Ministear airson Siainte Poblach Minister for Public Health

Micheal Matheson BPA Michael Matheson MSP

FIT: 0845 7741741

E: scottish.ministers@scotland.gsLgov.uk

The Scottish Government

Riaghaltas na h-Alba

Kezia Dugdale MSP The Scottish Parliament EDINBURGH EH991SP

::::?DELIVERING
A GAMES LEGACY FOR SCOTIAND

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Ur faidhlelYour ref: GC-04/11/11 Ar faidhle/Our ref: 2011/1024256 I~ December 2011

I refer to your letter of 4 November to Nicola Sturgeon, Cabinet Secretary for Health, Wellbeing and Cities Strategy, about the introduction of the Index of Orthodontic Treatment Need (IOTN). Your letter has been passed to me for reply as I have portfolio responsibility for dental policy in Scotland. It may be helpful if I explain that the Scottish Government is focussing orthodontic treatment in the NHS on those children who have a clinical need for treatment. In addition, we are making the system simpler to allow dentists to treat children with the greatest need more quickly. The purpose of NHS general dental service (GDS) provision is to secure and maintain the oral health of the patient. The Scottish Government is introducing the Index otlOTN into the GDS as this assessment method will ensure that orthodontic resources are focussed clearly on those children who have a clinical need for treatment and who will have an oral health benefit at its completion. If the problem is purely cosmetic, the patient will still be treated if the misalignment is significant. I should point out that the use of IOTN was proposed by the Labour/ Liberal Democrat partnership administration in the Dental Action Plan (DAP) in 2005. Prior to publication of the DAP a wide-ranging consultation was undertaken on "Modernising NHS Dental Services" which considered orthodontics and the place of IOTN. The DAP was subsequently debated in Parliament in November 2005.

IOTN gives an evidence based framework to the decision making, and has come into force only after negotiation with the profession, dentists in general and orthodontists specifically,
Taigh Naomh Anndrais. Rathad Regent, Dun Eideann EH1 3DG St Andrew's House. Regent Road. Edinburgh EH1 3DG www.scotland.gov.uk

and after systems have been put in place to record the IOTN. In essence it brings clarity to the system. The IOTN now being introduced in Scotland does not differ from the IOTN proposed by the Labour/ Liberal Democrat partnership administration in 2005. IOTN is also in place in the rest of the UK. Northern Ireland, like ourselves, has introduced IOTN this year, and it has been in place in England and Wales since 2006. In accordance with the regulations and policies which dictate the provision of NHS orthodontic treatment, any NHS dental treatment, including orthodontic treatment, the cost of which is likely to exceed a set limit, currently 350, requires the prior approval of the Scottish Dental Practice Board (SDPB) before treatment commences. Practitioners seeking orthodontic prior approval are required to submit treatment plans, radiographs and models to Practitioner Services Division (PSD) of NHS National Services Scotland, who consider such cases on behalf of the SDPB. In all cases where prior approval is refused the dentist or patient (or their representative) has the right to appeal to their NHS Board. I would like to make it quite clear that decisions not to approve treatment are made entirely on clinical grounds in accordance with the requirements of the regulations. There i~ no cash limit on the provision of oiiRooontic-treatmen( .~mdTundingmScotland under the NHS is available for all cases where the treatment is necessary to secure and maintain oral health. In your letter you also mention the General Dental Services (GDS) budget. The GDS budget has been protected in cash terms across the three years of the Scottish Spending Review 2011. We continue to take every opportunity to maximise the value for money derived from our investment in dental services. I hope this reply will help reassure you and your constituents that the Scottish Government is continuing to fund orthodontic treatment on the NHS for children who need it. I should like to reassure you also of the Scottish Government's commitment to improving oral health in Scotland. We have made a considerable investment in NHS dentistry since 2007 and all current indicators show the great progress that has been made. Since 2007 there has been an increase of 1.36 million patients registered with a dentist under NHS arrangements, an increase that has been reflected across all age groups, and the number of dentists working in General Dental Services has increased by nearly 500 since 2007.

Michael Matheson

Taigh Naomh Anndrais, Rathad Regent, Dun Eideann EHl 3DG St Andrew's House, Regent Road, Edinburgh EHl 3DG www.scotland.gov.uk

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