Mike Freelander (Macarthur, Australian Labor Party) Share this | Hansard source

I'd like to thank the minister for introducing this bill, the Health Insurance Amendment (Prescribed Dental Patients and Other Measures) Bill. I think it is actually a very important one. I note the comments by the member for Kooyong, who understands very well that people with quite significant disability find it difficult to navigate the support systems that have been put in place. The previous government was very good at setting limits, and this bill goes some of the way towards trying to make sure that people who have significant disability can get the care that they need.

I should say at the very outset that I'm the son of a dentist and the brother of a dentist, and I know how important dental care is. I also have worked in my community for almost 40 years as a paediatrician. I now see mostly kids with complex disability, and many of those kids have some of the conditions that we're talking about in this legislation—things like Pierre Robin syndrome, where babies are born with an unslung jaw; cleft palate; and various other abnormalities that make it difficult for them to breathe and to swallow. They require ongoing treatment. It certainly doesn't stop when they turn 22. They often miss out on the ongoing treatment that can improve their speech, their swallowing, their nutrition and their ability to interact with society. In that regard, I think this is a very important bill for them. We also see children with a condition called velocardiofacial syndrome, where children are born with facial abnormalities; palatal abnormalities, including cleft palate; and sometimes other abnormalities such as cardiac disease. Their treatment is lifelong. Their management is lifelong.

We know that dental treatment in particular is very important not just for appearance but also for things like nutrition, social interaction and proper respiratory function. These children often require surgery when they're very young, but they may well require revision as they grow older—well past puberty. Even as quite old adults, these kids—these people need ongoing treatment. I keep on calling them 'kids' because that's how I see them, but of course many of my patients are now adults, and they require ongoing treatment. Access to dental care in Australia, in many ways, quite shamefully, is very poor and very expensive. In the past, people have missed out on treatment because of the costs, and this bill will go part of the way to improving that.

Data published by the Australian Institute of Health and Welfare found that Australians aged 15 or over have on average 11 teeth that are decaying, missing or filled, and well over a third of this group have untreated decay. We sometimes see them in hospital. They present with dental abscesses requiring intravenous antibiotics before they can actually access any dental care. Only half of the people aged 15 and over had visited a dental professional in the 12 months of the survey by the Australian Institute of Health and Welfare. Only 10 per cent of people who saw a dental professional received public dental care. The vast majority of people in Australia have to pay for private dental care.

I agree with the member for Kooyong that many people who have other associated abnormalities should be seen in multidisciplinary clinics and should have access to dental care as part of that . Unfortunately, very few of them do. So, many of them will leave the paediatric age group still requiring ongoing intervention, and, once they turn 22, they have to pay for it privately, and it can be prohibitively expensive. It can affect things like speech. Some people who I've seen as kids feel very embarrassed about their speech, so they withdraw socially. They don't work, they tend to withdraw and they don't interact socially. Getting them access to dental care makes a huge difference to their lives, and this bill is very important in getting them that access.

There's only a very limited safety net for dental care for adults, and this bill will help those with some of the most severe abnormalities, such as cleft lip, cleft palate and velopharyngeal incompetence—that's where they have a hypernasal speech that can be very embarrassing for them, and, over time, they often need reviews for their palatal movement but also for their dental care. The current Deputy Leader of the Opposition, of course, was the Minister for Health and Aged Care in 2016, and she was the one who announced that the then Turnbull government would be abandoning the National Partnership on Adult Public Dental Services and the Child Dental Benefits Schedule, which was really devastating for many of those families—absolutely devastating and shameful, I would say. As a result, Australian children, particularly children with abnormalities, were forced onto longer and longer waiting lists, and that jeopardised their chances of improved dental health for the rest of their lives.

By passing this bill, we'll be delivering on our longstanding contribution to the accessibility of universal health coverage, particularly dental care. This goes part of the way to doing that. This bill amends the Health Insurance Act 1973 to remove age restrictions for patients with eligible cleft and craniofacial conditions. There are a number of conditions, some of which I have already mentioned. They include, for example, children with Down syndrome, who sometimes have palatal abnormalities and dental abnormalities that require ongoing treatment. I'm seeing a little boy with Down syndrome at the moment, who, at age eight, has had every one of his teeth removed because of severe dental caries. Children with Down syndrome often have enamel hypoplasia—that's what he's got—and they require ongoing dental treatment. For this boy, that is not going to stop when he's 22. He's going to need that for the rest of his life.

I do have some connections with the dental community, and I've sometimes had to ring and beg people to see older kids and adults who require dental care in this community. I think my oldest patient with Down syndrome that I see is now 38. So it's a bit old for a paediatrician, but they still like to come and see me, and, indeed, she has ongoing dental problems. We do need to make sure that the most disadvantaged can access this sort of care. This is, again, another sign of the Albanese Labor government and Health Minister Mark Butler moving through the things that should have been done a long time ago. It's part of our commitment to better health care for everyone.

This bill, thankfully, will remove the age restriction and enable access for those with severe abnormalities that are listed on the Medicare Benefits Schedule but who do not currently qualify due to the age restrictions. We also need to remember that occasionally you'll see an adult who has had an untreated submucous cleft palate with dental abnormalities as well, and they will benefit from this scheme. Even though it may seem to be small numbers and quite procedural, I actually think it's a very important bill. I'm really grateful to the health minister for making this commitment. This bill will confer eligibility for Medicare benefits to those who have reached the age of 22 or those who have had their treatment delayed beyond the age of 22, because of the pandemic, for example, or because they couldn't afford to see someone privately. The intent is that, for those who are born with severe craniofacial abnormalities, their family should know that their treatment will be for life. I think that's a really important thing. That will reduce the huge costs and the delay in treatment for many of these kids.

Again, as the member for Kooyong mentioned, it is very important that people with cleft lip and palate and palatal abnormalities get access to the NDIS, because they have ongoing needs for management—not just the surgical needs of repairing the cleft lip and palate, which is often ongoing; they require ongoing speech therapy, and they need ongoing management if they are to stay healthy. This bill is a big win overall for all these children, their families and the believers in accessible, equitable health care in Australia.

Other measures in this bill deal with some unrelated issues, such as developing a system to manage the Register of Approved Placements and to place and remove doctors from it. Currently doctors, to be eligible to access a Medicare benefit, must either hold a fellowship of an Australian medical college or participate in approved workforce or training programs. This is managed by the specific bodies responsible for determining eligibility. This makes it easier for the minister to allow or deny Medicare item numbers for this. It must be noted that, while Services Australia administers the Register of Approved Placements, this is based on notices provided by a specified body and that Services Australia does not have independent assessment capabilities or decision-making abilities. This bill helps in that regard. I think that this bill is supported by all the professional colleges, including the general practice colleges and the regional training organisations, and they're coming to Canberra this week to tell us about this, as they welcome the opportunity provided by this legislation to streamline the very complicated administrative processes associated with some of these schemes. It's imperative that constructive engagement is made between the government and the industries that our work and policies affect, and this is part of that.

This legislation also corrects the inconsistencies between the bill and the Health Insurance (Bonded Medical Program) Rule 2020. I don't know about the member for Kooyong, but I'm frequently being asked by people in the Bonded Medical Program to try and modify their placements. They often signed up to the Bonded Medical Program as very young medical students. Their lifestyles change, they get married, they have children. Sometimes they may have to deal with a major family illness—a parent who is very unwell et cetera. So they find their bonded placements in rural and regional areas difficult to manage. This bill simplifies the conditions around that. I think that is really important. Certainly for some of the people that have seen me about this, it will make it much easier for them to manage their weeks required in training in country and regional areas by splitting them up into weekly segments. They will be able to manage their time between their practice times and their time dealing with their family or other issues in Sydney.

All in all, this is a very important bill. It's not a minor bill. It does make some important differences to workforce training. We certainly know we need to improve our ability to get GPs, in particular, working in rural and regional areas. It also makes a big difference to those who've already signed up to the Bonded Medical Program being able to plan their lifestyle around much easier conditions. When I say 'easier conditions', I mean conditions that are simpler to understand. All in all, I commend this bill to the House. I know that, in the cleft palate community, this is going to make a big difference to many families.

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