Jennie George (Throsby, Australian Labor Party, Shadow Parliamentary Secretary for Environment and Heritage) Share this | Hansard source

I am pleased to have the opportunity in this debate on the Health Insurance Amendment (Medicare Dental Services) Bill 2007 to speak on the important issue of dental health because it is an issue of major concern to the constituents of Throsby. People need to be aware that in the Illawarra-Shoalhaven region we currently have over 7,000 people waiting on the public dental waiting list. Some have waited year after year without a proper and adequate response.

Today in question time we heard another classic example of the blame game. This time it was on dental health. There was a finely orchestrated introductory interjection on the eminently sensible and reasonable questions from the Leader of the Opposition to the Prime Minister. In the staged uproar that occurred after the first question from the Leader of the Opposition, the Minister for Ageing was expelled from the chamber for a period because the Leader of the Opposition was not allowed to continue stating what everybody in the community is well aware of—that is, in 1996 the Howard government abandoned a Commonwealth dental program which had been introduced by Labor to deal precisely with the problem we are witnessing in Australia today: the enormous growth in the number of people in our community waiting for urgent medical treatment, in many cases, and of people waiting for access to preventative dental care.

Today the ministers and the Prime Minister played the game that Australians are getting tired of—the blame game. This time it was about dental health, with the Prime Minister trying to deflect criticism from the federal government, which axed the Commonwealth program, by saying that it is all a matter for the states and territories and not a federal responsibility. It was quite an amazing performance. Despite the fact that the Leader of the Opposition quoted directly from the section of the Constitution in which there is a provision for the federal government to exercise its power in the area of dental services, it maintained its typical blame game attitude. I think people are starting to see through it. They know there is a problem out there. The 7,000-plus people in the Illawarra and Shoalhaven know that the blame game is not going to address the problems that they are experiencing in a very acute manner.

The economics of the government’s response is totally inadequate. What we see happening in our community is that, if people cannot get access to treatment, their simple dental problems escalate into much more complex health problems. In turn, that presents pressures at other points of our health system. People with mild dental problems have to wait for years to get them treated and end up seeing GPs and being hospitalised for preventable dental conditions. I understand that up to 50,000 hospital admissions are occurring each year for preventable dental conditions. We see an increased reliance on prescription drugs and anaesthetics for pain management and treatment.

All this is not only at an enormous cost to the wider health system but at an intolerable cost for many individuals. I have referred to our local media many cases of people who have waited year after year and in desperation had to resort to numbing their abscess pain with alcohol or, in many cases, pulling out their rotting teeth with pliers. They know that the solution to this issue is much more than the typical blame game that they are so accustomed to from the Howard government. It was in fact the government’s decision to scrap a Commonwealth dental scheme that had operated successfully under Labor and had cleared the backlog of people waiting for treatment. They know that this has been the cause of the huge growth in the number of people unable to access dental care when they desperately need it—let alone have any chance of getting any preventative care.

We have a national crisis and we have a deterioration in the standards of Australia’s oral health. Tooth decay today ranks as Australia’s most prevalent health problem, and gum disease is not far behind. Untreated dental decay in the Australian adult population stands at around 25 per cent. That is a shocking indictment of this government’s lack of concern for this problem, with a quarter of adult Australians not getting the dental care they need.

I am horrified when I read reports in the Sydney Morning Herald of young people having to be admitted to hospital to have all their teeth pulled out under anaesthetic. A recent study found that one in six Australians aged 15 or more were forced to avoid certain foods because of problems with their teeth. I had a situation in my own electorate where a man in his 40s whose teeth were crumbling was not able to get access to dental treatment and in the end had to resort to buying himself baby food to prevent the further decay and crumbling of his teeth. That is a shocking indictment of a country as rich as ours and a government whose surplus is huge. There are 650,000 Australians—and you know who they are: the low-income people, the pensioners, the people on fixed-income in retirement, the people who cannot afford to have private dental health insurance—who are missing out. If you are lucky enough to be able to afford private health insurance you can get some reimbursement from your private health fund, and the government does pay out for people who are privately insured. But a lot of the people in my electorate, probably around 60 per cent, do not have private health insurance, and they are the people who are feeling the impacts of this situation most intensely.

To get public treatment in my area at the moment you need to present with a swelling, an abscess or pain and bleeding. Even then, you might wait three days before you can get access to a dentist. It is not unusual in my region for people to be waiting for five or six years before they can get dentures. Of course, you can forget about any preventative treatment. And we have seen quite a wind-back of dental services for school-age children as well. It is a fact that the average cost of dental treatment has increased well in excess of inflation, and that puts it beyond the reach of many low-income people, who rightly deserve a proper public dental system to attend to their needs.

A recent study by the Australian Institute of Health and Welfare found that 30 per cent of Australians reported avoiding dental care due to the cost factor. In other words, they knew they needed to get treatment but a third of them said, ‘I just can’t afford to pay it.’ Twenty per cent said that the cost had prevented them from having recommended treatment, and 18 per cent reported that they would have a lot of difficulty paying a $100 dental bill. Well, $100 at the dentists these days does not get you very far at all. It is appalling that the cost of dental care is preventing many of the families whom I represent from being able to access proper services.

The other thing that is very important in this debate is to recognise that the government has done very little about the huge dental workforce shortages and the maldistribution of public dentists across the nation. It is exactly the same story as we have with GPs. If you are in urban Australia, if you are in a major capital city, your chances of seeing a practising dentist are far greater than if you are in a regional area like mine—and it is even more problematic in remote and rural Australia.

This government has known about the shortage of dental professionals for a long time. The neglect of the government in this area is longstanding, and surely no government minister would deny that it is a federal responsibility to train an adequate number of dental professionals. A national oral health training strategy for oral healthcare providers was recommended by the Senate Community Affairs References Committee as far back as 1998. But the Howard government, year after year, failed to act to ensure that we had a reasonable intake and graduation of dental professionals to service the needs of our community. Back in 2003, researchers were telling the government and the opposition that there would be an estimated shortage of 1,500 dental professionals by 2010 unless urgent action was taken. In 2004, just a few years ago and in the midst of this crisis, dental graduation levels were at their lowest level for over 50 years.

Belatedly, the government finally recognised that they needed to increase the number of places. As our shadow minister indicated in her contribution today, we welcome the recent budget announcement of a new dental school at Charles Sturt University. But much more needs to be done. Comprehensive and strategic policies are required to ensure a long-term solution to the dental crisis in our nation. After all, it is real people we are talking about. When we discuss the facts and figures about waiting lists and preventable hospitalisation and when we look at the statistics about workforce shortages and clinics that are closing their lists to people who need to see a dentist, we must always keep in mind that these are real people, real families. They are not just statistics, but real people with real concerns that need to be seriously addressed.

I want to say something about the response of this government to this crisis in our nation. No-one on our side of the chamber would begrudge people suffering chronic disease and illness having priority access to proper dental treatment. The government recognised, in a very limited way, that they needed to move on this issue because the com-munity—not just constituents but the professionals, the peak bodies and the dental associations—were saying quite clearly that something urgently needed to be done. The government’s response to the 650,000 people on the waiting list was to put forward a very limited scheme. It has helped some people. As I said, you do not begrudge the fact that people have had access to the government’s restricted scheme.

But people need to realise that the government’s scheme is limited to assisting those who have a chronic medical condition, such as heart disease or diabetes or malignancies of the head and neck. You have to have poor oral health or a dental condition which is exacerbating this chronic disease to even get a look-in to the government’s program. On top of that, your GP needs to be treating you under a multidisciplinary care plan. If you satisfy those criteria, you may be eligible for assistance. But it is very limited. As I indicated, eligibility is very tight. We can see that in the data that is on the public record. Since the introduction of this scheme by the government, only 7,228 Australians have had their dental needs attended to in the three years between July 2004 and June 2007. Only 7,228 people got access under this program—which is now going to be expanded—out of 650,000. So what about the hundreds of thousands of people who are not going to be able to access the government’s scheme under the tight eligibility requirements that exist?

In my state of New South Wales, 4,236 people with chronic illnesses got access to the government’s dental assistance scheme through Medicare in those three years. I do not begrudge any of those people that access, because they were in desperate situations, and I am very pleased for every one of them who got access. All of those 4,236 would have been very deserving cases. But that number for the whole of New South Wales is less than the number on the waiting list in the Illawarra and Shoalhaven region, so you can see that the scheme has not been a great success. What we have in the government’s announcements is additional money being poured into a scheme which, on the statistics and data available, has had very poor outcomes to date.

The poor take-up of the government’s program has been due to complex and restrictive eligibility criteria. As I said earlier, it limits coverage to those whose oral health exacerbates their chronic disease. The eligibility criteria announced by the government in the budget remain totally unchanged by the legislation before us. The minister did not challenge that argument when it was put today. The government has also failed to address the additional problems with this program: namely, the high out-of-pocket costs for patients and the very complex and restrictive referral process required before a patient can see a dentist under the health care plan. Fiddling with the detail of how this failing program is to work in the future in my judgement will do little to address the overall national problem: the 650,000 people languishing on the public dental waiting list. It will do nothing to make dental care more affordable and accessible to Australian families across the board.

Given the poor take-up rate to date, we on this side of the House have no confidence that the extended program will fare any better. Pouring money into a failing scheme will not solve Australia’s dental crisis. Today, the Leader of the Opposition and the shadow health minister outlined details of Labor’s proposal. Our Commonwealth dental health program will work in combination with the efforts of states and territories. Today, we committed up to $290 million to this combined effort. It is very important that people understand that this was only the first instalment. We wasted a lot of time in question time with this phoney argument about the so-called loss of $100 million between the government’s commitment and that of the opposition. If they had read the releases that went out today and listened to what the Leader of the Opposition said, they would know it has been made clear that the $290 million in our announcement today is only the first instalment. So I would urge all my constituents to make sure that they keep abreast of the additional announcements that Labor will make on our Commonwealth dental program.

Under our plan we are going to use the infrastructure that already exists in states and territories. They will get additional funding but they will be required to meet some new standards of dental care. At the top of that list of those who will benefit from the announcement today will be people with chronic diseases, who will have a high priority—and rightly so—but we will also expect that timely service is provided for preventative and emergency services and that governments will commit to maintaining their current effort.

Under our plan, over three years, up to one million Australians will finally receive much-needed dental treatment. The community at large will understand that only Labor, with national leadership on this issue, will end the blame game that they are so used to hearing from the other side of the House. We will provide the national leadership. We will provide the funding and resources, and request that the states sign up to clear objectives so that we can clear the huge backlog of 650,000 Australians languishing on the public dental waiting lists.

The states will be able to either supplement their existing public services and infrastructure or purchase private sector appointments for the hundreds of thousands of people who are now waiting for some light at the end of the tunnel to get their urgently needed dental conditions treated with some expediency. So it is for those reasons that I reject the government’s limited proposals. I do not begrudge the people that will benefit, but I say to the government again: if 7,000 people out of 650,000 got treatment under the scheme as it was first devised, I do not see that it will do much better into the future. (Time expired)

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