significant increase in the fee level for oral health assessments, assist dentists more with infrastructure costs in return for greater NHS commitment, reduce bureaucracy and simplify the current fee scale and expand the number of NHS salaried dentists and address dental workforce shortages by increasing the number of dental undergraduates and expanding the role and number of professionals complementary to dentistry.

Rhona Brankin (Labour, Midlothian)

I am rather surprised by Ms Robison's choice of subject for this morning's debate, given that the Scottish Executive is making a major statement in the Parliament next week. That rather smacks of political opportunism. If the SNP's concerns are so great, why has Nicola Sturgeon never once raised the issue of NHS dentistry at First Minister's question time since being elected as Salmond's Scottish helper? Why do we have Conservative complacency on the subject, given that the Conservatives were responsible for closing the Edinburgh dental school in 1996? I look forward to hearing what the Tories have to say about that.

As ministers have previously stated in the Parliament, we are committed to an effective and accessible NHS dental service for all who wish to use it. For some population groups in Scotland, oral health has improved steadily. There have been significant improvements in adult oral health: 82 per cent of Scottish adults have some natural teeth, compared with only 56 per cent three decades ago, which was appalling.

We absolutely cannot afford to be complacent, however. For our children, progress has been relatively static, with very little improvement in dental decay levels since the 1990s. Improving oral health, particularly that of our children, must be our priority. We recognise that that will require a co-ordinated approach, with genuine commitment from the dental profession and from individuals and organisations with responsibility for the care of children.

John Swinney (Scottish National Party, North Tayside)

I am interested in the commitment to improve children's oral health that the minister is giving. Will she give an answer to the many constituents who write to me who want to take their children to an NHS dentist somewhere in my constituency but cannot get access to a single NHS dental service for their children's benefit? What is the Government doing to tackle the crisis in rural Scotland?

Rhona Brankin (Labour, Midlothian)

I could give the member a much fuller response if this discussion followed the announcement that we will make next week. That is one frustration that has resulted from the SNP's opportunism. It is clear that health boards have a responsibility to ensure access to NHS dentists for everybody and there will be further announcements about that next week.

Carolyn Leckie (SSP, Central Scotland)

Will the minister take an intervention?

Rhona Brankin (Labour, Midlothian)

No. I must continue, as I have a lot to say.

In the primary care sector—in which 90 per cent of dental patients are treated—most general dental practitioners are independent contractors to the NHS who are free to choose whether to accept patients on the NHS. That there has been a reducing commitment to the NHS by some general dental practitioners in parts of Scotland is regrettable. To achieve improvements in dental provision, there must be the people to deliver such improvements—there must be the right number of people with the right skills in the right place. That means that we must combine effective workforce planning with measures to recruit and retain dental workers.

We recognise the value and potential contribution of the whole dental team in improving oral health and providing the services that are needed in a modernised NHS. Therefore, we are currently investing more than £800,000 to increase the number of professionals complementary to dentistry who are trained in Scotland. On planning the dental workforce, we have agreed a target output of 135 graduates per year for the dental schools and we have put in place funding to meet that target. We have also introduced a number of other measures to encourage recruitment and retention.

Shona Robison (Scottish National Party, Dundee East)

The Deputy Minister for Health and Community Care rightly outlines some good things that have been done, which we accept. However, the fundamental problem is that not enough dentists will do NHS work because they are not remunerated for it. What will the Executive do to ensure that dentists will carry out oral health assessments? Will the remuneration for oral health assessments be increased?

Rhona Brankin (Labour, Midlothian)

Again, I am not in a position to make announcements before next week. However, I can say that we are confident that our ambitious targets for free dental checks will be met and that we are putting in place the workforce to deliver them.

As I said, we have also introduced a number of other measures to encourage recruitment and retention. This year, 119 dental graduates who are undertaking their training in Scotland are in receipt of our vocational training grant, and an ever-increasing number of qualified dentists are joining our dental lists in Scotland as a result of our golden hello allowance. Through the partnership agreement, we are establishing a dental outreach training centre in Aberdeen that will further boost training opportunities. A number of measures are in place to encourage dentists to further their contribution to the NHS and to locate in areas in which NHS services are underprovided. Those measures include grants that are available under the Scottish dental access initiative and the provision of salaried dentists. There are more than 100 salaried dentists in Scotland, and I expect that number to rise.

Members will recall that in November 2003 we launched the "Modernising NHS Dental Services in Scotland" consultation on future arrangements for primary care dental services. In discussions with the dental profession and the general public, the consultation considered proposals for changes to the system for rewarding primary care dentistry in order to promote prevention, improve access to services and improve recruitment and retention. The consultation recognised the need to ensure that dental services are underpinned by a robust quality framework that is suitably rewarded. The consultation responses have been analysed and we will provide our response to it on 17 March. That response will include further measures to support NHS dental services. I am pleased to confirm that one additional support measure that we will make available to NHS dentists is a substantial increase in the general dental practice allowance, which will roughly double the practice allowance and incentivise NHS work. I am sure that that measure will be welcomed.

There has been a lot of media interest recently in the challenges that NHS dentistry faces. I accept that we need more NHS dentists and that there are particular local access difficulties. However, there is a forthcoming announcement on dental services, and it is fair to say that we have recognised the problems and introduced a number of measures to support NHS dentistry. In addition to the recruitment and retention allowances that have been mentioned, we have made available more than £12 million in the past four years for practice improvements. We have also introduced a general dental practice allowance to assist with practice costs. In the current year, the money for that will amount to around £4 million. In total, in the past year we have provided more than £10 million in additional funding to support NHS dentistry in Scotland. Many of the measures are unique to Scotland and provide Scottish solutions to Scottish problems.

I hope that the measures that I have outlined demonstrate to members our serious commitment to NHS dentistry in Scotland. However, we recognise that we need to intensify our efforts to ensure access to services, and we will continue to work to develop further measures to achieve that aim.

I move amendment S2M-2549.1, to leave out from "is concerned" to end and insert:

"recognises the need to tackle Scotland's poor oral health and improve access to NHS dental services; acknowledges the actions already taken by the Scottish Executive to improve oral health and to recruit and retain dental professionals in the NHS; recognises that further work needs to be undertaken to respond to the outcome of the consultations, Towards Better Oral Health in Children and Modernising NHS Dental Services in Scotland; notes that the Executive's response to the consultations, to be published very shortly, will include measures to address the Partnership Agreement commitments on workforce numbers, training and prevention including free dental checks and will identify the resources needed, and calls on NHS boards, higher education institutions, local authorities, the British Dental Association and the wider professions to engage positively with the Executive after publication to bring early and sustained benefits to the oral health of people in Scotland."

Nanette Milne (Conservative, North East Scotland)

In May 2003, I made my first speech in the Parliament in a members' business debate on dentistry and the difficulty of gaining access to an NHS dentist in the north-east of Scotland. Nearly two years on, the only change has been for the worse, with still more dentists opting out of NHS work and more patients having difficulties accessing dental services, even privately.

Bruce Crawford (Scottish National Party, Mid Scotland and Fife)

Should the member's first statement on dentistry not have included an apology for what the Tories did in 1996 in closing the Edinburgh dental school?

Nanette Milne (Conservative, North East Scotland)

I wonder when a party that has never been in power and is never likely to be in power will stop dwelling on the past and start looking to the future.

The problem of access to dentists is particularly acute in Grampian, Highland and Argyll. Only this week, yet another practice in Grampian—in Oldmeldrum in Aberdeenshire—closed its doors to NHS patients. I am sure that I am not the only MSP from the north-east who has received angry phone calls from patients in that area who have suddenly found themselves without a dentist.

The move towards private dental care has been prompted by a lack of investment in NHS dentistry and frustrations with the current system—particularly with the lack of time that dentists have to give their patients preventive advice. Instead, dentists see up to 40 patients a day on a treadmill of inadequately funded piecework.

Most dentists who move to private practice do not do so to increase their income, but to be able to sustain their income on a reduced list size, to give their patients a better service and to gain a better quality of life without the stress of having to push patients rapidly through the system day after day and week after week.

Early retirement is common in dentistry and stress has been identified as a principal reason for early retirement. As in other professions, an increasing proportion of women in dentistry want to have career breaks and to work part-time. Too many dental graduates are moving away from Scotland after they have completed their training, and there are concerns about the current system of charging, which is

"complex and difficult ... to comprehend. Any new system must be transparent and easy to understand, with the main drivers being clarity about patient charges; clarity about NHS availability; distinction between NHS and private treatment; and clarity about trust and accountability. Any replacement system must be easy to operate and avoid unnecessary bureaucracy."

Those are not my words, but the words of the BDA.

The short-term measures that the Scottish Executive has introduced in recent years to try to alleviate the current crisis have not solved the problem, and there is no doubt that a new contract is urgently needed if NHS dentistry is to survive in Scotland. The Executive's pledge to provide free dental checks for everyone by 2007 sounds attractive, but it is unlikely to be fulfilled when there is a 10 per cent shortfall of dentists north of the border.

Carolyn Leckie (SSP, Central Scotland)

The member has again mentioned the shortage of dentists. Does she agree that not closing the dental school would have meant that we would have had 400-plus more dentists now and that she would not have been be talking about a 10 per cent shortfall? There might even have been a surplus of dentists.

Nanette Milne (Conservative, North East Scotland)

Multiple factors are involved. I agree that we might have had more dentists, but I cannot answer for my party's previous actions way back in history. Nonetheless, the system has changed. Many more women are now in dentistry and the whole demography of dentistry has changed in recent years.

The Executive's pledge to provide free dental check-ups sounds attractive; however, in the words of the BDA, a quick look round the mouth to identify holes in teeth is not what is required in modern dentistry. Nowadays, patients' needs have to be assessed, and the implications of medical health and medication for dental health must be considered. Patients need to be given lifestyle and preventive advice. Those things are all time consuming, and that time is not funded by the NHS at the moment.

Children, young people, pregnant women, new mothers and people on low incomes are already entitled to free dental check-ups in the NHS—assuming that they can find a dentist—and we feel that the extension of that provision to people who can afford to pay is not the best use of scarce resources. We would look to introduce a capitation fee for adults that would be similar to that which exists for children, as we feel that that would get us away from the treadmill effect of the current system and would encourage preventive care.

Shona Robison (Scottish National Party, Dundee East)

Will Nanette Milne give way?

Nanette Milne (Conservative, North East Scotland)

No, I am sorry. I have quite a lot to say.

George Reid (None, Ochil)

You are in your last minute, I am afraid.

Nanette Milne (Conservative, North East Scotland)

Under our plans, children, people on low incomes and the over-75s would be entitled to free dental care. For those who wanted it, we would introduce a voluntary low-cost monthly payment scheme for non-exempt adults, to cover them against large, unplanned bills as an alternative to the present pay-as-you-go arrangements. We would also seek an expansion in the role and number of professionals complementary to dentistry, such as hygienists and therapists, to take over some of the more routine work that is done by dentists, thereby freeing them up to perform more complex procedures and to undertake more preventive work with their patients. In addition, we support the further development of outreach training facilities in Scotland in the expectation that senior students in the later stages of their training in more peripheral parts of the country will remain in the area that they have come to know as students.

Labour promised us great things in 1999, when Tony Blair said that within two years everyone would have access to an NHS dentist. I look forward to hearing, next week, just how the Scottish Executive plans to make good that broken promise.

I move amendment S2M-2549.2, to leave out from "recognises" to end and insert:

"and believes that in order to safeguard the future of NHS dentistry the Scottish Executive should move from fee-based remuneration to capitation-based funding in order to remove incentives for over-treatment and promote preventive measures, expand the role and number of professionals complementary to dentistry in order to free up time for dentists to focus on continuing care, reduce bureaucracy and continue with the development of outreach centres to encourage students to remain in Scotland after graduation."

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

There is no doubt that there is a crisis in NHS dentistry. That crisis is not recent and it certainly has not come out of the blue. Ever since the Conservatives closed the Edinburgh dental school some 10 years ago, we have been heading for trouble. We have simply been training too few dentists to meet the demands of a modern and effective health service. I agree with Bruce Crawford that the Conservatives should have started their contribution to the debate by recognising the mistake that they made in closing one of Scotland's three dental schools.

The Liberal Democrats have recognised the depth of this crisis. Two years ago, in our manifesto for the Scottish Parliament elections, we stated:

"Everyone in Scotland should enjoy access to NHS dentistry regardless of where they live."

We said that we would reintroduce free dental checks for all and that we would reform the remuneration arrangements for dentistry to reward dentists for preventing dental disease among their patients as well as for treating disease and decay. We also said that we would increase the number of dental training places and establish a new school of dentistry in Aberdeen.

As a result of taking those pledges into the partnership negotiations with the Labour Party, the coalition Government of Scotland has agreed to encourage preventive dentistry and design appropriate reward measures to support that objective.

The partnership agreement says:

"We recognise the need for an increase in the number of dentists and dental graduates in Scotland. ... We will expand the capacity of dental training facilities in Scotland by establishing an outreach training centre in Aberdeen."

That centre is well on the way. It continues:

"We will consult further on the need for its development to a full dental school."

The partnership agreement also commits the Executive to assessing the reasons for the shortfall in dentists and the options for addressing that shortage.

Mary Scanlon (Conservative, Highlands and Islands)

Where is the Executive going to get all the specialist lecturers from to lecture at the school of dentistry in Aberdeen when there is a shortage across the whole of Scotland?

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I thank Mary Scanlon for that right and proper intervention. The issue is serious. Because of that shortage, we decided to establish the outreach centre in Aberdeen first, as a practical measure, before consulting on the formation of the dental school.

Tom McCabe, the previous Deputy Minister for Health and Community Care, launched the consultation on the reform of NHS dentistry—the first opportunity to reform NHS dentistry in Scotland for more than half a century. My constituency has the lowest number of NHS dentists per head of population in Scotland, and there is a real crisis in the north-east. Last year, more than a thousand people queued outside Kenny Jones's practice in Stonehaven simply to register as patients. Last Monday, there were similar scenes in Nora Radcliffe's constituency. There is no doubt that a wholesale reform of the system is needed to ensure that such scenes are a thing of the past and that the Executive's promise that everyone will have access to an NHS dentist is fulfilled.

John Swinney (Scottish National Party, North Tayside)

Will Mike Rumbles give way?

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I am in my last minute, unfortunately.

In the long term, we need to train more dentists, and I am sure that the promised consultation will show the need for a new dental school in Aberdeen. In the short term, we need to attract dentists back into the system. That can be done in two ways: first, by removing the bureaucracy that is involved in NHS dentistry, thereby simplifying the system; and, secondly, by remunerating dentists properly to allow them more time with their patients. The SNP is arguing for an increase of only £40 million to £50 million in the Executive's dentistry budget. I believe that that is a rather low target. We need and should get a much larger investment than that from the Executive.

Stewart Stevenson (Scottish National Party, Banff and Buchan)

What is your figure?

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

Members will find that out when the minister makes his announcement to Parliament. I am afraid that SNP members' horizons are far too low and they should be ashamed of themselves. Only by investing properly in the future of the dental service in Scotland and by getting rid of the bureaucracy will we solve the dental crisis. I have every confidence that, when Andy Kerr outlines his plans to Parliament, he will have the package that is needed to solve the dental crisis once and for all. I am sure that he will deliver the goods.

Stewart Stevenson (Scottish National Party, Banff and Buchan)

I thank Mike Rumbles for that interesting insight into the Executive's announcement of next week. Obviously, Magnus Gardham has dropped below the standards that I expect of him in reporting the Executive's plans. However, let us give the Executive credit for its ambition. If what Magnus Gardham says in today's Daily Record is correct, the Executive

"intends that the service will be open to everyone."

If that is not a recognition of the fact that that is not the current situation, I have never heard one. Of course, Magnus prefaces that statement with the word "eventually". In the same article, Rhona Brankin is quoted as saying:

"In Glasgow, more than 60 per cent of children have dental disease before they reach the age of three. So there is a huge job to be done."

Furthermore, Andy Kerr is quoted by Douglas Fraser, in The Herald, as saying that the problems with children's oral health and dental services throughout Scotland are "quite appalling". We cannot disagree with any of those statements: on the contrary, we agree whole-heartedly with them.

The Executive's record on the issue is quite interesting, and I will go through some of the statements that it has published on the subject. On 28 October 2004, in response to parliamentary question S20-3755, asking how many dentists we would have in 10 years' time, Rhona Brankin replied that the Executive did not know. Two years ago, in March 2003, in response to parliamentary question S1W-34277, asking how many dentists there would be, Mary Mulligan replied that the Executive did not know. In response to parliamentary question S20-4341, asking about the average waiting time for NHS dentistry, Rhona Brankin replied that the Executive did not know. So it continues.

Rhona Brankin (Labour, Midlothian)

Does Mr Stevenson recognise that it is expected that, by 2006, more than 130 dentists will qualify each year?

Stewart Stevenson (Scottish National Party, Banff and Buchan)

If that is true—and I accept the minister's word for it—it is very welcome. However, let me point the minister at some other documents, such as the draft budget for 2005-06. It has nine objectives and targets for the health service, but not one on dentistry. It is not a one-off, though. If we go back a year and look at the budget for 2004-05, we find 14 objectives but not one on dentistry. It is not even confined to two years. If we go back another year, again we find not one objective on dentistry.

Rhona Brankin (Labour, Midlothian)

Will the member give way?

Stewart Stevenson (Scottish National Party, Banff and Buchan)

Just one moment.

If we look further, we will find in the current draft budget that one of the statements of priority is to

"improve dental services through incentives".

Nevertheless, the spending plans in the draft budget show that the money allocated to general dental services for 2004-05 and the following three years flat-lines at £225,176,000.

Does the minister still wish to intervene?

Rhona Brankin (Labour, Midlothian)

Absolutely. I presume that the member welcomes our commitment to provide free dental checks for everyone by 2007.

Stewart Stevenson (Scottish National Party, Banff and Buchan)

Of course I do. However, how will the minister pay for those checks and who will carry them out? Given the record to date, there is not the slightest evidence that we will see any measure that will meaningfully address the matter.

The scope of the problem becomes apparent in a parliamentary answer that the minister gave me yesterday. It appears that Nora Radcliffe, Mike Rumbles and I share the unenviable record of having the lowest number of dentists in any parliamentary constituency. In fact, when I work out the numbers, it becomes clear that we have one dentist for more than 4,000 people. Ken Macintosh is a great deal more fortunate in his constituency—he has one dentist for every 1,700 people. If the extra money—which some suggested before the debate would amount to £10 million—were to be spent in our three north-east constituencies alone, we would still not reach the level of dental care that is available in Eastwood. I hope that, given what Mr Rumbles has—perhaps—announced about the north-east receiving more than that, things will move forward.

Indeed, the number of dentists in the north-east and the Highlands is so low that the resulting high work rate is making it extremely difficult to attract any more dentists. I believe that Mr Rumbles said that everyone should be able to enjoy access to NHS dentistry

"regardless of where they live".

However, we must do something about people in the north-east.

A golden hello scheme has been introduced to attract more people into NHS dentistry. However, in its first year, it was singularly ineffective and brought only six new dentists into the health service. Moreover, those dentists went to NHS Forth Valley, NHS Lothian, NHS Greater Glasgow and NHS Dumfries and Galloway; not a single one went to the areas of greatest need.

Yes, it will help to double the dental practice allowance, but we will wait with interest to see whether that makes a difference for local dentistry. As for the £10 million that has been given over the past year, the previous figures that I received on dentists in the three constituencies to which I referred were obviously optimistic, because there have been closures since they were released. In fact, in my constituency, some people cannot even get a private dentist, never mind an NHS dentist. It is clear that the minister will have to spend money and energy on this substantial problem. Furthermore, some real objectives must be set down in tablets of stone that the Executive can be held to account for in future.

Some of my constituents have had to travel to the Czech Republic, the Netherlands and even Hungary to receive dental treatment. Well, we are hungry for dentists, and we need them now.

Richard Baker (Labour, North East Scotland)

The challenge of ensuring access to dental treatment for all has been a growing concern in the north-east, and particularly in Grampian, for many years. Indeed, my first members' business debate and my maiden speech—like Nanette Milne's—centred on the problems of accessing dental treatment, particularly NHS dentistry.

There is no doubt that concerns can only have been heightened by the picture of the lengthy queues that formed at the dental practice in Oldmeldrum when two of the dentists at the practice decided not to continue NHS dentistry. As the motion and amendments point out, that is a problem not only for Grampian. However, there are particular difficulties in our part of Scotland.

Of course I want the Executive to take further action to resolve the situation and I look forward to seeing what happens in that respect. That said, the suggestions that have been made by some in the north-east that the Executive has not sufficiently acknowledged the issue are unfair and misleading, because serious action has been taken and substantial investment made. This debate would have been better informed not only if it had taken place after next week's ministerial statement but if more time had been spent on discussing the further measures that could be introduced instead of on bemoaning the situation.

Shona Robison (Scottish National Party, Dundee East)

Does the member think that it would have been best to give the Daily Record its exclusive after next week's ministerial statement?

Richard Baker (Labour, North East Scotland)

It was quite right to bring forward constructive proposals for this debate, but we would have had a better debate in the full context of next week's ministerial statement. After all, in a half-morning debate each member has only four minutes to discuss this serious issue. As I have said, I simply believe that the right thing would have been to have the debate after the ministerial statement.

We can debate this matter in a truly informed way only if we properly acknowledge the great efforts that have already been made to meet this challenge. Many of the measures that have been introduced, including the doubling of the remote areas allowance, the doubling of the allowance for trainees in designated areas and the doubling of grants for new and existing practices, have been aimed particularly at the situation in Grampian and show that substantial investment has been made.

There have also been appointments of new NHS salaried dentists in NHS Grampian. Great efforts have also been made to recruit dentists from overseas to the area and Wendy McCombes and her team at the dental postgraduate school in Aberdeen deserve much credit for their success in attracting postgraduate students to train in the city. Such an important initiative encourages recruitment to the region.

I should also mention that not only short-term but long-term strategies have been introduced in Grampian. For example, as Mike Rumbles has pointed out, the partnership agreement to establish a dental outreach training centre in Aberdeen is an important commitment to help recruitment in future. We need such an approach. I must say to our Conservative colleagues that we cannot underestimate how much their rush to encourage the use of private treatment has led to many of the current problems. Only now will more dentists be trained in Scotland since the closure of Edinburgh dental school in 1996.

It is tempting to consider extreme solutions to force a resolution to this problem, but the SNP's golden handcuffs policy for those trained in medicine in Scotland is noticeable by its absence from the motion. It is clear that the Executive and others must make further efforts to tackle the problem, and I welcome the wide partnership working that the Executive has highlighted as necessary in its amendment. I hope that there can be a constructive liaison with the BDA on how it can encourage more dentists to take on NHS work and on introducing incentives for dentists who carry out preventive treatment as well as remedial dentistry. I think that there is a broad agreement throughout the chamber on that matter and I am aware that the BDA has also said that it wishes to see such action.

Dentists are highly trained and deserve to be remunerated highly—indeed, that is a pertinent issue—but we need to have a dialogue with professional bodies that has a more meaningful focus than fee levels. The profession must be able to play the full role that I know that it wants to in encouraging better access to treatment and promoting dental and oral health in the country.

I agree that more needs to be done, but we can have an informed debate on what should happen next only if we acknowledge what has been done so far. It is only through taking an approach that fully includes everyone who is able to increase access to dentistry, including NHS provision, that we will be able to take full advantage of the Executive's measures to achieve the kind of access to dental services that we all want.

Eleanor Scott (Green, Highlands and Islands)

I welcome the chance to debate this important issue, because I am very aware of dental and oral health problems in Scotland. I began my career in 1980 as a school doctor and, in those days, we carried out medical inspection on all primary 1 children. Although we were not dentists, we also had a cursory look at the state of the children's oral health and put the results of the medical inspection on the medical form as a four-digit code. Although we stopped universal health inspections in 1982, I can still remember code 521.0, which was the code for dental caries. Indeed, it is the only code that I can remember. That shows just how much dental decay there was at the time and I am sure that that will still be the case today. As a result, I very much welcome the commitment to provide all children with NHS dental services, although I share other members' concerns about how that will be met.

Poor oral health in children is due not only to a lack of dentists but to other important factors such as diet. Any joined-up policy for improving oral health in Scotland must include robust moves to improve diet, to reduce the sugar content of the food that we are eating and are feeding our children, and to remove sugary fizzy drinks from schools.

However, I do not include fluoridation in any form of preventive dentistry. Indeed, I am very glad that the Scottish Executive has made a commitment not to carry out fluoridation, at least in the meantime, because it is unlikely to work as a way forward. I include in preventive dentistry free toothbrushes, toothbrushing schemes in nurseries and schools and dental health promotion visits by dental hygienists to schools.

One reason why I welcome the debate is that it has given me the occasion to read the Scottish Parliament information centre briefing "General Dental Services: Key Facts", which points out that the BDA has said that a 25 per cent increase in dentists in the UK as a whole is required. The BDA has also said that 215 additional dentists are needed to deliver the free dental check-ups that are promised from 2007. It is a medical truism that screening should be carried out only if treatment can be offered. There is no point in screening people's oral health in 2007 if we cannot go on and treat the problems that are found. The proposals have huge resource implications.

I have no doubt that there is a crisis in dental health care provision. It is tempting to go on about my region, the Highlands and Islands, but other members will do so. I simply point out that rural areas are almost always the barometer of problems, because they show up first there. We are almost certainly not training enough dentists and we are certainly not retaining enough of them. The SPICe briefing contains an interesting graph that shows the numbers of people who have joined and left the ranks of general dental practitioners, with the number of leavers consistently exceeding the number of joiners.

The figures on which the graph is based reveal that the biggest group of dentists who join the ranks of general dental practitioners is made up of those who have completed vocational training. I welcome the moves to carry out vocational training in more remote and rural areas in the hope that people who enjoy the experience will come back to work in those areas. The second biggest group is made up of those who have returned to Scotland. It would be interesting to know why they left in the first place. Allied to those figures is the interesting increase in the proportion of dentists in the 35-to-54 age group who leave general dental practice. They may be taking a career break or choosing to leave Scotland—the issue must be examined.

The largest proportion of those who leave general dental practice is made up not of those of retirement age, who make up a mere 20 per cent of leavers, but of those who are under 35, who make up about 40 per cent. The reasons why people in that age group leave might be well known and researched but, if not, the minister should consider carrying out an in-depth study of why dental practitioners in the different age groups leave and what we can do to keep them. It is projected that the number of dental graduates in Scotland will increase from the 115 that are expected this year to 143 in 2008. That is good, but it would be even better if we kept them.

John Swinney (Scottish National Party, North Tayside)

Mike Rumbles began his speech by saying that the crisis in the dental profession—I am glad that he accepts that there is a crisis—was not exactly a surprise and that it could have been predicted because it was on the horizon for some time. He properly reflected the priorities of the 2003 Liberal Democrat manifesto in setting out the priority that is attached to the issue. However, that begs the question why we have had to wait six years under devolution, including two years under the present partnership agreement, for the Government to slumber its way into action just to give a ministerial statement on the issue. If the Government's standards and ability to deliver public service improvements are anything to go by, the statement will put progress and achievements way into the distance, rather than in the here and now, where we need them.

It is all very well for us to be lectured by ministers, Labour members and Mr Rumbles about how much more appropriate it would have been to have held the debate after the ministerial statement, but we could wait no longer—we have waited far too long for the Government to extract the digit and get on with improving Scotland's health services.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

Mr Swinney will note that I did not criticise the SNP for holding the debate at this time; other members did that. However, in retrospect, does he not agree that it would have been better to wait for next week's statement? I am sure that Mr Swinney will find out then that the Scottish Executive's ambition is higher than the SNP's low level of ambition to raise investment in the dental service by just £50 million a year?

John Swinney (Scottish National Party, North Tayside)

Mr Rumbles is free to correct me if I misrepresented his remarks, which I did not intend to do. However, we did not have to wait for the ministerial statement, only for this morning's exclusive edition of the Daily Record , which has a great smiling picture on the front, to find out what the Government is going to do. That makes my point. The Government tries to direct the agenda to suit itself, when it should start directing the agenda to suit my constituents and those of Mr Stevenson, Mr Lochhead, Mr Rumbles, Mrs Radcliffe and other members, who are suffering as a result of the lack of capacity in dental provision in Scotland.

I am most concerned about the effect on children. We all accept that if we influence children's behaviour, attitudes and approach at the earliest stage, we will reap the benefits in the long term. My oral health is a tribute to the persistence of my mother in taking me regularly to the dentist when I was an infant, much against my will. I am grateful to her for that—and, I would add, for many other things. If children throughout Scotland do not have easy access to dental services, we will have enormous problems in the years to come. We have presided over an era—the six years of the partnership Government and perhaps the years since the Conservatives closed the Edinburgh dental school—in which deliberately taken actions have led to the neglect of the oral health of children in Scotland.

Health services must be accessible. Like other members, I represent a large rural constituency. Just because a dental practice is available 10, 20 or 30 miles away, that does not make it easy for people to gain access to dental health care services. People who live in small towns in my constituency where dentists have given up NHS dentistry have to travel an extra 30 or 40 miles to access treatment. How can we expect parents and hard-working families in that situation to deliver for their children? We need the Government to have the highest ambition. If the Government delivers a great injection of resources and energy into dental health services in Scotland, I would have the good grace to welcome that, but it had better do so quickly, because people in the country are suffering and they should not suffer any longer.

John Home Robertson (Labour, East Lothian)

It is, literally, painfully obvious that there is a big problem in NHS primary care dentistry; we do not need the SNP or anybody else to tell us that. We could trace the problem back to the independent-contractor status of dentists at the inception of the NHS back in 1945. More particularly, we could trace it back to the deregulation of NHS dentistry in the 1980s and the closure of the Edinburgh dental school in 1996 by another Government, to which a number of members have referred. It would be easy to show that the nationalist agenda would only make things worse; the important issue is to understand the immediate problem and to work together to achieve solutions.

I understand the problem only too well. A substantial number of my constituents in places such as Haddington and Longniddry have been dumped as NHS patients by dentists who have gone private. I declare a personal interest: the dentist who had treated my family for 20 years or so wrote to me last year to say that he was no longer willing to treat us as NHS patients but that he would take us on as private patients, at a price and on the understanding that we would turn our backs on the NHS. By an unhappy coincidence, I lost one of my front teeth at the same time. Therefore, I am extremely grateful to the NHS dentist in Edinburgh who accepted my family as patients when my dentist in the Borders privatised his practice. However, it is not tolerable for any patient to be compelled to make a round trip of 120 miles or more to see an NHS dentist.

I was seriously shocked when a constituent who was in pain came to my constituency office this week to ask for advice from my secretary when he was refused treatment by his local dentist. That is an outrageous state of affairs, particularly in a country that has such an awful dental health record. Patients who cannot afford private treatment are being held to ransom.

Rhona Brankin (Labour, Midlothian)

Does the member welcome the appointment of two new dentists, in Kelso and Hawick?

John Home Robertson (Labour, East Lothian)

That is good news. My secretary got in touch with Lothian NHS Board about that constituent's problem, which occurred in Dunbar. I welcome what is being done, but there is clearly a problem.

We look to the Executive and, importantly, to the dental profession to find solutions that will enable all citizens to get regular dental checks and treatment. It seems clear enough that the Executive is willing to help to find solutions. As the minister said, it has taken steps to increase the number of dentists who are being trained—the target is to have 150 undergraduates starting every year—but it needs to look to the future with the dental profession. Patients should be entitled to expect appropriate commitment from that profession. I understand that the average earnings for dentists in Scotland are between £51,000 and £65,000 a year, after allowing for practice costs. The PayFinder.com website says that dentists are the second best paid professionals in Scotland after finance directors. I do not begrudge them their money, but in those circumstances it should not be too much to expect appropriate commitment from dentists to NHS patients in all parts of Scotland.

The dental profession might accept its share of responsibility for the present situation, but it must play its part in achieving solutions. Like doctors, dentists are rightly held in high esteem and their remuneration is high, but I am beginning to hear some strong criticisms of them. It worries me when I hear people using terms such as "greedy" and "uncaring" about an important group of health professionals.

I conclude by urging the minister to bring the Executive's authority and its resources to bear to help to rebuild NHS dentistry. Scots have some of the worst teeth in the world and people in every part of the country need regular access to good-quality dental checks and treatment. I hope that the minister will direct NHS boards throughout Scotland to identify areas where NHS dentists are required and to take steps to meet that need.

People are entitled to expect the Executive and the NHS to play their part in resolving what is a serious problem, but it is just as important that patients are entitled to expect the dental profession to be professional and to demonstrate a proper commitment to treating NHS patients in return for fair remuneration. The minister has shown that she is listening; I just hope that dentists are listening, too.

Carolyn Leckie (SSP, Central Scotland)

I start by agreeing with John Swinney that the Executive has a cheek to condemn any party for bringing forward a debate about dental health when Labour has neglected dental health since it came into power in this Parliament in 1999 and at Westminster in 1997. The Government has accepted that there is a crisis since as far back as 2001, but it has done nothing. Although it concluded its consultation on modernising dentistry last year, a year later it has taken the publication of a report by the Health Committee and the threat of a debate on the subject by Opposition parties to force it to make a statement. Even now, the Executive is not prepared to make a statement today and tell us what it intends to do, although it is prepared to make a statement to the Daily Record . That just about sums things up.

Rhona Brankin (Labour, Midlothian)

Will the member give way?

Carolyn Leckie (SSP, Central Scotland)

I am sorry; I tried to intervene on the minister, but she did not let me. I might give way later.

We need to put the situation into perspective. I remember when I was a small child in what were—in comparison with what we have now, at any rate—the glory days of the welfare state. I noticed at first hand the improvements that resulted from the move to community dentistry and the establishment of clinics. The Florence Street clinic in the Gorbals was brilliant, but before it came into being I had a horrific experience when I was about three years old: a dentist up a close in the Gorbals slapped me around to wake me up from an anaesthetic after an extraction. Thank goodness for the Florence Street clinic. Such clinics have not attracted the necessary investment since then. Their ability to radically change children's oral health demonstrates the arguments for universality.

My next example demonstrates the need for universality even more. The fact that most people are excluded from free dental treatment unless they are on income support or are pregnant can give rise to terrible situations. I remember the awful sight of my mother—who at the time was pregnant with my little brother—standing over the sink with blood pouring out of her mouth because she had taken the opportunity that being pregnant gave her to get all her teeth extracted and to have dentures fitted. She knew that she would not be able to afford any dentistry after my wee brother was born. Such horrors demonstrate the necessity for universality in dental treatment.

Since its inception, the NHS has failed to properly incorporate dental services. We are seeing the symptoms of that now. The system of having dentists attached to community health provision and general practitioner services obviously works very well. That is the case in Greenhills, the area of East Kilbride in which I live. I pay tribute to the dentists there who, despite all the difficulties, are still working to provide NHS services.

We have had some vague commitments to increase the number of dentists. Rhona Brankin said that there might be an extra 10 dentists a year. That would still amount to only a quarter of the 40 a year that were lost as a result of the closure of the Edinburgh dental school, so the Executive is not doing much better than the Tories.

In some responses to the Executive consultation, arguments have been put forward in favour of regressive charging methods, whereby those people who were most in need and could least afford treatment would have an incentive to take responsibility for improving their own health. What utter claptrap. That was the situation that prevailed prior to the establishment of the NHS and it is why, in 1948, a third of dental appointments were for the extraction of all teeth and the fitting of dentures. If we do not act, the state of the nation's teeth will deteriorate even further and we will soon have the situation in which every third person whom we bump into on the street has a set of wallies. We need to act now.

Jamie Stone (Liberal Democrat, Caithness, Sutherland and Easter Ross)

What I hear from all quarters of the chamber about the lack of dental services rings a bell with me. As members can imagine, the remoteness of my constituency means that the problem there is acute.

I want to deal with what other members have said. Shona Robison was correct to mention the need to increase the number of dentists. The revelation that the SNP seeks an increase of £40 million to £50 million in funding is interesting and bears scrutiny. That figure should be compared with the figure that the minister announces next week.

Shona Robison (Scottish National Party, Dundee East)

The Executive can increase the level of fees and the amount of infrastructure support that it provides by as much as it wants. What I am saying is that if we are to start to make a difference, a minimum of £50 million is required. If the Executive's figure is bigger than that, we will be the first to welcome it. I am sure that Mike Rumbles knows whether that is the case because he decides Executive policy on such matters.

Jamie Stone (Liberal Democrat, Caithness, Sutherland and Easter Ross)

The SNP's figure has gone from £40 million to £50 million.

The issue is not just about the numbers of dentists; I will return to that point.

The minister is right to talk about the doubling of practice allowances, which is important. Although Nanette Milne and Mary Scanlon represent the nice face of the Tory party—I am trying to be a gentleman—it is very difficult for them to account for the mistake that was made when the Edinburgh dental school was closed. I am afraid that that is an unhappy episode in history. We must learn from that and never repeat the mistake. Mike Rumbles is quite correct to say that in the partnership agreement we have gone for the new dental school. He mentioned outreach, to which I will return, along with Shona Robison's point about the numbers of dentists.

Stewart Stevenson commented on the goal of providing free dental checks by 2007, which is a worthy aspiration. All parties acknowledge the difficulty of reaching that target, but it is right for us to set our sights high. I thank Mr Stevenson for his support on that point.

Stewart Stevenson (Scottish National Party, Banff and Buchan)

Is it correct that the member is prepared to set high targets and fail rather than set achievable targets that can be resourced?

Jamie Stone (Liberal Democrat, Caithness, Sutherland and Easter Ross)

That is ludicrous. The member knows me well enough to realise that I would go for a higher target all the way. Nice try.

Eleanor Scott's point about the link with diet was correct and I whole-heartedly endorse it. In a high quality speech, John Swinney referred to the influence of his mother. The point that he made is true. By taking children to dentists and giving them proper things to eat, we can head off problems. John Home Robertson's impassioned speech spelled out the sorts of problems that we all face.

I turn to my view. The issue almost transcends party politics; that is why I welcomed John Swinney's worthy speech. In the Highlands, Eleanor Scott, Maureen Macmillan and members of all parties—except the Scottish Socialist Party, unfortunately—have been working together with NHS Highland in a think-tank to try to come up with solutions.

I return to the point about the numbers of dentists. That is not the only problem in the Highlands. We could have all the dentists in the world, but how could we persuade them to come to Caithness? In relation to Mike Rumbles's point about outreach, it is interesting that we are in the process of developing a system whereby two or three students will come north to work in a practice in Caithness for a number of weeks or months. The extractions and fillings that the students do will take a little longer, but they have the necessary skills. We hope that the students will come to love that special part of the world, which may increase the chance that they will stay there.

I will finish with a personal comment—it is my view, not that of my party. I believe that in dentistry, and perhaps with GPs, we might be able to be imaginative by emulating what the armed forces do. They pay students a salary while they are at university on condition that they sign up to the colours for five years. We could do that with dental students, who could agree to be put where a particular NHS board wanted them to go. It might be possible for them to be sent to Sutherland, Dumfriesshire or wherever. That sort of creative thinking from all political quarters is what is needed to address the problem.

The minister has done well. I look forward to next week's announcement; I am sure that the figure will be substantially more than £50 million.

Mary Scanlon (Conservative, Highlands and Islands)

I am pleased to debate dentistry—or the lack of it—this week, next week or any time after that. As Jamie Stone said, dentistry is one of the main issues in the Highlands.

If members focus only on the closure of the Edinburgh dental school, they are missing the mark. The retention of dentists is a real problem. Members should be asking how many trained, qualified and experienced dentists are not working in their own profession.

One of the points that John Swinney made took me back to the time when I paid for my two children to have fissure sealing. Although at the time it cost £8 per tooth, my two children are now in their 30s and neither of them has any fillings. As fissure sealing can now be provided free of charge, I hope that it will be made available to more children.

I point out the fact that a million more people in Scotland have their natural teeth than was the case 30 years ago, but in Caithness alone, 15,000 people are on the waiting list for NHS dentistry. In the town of Nairn, people face a wait of almost four years if they want to see an NHS dentist. Dentistry is not just about fillings: an extensive dentistry check-up will pick up the early stages of and the problems that are associated with oral cancer, which is one of the fastest-growing cancers in Scotland.

That takes me to the £16.8 million that Tom McCabe has allocated for free dental check-ups for everybody by 2007. Like Shona Robison, I want to know whether the check-up will be the £7 quick look round the mouth; the more extensive £9.95 check-up; or the full case assessment at £20.80. That point is important. If the free check-up is to be only the basic check-up, 2.5 million people will get it; if it is to be the £9.95 check-up, 1.68 million will get it; and if it is to be the all-singing, all-dancing full case check-up, just over 800,000 people will get it.

By any account, we are not talking about free dental check-ups for every person in Scotland. Whatever check-up it is, it is certainly not what was promised in the partnership agreement. Apart from the question of which check-up is on offer, I would like to know how many dentists the Executive has signed up to provide them. I understand that not many dentists have signed up—certainly not enough. The question of how many dentists do so will naturally depend on the payment that they receive from the Executive.

Although many people in the Highlands can afford the check-up at a price of between £25 and £32, they cannot afford the treatment. Every six months for four years, the free check-up will tell people what dental treatment they need, but all the while they wait to be treated. If people want to shop around for treatment in Inverness, they have to pay £25 to £32 for every estimate.

When we read the Government jargon, we learn that pregnant women and others are entitled to free dental treatment. However, they are only entitled to that treatment if they can find an NHS dentist. I return to another of the points that John Swinney made. Under an MEL—management executive letter—all children should be given three free check-ups during their primary and secondary education. That does not happen in the Highlands and I doubt if it happens elsewhere.

And now for the good news. I attended the dental think tank meeting in Thurso recently with my colleague Jamie Stone. I commend Cathy Lush of NHS Highland and Professor Bill Saunders, dean of dentistry at Dundee dental school, for their innovative approach to outreach clinics for the training of advanced undergraduate dental students. Although the initiative is not the full answer to the lack of dentistry provision in remote and rural areas, I have no doubt that it will help. I also hope that it will help in the recruitment of local dentists who will act as trainers. The advanced undergraduate students will provide a better integration between our community dental services and the dental school in Dundee.

I have one final point to make, which has not been mentioned so far in the debate. I hope that the Executive will take account of the six-minute clean-up time that is required for infection control, which now takes place between each patient appointment. Naturally, those clean-ups will reduce the time in the working day that is available to treat patients.

Rhona Brankin (Labour, Midlothian)

I listened with interest to the various issues that have been discussed in today's debate. Clearly, we still have a lot to do if we are to improve the poor state of Scotland's dental health; nobody would disagree with that.

In Scottish dental services, we have matched all United Kingdom developments; in fact, Scotland leads the way on changing dental services.

Stewart Stevenson (Scottish National Party, Banff and Buchan)

Will the minister give way?

Rhona Brankin (Labour, Midlothian)

No. I would like to finish the point. If the member will allow me to do so, I will respond to one of his earlier points.

As I said, Scotland leads the way in changing dental services with, for example, our individual preventative programmes for children. Clearly, we have a long way to go, but we have more dentists per head of population than the UK average.

Stewart Stevenson (Scottish National Party, Banff and Buchan)

Will the minister now give way?

Rhona Brankin (Labour, Midlothian)

No. In reply to the member's point that we have no targets, I suggest that he reads the workforce plan that was published in 2004. If he does so, he will see that by July 2008, we will have 143 dental graduates and, by July 2009, 157 graduates. That is a steady increase and I am sure that Mr Stevenson will want to welcome it.

Stewart Stevenson (Scottish National Party, Banff and Buchan)

rose—

Richard Lochhead (Scottish National Party, North East Scotland)

Will the minister take an intervention?

Rhona Brankin (Labour, Midlothian)

No, I would like to make progress.

We have made a considerable and encouraging start with the additional funding and short-term measures that we have introduced, including those that are uniquely Scottish. That said, the process needs to be inclusive, not exclusive. If we are to make a real success of improving the dental health of our people, we need to work in partnership with the professions, the service and patients.

Improving children's dental health is a priority for the Executive. A number of the initiatives that we currently undertake relate to prevention: if we are to secure lasting gains, prevention must be the right way forward. I am proud of the toothbrushing schemes that are now to be found in the majority of nursery schools and of the provision of fissure sealants for six and seven-year olds, free fruit for young children and the nutritional guidelines for schools.

We need to do more, however. By ensuring that parents register their children with a dentist at an early age and by providing advice on toothbrushing and the benefits of a healthy diet, we can offer an effective way of improving oral health.

Richard Lochhead (Scottish National Party, North East Scotland)

Will the minister give way?

Rhona Brankin (Labour, Midlothian)

No. If the member does not mind, I would like to make progress.

Prevention cannot start too early. As well as contacting all parents with new babies, we have introduced a unique toothbrushing scheme that already delivers daily toothbrushing training to over half the infants who attend nurseries in Scotland.

There is already a wide variety of initiatives to improve the diet of children throughout Scotland. Those initiatives include fruit for infants in pre-school settings such as local playgroups; support for breakfast clubs; and fruit and salad bars in school settings. The initiatives will increase the consumption of fruit, vegetables and carbohydrates. They are also likely to reduce the amount of unhealthy snacks, crisps and sweets that young children consume and so contribute to improved oral health.

Making cool water fountains or water points available to all young children in educational settings will also make considerable inroads into improving oral health. Our introduction of fissure sealing for the teeth of young children, through the enhanced capitation schemes that are targeted at those in most need, can only assist in the fight against tooth decay.

Stewart Stevenson (Scottish National Party, Banff and Buchan)

Will the minister take an intervention now?

Rhona Brankin (Labour, Midlothian)

No. If I may, I prefer to carry on.

On access to NHS dental services, I am aware that availability in some parts of Scotland is getting worse, particularly for adults. It is unfortunate that some dentists have chosen to move towards the provision of private services. As we have heard, that was encouraged from the time that the Conservatives were in power.

In circumstances where health boards have experienced particular difficulties in providing access to NHS dentistry, we are able to authorise the provision of salaried dentists. We will continue to operate and build on the salaried service. In fact, over 100 salaried dentists now operate in Scotland. Over the past two years, we have also made additional funding available for the provision of emergency dental services. If we can build on that provision, we will ensure that people who suffer unnecessary pain get quick and effective support.

There has been debate about the number of dentists we produce in Scotland and whether that number is sufficient to provide an adequate service. We have double the number of graduates per head of population than the rest of the UK. We have more dentists than ever before in Scotland and we have taken positive steps to further increase the number of dental professionals training in Scotland. We will keep that under review.

The nature of primary care dental services has also changed considerably, not least because of advances in technology.

Stewart Stevenson (Scottish National Party, Banff and Buchan)

One last chance, minister?

Rhona Brankin (Labour, Midlothian)

No. I am in my final minute. I have let Mr Stevenson intervene once already, and it was an exceptionally long intervention.

We need to continue to build on those developments—particularly in the quality and standards of service and in the rewarding of dentists who are committed to the NHS, to ensure that a modern NHS dental service meets the expectations of the people of Scotland.

As I mentioned earlier, the Executive will announce on 17 March its response to the consultations on children's oral health and on modernising NHS dental services. Our response will build on the work that we have already undertaken and will introduce further measures to support both prevention and the provision of NHS dentistry in Scotland.

Richard Lochhead (Scottish National Party, North East Scotland)

The minister and her back-bench colleagues may be unhappy that the SNP has chosen this subject for debate. In her opening remarks, she said that she was surprised by the choice. I explain to the minister and her colleagues that the reason why the SNP chose this subject for debate is that it is one of the biggest health issues in our constituencies the length and breadth of Scotland. The minister should perhaps bring the issue to the chamber more often, to let the country know what she is doing.

I have been amazed by the number of people in Grampian who have contacted me on this issue in the past few years. At a meeting just last week, I spoke to a person who asked me—after we had discussed what we were there to discuss—whether I could tell her how she could access an NHS dentist. I then went to the University of Aberdeen to meet an academic to discuss the oil industry. At the end of the conversation, he said, "By the way, can you give me some advice on how to get an NHS dentist, because I've just been deregistered?" Dentistry is a huge issue in all our constituencies, which is why we have to discuss it here today. As John Swinney said, we are in the sixth year of devolution but we are still waiting for real progress. We are in the sixth year of this Labour-Lib Dem coalition and we now have our sixth deputy minister with responsibility for health who is charged with trying to sort out the mess in the NHS dentistry sector. Iain Gray was the first to have a go; then we had Malcolm Chisholm, Frank McAveety, Mary Mulligan and Tom McCabe; and now Rhona Brankin is at the helm. I know that it is a huge task to follow in the illustrious footsteps of those immense individuals who came before her.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

Mr Lochhead mentions how long we have had to wait—and it has been a long time—but would it not be wiser to wait just one more week? I hope that Mr Lochhead will then welcome the Executive's initiatives, which will show much greater ambition than that shown by the SNP.

Richard Lochhead (Scottish National Party, North East Scotland)

I have to say that it would be helpful if the minister made more announcements to this Parliament, as opposed to going to the Daily Record . We might then have more of an idea of what the Government is doing.

We hope that this will be sixth time lucky. The minister has the chance to succeed where others before her have failed. The people of Scotland are keen to move on and to get access to NHS dentists in their communities as soon as possible.

The minister has not got off to a great start. One of her first actions was to allow the chief dental officer in Scotland to go part-time. That decision left dentists throughout Scotland completely perplexed. It was a sign of complacency. The minister is not taking the issue seriously enough.

Rhona Brankin (Labour, Midlothian)

Does the member acknowledge that the chief dental officer will in fact continue to work with the NHS and to work in the education field? That is a hugely important role, given his contribution to what Mr Lochhead will be hearing about next week, in our announcement on modernising dental services.

Richard Lochhead (Scottish National Party, North East Scotland)

That just shows how out of touch the minister is. She does not acknowledge the terrible message that has been sent out to patients and dentists in Scotland. At the height of the NHS dentistry crisis, she allows her chief civil servant to go part-time.

The minister has to acknowledge the scale of the crisis. Many members have today tried to illustrate the crisis in constituencies throughout Scotland. Mike Rumbles, Stewart Stevenson and others have talked about the scale of the crisis in Grampian—a crisis that Andy Kerr, the Minister for Health and Community Care, denied existed on his visit to the area a couple of weeks ago. As Mike Rumbles quite rightly said, it is a crisis. There is no other word for it.

Grampian region alone accounts for one third of patients in Scotland who have been deregistered from the NHS over the past few years. No dentist is currently taking on new NHS patients. The local helpline has been inundated with calls from worried constituents. Emergency dental services in Grampian and elsewhere in Scotland have become the first—and perhaps the only—port of call for patients who are trying to get dental treatment. Because they cannot see a local dentist for preventive work, patients are having to wait until the problem is so serious that they have to go to the emergency dental service at the local hospital.

We have heard about the queues at Oldmeldrum, Stonehaven and elsewhere. A Hungarian who is resident in Aberdeen found that it was cheaper to fly to London, then to fly to Hungary for treatment, and then to fly back, than it would have been to pay for private treatment locally.

The problem affects many rural areas, especially the Highlands, the Borders, Dumfries and Galloway and Grampian. People have seen their shops and banks close; now they cannot even get access to a local dentist. Salaried dentists are part of the answer—there should be more of them—but in rural areas that will not work unless a health board unit with a salaried dentist opens up in every community. We have to attract dentists back into the NHS.

I want to touch briefly on the growing problem in hospital-based dental services, which creates more of a logjam for local dental practices. In areas such as Grampian, local hospital-based services are overstretched. There is only one orthodontic consultant to cover the whole of Grampian, although there should be three. We heard about the family from Ellon who had to remortgage their house to get £3,000 for private orthodontic treatment for their 13-year-old son. Their son had been on the local waiting list for orthodontic treatment since he was nine. That is unacceptable; we have to address it.

Rhona Brankin (Labour, Midlothian)

Does the member welcome the fact that Grampian NHS Board has recently provided orthodontic consultations in the private sector, to try to alleviate the backlog?

Richard Lochhead (Scottish National Party, North East Scotland)

Of course I welcome that, but I am trying to convey to the minister the scale of the crisis in NHS dental services—not just in local communities but in hospitals in some parts of Scotland.

We have heard a lot about the benefits of oral health, and Eleanor Scott spoke about diet and other ways of improving oral health.

If we are to deliver free dental checks, we need the dentists. There is no point in making pledges that cannot be fulfilled. That is irresponsible. The minister does not even seem to know how many dentists we will need in Scotland to fulfil the pledge to deliver free dental checks. We have to attract more dentists to work in Scotland and we have to train more dentists here in Scotland.

At present, there are many more applications to dental schools than there are places. There is therefore scope to expand the training of dentists in Scotland. We may have to open new dental schools, because we have to ensure that more dentists are working in our communities.

This Government has somehow—at a time of record NHS investment—allowed dental services to implode in many areas. The Tory party's legacy in Scotland was long dole queues; this Government's legacy will be queues of people trying to get basic access to NHS dentists in their communities. The minister should acknowledge that this is a huge crisis that should be top of her health agenda.

Early Years Education and Child Care

Trish Godman (Labour, West Renfrewshire)

The next item of business is a debate on motion S2M-2547, in the name of Fiona Hyslop, on early years education and child care.

Fiona Hyslop (Scottish National Party, Lothians)

I will attempt to provide a link from the previous debate to this one by complimenting the Executive—I admit that I do not do that very often. This week, at his eight-month check, my baby son received a toothbrush and toothpaste from the health board. I am not sure about access to dental services for all babies who were born last year, but my son also received, in a canvas bag, baby books from the book store initiative, which is supported by the Executive. I therefore acknowledge that universal access to support for an early start in education is already part of policy.

Some children start nursery having never had a book in the home, and having never had the love and nurturing that most children receive. It is not only the child's development that can be supported. Early years policy supports working families and society in general. However, in the Government's policy, there has been too much emphasis on getting single mums back into the workforce. Tackling poverty is crucial, but there is a danger that the Government, in doing that, has lost sight of the primacy of the development of the individual child as the driving force behind policy. Developing motor skills and cognitive understanding is about more than simply improving later results; it is about enhancing the child's ability to understand the world, delivering for the child the magic of discovery and learning, and creating a wonder that will continue to feed interest and to create a hunger for learning to last a lifetime.

What about societal benefits? The abecedarian project in the United States, which offered intensive pre-school education, concentrated on children from low-income, multirisk families. Studies at age 21 of young adults who had attended the project produced impressive results. Those young adults were more likely to have attended tertiary education, and the study results showed a reduction in the number of teenage pregnancies and the use of illegal drugs. The US Perry pre-school project pointed towards a cost-benefit analysis: for every $1 spent on the US abecedarian project, society saved $4, while every $1 spent on the Perry pre-school project saved $8.

Where stands Scotland? I understand that we expect to see the Government's national early years strategy soon, but it was first consulted on in 2003, it was promised by March 2004 and it has been delayed in publication. It is right and proper that, in the absence of such a strategy, the Parliament should state its views on what it can expect.

In the meantime, the issue of the recognition of the work of nursery nurses still awaits long-term resolution. Scotland is ahead of England in many respects in early years education, and all that Labour in England is promising at the forthcoming election is 15 hours a week of education by 2010. In Scotland, if the Executive heeds the Scottish National Party call, we could increase provision to 3.25 hours a day for 38 weeks, starting now. That would mean an extra 200 hours of early years education this year for more than 100,000 children. The Government currently provides 12.5 hours a week for only 33 weeks a year, which is equivalent to only 11 hours a week over a normal primary school year of 38 weeks. A move to full half-day provision, as called for by the SNP, could be started this summer, where staff and accommodation capacity exist, rather than by some distant target in 2010.

Our ambition for young Scots does not stop there. The SNP would seek that increase as part of a commitment to move to eventual full-day provision for education and child care. Denmark and Sweden spend 2 per cent of their gross domestic product on early years education and child care, while Scotland spends only 0.5 per cent. Only 8 per cent of five to 10-year-olds in Scotland receive formal out-of-school care; in Sweden, the figure is almost 75 per cent. Schools should become children's centres for the community, and there should be a presumption against the closure of rural schools such as those that are currently under threat in Aberdeenshire; their use should be expanded to provide community child care.

If we want to tackle fundamentally the inequalities and if we want to cultivate the cognitive skills that the future economy will need—as an increasing number of economists, from Nicholas Crafts to Professor Heyman, have said—early years is the place that will make the biggest impact. Until we have the powers over the tax and benefit system that would come with independence, we are restricted here in Scotland in what we can do. We are operating child care policy with one hand tied behind our back.

Robert Brown (Liberal Democrat, Glasgow)

I am grateful for the credit that Fiona Hyslop gives to the Executive for its work on the issue, but at the end of the day her aspirations would have to be paid for. How, from the point of view of independence—which is what Fiona Hyslop is really proposing—would those aspirations be paid for? How do we raise spending by four times merely by moving to independence?

Fiona Hyslop (Scottish National Party, Lothians)

No Trident; no illegal wars; no identity cards; and by investing in children rather than bombs.

The SNP policy of early education and child care for all would mean a universal, comprehensive system in which there would be a fundamental and radical policy shift; public money from the state would be moved from subsidising the demand side to subsidising the supply side, or child care providers. Instead of operating an expensive, bureaucratic taxation system that subsidises parents' access to expensive, often inaccessible, child care, the Government would subsidise the providers of accessible, quality, affordable child care. For the Tories, that could mean parents. In short, if we are to emulate our Scandinavian cousins, instead of subsidising a few parents for 70 per cent of the 100 per cent of child care costs that they pay, the state would subsidise child care provision so that parents would have to pay only 30 per cent of the cost in the first place. No one would lose out and everyone would benefit. What better way to spend the benefits of an independent Scottish economy, growing at 4 per cent a year? That is real ambition. That is a real smart, successful Scotland.

The power of early years development and education in young children is staggering; the power for damage to be done at such an early age is frightening. If we want a strong, confident nation we need to build firm foundations for our future generations.

I move,

That the Parliament recognises the vital role of early years education and the importance of quality, accessible childcare in stimulating children's development and supporting working families in particular and the wider economy and society generally; notes with concern the delay in the publication of the national strategy for early years with provision for a national settlement for nursery nurses from the Scottish Executive; supports the immediate extension of free nursery education for three and four-year-olds to a full half day from the current part-time provision and the extension of "nurture groups" across Scotland for vulnerable young pupils, and recognises, however, that in order for Scotland to be able to shape and deliver comprehensive early education and childcare the Scottish government needs to have powers over tax and benefits in order to provide a universal entitlement to emulate the provision of Scandinavian countries who spend four times the proportion of their GDP in support of children in the early years as Scotland.

Euan Robson (Liberal Democrat, Roxburgh and Berwickshire)

Today's debate is a welcome opportunity to say just how much is being invested in early years education and child care. There is a mass of evidence that shows that positive interventions, such as high-quality early education and child care, when a child is very young, can have a significant beneficial impact on that child's whole life and future direction. Fiona Hyslop mentioned a number of such pieces of evidence. As I said in last week's debate on school meals, the Executive's vision is that children are safe, nurtured, healthy, achieving, active, respected, responsible and included. We also want to ensure that children and young people are successful learners, confident individuals, responsible citizens and effective contributors to society and at work.

So what investment is the Executive making in early years education and child care? I want to devote a few moments to underline just how much resource the Executive has already committed and will commit. Scottish Executive child care strategy funding this year is £30 million, rising to £43 million in 2005-06. Sure start Scotland funding for our youngest and most vulnerable children is £35 million this year, rising to £53 million next year. We also have more than £1 million for 2004-06 from the Department for Work and Pensions for two extended schools child care pilots, providing child care for lone parents who are on income support. We have provided £20 million from 2004-06, under the working for families fund, to provide child care support in the most deprived areas, to help parents to access education, training or employment.

In addition, community regeneration funding can support child care. The Minister for Communities announced on 9 December 2004 that the CRF will amount to £318 million over three years: £104 million in 2005-06; £106 million in 2006-07; and £108 million in 2007-08. Local authorities spent £195 million on pre-primary education in 2002-03, covering services that they provide directly as well as those that they provide in partnership with the private and voluntary sectors. At December 2004, more than 32,000 families in Scotland were benefiting from the child care element of the working tax credit, with an average award of £47 a week. Separately, awards from the big lottery fund child care programme totalled an average of £7.9 million per year for Scotland for the period 2001-03, and £14.5 million is available from its quality child care programme. I mention all that because sometimes we lose sight of how much we invest in child care and early years education. That is a key investment and one that we will continue to achieve.

Not only can child care help children in their growth, development and achievement, but it can support parents who are working or who want to work. We know that work is the best route out of poverty, so good-quality, accessible and affordable child care can help to prevent poverty.

Our Scottish child care strategy—which aims to ensure that good-quality, affordable child care is available for all—has been in place since 1998 and we have made progress. The Scottish Commission for the Regulation of Care now regulates all child care up to age 16, working jointly with Her Majesty's Inspectorate of Education on the inspection of pre-school education. There has been an expansion of child care, with 243,000 children—28 per cent of all children aged up to 14 and a 7 per cent increase on the previous year—now receiving formal care. Out-of-school care in particular has benefited from lottery funding programmes, with £29 million going into creating over 48,000 places. There is a pre-school education place for all three and four-year-olds whose parents want one, and we should celebrate the fact that 85 per cent of three-year-olds and 100 per cent of four-year-olds—a total of more than 103,000 children—attended pre-school education in 2004. The workforce is better qualified than ever before; almost three quarters of early education and child care staff hold qualifications.

Of course, in the pre-election period, while the Tories crank up the gramophone to play the worn-out tune of vouchers, the Scottish National Party feels obliged to dream up some ideas for what to say and promise in the full knowledge that it will have to deliver none of them. Despite that luxurious position—the ability to afford anything without the need to develop its proposals—the SNP still cannot offer much. It says nothing about quality of provision or flexibility and choice for parents and it deals with only one dimension of current provision. As the First Minister and the Deputy First Minister have said in recent weeks, we have ambition to expand provision even further and, when we do, we will not take the SNP's one-dimensional approach; we will show real ambition for parents and children and the quality of provision to which they aspire.

I move amendment S2M-2547.1, to leave out from "notes" to end and insert:

"supports the Scottish Executive's aim to provide more flexible and available childcare to all; acknowledges the significant successes already achieved through the Scottish Childcare Strategy, including making available free part-time pre-school education for every three and four-year-old, establishing a coherent regulatory framework under the Care Commission and expanding childcare provision across all sectors, and endorses the Executive's commitment to universal early education and childcare services with specific support to disadvantaged groups, including those for whom lack of childcare is a barrier to employment, education or training."

Bill Aitken (Conservative, Glasgow)

In the absence of our education spokesman—who will, I hope, be playing his part in a Government defeat in another place—I will speak to and move the Conservative amendment.

The debate is one of those in which we all agree on the ultimate goal—we all wish young children to be given the best possible start in life and consider pre-school education to be an essential part of that—but differ on how that may be achieved. The Conservatives' watchword in that respect is flexibility. I say to the minister that that is not the gramophone being cranked up, but a state-of-the-art CD player, which indicates our modern approach to education, as to everything else. That approach is based on the belief that families, not Governments, should decide how to run their family life. As Ms Hyslop will confirm, no one knows better than parents how children should be brought up. For some families, it might be better for the children to use a breakfast club or after-school club; for others, it might not. However, it is essential that parents should be given that choice.

Fiona Hyslop (Scottish National Party, Lothians)

Choice means services being available. It is not possible to have choice if there are no services, and the state can help to provide the services.

Bill Aitken (Conservative, Glasgow)

Exactly; that is why I take issue with some of the SNP's policies on early years provision, which will result in many of the services not being available. Despite her able put-down of Mr Brown, Ms Hyslop has not explained satisfactorily how the proposals that the SNP has in mind would be costed. Indeed, some of the SNP's policies are likely to have the opposite effect to the one that she seeks. For example, the SNP's dogmatic approach to the private finance initiative would result in our simply not having new nursery or primary school buildings. That is the bottom line.

I return to choice, which is important. I am sure that we all agree that class sizes should be the minimum possible that is compatible with educational accountability. The smaller the class, the more likely the child is to succeed, but if parents were to put class sizes before school reputations, they would select schools with half-empty classes rather than schools that are full to overflowing because of their performance and reputation. Of course we want smaller class sizes, but that is not a top priority for parents, who want quality of education, which must be the priority.

I fully acknowledge that more money has gone into the system, but despite that fact, the Executive's stance has not exactly been inspiring. One need only read the evidence of the Scottish Independent Nurseries Association to see how political dogma stands in the way of the provision of a more imaginative and flexible service than that which local authorities provide.

I have no doubt that members noted with interest a piece in the Edinburgh Evening News a couple of weeks ago reporting the concern—indeed, the anger—of Edinburgh parents at the City of Edinburgh Council's plans to close four nurseries and replace them with one supernursery. It seems that child factories are to join granny farms as the way forward. The Conservatives would allow the funds to follow the child, and the parents would decide which centres remained open. Parents would be given the choice and there can be no doubt that, on that issue—like everything else in life—if the individual is given choice, matters will improve. That is a fundamental truth in education in particular.

The debate is short, and I would have liked to raise other issues, such as the ability of schools, working with the voluntary sector, to do a great deal for young children's physical fitness. To be frank, the Executive is obstructing that at the moment.

Euan Robson (Liberal Democrat, Roxburgh and Berwickshire)

What?

Bill Aitken (Conservative, Glasgow)

Yes; the schools' ability to do that is being obstructed by the Executive's attitude towards the voluntary sector. The Executive seems to think that local authorities should do everything and that acts as a positive disincentive to those who are willing to give their time to provide children's services that the local authorities manifestly do not provide.

I move amendment S2M-2547.2, to leave out from "working families" to end and insert:

"parents who choose to work; notes that both the Scottish Executive and the Scottish Parliament's Education Committee are currently reviewing early years provision, including issues of recruitment and retention of staff and pay and conditions, and believes that parents must have the flexibility to choose the form of nursery education best suited to their family circumstances and that a nursery voucher that can be topped up represents the best way to achieve this."

Rosemary Byrne (SSP, South of Scotland)

Good-quality child care and early years education are crucial to the well-being and development of the youngest in our society. Many parents and children are trapped in a life of poverty because of the lack of affordable child care. Provision of nursery places for all three and four-year-olds is to be welcomed, but it does not solve the problem for working families, who require flexible arrangements for the care of their children. We need available places in after-school clubs and breakfast clubs, as well as day care for the very young. Private nurseries are expensive and beyond the budgets of many parents, which is why we need publicly funded child care provision.

The Scottish Socialist Party welcomes nursery provision for all three and four-year-olds, but we would like that provision to be extended. We should value investment for children, because, after all, they are the future of Scotland. Therefore, we should value the professionals who work with them. Nursery nurses took industrial action a year ago to secure an improvement in their pay and conditions and the recognition that they are key education professionals. What did they get in return? Local agreements with different wage settlements—nursery nurses remain poorly paid and undervalued. Talk is cheap, but it takes money to provide a professional service. Nursery nurses deserve that money, and so do our children.

Given the months of industrial action and the promises that were made, it is unacceptable that the Executive has delayed the publication of the national strategy for early years education, and I hope that the minister will give some indication of when the strategy will be published.

The Scottish Socialist Party believes that all child care should be state funded at the point of need and that flexibility to accommodate families' needs should be the norm. There should be a mixture of high-quality care and education for all children from birth to school age; child care that is provided by trained and valued staff; provision that suits the working lives of families; and early intervention to ensure the best possible start for all.

It is vital that the lasting benefits of early intervention be recognised, because a sound foundation in the early years is key to future learning and development. Early identification of special educational needs or social, emotional and behavioural difficulties reduces the long-term risk of underachievement and disaffection. Nursery nurses are the professionals at the front line of that issue and, alongside health workers, have a crucial role to play. Unfortunately, like many teachers, nursery nurses are frustrated by a lack of joined-up services and a shortage of educational psychologists, clinical psychologists, speech and language therapists and social workers; such shortages lead to gaps in provision and poor transitions because the resources to support the nursery nurses are not provided. In one case that I dealt with recently, a child with Asperger's syndrome ended up by suffering part-time education for the whole of primary 1 despite the fact that a pre-school community assessment had been undertaken.

The same thing happens with those children who display early signs of behavioural difficulties. Nursery nurses who taught children who I received in transition from primary to secondary school have asked me, "How's wee Jimmy doing?" and I have replied, "He's been excluded for setting fire to the toilets." The nursery nurses then say, "That wee boy had real problems from day one. We tried to get support for him and his family, but the intensive help they needed was not available." We reap the benefits of indiscipline in our schools later because we do not deal with those issues early and we do not put the resources into sorting out young people and supporting parents. We do not help people with parenting skills or with getting support from the nursery nurses, who are the professionals and who can provide support at an early stage. We make those mistakes over and over again and many nursery nurses, primary teachers and secondary teachers are frustrated by the situation.

Putting children into smaller classes in primary school would make a significant difference. Having classes of 20 or fewer would allow for individual support and, crucially, for the teacher to interact with the children in a smaller setting. That, along with the provision of support staff, would make an immediate difference to meeting the needs of all our children.

We need a fundamental shift in what we do at the early stages of child development. I ask the Executive to look at the Danish system, whereby playing, singing, role playing, going out into the woods and making the best use of nature provides three and four-year-olds—who are at a crucial stage—with the best start in life socially and in every other way. We should consider adopting that approach instead of keeping the formal curriculum that we have at the moment.

I move amendment S2M-2547.3, to leave out from "in particular" to end and insert:

"; calls for a recognition of the professionalism of nursery nurses and the immediate establishment of national pay and conditions commensurate with that professionalism; further calls for an immediate response from the Minister for Education and Young People regarding the delay in the publication of the national strategy for early years; demands a system of accessible childcare and nursery education publicly-funded and free at the point of need for all families; supports the wisdom of early intervention in the early stages of education and the implementation of developmental needs provision rather than formal learning, and calls for appropriate support for children with special educational needs and social, emotional and behavioural difficulties and also appropriate support for parents and carers of these children."

Scott Barrie (Labour, Dunfermline West)

In the previous debate, Carolyn Leckie said that she was a wee girl in the heyday of the welfare state. Given that Ms Leckie and I are roughly the same age, I assume that she meant the 1960s. In that period, I attended Carleton nursery in Glenrothes, which was run by the local authority. Let us be honest: in the 1960s, it was rare for any four-year-old to have a nursery place, even in Fife. Fife County Council, then Fife Regional Council and eventually Fife Council were well ahead of the national game in pre-school education. I am glad that it was a Labour initiative that ensured that all four-year-olds, and now all three-year-olds, whose parents desire it, have a nursery place, so that young people will have the same advantages and start in life that I was fortunate to have in 1966. I, more than most members in the chamber, know the benefits that a good-quality pre-school education can have for achievements at school, which I have mentioned in previous debates.

I am glad that when we debate education in general, and pre-school education in particular, there is consensus among all members about the needs of young children. We do not have to argue about that; it is a given. It is a bit unfortunate that the Conservatives have come round to the idea so late, because they had so much opportunity to do something about pre-school education when they were in power, but patently did not.

Bill Aitken made the bold statement that all parents know what is best for their children. I wish that that were the case but, for a small minority, it is not. We would not have child protection investigations into physical abuse and injury, emotional abuse and failure to thrive if parents always knew what was best for their children. The Conservatives should take on board the fact that parents do not always know best and that the state has an important role to play in ensuring that young people's needs are met properly.

David Davidson (Conservative, North East Scotland)

Does the member agree that we should be talking about the state giving choice and guidance to parents, who ultimately must make the choice that is in the best interests of their family?

Scott Barrie (Labour, Dunfermline West)

No. I do not accept that, if choice means returning to the old has-been of a voucher system, which gives some people a better start but does not offer the universal provision that I, and I think most members, believe that young people deserve.

The SNP motion highlights Scandinavia, and Fiona Hyslop mentioned Sweden and Denmark in her speech. We might also mention the Netherlands, whose pre-school provision is renowned and which has a compulsory education starting age of 6. We should consider that when we talk about pre-school education and the compulsory school age. Fiona Hyslop did not develop the cost of immediately offering Scandinavian-type provision. It is incumbent on anyone who brings proposals to the chamber to spell out the costs. We cannot have Scandinavian-type provision with Republic of Ireland tax rates. The SNP must answer that fundamental conundrum. If we want the level of public provision and services that exists in Scandinavia, we must also invest the amount of money that is spent there, and the Republic of Ireland does not spend that amount of money. It is said constantly of the Scottish economy that we should follow the Republic of Ireland model. If we do so, it stands to reason that we will have the same level of public services that the Republic of Ireland has, which is nothing like the level enjoyed in Scandinavia.

Rosemary Byrne said that an integrated approach was required in pre-school education. She is absolutely right, but even when such an approach is taken, it is not always the case that youngsters do not fall apart.

Let us not deride the developments that have taken place and the improvements that have been made but build on them.

Stewart Maxwell (Scottish National Party, West of Scotland)

I am pleased to have the opportunity to speak in support of the motion in the name of my colleague, Fiona Hyslop. On what Scott Barrie just said about investing in our young children, can he answer the question what would be the cost of not investing properly in them? That is the question that should be asked, not how much this or that cost. Those are genuine and relevant questions, but the fundamental question is what the outcome will be if we do not invest in the education and care of pre-school children. We see the outcome in some of the problems in our society today.

One of the most important things that the Parliament could do for families is to provide at least a full half-day's child care for three and four-year-olds, which is readily accessible to all parents, which means preferably within walking distance. That is not what we have at the moment, no matter what the minister might try to pretend.

By way of example, I cite my experience of trying to deal with child care arrangements for a pre-school child. The current arrangements are far from perfect. When it was time for my daughter to attend nursery school, we duly completed the local authority form, which included spaces to state whether we wanted mornings or afternoons and which nursery we wanted our child to attend. We asked for mornings and for a place at the nearest nursery, which happened to be located in the primary school that my daughter would be attending the following year. Some time later, the letter from the council arrived informing us of the offer that it was making us. We found that instead of mornings in a nursery within walking distance of our house, we were being offered afternoons in a nursery in a different area that was not within walking distance. Given that there is no direct public transport route between where we live and the nursery and that we did not have access to a car, it was impossible for us to accept the offer.

There is no point in saying that nursery provision is available to all, because that is not the case on the ground. The reality is that many parents cannot take up offers because of accessibility problems. We rejected our offer, because it was completely useless. It is no use having places available if they do not match the needs of parents. Places must match what families need. Therefore, they must be accessible to families and, in particular, to mothers, given that the burden of child care usually falls disproportionately on women. We know that many women do not have regular access to a car. Even if a family owns a car, often the working parent needs it to access their place of work.

Robert Brown (Liberal Democrat, Glasgow)

Does the member acknowledge that, nevertheless, something like 99.5 per cent of four-year-olds are taking up the opportunity of nursery education? We have to put the situation in perspective.

Stewart Maxwell (Scottish National Party, West of Scotland)

I accept the figures absolutely and I accept that it is better to have the care than not to have it. However, I am saying that the provision is not good enough at the moment.

Even if a family has a car, it is often not accessible to the parent who is looking after the child. We all know that many of the people who need services most are among the section of the population with the lowest percentage of car ownership. Therefore, they need places close at hand.

The issue should not be regarded as being merely about the needs of young children or of parents. Fundamentally, it is an equal opportunities and women's rights issue as much as it is a children's issue. The problem with the current arrangement is not just accessibility. The main problem is that provision simply does not meet the needs of women who wish to return to employment. Two hours of child care per day is not good enough. Women who want to, and often need to, return to work while their children are young depend on child care provision. The provision of two hours per day completely fails to help, even if a woman wants to take up part-time employment. Perhaps when the minister winds up he will be able to identify a single job that would allow a woman to work for an hour, or an hour and a half at the most, per day. Two hours' child care does not equate to two hours' work when travelling time is taken into account. That is why we must move on and provide a full half-day's child care at the very least. With a full half-day's child care, part-time work becomes possible for the first time.

Maureen Macmillan (Labour, Highlands and Islands)

Will the member take an intervention?

Stewart Maxwell (Scottish National Party, West of Scotland)

No, I do not have time. Sorry.

Many employers have posts that can be job-shared so that mornings or afternoons can be worked. It is clear from the amount of money that we invest in early years education and child care compared with the amount invested by many small, independent countries, such as Denmark and Sweden, that we are failing properly to address the issue. If we want to make a difference to young children, mothers and families, we need to solve the problem and give them the support that they need to grow, develop and prosper.

This Parliament cannot do everything that is required to sort out the problems that our country, operating with one hand tied behind its back, faces. Only by taking all the necessary powers to deal with the issues can we tackle the core problem.

Murray Tosh (Conservative, West of Scotland)

Quickly.

Stewart Maxwell (Scottish National Party, West of Scotland)

In conclusion, if we think that the provision of two hours of child care per day in any way helps families who cannot afford to pay for child care for the rest of the day, we are kidding ourselves. We are doing nothing more than window dressing what is a serious problem for so many families in Scotland.

I urge members to support the motion.

Maureen Macmillan (Labour, Highlands and Islands)

All members so far have emphasised the importance of early years education and early years child care, although I do not think that Stewart Maxwell realises that there is an important difference between education and child care.

I would like a more holistic service for children and families. I agree that we look forward impatiently to the introduction by the Executive of an integrated early years strategy. Of course, such a strategy has implications for the assessment of comparative pay, conditions, qualifications, training needs and career paths between the various sectors of child care and nursery education. Making that assessment is much more of a challenge than just addressing the need for agreed pay and career structures for qualified nursery nurses. I note that, when the matter was debated in June last year, the Executive said that it would have proposals on the table within a year. I hope that we will see them by the summer. Average pay in the child care sector is about £8 per hour compared with the Scottish average of £11 per hour. I hope that the Executive will take the opportunity to show its commitment to equal pay for women.

Universal, free nursery education for four-year-olds was at the heart of Labour's manifesto in the 1997 elections and the Scottish Executive extended such education to three-year-olds. Delivering that was not an easy task for local authorities, particularly for rural local authorities such as Highland Council, which often have to provide for a handful of children in remote and rural communities. Councils try to organise transport to nursery groups through community networks and voluntary organisations, and I have spoken to the minister about those pressures in the past.

Early years provision in rural areas has been helped considerably by the increase in both child care and sure start funding from the Executive. That increase has also allowed funding for family projects in deprived urban areas, which we also have in the Highlands, and the working for families fund has supported parents—mainly single parents—into work in remote areas by providing child care.

Highland Council is to be commended for what it has achieved from almost a standing start in both English-medium and Gaelic-medium nursery and playgroup provision. It has worked in partnership with various voluntary organisations. Bill Aitken gave the impression that such working does not happen, but I will mention some of those organisations and the sterling work that they do. My first example is a project that has been much visited by ministers. NCH's excellent project at Merkinch in Inverness supports young families in one of our most challenging environments.

There are also projects in remote and rural areas, such as the project that is run by Family First in Skye, Wester Ross, Sutherland and Lochaber. Vulnerable young families are supported in their parenting skills through one-to-one encouragement and engagement and they are given help to make contact with peer groups in the community. Home-Start Scotland, which operates throughout Scotland, also offers one-to-one support through home visits. Those two organisations operate with well-trained and dedicated volunteers and they provide a valuable service to our most vulnerable people. It has been shown in Scandinavia that the maximum benefit comes from supporting parents in looking after their children in the early years rather than from nursery education. The Scottish Childminding Association also deserves recognition for its contribution. Often, it cannot access funding for its training needs because it supports people who run businesses.

I mention those various bodies and funding needs to show that supporting children is about a lot more than free nursery education. The money that the SNP would spend on providing all children with an extra three quarters of an hour of nursery per day might be better directed towards the more vulnerable families that need more intensive support. I will not go into the £9 billion black hole, but I ask whether we would have the same levels of child benefit under the SNP. Would we still have the working tax credit, which gives families an average of almost £50 per week for child care? Would we have nursery education at all?

In conclusion, I ask the Executive when its integrated early years strategy will be published. Some councils are already some way down the line; Highland Council no longer has child care partnerships but has a family resource alliance.

Murray Tosh (Conservative, West of Scotland)

Quickly.

Maureen Macmillan (Labour, Highlands and Islands)

I also urge the Executive to consider how important the care of children is to society and to show its appreciation of that when it publishes its recommendations on the salary and career structures of those to whom we entrust our children.

Tricia Marwick (Scottish National Party, Mid Scotland and Fife)

On a point of order, Presiding Officer. I wonder whether you can do anything about the heat in the chamber this morning, which is excruciating.

Murray Tosh (Conservative, West of Scotland)

Actually, no, I cannot. Members who were present yesterday afternoon will remember that when whatever happens up here happened, it was very noisy and disruptive and it interrupted Ms Hyslop's speech, so perhaps it would be best if the matter was dealt with over the lunch period.

Robert Brown (Liberal Democrat, Glasgow)

That is perhaps an example of the lack of practical politics in the SNP.

Fiona Hyslop introduced today's debate with a powerful speech, most of which I agreed with. However, her colleague Stewart Maxwell then spoiled matters with his gross exaggeration, building an edifice on a pin-prick of local difficulties. I recognise that such difficulties will exist from time to time, but they are perfectly capable of being dealt with.

Stewart Maxwell (Scottish National Party, West of Scotland)

Is the member really saying that two hours of child care per day, often in the middle of the day, is sufficient to allow women to go back to work?

Robert Brown (Liberal Democrat, Glasgow)

No. I am saying that the achievements of the Executive and the Parliament on the matter have been substantial. Fiona Hyslop rightly gave recognition to them, but Mr Maxwell seems to dismiss them out of hand and suggest that they are non-existent to build his local problem of rural access—although that is an important point—into a general theory.

The SNP motion is, to parody Winston Churchill, a platitude wrapped up in an aspiration inside a non sequitur. The platitude is the recognition of the vital role of early years education and accessible child care. I doubt that anyone in the Parliament disagrees with that. Indeed, it is one of the proudest boasts of the Liberal Democrats that, through the partnership agreement with Labour, the Executive has delivered the right to and the reality of free nursery school education for three and four-year-olds. That is a stupendous achievement and it should pay huge dividends in the years to come. While the SNP has dilly-dallied in the highways and byways of constitutional rearrangements and the assorted irrelevancies, the Liberal Democrat and Labour Executive has delivered.

Of course, more could be done. My view, and the view of the Executive, is that a comprehensive, accessible and affordable early years education and child care service is in sight. The Education Committee is to conduct an inquiry into early years learning later in the year to map out where we are and identify what works, what does not, what the priorities are and what changes are needed. Fiona Hyslop's aspiration is pretty similar to the aspirations of most members in the chamber. Many of us have considered or read about nurture groups for vulnerable youngsters and we recognise their value, as does the Executive.

So we have a platitude, we have an aspiration and we come to fulfilment. The SNP contention is that the Parliament needs powers over taxes and benefits to increase spending on early years support to four times its current level. That is a non sequitur of a truly impressive kind. Liberal Democrats have always held the view that Scotland should have much stronger fiscal powers, but for good reasons: democratic accountability and transparency and to support the proper federal relationship that should exist between Scotland and the United Kingdom.

Fiona Hyslop (Scottish National Party, Lothians)

Will the member take an intervention?

Robert Brown (Liberal Democrat, Glasgow)

No.

Since 1999, the Executive's budget has risen from £14 billion to about £22 billion, which is a rise of more than 50 per cent. It is simply not credible for the SNP to claim that it can magic up more funding through independence—indeed, the motion does not ask for independence—and, as far as we understand, by reducing taxes.

The SNP's financial policies make even the Conservatives look like models of financial rectitude and practicality. The SNP should not play financial conjuring tricks with the future of Scotland's children. It should say where it will find four times as much funding for early years care as is provided now—that was not in the debating points of Fiona Hyslop's answer earlier—and say which services it would cut and which taxes it would raise.

The Liberal Democrat vision for Scotland's children does not rest content with current progress, impressive though that is. We believe that nothing is more important than giving every child in Scotland the best start in life and the best opportunity to fulfil his or her potential. Maureen Macmillan made important and useful points about the breadth of approach that we must take. Constant improvement in public resource is needed to bring about that vision.

I have much pleasure in supporting the Executive amendment.

Frances Curran (SSP, West of Scotland)

The question in the debate is what we want. We are after access for parents to good-quality child care and a Government guarantee that when a parent puts their young and vulnerable child in the hands of a carer, they will have good early years education. I take Maureen Macmillan's point that child care and early years education are different, but she should accept that, for most families and working mothers, they are tied together, because of the decisions that we must take.

We want professionals to be responsible for our children when we put them into child care and we want the resources to allow children to develop. That is what we want and need, but the reality is that Government policy is fragmented. Robert Brown said in an intervention that 99.5 per cent of four-year-olds have nursery provision. What a scream that is. I agree with Stewart Maxwell that two or three hours of provision a day is a complete waste of time for most part-time working women, never mind full-time working women.

Maureen Macmillan (Labour, Highlands and Islands)

Will the member give way?

Frances Curran (SSP, West of Scotland)

No; I want to finish my point.

If a parent accepts that provision, they have more hassle to arrange child care before and after the place that the Executive deigns to give them. Stewart Maxwell's experience is not a pin-prick; it represents what usually happens to most parents—mainly women—who want to take up a nursery place.

Full-time places for three and four-year-olds are few and far between in council, public and partnership nurseries and have a huge waiting list. Parents must fill in a criteria form for a decision on whether they can obtain a place, and 90 per cent of people who want a place do not obtain one.

That is the reality of the option that is available from the Executive.

Early years learning initiatives from the Executive are falling on professionals like confetti. I do not have time to go through the unbelievable number of initiatives that have been produced in the past few years. At some point, the Executive will have to learn that its progress and performance are judged not on the number of bits of paper that it produces, but on how it treats the service and the professionals in it.

The professionals who are on the receiving end of the initiatives—the diktats from the Executive—and who are expected to implement them without resources or recognition of professional status are the nursery nurses who went on strike against the Executive. The situation is not good enough. Maureen Macmillan said that the Executive hoped to have a review within a year. We have not had that and we do not know what the progress has been. Will we achieve equal pay and accept that we want professionals in the sector? Is the Executive prepared to put its money where its mouth is and to back that professional section of the workforce? We have plenty of bits of paper, but no evidence that the Executive will follow them through.

I agree in particular with the part of the SNP motion that calls for the immediate introduction of full-time nursery places in local authorities for all three and four-year-olds whose parents want such a place. Why is that target so hard to hit? Why is that aspiration beyond the Parliament? Why can we not implement that proposal? It is implemented in half of Europe, for goodness' sake. Child care provision goes much further in countries such as Denmark, but we have apologies for ministers who say that the aspiration goes too far. That shows the Executive's poverty of vision. We need the measure and I urge the Executive to support it.

Elaine Murray (Labour, Dumfries)

I thank the SNP for the opportunity to debate early years education because Labour in local, Scottish and UK Government has made a huge difference to it in the past 10 years. I thank the SNP for the opportunity to celebrate Labour's success and look forward to what we can achieve in the future.

My children were all born when Mrs Thatcher was Prime Minister—under a Tory Government, people had to do something to cheer themselves up. At that time, only 25 per cent of pre-school children who lived in Ayrshire—the part of Strathclyde in which we lived—were offered a half-day nursery place in the year before they started school. A parent had to put the child's name into a ballot in the hope that they might get something.

No choice of establishment or time was available and many areas of South Ayrshire had no provision. I probably used up all my lottery luck—I must have, because I have never won in the lottery—by having all three of my children being offered a place through that ballot. As a working mother, I appreciate that problems existed at that time in organising wraparound care, but that provision was still valuable and its extension is still a tremendous success.

Addressing the issue was a key priority for Labour South Ayrshire Council—Murray Tosh will remember its election in 1995, only 10 years ago. At that time, local government had to consider the Tories' voucher scheme, but the council decided not to become involved in it. I hope that the Tories will give us the opportunity before the general election to debate their proposals, because they will find that we are ready for their arguments.

We in South Ayrshire Council established nursery classes in primary schools that had capacity and by building additional classrooms. As convener of education services then, I was extremely proud to open nursery classes in areas that had previously had no nursery provision, such as the class at Kingcase Primary School in Prestwick, which my children attended. Those are among the moments of which I am most proud in my time as a politician.

Of course, things became a great deal better when Labour was elected to power in 1997, because we had the commitment to provision of free half-day nursery places for four-year-olds, and the establishment of child care partnerships that meant that for the first time the public, voluntary and private sectors worked together to provide a service for all families. Bill Aitken talked a load of unsubstantiated tripe about the Executive's attitude to the private and voluntary sectors—valuable partnerships have been established up and down the country.

Bill Aitken (Conservative, Glasgow)

Will the member give way?

Elaine Murray (Labour, Dumfries)

No. I am sorry; I must press on.

The introduction of child tax credits and working tax credits has assisted families who are on lower incomes. Support has been provided for the first child in a lowest-income family, which will be £60 a week from next month. That is far more than was available under the Tories. We have also introduced a statutory right to paternity leave.

Things have become even better under the Labour-Liberal Scottish Executive. We have the Standards in Scotland's Schools etc Act 2000, which placed a duty on local authorities to secure a pre-school education place for every three and four-year-old whose parents want one. Other members have mentioned the sure start programme, which operates on both sides of the border. This year, £23 million will be spent on the programme and £50 million will be spent in 2006. We also have the review of the early years and child care workforce. I agree with Maureen Macmillan and Rosemary Byrne that the review needs to address a number of complex workforce issues.

More will come if Labour is re-elected at Westminster this year. We will see extension of the entitlement to statutory maternity pay to nine months by 2007 and to 12 months by the end of the next Parliament. There will be increasing flexibility to allow both parents to share maternity leave entitlement or to take leave when the child is older. We also have a commitment on both sides of the border to expand both the right to nursery education and opportunities for early learning to all young children and their families. I thank the SNP for giving me a chance to run through just a few of the achievements of the UK Government and the Scottish Executive in serving Scotland's young families.

As many other members, including Scott Barrie and Robert Brown have said, the SNP motion is full of worthy aspirations, but there is no cost analysis of how they would be achieved. I reject totally the constitutional guff at the end of the motion.

Labour and Liberal Democrat members will continue to make progress to secure the best possible learning opportunities for our youngest citizens, by working in partnership with Westminster colleagues. I agree strongly with Rosemary Byrne and Maureen Macmillan that we need to address behavioural problems as early as possible, but we are making progress. That progress must not be halted by the election at Westminster this year of a Tory Government, with its stated intention to make £35 billion-worth of cuts.

David Davidson (Conservative, North East Scotland)

When Fiona Hyslop opened the debate, I thought that her speech would be very interesting. Speaking as a dedicated mother, she made points with which no one could disagree. In particular, she talked about the development of a child's cognitive skills, the discovery of learning and so on. However, she might also have commented on the development of parents. Children often need extra help because their parents have not been developed sufficiently early to be able to understand the issues. It is important that we do not isolate children from parents.

Fiona Hyslop was the first of a number of speakers to mention the delay in publication of the Scottish Executive's early years strategy. It is pertinent at this point for me to ask the minister to give us when he winds up the exact date at which it will be brought to Parliament. I appreciate that the Education Committee is, as Robert Brown said, conducting an inquiry into the issue, but I do not know whether the Executive wants to delay the announcement of its strategy until it has the benefit of the committee's input or whether it will put the strategy up front for the committee to debate.

The SNP provided no costings whatever—we heard the usual spend, spend, spend. Obviously, the money tree is still flourishing. However, I was surprised by one thing, which was that Fiona Hyslop did not mention staffing, qualifications or the 24 per cent of staff who do not have qualifications. A big chunk of that 24 per cent is not even in training. The Scottish Executive must consider qualifications.

The minister gave us a litany of spending—I presume that he was trying to outbid the SNP. However, there was nothing about quality or the access problems that affect so many parents. As I had in the past, many parents in my area have difficulty accessing convenient care and education for their children. Some people want to have somewhere near their place of work, whereas others want a place near where they live. Choice is distinctly lacking in the system. As Bill Aitken said, we all have the same main aims, but we differ on the routes to achieving them, and we differ most sincerely from the Executive in respect of the system's lack of flexibility and choice for parents.

Rosemary Byrne mentioned affordability and suggested that the private sector is too expensive. I am sorry to say that vouchers allow people to get over that hurdle if the appropriate care for their child is available in the private sector. That represents a way of putting money into the system so that new capacity can be built. The independent sector claims that it does not get the same support that some council systems get and we must somehow address the fact that early years care is a low-pay industry, so that we can attract people to enter the system and to take qualifications. A number of members made that point.

Maureen Macmillan was right to say that we need to consider holistic services for young children. I would go further and say that we must start early years screening literally from birth. I refer to screening for health problems that would hold back a child's learning process, as well as screening for sight, hearing and other difficulties. It is vital that we introduce early tests. They should be part and parcel of the assessment that would help to decide what sort of pre-school education and care a child needs.

It is interesting that the Scottish Executive admitted in its draft budget for 2005-06 that it is failing to meet the targets that it had set. It will be interesting to hear from the minister when he winds up exactly what he expects to deliver, given the comments of the Minister for Finance and Public Service Reform in the draft budget.

Many people want to return to work, and Scotland needs them to do so. We must ensure that appropriate choice and help is given to parents so that they can do that. We need many skilled people who have taken career breaks and so on to get back into the workplace. However, at the end of the day the money should follow the child and not be used simply to set up bureaucratic systems under local government control, which would not necessarily provide the support that parents seek and the care that their children definitely need.

Euan Robson (Liberal Democrat, Roxburgh and Berwickshire)

This morning's debate has been interesting and useful. It has been about not only children and young people, but parents and families, closing the opportunity gap and achieving everyone's full potential. The debate has touched on a broad expanse of policy areas.

Before I respond to points that members have made, I reiterate that our approach is not—contrary to what Mr Davidson said—one dimensional. We are intent on securing quality and depth in our provision. For that reason, we have published national care standards for child care services. We have introduced a robust inspection regime for child care, run by the Scottish Commission for the Regulation of Care. We have introduced joint inspection of pre-school education provision by the care commission and Her Majesty's Inspectorate of Education. We have established the Scottish Social Services Council, which from 2006 will regulate the early years and child care workforce. As has been alluded to in the debate, we have established a national review of the early years and child care workforce, in order to secure the workforce that will be required to meet the needs of children and families in the future. I confirm to Maureen Macmillan that the national review will report in the summer, as she suggested.

We have also provided £15.6 million between 2003 and 2006 to increase the qualifications of the early years and child care workforce. More than 6,000 child care qualifications will be awarded during that period.

David Davidson (Conservative, North East Scotland)

About 7,200 people—24 per cent of staff—do not currently have qualifications. By what date will all people in the service either be in training or have a qualification?

Euan Robson (Liberal Democrat, Roxburgh and Berwickshire)

That will depend on who is in the workforce at any given time. We cannot put a final date on something that depends on the development of the workforce.

The Education (Additional Support for Learning) (Scotland) Act 2004 will be implemented by the end of the year. That act places a duty on education authorities and other agencies to meet every child's additional support for learning needs—a point that has not yet been widely recognised. It also places a duty on education authorities to meet the needs—identified by health authorities—of under-threes whom education authorities determine as having additional support for learning needs.

Maureen Macmillan, Rosemary Byrne and David Davidson talked about the early years strategy. Last year we published a baseline study of outcome indicators for early years policies. In the next couple of months, we will publish guidance for practitioners. We will publish the early years strategy when we are ready to do so—we are not ready to do so at the moment.

Scott Barrie was right to allude to the partnership agreement commitment to make primary 1 less formal, which will be taken forward in the curriculum review. Referring to nurseries in Edinburgh, Bill Aitken blamed the Executive for limiting choice. However, he defeated his argument by saying that the council is closing the nurseries. Like Elaine Murray, I did not understand his point.

The Executive is also examining the quality of delivery of provision. We are undertaking a longitudinal study that is similar to the effective provision of pre-school education project in England. That will help us to see over 20 years or more what differences a wide range of early years policies make in practice to the people of Scotland. It will be a long-term evaluation of the work that we are doing.

We already know from evidence of the evaluation of sure start Scotland—the programme that is aimed at vulnerable families with very young children—that there are obvious benefits in early years provision. I remind Parliament that the 2002 report on mapping of sure start Scotland showed that service providers saw the programme as a major impetus for change leading to new and improved services for young children. An update of that mapping is under way, which will give us more detail about the numbers who are benefiting from sure start, the types and levels of services and the planning and partnership working that is taking place.

As I said earlier, the Tories play the worn-out gramophone record about vouchers and in his speech, Robert Brown rightly tried to pin down the costs of SNP policies. In the context of child care and early years provision, their initial policy proposal would cost some £80 million. Not only that, but there was no mention by Fiona Hyslop of the costs of Parliament's taking powers over tax and benefits or of the enormous cost of disaggregating the Scottish component of the benefits system. As always, pinning down the SNP on the cost of its policies is like trying to nail jelly to the wall.

The Scottish Executive does not lose sight of the bigger picture. We want extensive provision and quality provision. The whole reason why Government intervenes in people's lives is to make lives better. For the Executive, that means all the people of Scotland.

Adam Ingram (Scottish National Party, South of Scotland)

The defining feature of the Executive is its lack of vision and ambition for Scotland. Nowhere is that more evident than in its policies for children and young people. With problems such as one in three children living in poverty and one in 20 being referred to the children's hearings system for care and protection, we should focus in on the need to nurture our children better, rather than make the flagship policy an attack on antisocial behaviour, which is surely but one symptom of a deeper malaise.

Robert Brown is kidding himself about Liberal Democrat influence on Executive policy; the Executive is content to let policy development in early years education and child care be driven by London, although it may be a question of the Executive's waiting for the parameters to be set by Gordon Brown before it provides its own version of UK policy with minor Scottish variations. Either way, we are unlikely to have the kind of policy objectives that we need to establish in Scotland, let alone the resources to achieve them.

As Fiona Hyslop spelled out, our overriding objective would be to provide universal access to affordable high-quality education and child care services from the early years onwards. To do that effectively, we need to move away from means-tested targeting—through the use of tax credits and the like—to subsidising service providers along the lines of the Scandinavian model. That is not achievable overnight, nor can we deliver it using the paltry powers that are available to Parliament now. However, we can work towards that goal.

Robert Brown (Liberal Democrat, Glasgow)

I would be grateful for an indication of the SNP view on the appropriate resources for Scotland. Given that the block grant has gone up from £14 billion to £22 billion, how much more would the SNP require to achieve its objectives?

Adam Ingram (Scottish National Party, South of Scotland)

We have been challenged by a number of speakers on what our proposals would cost. Robert Brown should be patient; I will come to that in due course.

We are starting from where we are as regards our goals for child care and education. We are looking for incremental change now, but we need to support initiatives such as nurture groups that seek to help children who have missed out on the early experiences and relationships that provide healthy development. A growing number of very young children are being brought up in socially and emotionally deprived households by drug-misusing parents, for example. Those children have not learned to make trusting relationships with adults or to relate appropriately to other children and they cannot settle in school. The nurture-group approach has been successful where it has been adopted, most notably in Glasgow. It addresses the needs of children who have social, emotional and behavioural difficulties, it stimulates cognitive gains and it returns them to their base classes ready, willing and able to participate fully, like their peers. The nurture-group approach shows the clear benefits that are to be gained from high-quality provision, particularly for children from disadvantaged backgrounds.

As the director of the Social Market Foundation pointed out in his January newsletter, the single biggest determinant of quality provision is a highly qualified workforce. That cannot be bought on the cheap and certainly not by people who are in receipt of child care tax credits. To bring quality provision to areas where the cognitive gains to children will be greatest will require significant reductions in parental contributions to costs and increased provider subsidies. If we are to bring children under three into the system, provision will be even more expensive, given the need for much lower staff-to-child ratios.

We recognise that maximising access to high-quality subsidised early education and child care is an expensive policy to pursue. Spending will have to rise from the £320 million that we currently spend to about £1 billion a year. However, the educational, social and economic benefits that would accrue from such a policy would far outweigh the financial costs. The policies would include: attacking child poverty and educational inequalities at their roots; lifting the financial burden of child care from parents; allowing women in particular to increase families' income by participating more fully in the labour force; and not least, reducing the burdens that are imposed by dysfunctional behaviour on our education, health and criminal justice systems.

That is a truly ambitious policy. It is a policy to transform the life prospects of future generations for the better. Surely that is what Parliament should be all about.

First Minister's Question Time

Nicola Sturgeon (Scottish National Party, Glasgow)

To ask the First Minister when he will next meet the Prime Minister and what issues will be discussed. (S2F-1501)

Jack McConnell (Labour, Motherwell and Wishaw)

I have no immediate plans for a formal meeting with the Prime Minister.

Nicola Sturgeon (Scottish National Party, Glasgow)

Unlike the Prime Minister when he was in Scotland last week, I want to talk about the Scottish health service. Of all the patients who were seen as out-patients for the first time in the last quarter, how many had to wait more than a year for their appointments?

Jack McConnell (Labour, Motherwell and Wishaw)

I do not have that figure with me today, but I am sure that Ms Sturgeon is about to inform me of it.

Nicola Sturgeon (Scottish National Party, Glasgow)

I advise the First Minister that the information that I am about to bring to his attention has not yet been published, but it was given to me just yesterday by his central statistics unit. Is he aware that in June 1999 the number of out-patients who had waited more than a year to see a consultant was just 885, but that by the end of the most recent quarter, in December, the number of patients who had to wait more than a year was 7,679?

Two weeks ago, the First Minister told members that there had been

"a reduction in out-patient waiting times"

and a

"significant reduction in the number of people who have been waiting the longest".—[Official Report, 24 February 2005; c 14741.]

What did he mean?

George Reid (None, Ochil)

Before the First Minister answers, I ask Miss Leckie to withdraw the poster that she is showing to members. [ Interruption .]

Miss Leckie, I regard your refusal to withdraw the poster as a discourtesy to the chamber. I judge you to be guilty of disorderly behaviour and I ask you to withdraw from the chamber.

Jack McConnell (Labour, Motherwell and Wishaw)

The position on out-patients is clear and I have continually stated it in this chamber during recent years. The position on out-patient waiting times in Scotland was very poor indeed, which is why it required attention. The focus on the longest in-patient waits was right in relation to in-patients, but one of the reasons why waiting times for out-patients were coming down in England but not in Scotland was the decision to concentrate on in-patients in Scotland at a very early stage. We believed that it was also important to concentrate on out-patient waiting times, to ensure that they, too, came down, which is precisely why we established the centre for change and innovation and made its immediate priority to tackle out-patient waits. Because of that attention, the figures that were published in February indicated a dramatic reduction in out-patient waiting times in Scotland, for the first time in several years. That is to be welcomed, not condemned, and the figure will come down even further throughout Scotland.

Nicola Sturgeon (Scottish National Party, Glasgow)

I do not know what question the First Minister answered, but it was not the one that I asked. I asked him why the number of out-patients who had to wait more than a year for a first appointment had risen from 885 in 1999 to 7,679 in the last quarter. Will he address the central point? There are now eight times as many out-patients waiting more than a year to see a consultant than there were when the Government took office. The number has almost trebled since Mr McConnell became First Minister and it is still going up. How can the First Minister square those facts with his claim in the chamber two weeks ago that he is reducing the longest out-patient waiting times? The question is simple, so may we have an answer?

Jack McConnell (Labour, Motherwell and Wishaw)

If Ms Sturgeon had listened, she would have heard her question being answered. The very reason why there was a concentrated effort to reduce out-patient waiting times, particularly in the past year, was that those waiting times had gone up. Precisely because the number of people who were waiting too long for an out-patient appointment had gone up, the initial priority of the centre for change and innovation was to reduce out-patient waiting times. Because of that effort throughout the health service in Scotland, those waiting times are coming down. I agree that it is many years too late for those waiting times to be coming down, but they are coming down and they will continue to come down, because the focus is now rightly on out-patient as well as in-patient waiting times. The earlier decision to concentrate solely on in-patient waiting times led to an unacceptable increase in delays for out-patients, which had to be tackled.

Nicola Sturgeon (Scottish National Party, Glasgow)

The waiting times are not coming down.

Jack McConnell (Labour, Motherwell and Wishaw)

Yes they are.

Nicola Sturgeon (Scottish National Party, Glasgow)

At the end of the last quarter, 7,679 patients had waited more than a year for a first appointment. The figure was up on the previous quarter and the one before it, as well as the quarter before that one, and it was up from 885 in 1999. Is it not the case that the figures show the real experience of out-patients in Scotland and that the First Minister should be embarrassed by them? The Prime Minister is clearly embarrassed by the figures, which is why he talks about the English health service when he comes to Scotland. Does the First Minister realise that every time he tries to deny the black-and-white facts he insults every patient who is waiting too long for an appointment? When will he stop spinning and start standing up for patients in Scotland?

Jack McConnell (Labour, Motherwell and Wishaw)

The reality is as was published by the health service's statistics division just two weeks ago. Out-patient waiting times in Scotland are now finally coming down, because of the hard work of people in the health service in Scotland. As I have said before, I believe that that is far too late, but waiting times are now coming down and they will go down even further. It is to the credit of members of staff in the health service throughout Scotland that they are now achieving those reductions in waiting times.

Nicola Sturgeon (Scottish National Party, Glasgow)

But the figures are not coming down; they are going up.

Jack McConnell (Labour, Motherwell and Wishaw)

If Ms Sturgeon disbelieves the figures that were published only two weeks ago by the health service in Scotland—

Nicola Sturgeon (Scottish National Party, Glasgow)

These are your figures.

George Reid (None, Ochil)

Order.

Jack McConnell (Labour, Motherwell and Wishaw)

If Ms Sturgeon disbelieves those figures, she is questioning something very serious indeed; she is questioning the statisticians who published the figures and who are independent of the Executive. Their figures are subject to scrutiny in the Parliament every quarter, in the proper way.

David McLetchie (Conservative, Edinburgh Pentlands)

To ask the First Minister what issues will be discussed at the next meeting of the Scottish Executive's Cabinet. (S2F-1502)

Jack McConnell (Labour, Motherwell and Wishaw)

We will discuss a range of issues at Cabinet next week, all of which I am sure will be very important to the people of Scotland.

David McLetchie (Conservative, Edinburgh Pentlands)

I am sure that they will be. Perhaps I could suggest one issue: the early release of prisoners from our jails. When I raised the matter with the First Minister at question time on 22 April last year, he told me that the early release of people from prison on licence was a matter for the Sentencing Commission. Earlier this week, through its Management of Offenders etc (Scotland) Bill, the Executive announced that it would introduce a home detention curfew scheme, which could mean that some prisoners will serve only a quarter of the sentence that is handed out to them in court. Will he please tell me why the Executive is issuing more get-out-of-jail-free cards before it has even received the report from its Sentencing Commission?

Jack McConnell (Labour, Motherwell and Wishaw)

That is perhaps not a surprising question, although, given his training, Mr McLetchie should understand the system. As I pointed out to him last year, we were absolutely determined to review the system and we will do so sensibly and effectively through the Sentencing Commission, in the interests of the victims of criminals. I believe that the early release of prisoners without condition is unacceptable to the people of Scotland and needs to be reviewed sensibly and in a judicial context. That is entirely different from a tough regime of home detention curfews, which ensures that there are conditions on those prisoners who leave prison earlier than their full sentence. The curfews put conditions on those people when they are out in the community, making sure that they are properly rehabilitated so that they do not offend again.

We cannot go on with the level of reoffending that takes place among people who go in and out of our prisons. It is time to act on that and it is time to learn from the international lessons what is effective, to ensure that, within their sentence, people serve under tough conditions in the community. That element of the home detention curfew could work for certain individual prisoners.

David McLetchie (Conservative, Edinburgh Pentlands)

The First Minister's idea with the Sentencing Commission was to kick a scandalous situation into the long grass. I remind him that the commission was established in November 2003 and that we are still waiting for a report. Is it not the case that, the longer we wait for a report from the Sentencing Commission and for action to be taken, the greater the number of violent criminals who will be released to commit further crimes? The policies of the Scottish Executive demonstrate that it is far more concerned with emptying our prisons than it is with protecting the public.

Jack McConnell (Labour, Motherwell and Wishaw)

That is absolute rubbish. The proposals announced this week under the Management of Offenders etc (Scotland) Bill are indeed designed to ensure that we keep people out of prison. We will do that by stopping them reoffending and by ensuring that we have fewer people going in and out of prison again and again because of the ineffectiveness of the system. We will do it by ensuring that we have a tougher regime in prison for those who should be there, locked up for the security of the public, and for those who need to be rehabilitated so that, when they end their short sentence, they do not go back out into the community and commit crimes but go back out into the community with a job, looking after a family and taking some responsibility for their actions and behaviour. That is the purpose of the Management of Offenders etc (Scotland) Bill, which, alongside our new measures to end the early release of sex offenders, will protect more effectively the public and those victims who suffer from the actions of reoffending criminals.

David McLetchie (Conservative, Edinburgh Pentlands)

The problem with the First Minister's answer is that, from the evidence from England—where the scheme was first introduced—the reoffending rates of people who were on the home detention curfew scheme are no better than the reoffending rates of those who were not on it. When the scheme was introduced in England, we were told by the Home Secretary that it would apply only to low-risk prisoners. However, since its introduction, 2,107 prisoners who have been released have reoffended—they have been responsible for 3,748 crimes, including 10 sexual offences, 44 robberies and 525 crimes of violence. Is that the First Minister's idea of a successful policy? Will he put the protection of the public first rather than let criminals out of jail early?

Jack McConnell (Labour, Motherwell and Wishaw)

Of course we put the protection of the public first. That is why we propose to change the management scheme for offenders in this country and why we want to ensure that we have a system that, from top to bottom, is more coherent, seamless and in the interests of victims. We want a system that ensures that, whether a person is given a custodial or a non-custodial sentence, as well as serving their time, they will be forced to be rehabilitated in the process. In due course, that will ensure that fewer people will reoffend in Scotland after having committed a crime and served time. It is in the interests not only of victims of initial crimes, but of everybody in Scotland to ensure that we have a better system and less crime in the future, with fewer people reoffending and more people returning back into the community from their first offence and sentence to proper jobs, looking after their families and being decent members of society.

Alex Neil (Scottish National Party, Central Scotland)

Did the First Minister see last night's BBC documentary on Kilmarnock prison? The programme vindicated all the points that I have made in the past six years about the anarchic shambles that is Kilmarnock prison. Does he agree that a particular concern is that there have been seven suicides in the prison, at least two of which could have been prevented if the prison had been properly managed? Stewart Yates, a former assistant director of the prison, said:

"The primary focus of running the prison was the financial outcomes".

Does the First Minister agree that it is now time to take profit out of prisons and to make prisons a genuine service to punish and rehabilitate prisoners rather than a service that is about profits?

Jack McConnell (Labour, Motherwell and Wishaw)

To describe the situation in Kilmarnock as an "anarchic shambles" is, in effect, to call the prisons inspectorate liars. I say to Mr Neil that that is an unfortunate exaggeration of the situation. The prisons inspectorate is responsible for inspecting our prisons and ensuring that where action is required, it is taken. The Scottish Prison Service will rightly look into the matter as a result of the programme that was shown last night. We expect it to take the action that is required to ensure that anything that needs to be corrected in Kilmarnock prison will be corrected as soon as possible.

Margaret Jamieson (Labour, Kilmarnock and Loudoun)

As the local member for Kilmarnock, I would welcome Mr Neil coming along to Kilmarnock prison with me. I have visited the prison and met the workforce many times.

Does the First Minister agree that the facility at Kilmarnock prison has been shown to be much better than that at prisons elsewhere in Scotland by the prisons inspectorate and that SNP members should accept that many employees in Kilmarnock prison are doing a good job in difficult circumstances?

Jack McConnell (Labour, Motherwell and Wishaw)

Those are fair points. It is also important to take on board the points that were made last night by a very independent former chief inspector of prisons in Scotland in the small bit of the programme that I saw. He said that public and private sector prisons in Scotland must deal with these matters. In tackling these matters and setting standards, we must not only ensure that existing standards are met; it is also vital to improve on those standards. That is precisely why we introduced the Management of Offenders etc (Scotland) Bill in the Parliament this week. We want to ensure that our prisons and our community sentences system stop reoffending and ensure that criminals learn from their actions and that the public come first.

Colin Fox (SSP, Lothians)

To ask the First Minister whether he will attend a rally on 23 March 2005 organised by public sector workers in defence of their pension rights and in opposition to plans to raise their retirement age by five years. (S2F-1511)

Jack McConnell (Labour, Motherwell and Wishaw)

No, but I encourage all who have views to express about those matters to respond to the on-going consultations.

Colin Fox (SSP, Lothians)

Surely the fact that the Labour Party conference last weekend voted to condemn the United Kingdom Government's great pensions robbery is ample reason for the First Minister to attend the rally. On which side of Labour's great pensions divide does the First Minister stand—the side of the Scottish Labour Party conference or the side of the national Labour Government? Does he believe that public sector workers throughout Scotland are right to be up in arms about the great pensions swindle that they are suffering, or does he believe that they are mistaken about the Government's plans to rob them of their pension rights and force them to work five years longer? What does he intend to do to defend their pension rights?

Jack McConnell (Labour, Motherwell and Wishaw)

Those claims are not true for the staff who are currently in public sector pension schemes and they are not true for those who will retire between now and 2013. It is important that people respond to the current consultations. The Government at the UK level, where the responsibility for much of the issue lies, and here in Scotland will not respond to those consultations until they are over and we have heard everybody's views. We will then have the chance to make decisions about the way forward.

Colin Fox (SSP, Lothians)

Is it not true that each public sector worker stands to lose at least £20,000 if the proposed changes go ahead? I am sure that public sector workers throughout the country will be, frankly, disgusted by the First Minister's evasions. Will he do them and the Parliament the courtesy of providing straight answers to three straight questions? Does he support the raising of the retirement age by five years—yes or no? Does he support the early retirement age being pushed back by five years—yes or no? Does he support the abolition of the final salary pension scheme—yes or no?

Jack McConnell (Labour, Motherwell and Wishaw)

I do not think that anybody who had any interest in taxpayers' money or in the proper, efficient use of public resources would deny the fact that there should be a review of public sector pensions to ensure that we are able not only to adapt our public sector pension schemes to the changing nature of the workforce and our society, in which people are living longer and wanting to work longer, but to look after public finances properly. The consultation is on-going and it is important that people respond to it. The consultation responses will be listened to and we will respond to them in due course.

Frank McAveety (Labour, Glasgow Shettleston)

To ask the First Minister what action will be taken to curb reckless and irresponsible use of air-guns. (S2F-1512)

Jack McConnell (Labour, Motherwell and Wishaw)

The tragic shooting in Glasgow last week demonstrated just how dangerous air weapons are in the wrong hands. I am sure that the Parliament will join me in expressing our sympathy with the family of young Andrew Morton. We are contributing to the current Home Office review of firearms law, which is considering carefully whether further controls on air weapons are necessary. We will report back to the Parliament as soon as we can.

Frank McAveety (Labour, Glasgow Shettleston)

Like everyone else in Scotland, I was saddened and distressed by the events in Craigend last week. The area is represented by my colleague Margaret Curran and I had the privilege to serve it as a Glasgow city councillor for eight years. Does the First Minister recognise the fact that the decent majority of people in areas such as Craigend require our constant support in tackling persistent problems of antisocial behaviour—none more antisocial and dangerous than the misuse of air rifles? Will he ensure that the Executive makes it an urgent priority to deal with the purchase, regulation and use of such weapons in Scotland to reduce the possibility of such a tragedy occurring again?

Jack McConnell (Labour, Motherwell and Wishaw)

I agree with Mr McAveety. As I said last weekend, it would be wrong for politicians to have an immediate, knee-jerk reaction to the tragic circumstances facing that family and that community. Nevertheless, it is important that we do not rule out even the most severe action that we could take. We need to make it more difficult for people to acquire air-guns and to ensure that there are fewer air-guns in circulation. We are actively engaged with the Home Office in determining measures that will help to secure those objectives. The Executive is determined to close loopholes and to consider all options for tighter control and we will press the Home Office to make any changes that we think are required.

I believe that many gun holders and, in particular, parents of young gun holders will be appalled at what happened last week in Glasgow and will want to assist us in taking air-guns off the streets. We will work with Scottish police forces quickly to put in place arrangements that allow people in every community in Scotland who want to ensure that their air-guns or their children's air-guns are taken out of circulation can do so speedily and securely in co-operation with the local police force. My message, particularly to parents of young gun holders, is to bring the gun in, get it off the street and ensure that Scotland is a safer place.

Kenny MacAskill (Scottish National Party, Lothians)

I welcome the First Minister's comments. However, I should point out that replica weapons are as much of a problem as air-guns in our society. As we approach the ninth anniversary of the Dunblane massacre, is it not about time that we had a consolidated act that addressed such matters? Why, when Scottish ministers are competent and capable of taking a different approach from that taken south of the border to the problem of knives and swords, are we incapable of addressing the problem of the prevalence of replica weapons and air-guns, which are causing misery and tragedy in our society?

Jack McConnell (Labour, Motherwell and Wishaw)

Mr MacAskill might feel incapable, but I certainly do not. We intend to take action on the issue not only in conjunction with the Home Office but in a measured way. I believe that the Home Office confirmed this morning that it has already proposed to take action on replica weapons and that it is already considering new legislation on firearms. However, I think that it probably needs to go further than that.

I believe that we need to take a measured approach to the issue. I do not want to take an immediate decision in the week after this family tragedy. However, we need to introduce tighter controls on air-guns and to ensure that communities in Scotland and throughout the United Kingdom are safer. Although we will work with the Home Office to secure that additional legislation, we will do so in a measured and reasonable way.

Robert Brown (Liberal Democrat, Glasgow)

To ask the First Minister how the Scottish Executive expects Scottish police forces to employ the proposed house arrest, tagging and curfew measures outlined in the Prevention of Terrorism Bill. (S2F-1517)

Jack McConnell (Labour, Motherwell and Wishaw)

The Prevention of Terrorism Bill is reserved legislation, but Scottish police forces have a duty to enforce the law, no matter whether it is made at Westminster or at Holyrood.

Robert Brown (Liberal Democrat, Glasgow)

The First Minister is aware that Liberal Democrats and many others, including eminent Labour people such as Helena Kennedy and Derry Irvine, are very uneasy about the direction of the Labour Government's proposed anti-terrorism legislation. Is he aware that that unease is particularly shared by many people in Scotland's law-abiding Muslim community, who fear that they could be targeted by the legislation? Does he agree that the bill's somewhat questionable advantages would not be worth the cost of impairing the good relations with Scotland's Muslim community that the Executive has worked so hard to achieve? What practical reassurances can he give that community on the matter?

George Reid (None, Ochil)

I should point out that we are straying into reserved matters.

Jack McConnell (Labour, Motherwell and Wishaw)

As the bill will go through many debates and, potentially, more changes in the day-to-day business of the House of Commons, it would be a good leap of the imagination to talk about what might result at the end of the day. However, I must say that I do not agree with Robert Brown. There is a case for looking at the legislation. We have a duty in Scotland to ensure not only that our police forces enforce the law, wherever it is made, but that we work very closely with Muslim and other minority communities in Scotland so that they are properly a part of our society. They must feel strongly that they have a part to play in enforcing the law, not that they are unreasonably subject to it. We will therefore continue to work closely with the Muslim community and others to ensure that everyone feels very welcome in Scotland.

Mary Scanlon (Conservative, Highlands and Islands)

To ask the First Minister how many people have opted out of the national health service to take private health cover in the last year. (S2F-1508)

Jack McConnell (Labour, Motherwell and Wishaw)

Fortunately, because the Tories have not won the general election yet—

David McLetchie (Conservative, Edinburgh Pentlands)

Yet.

Jack McConnell (Labour, Motherwell and Wishaw)

I was there first. We need to remind people that that is still a possibility, because they need to know what might happen.

Everyone in this country still has access to the national health service, regardless of whether they receive private health care. The only circumstance this year in which people in Scotland might have to opt out of the national health service and choose private health care is if the Tories win the general election and force them to do so.

Mary Scanlon (Conservative, Highlands and Islands)

I thank the First Minister for not answering my question. I advise him that figures from a private health analyst show that 1,000 Scots leave the NHS and pay for private health care every week and that thousands more are forced to seek private treatment in dentistry and chiropody. Does he acknowledge that, whereas the Tories would offer people the choice of paying for private treatment, the Liberals and Labour are forcing people into private care?

Jack McConnell (Labour, Motherwell and Wishaw)

Thankfully, so far—although one never knows what the Scottish National Party will do—the Tory party is the only party that supports forcing people to opt out of the national health service to secure operations in the private sector. Yet again, Mr McLetchie has made it absolutely clear that the Tory party's main policy—in fact, its only policy—for the health service that has been publicised for the forthcoming general election is that people who can already afford to pay will get a subsidy directly from the health service to help them to pay for private health care. That money will be taken away from the care of those who cannot afford to pay. Everyone in Scotland needs to know that the direct implication of electing the Tories in the general election would be that those who can afford to pay would get a subsidy and those who cannot afford to pay would get less.

Shona Robison (Scottish National Party, Dundee East)

Despite all the bluster, is the First Minister not concerned that the increase in the number of people taking up private medical insurance in Scotland, which is faster than the increase south of the border, reflects people's frustration and concern about waiting too long for treatment? My colleague Nicola Sturgeon pointed out that frustration earlier, but the First Minister did not respond to the point. Given the Executive's pledge to decrease out-patient waiting times to no more than six months by the end of 2005, will the First Minister explain why 35,058 people were waiting for more than six months at the end of last year? How will he meet his pledge and reassure people, so that they do not have to turn to private medical insurance because of the NHS's failure to get to grips with waiting times?

Jack McConnell (Labour, Motherwell and Wishaw)

I am glad that Ms Robison has the figures, which show that out-patient waiting times came down in Scotland in the last quarter. I hope that she will give them to Ms Sturgeon, who was clearly ill informed in her earlier question. I will not take lessons from the SNP on health service spending in a week when it proposed to take £1 billion directly out of the Scottish budget—more than £700 million in corporation tax and more than £200 million in business rates. Given that the health service in Scotland takes up a third of our budget, that means that more than £300 million would be taken out of the service if the SNP ever managed to achieve independence. The SNP should be more honest about where the cuts would come, rather than proposing them on a Tuesday and not wanting to talk about them on a Thursday.

Christine May (Labour, Central Fife)

Does the First Minister agree with me—

George Reid (None, Ochil)

Order.

Christine May (Labour, Central Fife)

Does the First Minister agree that the election of a Tory Government would put at risk the £130 million capital investment in the right for Fife project and the new St Andrews community hospital? Does he agree that, under the Tories, we would not have the investment in improving out-patient and local community care services that we have had under the Executive?

Jack McConnell (Labour, Motherwell and Wishaw)

Services would be put at risk by the incredible scale of cuts that the Tories propose and by the cuts that the SNP proposes. The fact that the number of people in Scotland who wait more than six months, nine months and 12 months is lower than anywhere else in the United Kingdom and that Scotland is the only place in the UK where no one waits more than nine months for in-patient treatment would also be put at risk. Scotland has a lower median wait than anywhere else in the UK. It has the fastest treatment times for heart disease in the UK. By voting for the SNP or the Tories, people would be putting at risk all those achievements and improvements and all that investment. I urge them not to do it.

Question Time — SCOTTISH EXECUTIVE — Enterprise, Lifelong Learning and Transport

David Davidson (Conservative, North East Scotland)

To ask the Scottish Executive what performance indicators it has set for ministers with responsibility for developing the economy. (S2O-5684)

Allan Wilson (Labour, Cunninghame North)

The Scottish Executive does not set performance indicators for ministers.

David Davidson (Conservative, North East Scotland)

That is a surprise, as it seems to have set targets for everyone else.

I thought that the Scottish Executive's priority was growing the economy, yet statistics show that, from 1995 to 2003, the United Kingdom economy grew by nearly 24 per cent while the Scottish economy grew by only 16.9 per cent. The rate of business start-ups per head of population in Scotland is only three quarters of the UK rate. The highest business survival rate is 72 per cent, in Northern Ireland, but the Scottish rate is only 65 per cent.

Does the minister agree that it is time for the Executive to accept that it is failing in its responsibility? What measures will be taken to ensure that ministers carry out the policies that they claim to have?

Allan Wilson (Labour, Cunninghame North)

I would not accept that we are failing—quite the contrary. Mr Davidson's question referred to performance indicators for ministers as opposed to the economy. Of course, we set a number of performance indicators under "The Framework for Economic Development", which considers adult education and skills; research and development; entrepreneurial dynamism; the electronic and physical infrastructure; and managing public sector resources. "A Smart, Successful Scotland", which we recently refreshed, gives a range of related indicators against which we manage progress. There are also a couple of sustainable development indicators that we add to the mix.

Mr Davidson's basic contention is completely without foundation.

John Swinney (Scottish National Party, North Tayside)

Does the minister agree that there is a compelling case for a target annual growth rate in Scotland? Over the past 25 years, economic growth in Scotland has trailed that in the rest of the United Kingdom and has been lower than that of most small European countries. Further, it has been dwarfed by economic growth in Ireland—over the past 25 years, Irish economic growth has been 5.2 per cent a year compared to 1.8 per cent in Scotland. Does the minister accept that those indicators amount to a compelling reason why Scotland should have the full economic and financial power that independence would bring to allow us to strengthen the Scottish economy?

Allan Wilson (Labour, Cunninghame North)

No. Surprisingly enough, I do not believe that. We set performance targets for the Scottish economy. We aspire to see Scotland reaching the upper quartile of comparator Organisation for Economic Co-operation and Development nations. As I said, "The Framework for Economic Development" sets aspirations across a range of indicators.

I do not accept that independence would be beneficial to the Scottish economy and I think that there are a number of questions that the Scottish National Party needs to answer relating to the day after independence. Will there be a Scottish pound? Will there be a Scottish interest rate? At what level would that interest rate be set? What would the SNP's fiscal and monetary policies be? All those questions need to be answered by the nationalists.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

To ask the Scottish Executive whether it has any plans to increase the graduate endowment above the rate of inflation. (S2O-5722)

Allan Wilson (Labour, Cunninghame North)

There are no plans to increase the graduate endowment above the rate of inflation.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I am delighted to hear that the endowment fund is tied to the level of inflation. As the endowment is used exclusively for student support, how much would it cost the Executive to fund that directly?

Allan Wilson (Labour, Cunninghame North)

We estimate that the resource cost to the Scottish Executive of paying the graduate endowment would be approximately £3.3 million in 2005-06 and £19.6 million in 2006-07. That would rise slightly in subsequent years.

Fiona Hyslop (Scottish National Party, Lothians)

Does the minister agree that the graduate endowment will add to the already heavy burden of student loans and that it will further exacerbate the problem of graduate debt? Will he take this opportunity to explain why the publication of the research on student poverty and graduate debt, which was supposed to take place in January, has now been postponed until the summer? Has the publication of the research been delayed because it will show that graduate debt is a millstone round the necks of individuals and an unsustainable drag on the Scottish economy?

Allan Wilson (Labour, Cunninghame North)

I do not believe that. Entrance to universities and higher education is at an all-time high as a result of the policies of this partnership Government. Further, the introduction of the young students bursary is helping to ensure that young students from low-income backgrounds get the opportunity to go to university. Far from adding to student debt, the graduate endowment has reduced overall student debt.

Jamie Stone (Liberal Democrat, Caithness, Sutherland and Easter Ross)

To ask the Scottish Executive whether it will ensure that the European Commission is provided speedily with the full information that it needs to complete the audit into ERDF funding in the Highlands and Islands. (S2O-5712)

Allan Wilson (Labour, Cunninghame North)

We have already provided a substantive response to the Commission's draft report, which included all the detailed documentation that was requested by the Commission. As to the second audit, which takes place this month, officials are working closely with applicants to ensure that all documentation is available. However, ultimately it is the responsibility of the individual applicants to ensure that all original documentation is to hand.

Jamie Stone (Liberal Democrat, Caithness, Sutherland and Easter Ross)

It will come as no surprise that I am asking this question. We were fearful that bits of the Highlands and Islands might lose future funding. Will the minister confirm that there are parts of the Highlands and Islands that are in desperate need of European assistance and, despite what might or might not have happened in the past, will he support the case for the Highlands and Islands getting access to European funds?

Allan Wilson (Labour, Cunninghame North)

I will indeed and the Executive is working tirelessly behind the scenes to ensure that the appropriate information is available to the Commission to ensure that there is no clawback of the much needed funds to which Jamie Stone refers. We are also working in close concert with the United Kingdom Government to ensure that, in the current negotiations on future structural support for the Highlands and Islands in particular, and for the whole of Scotland, we maximise the benefit that European structural funding can bring to Scotland. I am confident that we will be able to secure an advantageous settlement for the Highlands and Islands within the overall settlement.

Fergus Ewing (Scottish National Party, Inverness East, Nairn and Lochaber)

The minister has just informed the chamber that he is working tirelessly to get future European funding for Scotland. We all recognise the past importance of that funding and we hope that it will play an important role in the future.

I have a very straightforward question for the minister, which I hope he will answer using one of the options that are rarely tried—yes or no. Has the Executive set out in a position paper to the European Commission its views on what Scotland should receive?

Allan Wilson (Labour, Cunninghame North)

In more than one position paper, we have put our views on the future organisation of structural funds to the European Commission through the UK Government. We work very closely with our colleagues in the Westminster Government because that is how we maximise our impact on the Commission. As the member knows, the issue comes entirely under the aegis of the European Commission, so it is important that we have the strength of the UK behind us when we make those representations.

To address the substance of the member's point, I am hopeful that the Scottish position—if I can call it that—will be adopted by the Commission on future areas of regional selective assistance. Without that, an important arm of regional development policy would be lost to the Parliament and it is important for the future of Scottish industrial growth that it is retained.

Eleanor Scott (Green, Highlands and Islands)

To ask the Scottish Executive what action it is taking to ensure that businesses have access to support and advice on energy efficiency, waste minimisation and improved resource efficiency. (S2O-5778)

Allan Wilson (Labour, Cunninghame North)

The Executive is highly committed to improving resource efficiency in Scotland. We already fund a number of organisations that promote better energy and environment management. Those include the Carbon Trust, the Energy Saving Trust, Envirowise and the Business Environment Partnership.

Eleanor Scott (Green, Highlands and Islands)

As the minister outlined, a number of organisations provide support and advice to businesses on how to use resources efficiently. Does he acknowledge the potential for confusion among businesses about which of those organisations they should ask for such advice? Will the Executive ensure that any overlap between those organisations is minimised, perhaps by providing a one-stop shop, so that businesses find it more straightforward to seek advice?

Allan Wilson (Labour, Cunninghame North)

I am not sure which of the organisations the member argues is superfluous. Each organisation does an important job in providing advice and assistance. The Carbon Trust and, say, the Business Environment Partnership each bring different perspectives to bear in the domestic and industrial sectors. However, there may be a case for bringing together organisations so that they can work more collaboratively and co-operatively to maximise the potential benefits.

Christine May (Labour, Central Fife)

To ask the Scottish Executive what progress it has made on its priority of growing the economy. (S2O-5757)