Health boards are to share £2 million to deliver annual health checks for all people with learning disabilities.
The new service will help to address health inequalities and ensure that people in this group are able to have any health issues identified and treated as quickly as possible.
Health checks will be delivered in the local community.
Mental Wellbeing Minister Kevin Stewart said: “Unfortunately we know that people with learning disabilities can experience poorer health than the rest of the population.
“Evidence suggests that people in this group are twice as likely to die from preventable illness. This is clearly unacceptable and I hope these annual checks will help to address this and begin to reduce this health inequality.
“Health issues like respiratory disorders, diabetes and thyroid problems can become serious if picked up too late. But if they are detected and treated early there’s a much better chance of a positive outcome and a good quality of life. That is where these annual health checks will be so valuable.”
Eddie McConnell, Chief Executive of Down’s Syndrome Scotland, said: “This is a really significant moment in the lives of people with learning disabilities and their families.
“The rollout of the annual health checks across Scotland has the potential to be a game-changer in improving the health outcomes for this community who deserve equal access to good health. It is no exaggeration to say that a well-implemented annual health check could save lives.”
Community Learning Disability Nurse, Sharon Bandeen, who has an adult son with Down’s Syndrome, said: “The new health checks are a welcome additional layer of good health practice for people with learning disabilities in Scotland.
“It is so important that everyone living with a learning disability has equal access to the health checks, no matter where they live in Scotland.”
The report includes a range of indicators selected in order to monitor health inequalities over time. These indicators include: healthy life expectancy, premature mortality, all-cause mortality, baby birthweight and a range of morbidity and mortality indicators relating to alcohol, cancer, coronary heart disease and drug use. The report investigates both absolute and relative inequalities.
The COVID-19 pandemic is likely to have had an impact on the most recent data for most indicators included in this report. Where there has been analysis undertaken to assess the impact of the pandemic that is relevant to a specific indicator the details have been included in the corresponding chapter.
MAIN FINDINGS
With the exception of the healthy birthweight indicator, significant health inequalities persist for each indicator covered in the report.
Changes in the gap between the most and least deprived areas in Scotland
For a number of indicators, absolute inequalities (the gap between the most and least deprived areas) have narrowed over the longer term:
Heart attack hospital admissions (aged under 75 years) – the gap in 2020 (63.2 per 100,000 population) is the lowest it has been since 2008 (58.4 per 100,000). The reduction in the gap between 2019 and 2020 has been driven by a 7% decrease in admissions in the most deprived areas and an increase of 13% in the least deprived areas.
Coronary heart disease (CHD) deaths (aged 45-74 years) – the current gap is 47% lower than at the start of the time series (185.4 per 100,000 in 2020 compared to 347.3 per 100,000 in 1997). However, between 2019 and 2020 the CHD mortality rate increased in both the most and least deprived areas (by 14% and 40% respectively).
Alcohol-related admissions (aged under 75 years) – the gap was widest at the start of the time series in 1996 (613.0 per 100,000) and reduced to its lowest level in 2020 (322.0 per 100,000). Between 2019 and 2020 the rate of admissions decreased in both the most and least deprived areas (by 14% and 10% respectively). It is possible that this reduction is a result of hospital admissions policies associated with the COVID-19 pandemic.
Alcohol-specific deaths (aged 45-74 years) – the gap has reduced from a peak of 184.7 per 100,000 in 2002 to 71.8 per 100,000 in 2020, the lowest in the time series.
Low birthweight – the absolute gap in 2020 was 3.4 percentage points, the lowest it has been since 2013 (3.2 percentage points).
The gap in healthy life expectancy for males has increased since the start of the time series, from 22.5 years in 2013-2015 to 23.7 years in 2018-2020.
The gap in premature mortality rates increased to its highest point since 2004 (680.4 per 100,000 in 2020 and 683.2 per 100,000 in 2004), although the gap remains lower than at the start of the time series (648.7 per 100,000 in 1997).
In 2020 the absolute gap in cancer deaths was the highest it’s been since 2015 at 353.7 per 100,000.
Whilst the gap for all-cause mortality (aged 15-44) reduced to its lowest level in 2013 (159.6 per 100,000), it has shown an overall increase since then and was 241.1 per 100,000 in 2020.
The gap for drug-related hospital admissionshas increased overall since the start of the time series to reach a high of 696.1 per 100,000 in 2019/20 before falling slightly to 625.1 per 100,000 in 2020/21. This decrease may be due to hospital admission policies associated with the COVID-19 pandemic.
For the other indicators in the report, there has either been little change or long-term trends in the absolute gap are less clear:
Healthy life expectancy for females
Cancer incidence
Relative inequalities
The relative index of inequality (RII) indicates the extent to which health outcomes are worse in the most deprived areas compared to the average throughout Scotland. It is possible for absolute inequalities to improve, but relative inequalities to worsen.
There are three morbidity indicators for which the RII can reasonably be compared with one another: alcohol-related hospital admissions; heart attack hospital admissions; and cancer incidence.
Amongst these, relative inequalities in alcohol-related hospital admissions have remained highest over the longer term, though they have been decreasing. Relative inequalities in heart attack admissions have increased in recent years and cancer incidence inequalities have remained relatively stable.
Amongst the three comparable mortality indicators (CHD deaths, alcohol-specific deaths and cancer deaths), relative inequalities in both CHD and cancer deaths have increased over the long term whilst the RII in alcohol-specific deaths have shown more year to year fluctuation and are currently lower than at the start of the time series (2.02 vs 1.80). However, relative inequalities in alcohol-specific deaths remain higher than the other comparable mortality indicators.
Of the other indicators in the report, the two indicators relating to mortality (premature mortality for those aged under 75 and all-cause mortality for those aged 15-44) and healthy life expectancy for males and females have all shown increases in relative inequality over time.
A new fund has been established to help tackle the impact of social isolation, loneliness and the mental health inequalities made worse by the pandemic. The £15 million Communities Mental Health and Wellbeing Fund aims to support adult community-based initiatives across Scotland.
Grass roots community groups and organisations will be able to benefit from the funds to deliver activities and programmes to people to re-connect and revitalise communities building on examples of good practice which have emerged throughout the pandemic.
Mental Wellbeing Minister Kevin Stewart launched the fund at Saheliya in Edinburgh, a specialist mental health and well-being support organisation for black and minority ethnic women and girls.
Mr Stewart said: “This funding reflects the importance we place on promoting good mental health and early intervention for those in distress and will help develop a culture of mental wellbeing and prevention within local communities.
“It is vital now, more than ever as we start to re-open society that we support the mental health and wellbeing of individuals. I am very keen that this benefits communities across all of Scotland.
“I was pleased to be able to visit Saheliya this morning and meet some of the people involved with running and the project, and some of the people they help.”
A range of charity-support bodies and social enterprises, known as third sector interfaces, will manage the fund in partnership with local integrated health authorities and other partners including Community Planning Partnerships and local authority mental health leads.
The Communities Mental Health and Wellbeing Fund is part of the wider £120 million Recovery and Renewal Fund announced in February 2021 to ensure delivery of the commitments set out in the Mental Health Transition and Recovery Plan in response to the mental health need arising from the pandemic.
The data show in 2020-21 in the most deprived areas of England there were 39,161 attendances per 100,000, while in the least deprived areas this figure is almost halved to 20,784.
Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said:“The pandemic has highlighted the scale of health inequalities across the country. The data show that those from the most deprived area are almost twice as likely to visit their Emergency Department than those from the least deprived area.
“We welcome NHS England’s willingness to engage on the issue and address health inequalities, but we must see real action taken. We also look forward to the formation of the Office for Health Improvement and Disparities (OHID) and would welcome the opportunity to input into their agenda.
“The health inequalities are clear and tackling them will be a serious challenge. On a fundamental level, if the government is serious about levelling up and tackling these inequalities, the first steps must be to fund and support local authorities and Integrated Care Systems and invest in preventative health.
“The scale of health inequalities means tackling homelessness; immigrant health; domestic violence; and youth violence. While supporting those with; mental health illnesses; learning disabilities; and both drug and alcohol addiction.”
There were also 1.39 million reattendances in 2020/21 which is equal to 10.4% of all unplanned attendances. This is the highest figure on record and up 1.7 percentage points when compared to the previous year 2019/20.
Dr Henderson continued:“It is also deeply concerning that one in ten patients reattended the Emergency Department (ED), it is vital that patients have the appropriate information and support available to manage their condition following their visit to the ED. We need better data on this issue to understand what is driving people to reattend.”
In 2020/21 302,784 patients stayed in an Emergency Department for 12-hours or more from time of arrival, this is 21 times higher than the 12-hour figure from decision to admit, which is 14,150.
Dr Henderson concluded:“Utilising the right metrics in Emergency Departments is crucial to improving patient safety. It is vital that we measure health equalities, reattendances, and 12-hour stays from time of arrival across the country.
“Analysing these metrics will help us, NHS England and the government to take effective action to support the patients, communities and areas that need it most. That means fewer reattendances, closing the gap on health inequalities, reducing long stays, and improving the patient experience.
“This data paints a very real picture of the state of health and the state of healthcare in this country. We welcome the engagement of NHS England and the government’s agenda on these matters, but we must now see the tangible actions taken to tackle these issues.”
Plans to improve health and reduce inequalities for women in Scotland have been published today by the Scottish Government.Women’s Health minister Maree Todd said the plans are an ‘ambitious vision’.
Scotland is the first country in the UK to have a Women’s Health Plan, which outlines ambitious improvement and change in areas including menopause, heart health, menstrual health including endometriosis, and sexual health.
The Women’s Health Plan sets out 66 actions to ensure all women enjoy the best possible healthcare throughout their lives. It takes on board the real life experiences of women who have given their feedback on what is important to them.
Key actions include:
appointing a national Women’s Health Champion and a Women’s Health Lead in every NHS board
establishing a Women’s Health Research Fund to close gaps in scientific and medical knowledge
providing a central platform for women’s health information on NHS Inform
setting up a Women’s Health Community Pharmacy service
commissioning endometriosis research to develop better treatment and management, and a cure
developing a menopause and menstrual health workplace policy, and promoting it across the public, private and Third Sector
improving information and public awareness of heart disease symptoms and risks for women
Women’s Health Minister Maree Todd said: “Our vision for women’s health is an ambitious one – and rightly so. It is clear that wider change must happen to ensure all our health and social care services meet the needs of all women, everywhere.
“Women’s health is not just a women’s issue. When women and girls are supported to lead healthy lives and fulfil their potential, the whole of society benefits.
“Together, we are working to address inequalities in all aspects of health that women are facing. The Women’s Health Plan signals our ambition and determination to see change for women in Scotland, for their health and for their role in society. We want Scotland to be a world leader when it comes to women’s health.”
Head of British Heart Foundation Scotland James Jopling said: “Coronary heart disease is one of the leading causes of death in women in Scotland and kills nearly three times as many as women as breast cancer.
“At every stage – from the moment they experience symptoms through to their cardiac rehabilitation – women with heart disease can face disadvantages. We need to improve understanding of the risks for women and increase their awareness of the symptoms of a heart attack.
“We must also promote equality of treatment for women with heart disease within the healthcare system, at every point in their journey. The publication of the Women’s Health Plan, with heart health as a priority, is a welcome step to tackle these inequalities and we look forward to working together to help save and improve lives.”
Vice President of the Royal College of Obstetricians and Gynaecologists Dr Pat O’Brien said: “We welcome Scotland’s commitment to this ambitious and detailed plan as a key marker to making improvements to healthcare services for all women from different backgrounds.
“We are pleased to see the Women’s Health Plan adopts an approach to prioritise the health and wellbeing of women throughout every stage of their lives, and ensure they can access care when they need it – something we called for in our Better for Women report.
“It is important that all women are included and consulted about how health services can fit their needs. This Plan has been developed with extensive consultation with a diverse group of women, ensuring that the health service is inclusive and respectful, and can work to focus on closing inequalities in women’s health experience and outcomes.”
The University of Edinburgh, Queen’s University Belfast and University of Liverpool have been awarded over £7.1 million from the UK Prevention Research Partnership (UKPRP) as part of a consortium to investigate the impact that nature can have in helping to prevent and reduce health inequalities in urban areas.
The Consortium, ‘GroundsWell: Community-engaged and Data-informed Systems Transformation of Urban Green and Blue Space for Population Health’ will explore how transforming cities with nature can reduce health inequalities, primarily around chronic and non-infectious diseases such as heart disease, diabetes, cancer and mental health.
Over the five-year project, the interdisciplinary team will develop innovative approaches to work with communities where there are high levels of health inequalities. They will work with communities as key partners to develop and implement ways to improve health inequalities and prevent a range of chronic illnesses through harnessing the positive impact of nature.
Dr Ruth Hunter, from the Centre of Public Health at Queen’s University Belfast and Groundswell Co-Director, said: “There is strong evidence that natural environments within urban areas, such as parks, woodlands (green spaces) as well as lakes and beaches (blue spaces), have positive impacts on health.
“These urban green and blue spaces could be huge assets for protecting and equalising health if they were available, accessible, valued and well-used, particularly by less advantaged groups. The problem is that they are not, which is what this project aims to address.”
Dr Hunter added: “We are delighted to receive this funding from UK Prevention Research Partnership. Working with a range of experts across health, data and community engagement, over the next five years we will seek solutions to improve our urban environment that will in-turn improve population health.”
UKPRP supports multidisciplinary teams looking at ways to prevent non-communicable diseases such as heart disease, poor mental health, obesity, cancer and diabetes. Non-communicable diseases make up the majority of illnesses in the UK and account for an estimated 89 per cent of all deaths.
Professor Kevin Fenton, London Regional Director for Public Health England and Chair of the UKPRP Scientific Advisory Board, said: “UKPRP is an important and timely programme that we need to address health inequalities and prevent the onset of non-communicable disease.
“The projects funded under this programme are pushing the boundaries of prevention research by taking multidisciplinary approaches to addressing the complexities of population health, with the aim of improving people’s lives and health.
“As we look to build back fairer from the pandemic, the creation of healthy communities and places is a key priority.”
The project will use a range of approaches to ensure that communities, including residents, businesses and organisations, are fully represented.
The Consortium will comprise of active, equal and embedded members and partners at all stages of decision making and will involve co-designing solutions that will benefit communities.
Professor Sarah Rodgers, from the University of Liverpool and GroundsWell Co-Director, said: “Working with local authorities and charities, we will record how our environments change through time.
“Knowing when parks were adapted to encourage new visitors and how this subsequently impacts health outcomes will help provide robust evidence on what works and for whom. Everyone should have access to the right environments to support their health and wellbeing.”
Professor Ruth Jepson, from the University of Edinburgh and Groundswell Co-Director, added: “We propose a new way of working which encourages communities and citizens to work with our partner organisations to plan, design and manage urban green and blue spaces so that they benefit everyone, especially those who need it most.
“Through our partnerships and with the active involvement of our communities, we will identify small and large scale projects which can be developed and evaluated. We will involve communities and citizens in all stages of the work; from planning and prioritizing, to collecting data through citizen science apps, to writing, speaking and blogging on what is working well and what is not.”
The impact of the COVID-19 pandemic has not been felt evenly across Scotland. Some people have been much more likely to get ill or die from COVID-19, and others have been disproportionately affected by the measures taken to control the virus (write ALEX PRIESTLY, Researcher and LIZZY BURGESS, Senior Researcher, Health and Social Care).
This blog looks briefly at health inequality in Scotland before the pandemic, how the virus has had an uneven impact, and what could be done during the recovery to address these differences in health across the nation. For a more detailed look at the effects of COVID-19 on health inequality, check out the SPICe research briefing Health Inequality and COVID-19 in Scotland.
What are health inequalities?
Health inequalities are “avoidable and unjust differences in people’s health across the population and between specific population groups”. Many people think they are unjust and avoidable as they are caused by societal and economic factors known as the ‘social determinants of health’.
Which groups are affected by these inequalities?
People living in deprived areas, people with physical and learning disabilities, people belonging to ethnic minority groups and unemployed people are just some groups who are more likely to have worse health than the rest of the population. This list is not exhaustive, and where people fit into more than one of these groups, the effects can be compounded. This is known as intersectionality – a word used to describe the “interconnected nature of social categorisations such as race, class, and gender, creating interdependent systems of discrimination or disadvantage”.
In 2019, healthy life expectancy, the length of time someone can expect to live in good health, was 26 years shorter for men and 22 years shorter for women living in the most deprived parts of Scotland compared to those in the least deprived.
Cancer incidence is also more common in the most deprived areas of Scotland. Public Health Scotland found mortality rates for all cancers combined are 74% higher in the most deprived compared with the least deprived areas.
How uneven has the impact of COVID-19 been?
Early in the pandemic, some politicians and commentators referred to COVID-19 as “a great leveller” which would affect everyone equally. It has become clear that this is not the case. A few examples are outlined below, but many more groups have been affected particularly badly.
Research during the first wave of COVID-19 infection found that people with learning disabilities were twice as likely to test positive for COVID-19, twice as likely to be hospitalised, and three times as likely to die from COVID-19 than the general population.
People from ethnic minority backgrounds have also been disproportionately affected. National Records of Scotland analysed deaths from COVID-19 in the first wave of infection in 2020, and found that people of South Asian background were twice as likely to die compared to white people. When Public Health Scotland analysed data looking at the second wave of infection, they found that people of South Asian background were three times more likely to die or be hospitalised than white people.
The figure below shows how the impact of COVID-19 has varied by area of deprivation.
How could we address health inequality as we recover from the pandemic?
So we’ve seen that some groups mentioned above (and many others) were more likely to experience poor health before COVID-19, and have suffered more than the general population during COVID-19. How will we ensure that these groups are not left behind as we recover from COVID-19?
Looking specifically at Scotland, the Scottish Government set up the Social Renewal Advisory Board to make proposals for how to renew Scotland after the pandemic. Its report “If not now, when?” looks at how income could be distributed more fairly and how everyone should have access to basic rights and services.
The Mental Health Foundation, has looked at how the COVID-19 recovery can address worsening mental health in Scotland. Its manifesto outlines building a ‘wellbeing society’, where the causes of poor mental health are addressed highlighting the importance of prevention.
Most organisations who have looked at the COVID-19 recovery’s impact on health inequality agree that it needs to focus on addressing the fundamental causes of differences in people’s health across the population, rather than just dealing with the symptoms.
The report explores the key barriers and enablers to accessing the COVID-19 vaccine and how the vaccine delivery model can be improved to reduce inequalities and provide holistic support to those who need it the most.
The key messages from the report are that our health system has a clear moral and human rights duty to those vulnerable groups who fall through the gaps of public service provision to ensure that they are not failed by this crucially important public health intervention.
Some of the key demographics highlighted within the research are at very high risk if they do contract COVID-19, including people who are homeless, prisoners, people living in poverty, people who abuse drugs and alcohol, black and ethnic minority groups, gypsy travellers, refugees and asylum seekers.
The report calls against viewing the Covid-19 vaccine programme as a silo: the programme has to be part of a whole-system, preventative approach to public health and to health inequalities. This requires a joined up suite of interventions that not only help people access the vaccine but supports them to stay well afterwards and enables them to adhere to the Covid-19 regulations safely.
There are a number of recommendations calling for improvements in the communications relating to the COVID-19 vaccine, a need to prioritise collection and analysis of local data about uptake of Covid-19 vaccine by different communities and groups as well as the need to conduct active research into the ongoing vaccination programme.
The report also recommends developing a rolling programme of outreach vaccination clinics, services and events as well as provision of accessible, affordable transport to vaccine centres and clinics.
Finally, the report highlights the importance of involving third sector and community partners in the planning, communications and delivery of public health interventions that could help prevent, mitigate and reduce health inequalities.
The findings of the report will be shared with Scottish Government, Public Health Scotland, NHS Boards as well as a range of key stakeholders across the third sector.
Unpublished data from Public Health Scotland has shown a dramatic reduction in NHS dentistry due to COVID, which is hitting those in most deprived communities the hardest. Between April and November 2020, the number of courses of treatment delivered was 83% lower than during the same period in 2019.
Official figures show that primary school children from the most deprived communities experience more than four times the level of tooth decay compared to children in the least deprived areas. Latest data also shows that in 2020 children and adults from the most deprived areas were less likely to have seen their dentist within the last two years than those from the least deprived areas (73.5% compared to 85.7% of children and 55.9% compared to 67.1% of adults) and this gap has widened compared to the year before.
The impact is now being felt in all corners of the service. The Public Dental Service– which treats specific patient groups including care home residents, children with additional needs and adults with disability – also faces a huge backlog, with many of its staff redeployed to urgent dental care centres. 2,500 children are now estimated by the BDA to be on waiting lists for dental extractions under general anaesthetic, which may take years to clear.
High street practices continue to face wide-ranging restrictions, which have radically reduced patient numbers, including the need to maintain gaps between most routine procedures where surgeries are left ‘fallow’ to reduce risk of viral transmission.
Governments in Northern Ireland and Wales have already offered millions to help practices invest in new ventilation systems to cut down this time, and hence significantly expand patient volumes. The BDA is seeking commitments from Scotland’s parties to follow the same path.
The BDA says prevention is now more essential than ever. The pioneering Childsmile programme, delivered via primary schools and nurseries, has secured record-breaking reductions in decay but has been suspended for much of the last year, with many core elements like supervised brushing yet to resume.
Restarting that programme, and providing additional support in high needs areas is at the centre of the BDA’s plan, alongside calls for Health Boards to be supported to conduct feasibility studies on water fluoridation.
Dentistry challenges are now likely to be exacerbated by workforce problems. None of Scotland’s dental schools is on track to graduate classes at the usual time this year, which will have a domino effect on workforce planning for years to come. The BDA has called for a long-term strategy to ensure Scotland has the dentists it needs to meet this threat, and parallel challenges – including Brexit.
Oral cancers kill three times more Scots than car accidents – and the country has one of the highest rates for the condition in Europe.
Residents in Scotland’s most deprived communities are more than twice as likely to develop and die from oral cancer as those in more affluent areas. The BDA is therefore seeking action on smoking cessation, and assurances that a rapid catch up programme will be in place to ensure school children are protected from the Human Papillomavirus via vaccination.
HPV is an important risk factor for oral cancer, and while steps were in place to extend the programme to boys in the last academic year, the programme continues to face massive disruption as a result of school closures.
The Association is making direct contact with every candidate seeking election to Holyrood to ask them to commit to addressing oral health inequality.
Robert Donald, Chair of the British Dental Association’s Scottish Council said:“A wealthy 21st century nation shouldn’t accept that a wholly preventable disease remains the number one reason its children are admitted to hospital. Sadly, COVID risks undermining hard-won progress, while leaving our dental service a shadow of its former self.
“The result is that from decay to oral cancers, Scotland’s oral health gap is set to widen, and we need all parties to offer a plan.
“In this campaign we need candidates to do more than talk about ‘prevention’. From helping practices boost capacity, through to expansion of the sugar levy, we have set out simple steps that can put that principle into action, addressing inequality, and restoring services to millions.”
The BDA Scotland manifesto: Bridging the Gap: Tackling Oral Health Inequalities(PDF)
While registration rates remained high and broadly stable – owing to lifetime registration – data indicates the number of children seen between May and December 2020 was around a quarter of the 2018-19 average due to the pandemic.
Between September and November 2020, the number of adults seen was around a third of the 2018-19 average, before falling to 28% of the 2018-19 average in December 2020.
The traditional measure of ‘participation’ – capturing attendance at an NHS dentist in the past 2 years – has less meaning in the context of COVID, as the full impact of the pandemic has yet to filter through.
Those in more deprived communities have traditionally experienced lower levels of participation. This data shows that in 2020, children and adults from the most deprived areas were less likely to have seen their dentist within the last two years than those from the least deprived areas (73.5% compared to 85.7% of children and 55.9% compared to 67.1% of adults). These inequalities in access between the most and least deprived areas have grown since 2019, particularly in children.
The BDA has warned lower levels of participation will inevitably translate into a higher disease burden. Early signs of decay and oral cancers are picked up at routine check-ups, and delays will mean both higher costs to the NHS and worse outcomes for patients.
Dental care in Scotland is now facing crises on many fronts, with deep oral health inequalities expected to widen even further, given the cumulative impact of limited access to services, the suspension of public health programmes, and the impact of lockdown diets. The pioneering Childsmile programme has not fully resumed, with many key elements, such as supervised brushing, delivered via schools and nurseries.
Recent announcements by Scottish dental schools that many final year students will not graduate in 2021 and will also not be in a position to take on new undergraduates, are likely to have wide-ranging effects on the NHS workforce for years to come.
While both the Welsh and Northern Irish governments have set aside ring-fenced investment to improve practice ventilation – and thereby increase patient numbers while meeting tight COVID restrictions – no commitments have yet been made by the Scottish Government and the BDA await clear guidance for practices.
Robert Donald, Chair of the British Dental Association’s Scottish Council said: “These numbers underline the scale of the challenge ahead. Millions have missed out on dentistry. Problems that could have been caught early, from decay to oral cancer, have been missed.
“Scotland’s huge oral health inequalities cannot be allowed to widen. Every party heading into May’s election now has a responsibility to set out how they will ensure families across Scotland can get the care they need.”
