David Hawker (Speaker) Share this | Link to this | Hansard source

I have received a letter from the honourable member for Gellibrand proposing that a definite matter of public importance be submitted to the House for discussion, namely:

The crisis in dental care caused by the Government’s distorted funding priorities.

I call upon those members who approve of the proposed discussion to rise in their places.

More than the number of members required by the standing orders having risen in their places—

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

It is a great privilege to be able to debate this issue today, because clearly the government is determined to misrepresent not only its own program but Labor’s program as well. This gives us a perfect opportunity to set out in detail the failings of the Howard government’s approach to dental care—its failing to deliver services to the hundreds of thousands of Australians around the country who are waiting for dental care and are in need of it. On top of that, whilst these failings are continuing, the government is spending hundreds of millions of dollars that could be paying for consultation after consultation and treatment after treatment in dental services for our children, the elderly and those who are finding it hard to meet the high costs of dental care in the private sector. Instead, since the last election the government has already spent in excess of $200 million just on government advertising.

Put this in contrast with how much the government has spent under its chronic disease dental care program, which it trumpeted so much today in question time. When the program was announced three years ago, only about $15 million was allocated to it. Do members on this side of the House know how much of the $15 million it has spent? You would not be able to guess because it is such a small amount. Not even $2 million has been spent on a program that the government has suddenly said it will be able to spend $384 million on, even though the eligibility criteria have not changed and the complex referral processes have not changed. In fact, the paperwork has got worse; instead of three Medicare item numbers we are going to have 450 Medicare item numbers. Suddenly the government expects us to believe that this is going to provide great relief to many families around the country.

It is true that the few people who can manage to squeeze themselves through the eye of the needle and meet the very strict eligibility criteria of having a chronic disease that is being exacerbated by an oral health problem and who are being managed by a GP who has written a proper management care plan and who can find a dentist who will comply with those conditions may get some extra money because of the government’s changes. But you cannot call this a dental care program. This is a shambles.

I am going to take the time to tell the members, at least those on this side of the House, because I am not sure the Minister for Health and Ageing wants to hear it, how few people have been assisted by this program—which we are not prepared to support, because we believe that, if you are going to spend $384 million on dental care, you should spend it in a way that is going to be effective, you should spend it in a way that is going to provide relief to working families and you should spend it in a way that uses the infrastructure that is in place. The minister can be as critical as he likes about the type of care that the states and territories provide, but in many rural and regional communities around the country they are often the only dental services that exist. If we do not resource them properly, if we do not give them the money to be able to pay for dentists and if we do not give them support to make sure that the infrastructure that is there can be used to provide services to families in our electorates, then we are wasting money and using it ineffectively. That is what the government wants to tip more money into.

I hope that there are still some South Australian members in the chamber because, in the three years that this program has been running, not a single South Australian under the age of 14 has had any assistance from it. I note that the member for Swan is in the chamber. Not a single Western Australian under the age of four has had any assistance from this program. Not a single person in the ACT under the age of 14 has had any assistance. And listen to this one: not a single person under the age of 24 in the whole of the Northern Territory qualifies for services under this program.

I am taking the time to take the House through this as the government will stand up and pretend that we are taking away Christmas—that we have signed the death warrant for Santa Claus—because we are not voting for this proposal. The reason we are not voting for this proposal is that we do not vote for things that do not work. If you have a program that has already been running for three years and a government that cannot even spend the amount of money that was allocated over those three years—it can only spend about 10 per cent of it—and then does not fix any of the problems with the program, you cannot expect us to vote for it, since the program will help so few people. If you do the sums and every single person assisted by this program gets what the minister now says is a fantastic new program instead of getting the amount of money they were eligible for under the old program, even then you cannot spend $30 million—and the government wants us to agree to spend $384 million on this program. It is just a waste of money. It is the government positioning itself and pretending it is doing something on dental care for the sole reason that it cannot bring itself to give any money to the states and territories. It is so determined not to give any money to the states and territories that it has forgotten that this money should actually be directed to helping people.

If it is the states and territories that have infrastructure that can be used, why would we not maximise it? Why would we not make sure that we are using those resources efficiently? Why would we not work with them to deliver those resources? Certainly we would expect in return that the states would do some particular things with this money. We have said that we would demand that they make sure that priority services are provided to those with chronic diseases that are affected by poor oral health. So the very small number of people who do manage to get through the strict criteria that the government imposes will still be covered by our program. We want to make sure that those people who are worthy and are in need do get assistance.

But let’s not kid ourselves. Assisting a few people who qualify for the government’s program does not attend to the problems in my electorate of thousands of people waiting in Footscray. I know there are thousands and thousands of people on waiting lists in the member for Throsby’s electorate, in Capricornia, Ballarat, Bendigo, O’Connor and Geelong. I have travelled around the country. Everywhere we go, every dental clinic has waiting lists that would make your skin crawl—really, they would. I know that the minister wants to be dismissive of this, but the truth is that Labor is going to take to the election a Commonwealth dental program which is way in advance of what the government has done, in a number of ways: way in advance, as you have seen today, with the first instalment of our announcement—

Tony Abbott (Warringah, Liberal Party, Leader of the House) Share this | Link to this | Hansard source

So there is more, is there?

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

Minister, if you actually ever listened, if you read a press release, if you looked at the detail or if you listened to the radio, you would know that it clearly says that this is the first instalment of Labor’s Commonwealth dental program. What I have learnt about the minister is that suspense about anything kills him. He is very impatient. He does not like waiting for anything. If there is something that he thinks we should say and we do not say it straightaway, there is clearly a problem. Maybe I am actually just enjoying making you wait, Minister! Maybe we will keep doing that for a lot longer.

The truth is that the minister still has to be able to explain to the public why a program that has only served 7,000 people across the country in three whole years and spent less than $2 million is suddenly going to turn into a program that can spend $384 million and actually help lots of people around the country. We know it is not true. Even the government’s most generous estimations think it might reach 200,000 people. That might just clear the waiting lists in New South Wales, but there are many, many thousands of other people around the country who need assistance. Labor has committed to one million consultations and treatments, which will have a big impact on the waiting lists around the country, and there will be more to come.

I am sure we will deal with the issues that the minister has so spectacularly failed to deal with on his watch. Let us look at one of the most critical ones: the dental workforce. Every time over the last 11 years that Mr Abbott, the minister for health, has stood up and said that this is an issue just for the states to deal with, we have never heard him say that, actually, it is the Commonwealth government that has the responsibility for training health professionals. We just do not hear that at all. The minister still has nothing to say on the fact that there is actually a workforce crisis, that there is a shortage of dentists, that this puts strain on both the public and the private systems, and that it puts strain on people for a whole lot of reasons, but particularly by pushing up prices.

The only thing that we have heard in an election year budget is that the minister is going to establish a new dental school at Charles Sturt University, and we said, ‘That’s a great idea.’ We agree with that being part of the strategy. But where is a national comprehensive plan to deal with the needs of the workforce? Where is a national comprehensive plan to clear these waiting lists and make sure that we are going to be able to move forward in the future and have a dental care system that is the envy of the world, like we used to? Instead what we have is a growing problem of one in three Australians who cannot afford to go to the dentist because of cost. We are seeing figures absolutely going through the roof of hospitalisations of young children with dental problems who have not been able to get dental care early enough. Instead they are ending up in our hospital system, because we have not been able to find the money to treat those people through our public dental services or to assist them to get to private dentists.

The minister cannot pretend to be proud of these figures. He cannot, when he stands up here today and tells us how wonderful he thinks this new program might be, expect us to take him on his word, because what we are going to do is look at the figures that are there. In fact, many, many times in this House in the last nine years I have heard the Prime Minister say, ‘My word is my record.’ Unfortunately for the minister for health, his record being his word does not paint a pretty picture. This program has failed, and you do not fix a failing program by tipping more money into it.

The minister tried to just skirt around the detail in question time today, pretending that the eligibility for this program is changing, when he knows that is quite false. In fact, we have before the parliament at the moment a bill that makes absolutely clear that not a single part of the eligibility rules is changing. What the minister wants to pretend, by increasing the entitlements for the very small number of people who get through that eye of the needle, is that he is somehow changing the eligibility. But the truth is that 650,000 people on dental waiting lists around the country will not be assisted by providing more money to those small numbers of people.

If you are in Western Australia, South Australia, the ACT or the Northern Territory, or if you do not happen to be a lucky child under four in Queensland who is eligible for this program, it is really not going to be enough, Minister. You are going to have to be able to explain to this House why any good opposition in good conscience would support this when that money could be used and spent in a better way—where, by working with the states, we could actually make their dollars and our dollars go further. Doesn’t that sound like a sensible idea? Even the minister cannot bring himself to say no because it is so obviously a sensible idea. That is where we have got to. I think it is quite devastating—

Andrew Southcott (Boothby, Liberal Party) Share this | Link to this | Hansard source

He doesn’t like to interrupt.

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

I am absolutely sure it is not because the minister does not want to interrupt. We have been here often enough to understand what rules of etiquette and engagement there are from the minister. I am 100 per cent confident that it has nothing to do with his sense of politeness that, when a lady is speaking, he has not been prepared to interrupt.

The truth is that even the minister at the table has had to acknowledge the previous scheme’s success. He occasionally does have a flash of honesty where he speaks his mind. We have seen it with hospitals. We have seen it when he said, ‘Really, it might be quite a good idea to have the federal government take over hospitals; it might be quite a good idea to have a national plan.’ Lo and behold, when Labor says anything like that, it suddenly becomes a bad idea. But we found the same thing when, in February 2005, the minister was quoted in the Sydney Morning Herald as clearly stating:

The Keating government’s program did reduce waiting times, no doubt about that.

He is on the record in the same interview as indicating, more than 2½ years ago, that the public dental scheme in his view was a ‘nightmare’ and, in the words of the journalist, not of the minister:

... a scheme his own government had abolished had successfully cut waiting times for treatment.

This was a number of years ago. Unfortunately those waiting lists have got worse. Pressure has grown, the price of going to see the dentist has gone up, and the minister has had nothing to offer other than a little bit of mea culpa, saying: ‘Well, actually there were a few problems with the program. Now that we are going to tip a whole heap of extra money into it, that will fix it.’ Minister, you know that that is not the only problem with the program. Minister, you know that, if you do not change the eligibility, you are not going to help an extra number of people. You know that the doctors do not want to sign on to the sort of detail that is required because it is just too complicated for them.

I got an email today, obviously following some of the media reports of the announcement that the Leader of the Opposition and I made. This person, not known to me—I will not use his name because I am not sure if he wants to be identified—had gone and looked at the speech that was given last night on the bill that is before the House. The email says:

Excellent speech—just what the dentists want and have been asking for. My friends in private practice prefer to treat deserving cases for free rather than bother with the hopeless Medicare scheme. By the time they’ve paid their tax on the miserable fees it’s not worth the cumbersome administrative time, let alone the hassles. Patient and relative appreciation is better too.

Minister, this is just one person who has bothered to send us an email and does not in any way discount the hundreds of people that all of us have met over the last 11 years. We have been faced with constituents who come to our mobile offices and come when we have been campaigning to say, ‘Bring back the Commonwealth dental scheme and provide some relief to people who do not have enough money to pay for dental care,’ and your program does not provide that. (Time expired)

Tony Abbott (Warringah, Liberal Party, Leader of the House) Share this | Link to this | Hansard source

A smart opposition would have had a very obvious tactic before it. A smart opposition would have supported the government’s scheme and then proposed one of its own on top of that. That is what a smart opposition would have done, but not this opposition. This opposition wants to abolish the government’s scheme and instead propose a scheme which is smaller and worse than that which the government has put on the table and which is going through the parliament at this time. The fact that the shadow minister opposite, the member for Gellibrand, felt the need to commence her remarks today by saying that what she announced today was but the first instalment of Labor’s dental plan demonstrates that she knows that she has got it wrong. It demonstrates that she knows that trying to trump a $385 million scheme with a $290 million scheme simply does not work. So she has made a terrible mistake. She has dumped her leader in it, and the fact that she was buzzing around throughout question time today getting a bit of trauma counselling from the member for Jagajaga and others shows that she knows that she has made a serious tactical mistake.

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

Ms Roxon interjecting

Patrick Secker (Barker, Liberal Party) Share this | Link to this | Hansard source

Order! The member for Gellibrand has spoken.

Tony Abbott (Warringah, Liberal Party, Leader of the House) Share this | Link to this | Hansard source

Let me say in all frankness that the allied health professionals scheme in respect of dentistry that was put in place early in 2004 has not worked as well as the government wanted it to, and that is why the government has completely restructured the scheme. The problem with the scheme that we put in place in 2004 was not the referral system. The referral system works perfectly well now that doctors have got used to it. For allied health professional consultations for people on team care plans, it works perfectly well. In the last financial year 400,000 people were put on team care plans. Those doctors did not have a problem with establishing which of their patients had chronic disease and complex care needs. Those doctors did not have a problem. Those patients were perfectly qualified for assistance under Medicare. There were one million allied health professional consultations under these team care plans. Those allied health professionals did not have a problem with the paperwork. So, if the doctors do not have a problem with the referral process and if the allied health professionals do not have a problem with the paperwork in respect of all other conditions, there is no reason to think that there is going to be an insuperable problem in respect of dentistry.

No, the problem in respect of dentistry was that the scheme as it has operated just covered consultations. People with poor oral health do not want a consultation; they want to treatment, for God’s sake! And do you know what Labor are going to give them? Consultations! Useless consultations, not the treatment that they need. That is why our scheme is so good and that is why it is so sad, not so much for the people who need this treatment, because this legislation will pass the parliament, but for the credibility of the shadow minister opposite. Just like the former Leader of the Opposition voting against tax cuts, she is voting against $385 million worth of dental treatment for people who really need it.

Who is going to get dental treatment under this scheme? People with chronic disease and contributing poor oral health. There are about a million Australians with diabetes, there are a lot more than that who have heart disease, there are hundreds of thousands of people who have cancer and there are tens of thousands of people who have serious mental health problems. All of those people are potentially eligible for this scheme. Does the shadow minister opposite seriously believe that none of the 700,000 people for whom GP care plans were established in the last financial year has serious oral health problems? Is that really what she is saying? The fact is that many of them do, and they will be eligible, or potentially eligible, for help under this excellent scheme which is going through the parliament as we speak.

Let us be absolutely clear about the political folly. I see the shadow minister is getting a bit more trauma counselling from her predecessor, the former shadow minister for health, the member for Lalor. I am afraid the author of Medicare Gold is not going to be able to give too much good advice to the author of the current policy turkey from the Australian Labor Party.

Ian Causley (Page, Deputy-Speaker) Share this | Link to this | Hansard source

I remind the Deputy Leader of the Opposition that she is not in her seat.

Tony Abbott (Warringah, Liberal Party, Leader of the House) Share this | Link to this | Hansard source

Let me just say again to the member for Gellibrand: how on earth can you trump a $385 million plan with a $290 million plan? How on earth can you trump a plan that covers 450 dental items with a plan that covers just one dental item, a consultation alone? It does not cover dentures, it does not cover fillings, it does not cover extractions and it does not cover root canal work—it does not cover all the things that people with poor dental health need. So how can her plan, which covers just one item, trump a plan that covers 450 items? How can you trump a plan that is ongoing, as the government’s plan is, with one which will terminate after just three years? How can you trump a plan which is demand driven, as the government’s plan is, with one which is budget limited?

No, the member for Gellibrand has got herself into a real mess here. She would have been much better off just keeping her counsel. If she really does have something up her sleeve, something in addition for dental health, she should have saved what she announced today for then and given us a full dental health plan rather than this pathetic, puny effort which has been announced today and just makes members opposite look like they are not serious about Medicare, not serious about dental health and do not really understand what they are talking about.

I accept that there are many people in this country who would like better dental care. I have no reason to doubt the figures that the member opposite quotes of 650,000 people on public dental waiting lists around Australia. I am aware, thanks to my friend and colleague the New South Wales member for North Shore and shadow minister for health in the state of New South Wales, of the appalling state of public dental treatment in New South Wales. I know that at the Westmead dental clinic, for instance, there are people with no teeth of their own and no false teeth who, according to the clinical guidelines, should be treated within three months—and even that is far too long; an inexcusable delay. But I am aware that, thanks to the incompetence of the New South Wales government, people in that tragic condition are waiting not three months but 2½ years for treatment. I am aware of that. But, unlike members opposite, I do not say that the incompetence of the states is the fault of the federal government; I say the incompetence of the states is the fault of the states.

I know, as members opposite do, that the Howard government did not renew the Keating government scheme. While the scheme did not work especially well, whatever good it was going to do had been done by 1996, and so it was not renewed. This idea that the problems of 2007 are all the fault of a federal government decision in 1996 does not stand serious scrutiny. It is ridiculous to think that the problems of 2007 all stem from a federal government decision back in 1996 when the problems in question have always been the responsibility of the states. The constant claim from members opposite is verging on the ridiculous. It is almost as if the people of Britain would complain against the Italians because the Romans went home in 410 AD and they have been suffering ever since from the lack of the legions.

Let me tell the member opposite a little about the Keating scheme. When the Keating scheme was in place, spending $100 million a year, the states were spending $200 million a year. Under the member for Gellibrand’s proposal, she is going to spend less than $100 million at a time when the states are spending $500 million. So her scheme is less than half as significant—

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

What are you spending?

Patrick Secker (Barker, Liberal Party) Share this | Link to this | Hansard source

Order! The member for Gellibrand is warned!

Tony Abbott (Warringah, Liberal Party, Leader of the House) Share this | Link to this | Hansard source

as the Keating scheme was in terms of weight of money dedicated to public dentistry. The Keating scheme was not very good because we know that public dental waiting lists in Queensland were still up to three years in 1995, notwithstanding the political brilliance of the Leader of the Opposition in managing everything in the Christian socialist state of Queensland at that time. If the Keating government scheme did not work very well when it contributed 50 per cent of the quantum being spent by the states, this revived Keating government scheme is going to work even less well when it is spending 20 per cent of the quantum spent by the states. The Prime Minister was asked again and again today: will you embrace Labor’s plan? Of course we won’t embrace Labor’s plan, because Labor’s plan is not a very good one and the plan that the government has put in place, which has been out there for all to see since this year’s budget, is a much better one.

Members opposite are constantly accusing this government of neglecting dental health. Through the private health insurance rebate we spend about $400 million on dental health. How much did Labor spend on dental health except for the $100 million a year of the Keating scheme? Nothing; absolutely nothing. So, on top of the $385 million that we are proposing to spend under the revamped allied health professional scheme there is the $400 million a year that we spend through the private health insurance rebate.

The member for Gellibrand said that we were neglecting dental training. Let me inform the member that there was no substantial increase in dental training places throughout the life of the former Labor government. In 1996 there were 356 commencing dental students in this country; by 2002, thanks to the policies of this government the number had risen to 444; by 2005, thanks to this government the number had risen to 529; in 2010 there will be 569—and I am pleased that the member for Gellibrand is writing these figures down because she might learn something for a change; she is listening for once. It is good that she is writing it down and I hope she remembers it, because these figures show that there has been a 50-plus per cent increase in public dental training, thanks to this government.

As I said, I do not pretend for a second that the states have managed the public dental schemes well. I accept there are problems, but the job of the federal government is not to relieve the states of what is their responsibility; the job of the federal government is to run federal health programs as well as it possibly can. That is why we have chosen to make our good Medicare system—our great Medicare system—even better by giving it not just a small and minor dental component but a very substantial dental component.

I accept that not all of the 650,000 people on the public dental waiting lists are going to be helped by our scheme, but many of them will. The people on the public dental waiting lists are invariably pensioners—most of them are old age pensioners. Most old age pensioners have chronic disease and those of them that have serious oral health will at least potentially be helped by this scheme. It is a demand driven scheme. I would not be at all surprised if, as things pan out, an enormously larger number than the 200,000 currently envisaged benefit from this scheme and the government ends up riding to the rescue of these people to the tune of much more than $385 million over four years.

Kelvin Thomson (Wills, Australian Labor Party) Share this | Link to this | Hansard source

Old age pensioners in my electorate have seen the government’s scheme. Two of them—Salvatore and Carmella Raiti of Merlynston—recently visited the Brunswick dental health clinic seeking a new set of dentures and were told that they would have to wait three years for a new set of dentures. They could have the dentures made privately for between $3,000 and $5,000. They do not have $3,000 or $5,000 apiece—and so they wait. Mr Raiti, aged 78, and his wife, who is disabled, have been left in constant pain. She is unable to eat many foods because of the poor state of her teeth.

Another pensioner in my electorate, 86-year-old Vito Romeo of Coburg, also visited the Brunswick dental health clinic and was told that he would have to wait four years for a new set of dentures to replace his 15-year-old set. He is a widower who lives alone. He was quoted $4,000 if he wanted to get a new set of dentures through a private dentist. He said, ‘I can’t wait much longer because of the pain. It hurts very much.’ It is disgraceful that my constituents should live like this, living a Third World life in a First World country.

There are currently two dental care centres in Wills. Residents who go to the Morelan community dental service in Brunswick or the Dianella service in Glenroy face waits of anywhere between two and three years for check-ups for natural teeth and even longer for dentures. This is not the fault of these services. It is scandalous that, in a prosperous country, in a prosperous era, Australia’s teeth should be in such dismal shape.

There are 650,000 people on waiting lists for public dental care, with an average waiting time of 27 months. Tooth decay ranks as Australia’s most prevalent health problem. Untreated dental decay in the Australian population stands at over 25 per cent—incredible! More than a quarter of Australians are not getting the dental care that they require. Even worse, about 50,000 Australians a year are being hospitalised for preventable dental conditions. What a false economy. We do not give people timely dental treatment and then we have to treat them in hospital, picking up the pieces of our earlier neglect. It is pure folly and, from my point of view, most disturbing of all is the evidence now coming out about the decline in the dental health of our kids.

In the mid-1990s, Australian kids had the world’s best teeth, but from 1996 to 1999 five-year-olds experienced a 20 per cent plus increase in tooth decay. Between 1994 and 2004 hospitalisation rates for children under five, for the purposes of removal or restoration of teeth, increased by over 90 per cent, according to the New South Wales Chief Health Officer. The health insurance company, MBF, recently released information which showed a 42 per cent increase in children being treated in private hospitals for dental cavities.

There are two reasons why we have these Third World dental care arrangements in Australia: the first is the lack of funding, which has been severely exacerbated by the actions of the Howard government; the second is a workforce shortage issue—a lack of trained dentists. This is entirely the responsibility of the Howard government. As to the first issue, the underfunding, members opposite, in their typical blame game way, say, ‘This is the fault of the states.’ They are interested in playing the politics of the issue. This is what they have done for the past decade and, if they get re-elected, it will happen all over again for the next three. We will get finger pointing and blame shifting instead of what we need: a genuine cooperative attempt to solve the problem. It ought to be remembered that Labor had a Commonwealth dental health program back in 1996, but when the Liberal and National parties came to power, they scrapped it. They ripped out $100 million a year from Australia’s public dental system; they said we could not afford it. They said that the axing was necessary to deal with the budget deficit, but when the budget went into surplus was the dental health program restored? No, it was not. And so it is that we now see hundreds of thousands of Australians languishing on dental waiting lists.

In July 2004—correct me if I am wrong, but I think that was an election year—the government came up with what it called the Medicare dental program for people with chronic conditions and complex care needs. The number of people that this program, trumpeted loudly in 2004, has assisted is around 7,000—just 7,000 people assisted in over three years when we have a dental waiting list of 650,000. The reason for this is simple enough. The program has been narrowly targeted to people with chronic conditions and complex care needs. When I use the word ‘complex’, I mean complex. Let me take the House through the eligibility guidelines which have been in operation for these services over the past three years:

a) the service is provided to a person whose dental condition is exacerbating a chronic and complex condition that is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an Enhanced Primary Care plan; and

b) the service is recommended in the person’s EPC plan as part of the management of the person’s chronic and complex condition—

But wait, there’s more:

c) the person is referred to the eligible dental practitioner by the medical practitioner using a referral form that has been issued by the department (of Health and Ageing) or a referral form that substantially complies with the form issued by the Department—

and there is still more:

d) the person is not an admitted patient of a hospital or day-hospital facility; and

e) after the assessment, the eligible dental practitioner gives a written report to the referring medical practitioner—

We are still not there yet:

f) in case of a service in respect of which a private health insurance benefit is payable—the person who incurred the medical expenses in respect of this service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit.

If you have managed to negotiate your way through the maze, you are entitled to a maximum of three services. It is in fact easier to extract a tooth, and it is little wonder some people are reported to have resorted to do-it-yourself methods like the old piece of string tied to the doorhandle.

This sort of gobbledegook leads to chronic underspending, and the government’s claim that it has a $385 million program would make a cat laugh. It is fanciful. It is a fraud. It is one of those programs which has a large allocation with precious little money being spent. This government has not been able to find $100 million a year to reinstate the dental health program to look after people’s teeth, but it has been able to find $200 million a year—twice as much—to engage in self-promotion by way of government advertising.

I remind the House that in September 1995—12 years ago—when the then opposition leader, John Howard, promised that a Liberal government would ask the Auditor-General to establish a set of guidelines for government advertising, he said:

We will run our advertisements past the Auditor-General and they will need to satisfy those guidelines.

This turned out to be one of the Prime Minister’s notorious non-core promises, a deceptive piece of propaganda designed to get voters to support him. Since then, we have seen a staggering $2 billion spent on such notorious propaganda campaigns as the GST ‘Unchain My Heart’ ads, the Strengthening Medicare campaign and the Work Choices campaign.

After the ‘Unchain My Heart’ campaign, the Auditor-General, to his credit, produced a set of guidelines designed to draw the line between bona fide government advertising and political advertising, for which the Liberal Party should be paying, not taxpayers. The government ignored those guidelines. The consequences are that while the polls are indicating the electorate wants the government to listen to it more, to pay more attention to it, instead the government is out there with a taxpayer megaphone, a taxpayer funded loudhailer, screaming into the electorate’s ear because it thinks the electorate will get the message if only the government yells a little louder. So we have seen massive spending: $200 million this year on Work Choices, superannuation, private health insurance and the climate change campaign.

In stark contrast, Labor has a vision for the future: one million additional dental consultations for Australians through a $290 million program which is real money, not Monopoly money.

Andrew Southcott (Boothby, Liberal Party) Share this | Link to this | Hansard source

The most authoritative survey of Australia’s oral health is the Australian Institute of Health and Welfare’s national adult oral health survey, which looked at the health of our teeth from 2004 to 2006 and reported in March 2007. It found that 30 per cent of Australians were avoiding dental care due to cost, that 20 per cent of people identified cost as preventing them from seeking a recommended treatment and 18 per cent reported that they would have difficulty paying a $100 dental bill. This is not something that is in dispute; this is something that is agreed. It is based on the best information that we have from the Australian Institute of Health and Welfare.

Where we differ is how we should approach this to do the best for Australia. It is worth recognising that in the contributions from the shadow minister for health and from the previous speaker, also from the Labor Party, we heard a lot about the state of Australia’s oral health but we did not hear a lot about the state and territory governments. It is a matter of fact that our public dental services are run by the state and territory governments and always have been. What we see now when we look around Australia is lengthening waiting lists for public dental services.

The Australian government does have a role to play in dental health but it is important to recognise that, for most people, something like 85 per cent of dental services are run through the private sector. It would be a big mistake to put all of your eggs in one basket, to focus exclusively on the public dental services because on this side we believe that people, where possible, should be able to visit a dentist of their choice. We have done a number of things to make that option more accessible to people. We introduced in 1998 the private health insurance rebate, a subsidy of 30 per cent for people who have private health insurance. That subsidy is greater for people over 65 and 70 years of age—it is 35 per cent for people over 65 and 40 per cent for people over 70. The direct contribution we make just in the private health insurance rebate is approximately $400 million a year for dental services.

We also make a contribution for the university training of dentists. Most recently we have announced a new school of dentistry and oral health at Charles Sturt University in Bathurst to address some of the workforce issues in dentistry. We announced a new measure for Medicare in this year’s budget which should help 200,000 people with chronic health conditions over the next four years. It should help to reduce the numbers of people who are on the state government dental waiting lists.

What the measure in this year’s budget provided for was that, for people with chronic and complex conditions like diabetes, heart disease or cancer, where oral health is having or could have an impact on the person’s general health, there would be a Medicare item for them to visit a dentist. They must be under a GP management plan, but there are something like 700,000 people on GP management plans. They must be part of a team care arrangement. Residents of aged-care facilities are eligible for this measure if they are managed by a GP under a multidisciplinary care plan. But what it requires is for the patient to be referred to a dentist by a GP.

This is a very significant measure. It allows for up to $4,250 worth of Medicare funded dental treatment over two consecutive calendar years. It covers 450 items on the Medicare Benefits Schedule. It allows for things like restorative dental work and dentures, which federal Labor’s scheme does not allow for. When we look at this scheme I think it is true to say that the scheme that we first introduced has not met our expectations. But what we do find is that a similar scheme to this works very well with the veterans. What we have done is mirror those arrangements.

So when we look at the differences between Labor and the government, their scheme is just the old Keating scheme. What it involves is giving $295 million directly to the states. It is a bureaucratic solution. I guess the only thing we have to be thankful for is that the Leader of the Opposition has not announced another committee or another review, but this is a bureaucratic solution. It is the sort of solution you would expect a bureaucrat to come up with. The problem is that our scheme, which is $385 million over four years, would be axed and replaced by one which is $90 million less and which just involves giving the money directly to the state and territory governments.

When we look at how the state and territory governments have performed, we find that in the public dental services the infrastructure is run down and they have tremendous problems attracting people to work in that sector. I think it is crazy to ignore the role that the private sector can play in delivering these services. The Labor Party have announced that state governments would be required to meet new standards and that there would be: priority services for individuals with chronic diseases affected by poor oral health, timely service for preventative and emergency services, maintaining current effort.

That is basically meaningless. The state governments would argue that they already do that. In fact, when you look at the guidelines that the state governments set for their own schemes, you find out that they are meaningless within their own systems. For example, in New South Wales it is required that someone with no false teeth and no teeth of their own should be seen within three months, and yet the waiting list is more like 2½ years.

The debating point raised by the member for Gellibrand and shadow minister for health was that our current scheme has not been utilised by any child in South Australia and a number of states. Speaking from the perspective of my own state, there is a very simple reason for this. The South Australia Dental Service has, as part of it, the school dental service, which offers comprehensive dental care to all South Australian children from birth to 18 years of age. The service is free for preschool, primary and high school students with a school card or who are dependants or holders of a Centrelink concession card. So this is one of the dangers of having someone inexperienced look at a whole bunch of statistics and say: ‘Eureka! I’ve found it. Children aren’t using this in South Australia.’ There is a very simple reason: we have a school dental service available for all children.

One of the problems with Labor’s scheme is that it relies on having more people to work as public sector dentists and it completely ignores the role that the private sector could play in providing these services.

In conclusion, there is a very clear choice here. We recognise that people should be able to go to the dentist of their choice and we have found a way to do this through Medicare. That will allow people to have up to $4,250 of Medicare funded services with their dentist and will include things like dentures or restorative dental work as well as all of the preventative dental health that is so important for people with the chronic conditions like cancer, heart disease and diabetes.

Steve Gibbons (Bendigo, Australian Labor Party) Share this | Link to this | Hansard source

The Howard government’s neglect of this nation’s dental health for the past 11 years is nothing short of scandalous. The decaying state of our dental health system under the coalition is matched only by the decaying state of Australians’ teeth. The Minister for Health and Ageing’s answer to the dental crisis is, once again, that standby of the Howard government—blame someone else. But in taking aim at the states and territories he is conveniently ignoring two things.

Firstly, it was the Howard government that scrapped Labor’s Commonwealth Dental Health Program in 1996, ripping $100 million a year from Australia’s public dental system. The state and territory governments have more than doubled their investment in public dental care over the past decade, but the impact of the Howard government’s decision is still being felt today, with 650,000 Australians languishing on public dental waiting lists. In my own electorate of Bendigo there are more than 6,500 people waiting for treatment, some of whom have been waiting over three years.

Secondly, the minister and the Prime Minister seem to have forgotten that the training of dental professionals is a Commonwealth government responsibility. Like workforce shortages in other areas of the health system, the neglect of this area is chronic, despite plenty of warnings of the consequences. For example, as long ago as 1998 the Senate Com-munity Affairs References Committee recommended a national oral health training strategy, which the Howard government has failed to act on. The recent increases in oral health training places at universities, while welcome, are far too little and far too late.

The tough guy health minister seems to have no regard for battling Australians’ dental health. The health minister, the member for Warringah, is the Doc Holliday of Australian politics—the legendary psychopathic, gun-slinging dentist who administered his dental treatment without anaesthetic and, like the minister, who inflicts his health and dental policies on battling Australians without any anaesthetic, enjoyed inflicting pain on people. But, rather than being a gunfighter, the health minister fancies himself as a street fighter and is also proud of his prowess as a boxer. According to the Sydney Daily Telegraph, the health minister was awarded an Oxford half blue for his participation in that sport during the time he was at Oxford. It was only a half blue as boxing was not considered an appropriate sport to warrant a full blue—or perhaps the minister’s opponent was not considered a worthy opponent, as he later went on to become the director of choreography at the London ballet. Rumour has it that the ballet dancer sat the minister down with a single punch—

Patrick Secker (Barker, Liberal Party) Share this | Link to this | Hansard source

The member for Bendigo will return to the subject. I fail to see what this has—

Steve Gibbons (Bendigo, Australian Labor Party) Share this | Link to this | Hansard source

Rumour has it that the ballet dancer sat the minister down with a single punch in the first round of that contest, but I am unable to confirm or deny that rumour.

Ian Causley (Page, Deputy-Speaker) Share this | Link to this | Hansard source

The member for Bendigo will return to the subject.

Steve Gibbons (Bendigo, Australian Labor Party) Share this | Link to this | Hansard source

Yes, Mr Deputy Speaker. Almost one-third of Australians are avoiding dental care due to the massive costs that they face today. Tooth decay is Australia’s most common health problem and is easily preventible, yet more than one-quarter of all Australians are suffering from untreated dental decay. Many on dental waiting lists are elderly, and surely we can and must do more for these people who helped build this country into what it is today. But perhaps an even bigger tragedy is the state of our children’s teeth. In the mid-1990s, Australian kids had world’s best teeth, but now there are real concerns that this is slipping. Between 1996 and 1999 there was a 21.7 per cent increase in decay among five-year-olds and there were soaring hospitalisation figures for the removal or restoration of teeth. Over a decade there has been a 91 per cent increase in hospitalisation rates for our children with dental health problems.

A Rudd Labor government will end the blame game and work with the states and territories to fix Australia’s crumbling dental care system. We will provide services for those in our communities who are desperately in need of dental care. We will ensure that working families under financial pressure from higher housing, child care and petrol costs do not have to choose between the dental care they need and putting a meal on the table. Labor will provide almost $300 million to make available one million new dental consultations. This funding will allow the states and territories to either supplement their existing public services or pay for private dental appointments. State and territory governments will be expected to meet new benchmarks of care and will be required to maintain their existing commitments. Labor’s policy will provide the treatment battling Australians have needed for the past 11 years.

If the Howard government spent a fraction of the money it is spending on government paid advertising to try and get itself re-elected on Australia’s dental care needs, millions of Australians would not be in the situation they are in now. I urge the Howard government to adopt Labor’s plan and put in place a decent dental health scheme that will actually deliver the care that most Australians need to those who need it.

Kay Hull (Riverina, National Party) Share this | Link to this | Hansard source

It is a great pleasure in this matter of public importance to be able to advise and explain to the member for Bendigo, who cites the training of oral health and dentistry as a Commonwealth responsibility, that the Commonwealth are taking full responsibility for dental services and they did so in the last budget. They actually announced a significant $64 million to establish an oral health and dentistry school at Charles Sturt University. In fact, they are providing $65.1 million for a school of dentistry and oral health. This is taking place under the guidance of Professor Mark Burton as the Director of Dentistry at Charles Sturt University, and I congratulate the member for Macquarie, Kerry Bartlett, for his tireless work and support, in association with me, in delivering this dental school to the rural people of New South Wales. It is my understanding that the CSU already has expressions of interest from students who are considering studying at the dental school, and that is without any advertising of the program at all. The Student Information Centre has already received more than 300 calls from prospective students from across inland and rural Australia. So you can imagine what is going to happen when the marketing campaign from Charles Sturt University really focuses on getting the workforce and training established.

It was an absolutely calculated decision of the Minister for Health and Ageing to provide this funding in adjusting and responding to the dentistry workforce needs. When I was a child we grew up with tank water. That tank water had no fluoride. The only time you went to the dentist was when you had an abscess or a mouthful of decaying teeth. There was no such thing as fluoride in the water in the town that I came from because there was no public water system—it was all tank water. Now we have the bottled water brigade. Everybody runs to the fridges in the supermarket, the local corner store or wherever. We have the bottled water brigade out there. Everybody is contributing to the demise of their teeth by consuming all this water in plastic bottles. I wonder how, in the future, we are going to address the cavities in people’s teeth that are being contributed to by this move of people to consume only bottled water as if it is the new fad of the season. The government’s support of the CSU is a great initiative. We are going to have an extra 240 new training places for dental and oral health students over the next five years, and we are going to need those 240 places.

We currently have in the House—and it will continue to be debated later—a great piece of legislation that will arrest the issues of those with chronic dental problems. However, we must look at the workforce issue. We cannot deliver dentists out of mid-air. I am very fortunate to be able to afford to pay for my dentistry work, but to get access to a dentist in a regional and rural community means long waiting periods because we simply do not have the dentists available. We really need to focus on the delivery of a workforce. There has to be a succinct plan of action that trains and delivers dentists so that they can ease the supply side. There could be so many people being provided with free dentistry at the moment, but people are not able to access it because there simply are not enough dentists out there. That is where the minister has come in with funding for this dental school, recognising that if you train rural people and rural professionals in the country they will stay in the country. I am pleased to see the member for Macquarie come into the chamber now as I have made significant reference to his efforts in delivering this school of dental and oral health.

Patrick Secker (Barker, Liberal Party) Share this | Link to this | Hansard source

Order! The time for discussion has concluded.