Nicola Roxon (Gellibrand, Australian Labor Party, Shadow Minister for Health) Share this | Hansard source

I am quite happy for the member for McPherson to hear why I think the state governments have a role to play. I am quite happy to explain why I think the Commonwealth also has a role to play. My point is that this budget is not using the Commonwealth money in a smart way at all. The Commonwealth spent 11 years denying that they had any responsibility for dental care and we are pleased that the government has finally done a backflip and decided to put some money into dental care. But if you have a spare $370 million, why on earth would you put it into a program which has, for the last three years, been failing? Why would you not look at something that was actually going to help fix the range of problems around the country?

This program deals with giving dental treatment to people who have chronic diseases if their chronic disease will be made worse by their dental condition. So it applies to a very restricted group of people. It will be very welcome for the people who qualify. But what we have found is that in the last three years, when the government thought this program would spend $15 million, it has only been able to spend $1.6 million. Perhaps the member for McPherson will be able to do the sums. If it is $1.6 million over three years over 150 electorates, there cannot in her electorate be more than a handful of people who have benefited. And to think that this scheme with all the same restrictions and problems is suddenly going to be able to deliver massive improvements in dental care across the population is just ludicrous. I will go through in detail why we believe this is a misuse of the money. As I say, we welcome the Commonwealth finally giving in on their outdated view that they have no role to play in dental care, but why on earth could they not spend it in a more sensible way that would actually help people in our communities?

I have been travelling around the country in the last couple of months and dental care has been raised with me almost everywhere I have been. I have been in Adelaide, north Tasmania, Brisbane, Petrie and Longman. I have been on radio in Cairns, Bathurst and everywhere else, and people desperately want to talk about dental care. I agree with the member for McPherson that the states have some responsibility. I do not pretend at all that they do not. But in the last period of time, despite the minister trying to pretend that the states have taken money out, they have actually massively reinvested in this area. But to be frank, on their own, they cannot fix this problem. So if we have Commonwealth money that the Howard government is at last prepared to put in, why wouldn’t we actually put it in to help people who have been waiting for years to get access to care or to help people on the waiting lists to get a preventative check-up? Quite rightly, the people who have emergency needs or some particular crisis, or who are in pain, get dealt with first and the people who are trying to do the right thing to look after their teeth and get their regular check-up can never be seen in public dental clinics, which are dealing with ongoing crises.

There is a sensible role for the Commonwealth to play. We just do not think that they have picked the right way to do it. Unfortunately, I think it is typical of Mr Abbott. As we all know, he got put into health as a political fixer. He got put in to fix and close down political debate that was causing the government some grief. He has been fine as a fixer in political terms. What he has not been good at doing is actually fixing the problems that the community needs fixed. So the problems in the health system and the difficulties for the community are not the government’s concern. What is actually causing the government grief is their concern, and the dental program they have announced in the budget highlights this perfectly. It is about closing down a political campaign if they can, not about actually making some lasting change.

I mentioned some of the seats I have been travelling through because I think the government would be aware that this is a very politically potent issue for them—to have people resorting to using pliers to pull out their teeth and to have kids’ teeth getting worse. We used to be at the top of the international tables but we are starting to drop. We do not want that to happen. We want to be able to make sure that in a first-world country we can have first-world health care, and that includes first-world dental care.

I was not going to start on the dental care issue, but the member for Dobell provoked me, in particular knowing how big an issue it is in his electorate. I know that as a local member he will be very concerned that when those thousands of people on the waiting lists in Dobell—who no doubt will knock on his door and say: ‘Good. What does this mean? Will I now be able to access dental care?’—find they cannot get access to dental care, they are going to be absolutely furious. There will be a really heavily fought campaign in that electorate on this very issue. I think it is a shame that the member has not appreciated what sort of ground he is going to be fighting on. Had he been prepared to take a question from me on this, he might have explained why he is comfortable with the view that this will deal with his electorate’s concerns. I am not at all confident that that is the case.

In the health budget in particular, we have seen some welcome measures. We do not pretend for a moment that there are not some welcome initiatives in the health portfolio. We have made announcements and given our support to a range of those. By and large, the health budget has been what you could not describe as anything other than a sort of grab bag of initiatives—bits and bobs of programs, individually useful but with no really consistent message or theme, with no direction that the government is particularly trying to pursue. I think there are around 60 different initiatives in this package but there is little strategic planning or focus in any of them.

I have spent quite a lot of my time, since becoming the shadow minister in the last six months, arguing for a pressing need in the health portfolio for us to have a much more strategic approach to how we are going to spend our money in health. We believe that there is a need to refocus some serious attention on chronic disease and preventible disease—particularly prevention, not just treatment of these conditions—but it has been a message that the government has been determined to ignore. I think that has already been to the detriment of all Australians but it could get much worse if we do not actually see the government refocus its attention.

Having pursued this issue for the period that I have been the shadow minister, initially the minister was quite dismissive of these concerns, quite patronising really, thinking that we can just go off and play around on this issue of prevention without fully appreciating how serious a health issue this is for us. But I know that many of the stakeholders have been very positive about this approach, because they see a clear growing burden which, if we do not tackle, our health system will not be able to cope with. They have obviously passed that message to the minister. We did see in the budget that the minister had tied together with a big bow a range of different initiatives and said, ‘This is the amount of money we are going to spend on chronic disease.’ Unfortunately, the biggest chunk of that is on the dental package, which I have already touched on in more detail, where we know money is going into a program which has already been shown to fail. I do not think you can call the dental program available to people with chronic disease as successful, having only been able to spend $1.5 million over the last three years. To put that sum of money into it and call this part of a chronic disease program I think is overstating it a little bit.

There were also a number of initiatives in there that dealt with clinical changes—for example, specialists being able to consult for longer periods. They are welcome. No doubt they will be helpful for people who have chronic disease and need a longer consultation to deal with the way they should handle it. There was only just over $236 million in actual new money aimed at preventing chronic illness. While we welcome these initiatives to help Australians avoid preventable chronic illnesses, the funding committed does fall far short of what is desperately required.

Take, for example, the diabetes package. As part of the COAG initiative announced in April, the Commonwealth government has already announced that it would provide around $100 million over four years as its contribution to a cost-share initiative with state and territory governments to address type 2 diabetes and that money was found in the budget. When you think that $100 million sounds like quite a lot of money over four years, and when you are dealing with the prevalence of type 2 diabetes in our community, which has doubled since 1996—doubled in the life of the Howard government—really this is not a large amount of money per person. In 2001, about one million Australians had type 2 diabetes and the projections are that by 2031 this figure will be over three million people.

I think everyone in this House knows that without adequate management a person with type 2 diabetes is two to five times more likely than other people in the general population to have a heart attack or stroke. Access Economics has estimated that in 2005 the net cost of lost wellbeing due to type 2 diabetes was $11.6 billion, and of course with the expected growth that cost is going to balloon. So when you think about the scope and scale of the problem and how much diabetes costs the community—and not just individuals who deal with the personal cost but also the community in lost productivity—and the fact that the government has pledged simply $103 million over four years, it does put into perspective whether this is a major investment or not.

I am also particularly worried that the diabetes package that the community will be able to participate in requires a $50 copayment. We know that the highest incidence of diabetes occurs in our Indigenous communities and in our communities in lower socioeconomic areas. It is a disease where the impact burden is not evenly distributed across the community. I am concerned that a $50 copayment particularly in our Indigenous communities may well mean that the people who actually need these programs most will not be able to afford to participate. I would like the government to consider whether they will look at some sort of waiver system for people who clearly need to be part of this program but may not be able to afford that payment. I am sure the government, or the minister if he were here, would say, ‘Look, we want to give people some incentive to make sure they keep participating in the program.’ We must be aware that it can be a disincentive for people to pay that amount of money. If your cost of living is already under pressure because of a whole range of other things, something that looks like an optional expenditure, even though it might fundamentally change your health, might be something that people are not able to pay and I think we need to look at a way to support our Indigenous community particularly to make sure that they have access to these programs.

We are concerned about the approach the government has taken on a number of other issues. For example, in tackling obesity, which we know is a growing problem in our community, particularly childhood obesity, I am extremely concerned that the government has decided to fund the CSIRO to develop a diet book for children. I think it is absolutely outrageous that we would suggest introducing children to dieting. I think it is perfectly acceptable to want to talk about nutrition and healthy eating and I think the CSIRO is a great organisation able to do that. I have no problem with that. In fact, it is actually a rip-off of an idea that Labor had already committed to. Labor is developing a Healthy Habits for Life guide for parents to be able to use with their children promoting healthy food, healthy exercise and healthy lifestyles.

But should we introduce children to dieting when we already know that so much damage is done to very young children through eating disorders? We have very young children now with eating disorders. We have girls being bombarded with expectations of what their body image should be. We have increasing numbers of young men who have eating disorders. Do we really need to get children interested in fad dieting or even the concept of doing something for a short time and then getting back off it rather than developing habits they can live with for life? It may be just a naming issue but in this area the message is important and, if we send our children a message that they need to be worried about fad dieting, we are setting them up for more problems in the future rather than tackling what is a serious issue within the community. I have written to the minister to encourage him to make sure that this book will not be called a ‘diet book’ and will not be marketed as such. I hope that some members on the other side will raise this as well. I think it is a good initiative that could otherwise be spoilt simply because someone has not thought through clearly enough the way it should be marketed to children.

I would also like now to focus on the dental program. I have covered some of the issues and obviously many people on our side of the House have spoken about the program over the past years. The history is clear. The Howard government closed down the Commonwealth dental program when it was elected in 1996. It took about $100 million out of the public dental sector. We know that the waiting lists have skyrocketed since that time and there are now around 650,000 Australians on those waiting lists. The minister and the Prime Minister have said time and time again that they are not going to spend any money on dental care because it is the responsibility of the states, that they do not care if it is a community problem, that they are just not going to fix it. Despite this, we welcome their decision to play a role. But they have decided to play such a small role that there are going to be many people in the community disappointed that there is no solution to their problem. I think the government has done this to make it look like it is  doing something rather than seriously tackling this problem.

I want to go particularly to some of the concerns that we have about the package, because there are a number of unanswered questions. People in this House are no doubt aware that the policy is an extension of the MedicarePlus, or ‘Strengthening Medicare’, package for people who are being treated under a multidisciplinary care plan and who have an oral health problem which is significantly exacerbating their chronic medical condition. We know that under this package there have already been problems for people taking it up. We know, for example, that there is a fairly complex referral process, almost like a statutory declaration that doctors have to fill in, in order for their patients to access the dentist. We know that to meet that standard your chronic condition, such as heart disease, diabetes or malignancy of the head or neck, must be combined with poor oral health or a dental condition which will exacerbate that chronic and complex disease.

Even when you had gone through those hoops of the old program, all you could claim were three visits to the dentist; I think it was around $75 or $77 a visit—a maximum of $220 per year of program treatment. Way back in 2003, an hourly visit to the dentist cost $295. That was the average figure for visiting the dentist. So most people, even when they had gone through the hoops and qualified, were not able to get the treatment they needed under this program.

The government have increased significantly the amount of money that people will be able to claim if they get through all those hoops. But what they do not appear to have fixed in any way is the referral from the doctor that is still required and the strict qualifications that are required before you will be able to be part of this program, and they still have not dealt with the fact that large copayments will have to be paid by people who qualify for this system. We know that some of the people who will qualify will be the most vulnerable in the community. They have the least resources available to them and will be unable to pay what are often quite extensive copayments required to access this service. Mr Deputy Speaker, you would be surprised to know the amounts of some of the out-of-pocket expenses under the existing scheme—the copayments were almost $700. How people are expected to be able to meet that sort of payment I do not know, and the government have not been able to answer how this program is going to fix that.

A question that is also unanswered is: how is a program that has helped under 6½ thousand people going to make any impact on those massive waiting lists? The Commonwealth should not, of course, take over responsibility for those waiting lists, but they should help. We should help fix that problem.

The Australian Dental Association has criticised the program and has said that it will continue to fail to address the problems that those with chronic disease have unless prosthetic appliances like dentures are included. We do not even know the simple detail of whether dentures are going to be available under this program that the government has announced. If you meet all the qualifications, if the doctor does the referral and if you can make the copayment—if you can get through all those hoops and you need dentures—are you going to get anything from the government? We still do not know the answer to that.

It is critical, and I think that there will be many people in the electorates of government members who are going to start knocking down their doors when they find out that these sorts of things are not going to qualify or that they are going to have to make large copayments to get access to them. People will feel that a hoax has been played on them. There is a significant amount of money provided and we welcome that contribution, but it could have done so much more. Labor will look at how it can be redirected towards a dental care program that will really benefit working families.

See this speech in context