Daryl Melham (Banks, Australian Labor Party) Share this | Link to this | Hansard source

Mr Deputy Speaker Scott, at the outset can I congratulate you on your appointment as Deputy Speaker. You and I were elected into the parliament on the same date, 24 March 1990—a long time ago—and I know that you have taken great delight in your previous duties as a Deputy Speaker of the parliament, and it is a testament to the high esteem in which you are held that you were elected to this position. It is also a testament to you that you have staved off the ambitions of one from the other side, who, legitimately, has expectations, but the work that you have done over the years has been recognised both at the local level and at a parliamentary level, and I wish you all the best in the discharge of your duties.

As previous speakers on the Dental Benefits Amendment Bill 2012 have indicated, its purpose is to extend the existing Teen Dental Plan to include younger children and to extend the range of services available. This will be done by amending the Dental Benefits Act 2008 to set up the framework for the Child Dental Benefits Schedule to commence in 2014. This is the first step in this government's plan to ensure that, for those who cannot afford it, dental care will be available. It makes no sense that Medicare and free hospital care have been available for many years yet dental care has been unaffordable.

Statistics show that the oral health of our children has been declining since the 1990s. The Australian Institute of Health and Welfare noted in its 2007 report on 30-year trends in child oral health:

Just under half (46%) of children aged 6 attending school dental services had a history of decay in their deciduous (‘baby’) teeth—that is, one or more decayed, missing or filled deciduous teeth (dmft). On average, children aged 6 had almost two dmft per child (dmft = 1.95).

The report went on to say:

Thirty-nine per cent of children aged 12 and 60% of children aged 15 had some history of decay in their permanent teeth …

What was distressing was the high number of children who by the age of 15 had significant issues with their teeth:

The one-tenth of children aged 12 to 15 with the most extensive history of permanent tooth decay had between 5.21 and 8.60 permanent teeth affected, which was more than 4 times the national average of decayed, missing and filled teeth for children of those ages.

Child dental benefits will provide benefits for basic dental services for treatment but, most importantly, given the statistics I have quoted, will also provide assistance for preventative care. Simply being able to ensure regular check-ups and access to professional expertise means that those figures should reduce in coming years. By learning to look after their dental health and not fearing a trip to the dentist means that our children will be able to look to a future with good oral health.

A background note from the Parliamentary Library published earlier this year provides an overview of universal dental schemes. The note makes the point that the definition of exactly what constitutes 'universal' varies. The paper acknowledges that affordable dental health care generally remains out of reach for many Australians. Several reports over recent years have highlighted the issue of poor dental health and access to affordable dental care.

The background paper outlines briefly the history of dental reform in this country over the past two decades. It is worth putting on the record:

The Keating Government introduced a Commonwealth Dental Health Program in 1994 which provided additional funding to states and territories for public dental services for those on low incomes. The Howard Government abolished this but introduced the Chronic Disease Dental Scheme (CDDS) which provides capped Medicare benefits for dental treatment to patients with chronic illnesses. The Rudd Government introduced the Teen Dental Plan—a means tested voucher entitling eligible teenagers to an annual dental health check-up—and promised a revamped Commonwealth Dental Health Program (CDHP) that would deliver an expanded range of public dental services.

Obviously, the government is moving to implement that promise. The minister indicated in her second reading speech that this bill is the first step in implementing the government's reforms.

Federal involvement with any type of provision of dental services started with the introduction of the Whitlam government's school dental program from 1973. This program aimed at providing comprehensive dental treatment for all schoolchildren less than 15 years of age. Trained dental therapists provided the service under the supervision of dentists. The Commonwealth provided funding directly to the states for the implementation of this program although it was effectively subsumed under the Fraser government. Most states and territories, however, maintained some form of dedicated school programs to varying degrees.

I earlier noted the Chronic Disease Dental Scheme. The figures provided by the Parliamentary Library show that, in the three months from November 2007 when a revised version of the scheme was introduced, 171,000 dental services were accessed and around $21.8 million paid in Medicare benefits. From March to June 2008, the number of services increased to 480,000—more than double—with an associated increase in Medicare benefits to $79 million. It is interesting that the majority of services were provided in New South Wales and Victoria with only 184 services provided in the Northern Territory.

The problem with the CDD Scheme has been that some of those benefiting from the scheme were not intended to benefit. One of the key differences between this side and the other side of this chamber is that this government is ensuring that available funding is targeted to those who need it: people on low incomes receiving family tax benefit A or who are in receipt of specified benefits. This is how it should be.

The background paper concluded that, while it is difficult to make direct comparisons primarily due to definitional issues, it is fair to say that, where there is direct dental funding and services provided to children, those children under 12 tend to have lower rates of DMFT—in other words, decayed, missing or filled deciduous teeth.

Currently, Australians primarily meet the cost of their own dental health services; however, it is now understood that there is a public benefit for public funding to support them in meeting these costs.

Poor dental health, as we have seen, is associated with a range serious health conditions such as poor nutrition, cardiovascular disease, stroke and diabetes that can place other burdens on the health system. I would also be contending that treating funding of basic dental services differently to other medical services is contrary to the view that oral health is integral to overall health and an important part of primary health care.

In our community the problem starts young—and I will come to that in a minute. Dental health is one of the first things to go if people are struggling and has a big impact on their lives. That is why the federal Labor government believes we have a responsibility to ensure people who are the least able to afford to go to the dentist, particularly children, have access to government subsidised dental care.

In May this year the minister visited a public health surgery in Hurstville in my electorate. The funding will deliver two additional chairs to that surgery. About 16,400 kids in Banks will now be eligible for government subsidised dental care, just like they are eligible for Medicare funded visits to their GP. As part of the government that has introduced this equitable scheme to benefit those who can least afford dental care I am pleased to commend the bill to the House.

I have had personal experience in the benefits given to people who could not afford dental care. I am one of 10 children. I was born in 1964. My father was a bootmaker and a market gardener. We could not afford dental health care in the sixties. My dental health care came about by getting on the train and going to the dental hospital at Central, so it was the dental hospital at Central that worked on my teeth as a young child. Obviously, as I grew older I went and paid for it.

We need, on both sides of the House, to get these benefits to those who can least afford it. It has a great impact on nutrition, diet, everything else, and those statistics in the Northern Territory show that something is sadly missing if that was the take-up rate.

We should not apologise as a parliament, as a government—indeed as an opposition—on some aspects. We might disagree on certain things, but there are some aspects that we should not disagree on. I am not into welfare for the middle and upper classes and welfare for the business community when it cannot be afforded but I make no apologies for those who can least afford it in our community having decent services and standards. When it comes to dental, we have a mandate. Only eight referendums have been passed in relation to the Commonwealth since Federation. One of them related to giving the Commonwealth the power in relation to dental—that was a referendum passed in the forties. We have a mandate to do it, and it is not something we should be doing exclusively; it is something we should be doing in cooperation with the states and in cooperation with the territories. It should be a partnership approach and we should make no apologies for it.

It is something that I would rather see happen, frankly, than give a tax cut to people who have had the benefit of the tax cut and that tax cut has continued year in, year out and then you hear the cry: 'Too much tax for business. Too much tax for the top end. Where are our further tax cuts?' I am not opposed to tax cuts per se, but if we are left with options we need to be fair dinkum about what is in the interests of our community. We need to make some strategic decisions, and that is why in relation to what the government is doing, this is a strategically correct decision in the society that we have. I commend the bill to the House.

Scott Buchholz (Wright, Liberal Party) Share this | Link to this | Hansard source

Mr Deputy Speaker, I acknowledge your new position here in this House. There are people in this place that one tends to model themselves on and there are good men and women in this House. You have displayed statesmanlike qualities, which I have tried to emulate, and I praise you. For your contribution and ongoing contribution to the House, due recognition has been bestowed upon you with your recent election as Deputy Speaker. I acknowledge that as a position well fitted.

I rise to speak on the Dental Benefits Amendment Bill 2012 that is currently before the House. The bill makes amendments to the Dental Benefits Act 2008, changes that do not assist people who are in need of dental services right now or those undergoing current treatment plans. This change is designed to give this Labor government its own authored dental scheme. We the coalition would not mind so much if the bill actually improved the scheme that the coalition, under Tony Abbott as the then health minister, presented to the Australian people and that has been delivering dental services ever since.

The member for Banks, the previous speaker, referred in his speech to those people who could least afford dental care. One of the flaws in the bill that is currently before the House is that it punishes the very people he was claiming to represent. This bill in its entirety affects those people who can least afford it. It creates a gap until the proposed government scheme would come in. It leaves a void. No speakers from the other side have mentioned this in their speeches. I think they are not mentioning it because it must be evident that their electorate will be affected by this oversight. This government in its explicit wisdom has chosen to delay the start of the program till 1 January 2014 for children and 1 July for adults but closed the current program on 30 November this year. That is quite a gap, as will be the gaps in the mouths of patients requiring dental treatment right now.

Up until these start dates it will be 13 months for children and 19 months for adults. That is inexcusable in this country when the Treasurer boasts on the floor of this parliament about how wealthy we are, how great the country is fiscally and what strength we have. Dental care will be taken away from a class of people in our community for up to 19 months, depending on their age demographic. The Australian people and the people of Wright, whom I represent, have no choice but to suffer yet again because of this government's hasty policy tactics. These hasty tactics include rushing this bill through the parliament without providing the appropriate details. This does nothing to help this parliament to put into action in this country clean and healthy policies. It only proves this government's contempt of the Australian people.

It is somewhat ironic that we are looking at a health issue and yet the government cannot even exercise healthy methods of policy development. We have a government with such contempt that they have decided it is good policy to close on 30 November this year the Medicare Chronic Disease Dental Scheme, which has provided some 20 million services since 2007. No new patients have been able to access services after 7 September, leaving a 13-month gap in the availability of services—13 months of being left in the dark; 13 months of Nurofen, cold packs and whatever other remedies patients can find to soothe their abscesses, broken teeth and various other dental ailments that children suffer.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

Mr Deputy Speaker, I wish to ask the member a question.

Bruce Scott (Maranoa, National Party) Share this | Link to this | Hansard source

Will the member for Wright take a question from the member for Shortland?

Scott Buchholz (Wright, Liberal Party) Share this | Link to this | Hansard source

Absolutely.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

Thank you very much. I would like to ask the member for Wright what assistance is available to those people at the moment who do not qualify for the chronic dental health program and how will his government help those people who have been on the waiting list for sometimes in excess of 10 years?

Scott Buchholz (Wright, Liberal Party) Share this | Link to this | Hansard source

I thank the member for that question, and I will provide those answers during the course of this address. I will quote the health minister, who states in her news brief on the ALP website:

Labor believes we have a responsibility to ensure Australians who are least able to afford to go the dentist, and particularly children, should be given access to government-subsidised oral health care.

Well, that is great to have that there, but when they say that they should be given access, that should be qualified by saying 'access today'. It is not qualified by saying, 'They will be given access at some point in the future, once we get our fictitious surplus put together, once we go back and try to find the savings in the budget where we have wasted billions of dollars.'

This is the unintended consequence of poor management. This is the unintended consequence when we have families in lower socioeconomic sectors who are being punished under the argument that millionaires have access to this. I actually rang one of the local dentists in my electorate and asked, 'How many millionaires do you have come in and take advantage of the chronic disease scheme?' And he laughed at me. He said: 'You're kidding! Millionaires have their own health insurance. They don't come here to regional Australia to get dentistry work done.'

So the argument that is put up by this government that the changes that are being proposed are to block millionaires from getting access to this is nothing short of farcical. There is no access for children for 13 months, and there is no access for adults for 19 months—and that is shameful. I consider it only fair that the Minister for Health should explain why these children must suffer without dental care for up to 13 months and why adults should suffer for 19 months. Furthermore, how does this government propose to actually deliver on its unfunded 2014 promise? I suggest that it is just because of a blind obsession by this government with a money grab to create the surplus. They are not happy to take food out of the mouth through increased taxes on the Australian public and to take food out of the mouth of mums and dads in my electorate. They are now delivering a cruel blow of putting a bowl of fruit in front of someone with no teeth, who is unable to eat it. Perhaps members on the other side of the House have not had to suffer the pain of going without dental treatment. Perhaps members on the other side of the House should take a Nurofen or a Panadol next time they have an infection and see how long they will last in the absence of dental care under their scheme.

A lady in my electorate—her first name is Erica—who lives on Mount Tamborine called me at nine o'clock one night when I happened to be up there on the hill. She said, 'Scotty, I'm in a heap of pain; can you come round?' So I went around with my chief of staff, who had spent some time as a dental technician. This lady had a mouthful of abscesses. She was in a heap of pain. The very next morning we got her down to the local dentist. We got her elevated through because of her chronic pain. She took a series of antibiotics and then, under the chronic scheme, was able to apply for a set of false teeth, which enabled her to return to some type of healthy eating habits.

After 30 November, Erica will not have access to the chronic dental scheme. I really hope that Nurofen lasts long enough, because for those with chronic dental conditions the loss of $4,250 in dental fees over the two years is going to be a painful experience. We are talking about a scheme that has provided approximately 20 million services to more than one million patients since 2007.

The Medicare Chronic Disease Dental Scheme introduced by the coalition when in government has been an enormous success. Yes, there have been overruns. These overruns have been a result of the number of people taking up this program. It is the only Medicare dental scheme that has provided treatment for adults, and it has been very successful at that. The scheme that was conceived by the current Leader of the Opposition, Tony Abbott, had started by placing the needs of the sick first. And now we have a government that is doing everything it can to increase the sale of Nurofen and Panadol.

Despite claims of its expenditure blowouts the average claim per patient, according to recent figures from the Department of Health and Ageing, is $1,716 per unit—well below the allowable $4,250. It is even more disappointing knowing that the coalition's offer to work with the previous health minister to refine and improve the new scheme, including through a process of providing high-cost items when needed, such as crowns and bridges, was rejected.

Now we move on to the replacement scheme for the national partnership agreement for adult public dental services.

Let me make the very important facts about the current situation facing the dental health system absolutely clear. Under the new scheme, services will no longer be available for adults through private dentists under Medicare. At present we have 650,000 people on the public dental waiting list and 400,000 of those are adults, according to the government's own figures—that is, 400,000 people that this government is going to forget. Even if it does deliver on its funding promise for the state governments, the cutting of the Chronic Disease Dental Scheme and the delays in delivering the new commitments are likely to lead to an increase in waiting times for public dental patients. Disturbingly, knowing this, the government continues to maintain its position to close the Chronic Disease Dental Scheme. The current scheme has provided approximately 20 million services, including seven million in the last financial year alone, and yet we have a minister who said that the plan will only provide 1.4 additional services over six years, or 20 per cent of what the Chronic Disease Dental Scheme provided last year alone.

The facts speak for themselves. I have done the maths and it just does not add up. Playing politics with the Australian people's health is a dangerous game—a dangerous game for the wellbeing of the Australian people; a dangerous game for the wellbeing of the people of Wright, and I have their best interests at heart. For the record, it is clear to those on this side of the House that the government is creating a gap in treatment for patients in an attempt to deliver on a much promised surplus—the surplus that they would rather invent at the expense of the health and wellbeing of Australian people.

Just before I finish, I want to emphasise the coalition's position on this issue. I state for the record the coalition's clear support and strong investment in dental health in the past. I am explicitly concerned knowing that thousands of children in particular will lose access to treatment on 30 November with the closure of the Chronic Disease Dental Scheme. That those on the other side of the House believe it to be a sacrifice for the health of Australia's future is a serious matter. The government's actions suggest that it is more about politics than an issue of policy. The government's vague promise that at some time in the future it will provide money to the states and territories for public services is just not good enough—unsurprisingly, it is at some point in the future. There is no caveat on where that money is coming from at some point in the future. There is no mention of what services will be cut on the Australian landscape to provide for that. There is no mention of which existing services will be cancelled, such as those that are already under stress from an interest payment and the federal government having to come up with an extra $6.8 billion a year, an expense that was never in place when the former government left office. Will they cut from the pensioners who can least afford it? They have form on that. Will they cut welfare? They have form on that by putting extra expenses on families by increasing taxes through their electricity bills. This government has gone to great lengths to undermine the scheme because it was established by Tony Abbott, as health minister, and it has been a success in improving access to treatment.

I know for sure that people in my electorate are tired of waiting for good policy from this government. Now those who suffer with chronic dental health problems are literally going to have to suffer pain for a lot longer. I want the Australian people to know, and the people of Wright in particular, that those on this side of the House are doing everything they can to protect their dental health and deliver funded programs.

Ms Catherine King (Ballarat, Australian Labor Party, Parliamentary Secretary for Health and Ageing) Share this | Link to this | Hansard source

Mr Deputy Speaker, I congratulate you on your election to the position of Deputy Speaker. I am delighted that you are in that position and I look forward to a long, constructive working relationship with you. I promise to try to not interject as much as I have in the past.

I rise today to support the Dental Benefits Amendment Bill 2012. I have spoken in this chamber at some length over the course of my time here about the issues with dental care. In fact, I have very strong recollections of many constituents who have seen me over the course of that time with issues of dental health—not just about dental health itself but the social isolation of having poor dental health, particularly for people on low incomes and those from low socioeconomic backgrounds, as well as the lack of employment opportunities many of them have faced and the lack of opportunity to participate within their own communities, in ways that other people would be able to.

Being here for a little while gives you the opportunity also of having some history when it comes to particular public policy issues. I know the member for Wright genuinely means his heartfelt contribution to this debate, but I find it passing strange, frankly, coming from his party, when the first act of the Howard government was to cut the Commonwealth dental scheme. For you to now somehow or other be trying to reinvent yourselves on dental is, frankly, a bit rich.

The Commonwealth dental scheme was a very important scheme. It was the first time a Commonwealth parliament—a Labor government but a Commonwealth parliament—took the decision that the Commonwealth had a role to play in oral health. It was a very important scheme, and what we saw under that scheme was a reduction in public dental waiting lists. It targeted the poorest people in our community, and what it attempted to do was to reduce the gap in equity on oral health issues. One of the first acts of the Howard government when it came to office was to get rid of that scheme. So I have a long history with this. I know what you did in government.

The Howard government got rid of that scheme. The reality of what then happened in my community was: dental waiting lists had got down to around 18 months, which was still way too long; they blew out to four years because of the decisions of the Howard government. Belatedly, the Howard government took the decision to introduce the Chronic Disease Dental Scheme. That scheme was designed to be quite a limited scheme that was going to cost $90 million a year. It was particularly designed to look at people who had a chronic disease and whose chronic disease was being exacerbated by, or was exacerbating, poor oral health. It was meant to be a very limited scheme. It was not a big scheme; it was a very small scheme: $90 million a year. That scheme is now costing $80 million a month. It is doing what it was never designed to do.

I understand that people feel unhappy that the scheme is now to be closed. I understand that the opposition feels unhappy that their scheme has now been exposed for having been literally expanded beyond what it ever imagined it to be. If any members of the opposition honestly believe that if they were in government they would not be means-testing this scheme, they have got to be kidding themselves. You may have decided to keep it, but you would be absolutely cutting it back. You would not be allowing it to be costing $80 million a month. So let us have a really clear idea about what this policy debate is about.

What we have tried to do with this policy is to retarget it. There are scarce government resources; we all know that. That is the reality that health faces. That is the reality that other areas of public policy face. But, with scarce government resources, governments have to make decisions about: 'What are the most important areas? What are the areas that we believe most strongly need government assistance?'

What we believe, fundamentally, on oral health is that you have to look at the equity issues. You have to look at what is happening for people who are on low incomes. You have to look at pensioners. You also have to look at what you are doing in the space of prevention, because we do know that if we set kids up with good oral health to start with, the chances of us experiencing, down the track, some of the chronic conditions that we have now are going to be lessened.

It has been a complete shock to me to find, when I have gone into childcare centres and schools in my constituency fairly recently, that there are four-year-olds who have blackened teeth. That is not acceptable under any circumstances. We have to do something about that. I have heard a few contributions from members opposite about four-year-olds, saying, 'Prevention is not really a big deal. Kids don't have problems with their teeth.' Well, you need to start to have a look at what is actually happening. In communities like my own—and we have not had fluoridation of water; it has only recently been introduced—the rate of dental caries amongst children is huge, and it is an ongoing, long-term issue for those people. Most of them have lost their teeth well and truly by the time they are teenagers. It will be too late if we leave it until they have a chronic disease and then try to do something about it.

So the package of measures that we have in this program and that are represented in this bill are very much designed to actually deal with prevention. They are actually designed to continue to help people who are on low incomes but to target it in a better way. That is what we are trying to do. So I do not want to hear this nonsense that there has been no policy thought in this. This is all about policy; it is absolutely about policy.

The other issue that seems to have been continuously raised, and which the opposition does not seem to acknowledge at all, is that in fact many of the people who are eligible under the Chronic Disease Dental Scheme will be eligible for public dental services under this scheme. We are trying to undo the damage the Howard government did with the abolition of the Commonwealth dental scheme. We are actually trying to reduce public waiting lists. It is critically important that we get those waiting lists down so that people can actually access what they historically should always have been accessing by spending more money on public dental care, which is an incredibly important thing to do to get public dental waiting lists down, to do what has been done historically throughout this country, to support the state governments' initiatives to actually look at public dental care and how you actually deal with and help people from low socioeconomic backgrounds. It is about equity in oral health. That is what the policy is all about.

So I really do support this bill. I certainly support the closure of the Chronic Disease Dental Scheme. I want to reassure people that pensioners, concession card holders and those with special needs will be eligible for treatment under the government's scheme. It is a $4 billion-plus dental package. Our $515.3 million commitment in the May budget to dental spending includes $345 million specifically for taking care of adults on state government public dental waiting lists. The money will be available to states' and territories' public dental systems from January 2013—that is, one month after the closure of the scheme. States and territories have always been responsible for the treatment of eligible high-needs patients in their public dental systems, and with this extra Commonwealth money they will be able to treat more people sooner. The members opposite fail to tell their local communities about that assistance and continue to run a fear campaign on the closure of this scheme.

I reiterate: the Commonwealth dental scheme has been costing $80 million a month. It was never, ever designed to be that expensive or to cover some of the procedures—and even some of the people—that it currently is covering. This bill before us amends the Dental Benefits Act to replace the Medicare Teen Dental Plan with the new Child Dental Benefits Schedule. That schedule is one of the most significant pieces of the Dental Health Reform Package.

Across the country, as I said, we are investing some $4 billion to improve dental health, and that level of commitment is certainly one I know many organisations have welcomed. We know that there are over 400,000 people on public dental waiting lists. Many of these people are from low-income households and have a high number of family members with untreated tooth decay. On this side of the House we want to support equity in oral health.

What we have seen in some of the stats, particularly for children's dental health, is pretty shocking. Oral health of children has been declining since the mid-1990s. Almost 20,000 kids under the age of 10 are hospitalised each year due to avoidable dental issues. By age 15, six out of 10 kids have tooth decay. Untreated decay and fillings are similar across income ranges, but if you earn more than $60,000 a year you have, on average, seven more teeth than Australia's poorest people, who are on less than $20,000. And 45.1 per cent of 12-year-olds had decay in their permanent teeth. In 2007, just under half—46 per cent of children aged six who were attending school dental services—had a history of decay in their baby teeth.

That is why I am supporting these packages. This is about changing the emphasis of programs to actually look at prevention and long-term prevention for kids' oral health; $2.7 billion is going to 3.4 million children to receive subsidised dental care—what an amazing thing, frankly: actually setting those kids up for a long-term future of good oral health. That is absolutely critical for anybody who is serious about good public policy in this country.

This means that for almost 3½ million children a trip to the dentist is going to be much like a trip to the GP. Across my electorate alone, well over 20,000 children will be eligible for government-subsidised dental care—and they are children from families who receive family tax benefit part A, ABSTUDY, carer payments, disability support pensions, parenting payments, special benefits, youth allowance, double orphan pension, veterans' children's entitlements, or benefits under the Military Rehab and Compensation Act Education and Training Scheme.

They will qualify for the new dental for kids scheme and will be eligible for $1,000 per child every two years. The government's dental health reform package will see $1.3 billion allocated for 1.4 million additional services for adults on low incomes, including pensioners, concession card holders and those with special needs. There is also a further $225 million to support expanded services for people living in outer metro, regional and rural communities.

In this debate I particularly want to focus a little on dental services in my electorate of Ballarat. I have been talking about dental issues for well over a decade. I am very proud to have in the last budget announced a substantial amount of funding for a dental clinic in the electorate of Ballarat. We announced that $8.4 million from the government for a dental clinic to be built within Ballarat. I visited the site of that new clinic recently. It is going to be on the grounds of Phoenix College in Sebastopol in my electorate. That expansion will double the current number of chairs available to 20 and enable a significant reduction in waiting times for dental care. It will increase the capacity to deliver publicly accessible dental services and reduce waiting times from the current 30 months to around 18 months. I would like to see that reduced even further. There are 61,000 adults and children in the region who are eligible for the service.

Under the project, we will see the replacement of aged dental equipment, including oral X-ray equipment, sterilising equipment, an instrument washer and 120 sets of hand pieces and dental hand instruments. Ten of the chairs in the new facility will be available for dental training for students of the dental school at La Trobe University's Bendigo campus. The new dental clinic will cater to eligible people not only from Ballarat but also across the local government areas of Golden Plains, Hepburn and Moorabool Shires and eligible members in the Maryborough community. It is specifically designed to reduce public dental waiting lists in my electorate.

Not only that, we have also provided $2.6 million in funding to develop residential accommodation for the 20 La Trobe University allied health and dental students while they are on their clinical placements at Ballarat Health Services. We want to make sure that we have lots more dentists trained in our region who will hopefully stay in our region. At the same time as they will be being trained they will be providing very important dental services to my community.

I also want to briefly mention that for the first time ever the Ballan community, because of the government's commitment to and funding of the Ballan GP superclinic—the first opened in the country—has access to a dental chair. Putting money into dental infrastructure is a critical part of this package. We have made the commitment as part of this package that there will be funding announced for dental infrastructure, particularly in rural and regional communities. That will increase the capacity of their public dental services and reduce public dental waiting lists. That is very critical, particularly for people on low incomes.

I want to reiterate my support for this bill. This is all about good public policy. I understand the concerns that some people have about the closure of the Chronic Disease Dental Scheme. But I reiterate that that scheme has been doing far more than the opposition ever intended it to do. There is no way that it would keep it in its current form. I support good public policy to address the current and future oral health needs of children and to deal significantly with issues of equity in oral health, particularly for those people who are eligible for public dental services.

Steven Ciobo (Moncrieff, Liberal Party) Share this | Link to this | Hansard source

On this more formal occasion I take the opportunity to congratulate you, Mr Deputy Speaker, on your elevation to the role of Deputy Speaker. I rise to speak about the Dental Benefits Amendment Bill 2012. I must say that it takes a certain amount of audacity for Labor members to come into this chamber and try to claim that events some 17 or 18 years ago are the reason why they are undertaking this activity now. That is what we heard from the member for Ballarat. That is complete rubbish, frankly. They are talking about the closure of the Commonwealth Dental Scheme some 17 or 18 years. That was closed in a fiscal environment in which the former coalition government inherited $96 billion of debt. That mountain of debt, incidentally, is substantially less than the $145 billion of net debt that we are currently facing as a nation, with a further $120 billion of additional unfunded net debt that the Labor government has promised between now and 2020. That will push Australia's net debt levels to conceivably up around $260 billion. That is the reason why we find these kinds of arguments from Labor members to be farcical.

The other frankly insulting aspect of the way in which Labor members are debating here is that they are coming into this chamber and making out, with earnestness and sincerity, that this is about who cares for children's teeth more. You would think from listening to the contribution by Labor members that they have some kind of monopoly on children's dental health; you would think that it is choice for the Australian public between a kind, caring and cuddly—albeit debt laden—Labor government or the mean, nasty coalition that does not care about children's teeth. Nothing could be further from the truth.

The reality is that if you look at the policies of both the coalition and the government there are some marked points of difference that need to be recognised. The first is that we reject the criticism from the member for Ballarat, among others on the Labor Party, that we abolished the Commonwealth Dental Scheme and then introduced the Chronic Disease Dental Scheme and that it has expanded to be much more than it was ever going to be. They make some vague reference back to the initial projections of the CDDS being $90 million per annum. There is a reason for that: it is because we expanded the program. We saw that there was a need in the community and we expanded the program. That is the reason why the CDDS was so successful. There have been 20 million interactions or visits—whatever the correct phrasing is—by members of the Australian public to have their chronic dental diseases fixed. So when I hear Labor members in this environment therefore claim, 'This scheme is simply unsustainable, and that is why we're going to introduce our new scheme, which will offer more services to more people,' I am a little incredulous.

There is an issue that the member for Ballarat never touched upon. I suspect that no Labor members will touch upon this issue. The issue is the timing of this bill and the entire framework. Australians are a pretty savvy lot. They recognise a con when they see one. When it comes to dental health, they recognise that this is nothing other than a big Labor con. Labor like to stand up and make out that they are holier than thou and that they have moral superiority over members of the coalition when it comes to children's dental health. But let us look at the facts.

This government is axing our scheme—the coalition's scheme—on 30 November this year. Their scheme—the scheme implemented through the bill that we are debating today; a bill that does not even apply a framework when it comes to the rebate and the fees for services, and all those types of important technical details—is being rushed through the parliament even though it does not commence until 1 January 2014. So what is going to happen between 30 November 2012 and 1 January 2014? The reality is that absolutely nothing is going to happen. What is more, when it comes to services for adults, it is not 1 January 2014, it is July 2014. That is nearly two years away. And the Labor Party have the gall to make out that they are the ones most concerned about the needs of children and adults when it comes to dental health. I call them on it and the Australian public will call them on it because it is rubbish.

If they were genuine in their expressions of concern about the dental health needs of children and adults, they would not have 13 months between the end of one program and the commencement of another program. They would not say to children that are getting treatment under the former, coalition scheme, 'Tough luck: you get nothing for the next 12 months.' Is that compassion? Is that good public policy? Is that in the best interests of children's health? No.

It is happening for one reason alone: pure political posturing. This Labor government want to be able to put it in their election brochures, want to get their members issuing media releases, wanted to have the opportunity to make a big announcement and say, 'Look at us! Look at how wonderful we are! We've got this you-beaut $4 billion unfunded medical dental scheme! We're really concerned about the needs of the community! Aren't we great? This is the Labor government that delivers again.' Sure, the reality is that they are delivering a $4 billion unfunded scheme that will not start for at least 13 months and, with respect to adults, for closer to two years, but do not worry about that detail—that's just detail! It is about: 'Look over here, we've got a $4 billion scheme!'

The reality is that Australians are not mugs. They recognise that this is just the latest example of a government that simply cannot be trusted. This is just the latest example of a Prime Minister with no judgement. And this is just the latest example of a Labor Party that are so obsessed with political posturing that they fail to recognise that Australians recognise them for being exactly what they are: nothing but a bunch of cons. So, I say to the member opposite: if you are really concerned about dental health—and I notice she has popped her head up—please explain the reason you have a gap of 13 months, please explain the reason adults will have a gap of closer to two years and please explain where the $4 billion is going to come from.

On every single one of these measures, let me tell you what you hear if you put your ear to the wind: you hear the sound of crickets chirping. That is what you will hear, because this is the latest example of a Labor Party completely devoid of anything meaningful when it comes to a contribution to public health. This is the latest federal iteration of policy failure that we have seen at a state level for so many years. I reflect on the fact that in my first several terms in office we saw the Labor Party in government at a state level in the great state of Queensland. At a state level, it was not uncommon for me to get phone calls—and not so much emails but letters, certainly, in those days—from people saying, 'I have been waiting for treatment for my teeth for in excess of two years'—or three years. That is how completely shambolic and broken down the Queensland system was when it came to dental health.

The good news—and there was a brief moment of good news, when the light shone through the dark clouds—was the coalition's CDDS. That stopped that problem, because people were able to access treatment and have their oral problems fixed as a consequence of the expansion of and the role that the CDDS played. But now we are unfortunately going to revert to the bad old days where we have at a federal level the same failed approach, the same unfunded policies and the same political purpose and posturing that this government has basically adapted and adopted from various state Labor governments. That is the reason I challenge any of the Labor members opposite—and I notice in particular a friend of sorts from the opposite side—and say to them: talk about and justify why you will have a 13-month gap where no child will have access to services under the Commonwealth program. Talk about and justify why—

Government Members:

Government members interjecting—

Steven Ciobo (Moncrieff, Liberal Party) Share this | Link to this | Hansard source

You will have the opportunity; sit down, relax.

Andrew Leigh (Fraser, Australian Labor Party) Share this | Link to this | Hansard source

Mr Deputy Speaker, I seek to intervene.

Bruce Scott (Maranoa, National Party) Share this | Link to this | Hansard source

Is the member for Moncrieff willing to give way?

Steven Ciobo (Moncrieff, Liberal Party) Share this | Link to this | Hansard source

No. I am certainly not frightened. I am not interested in some kind of rhetorical political question from the member opposite. He will have his opportunity in about four minutes and 48 seconds to make his contribution, and I think he should do so then.

Let me throw back to the issue I was talking about. Let them justify and explain why they are going to have a 13-month gap when children will not have any access to Commonwealth-funded dental services. Let them also explain why there is a two-year gap for adults, and let them also explain where the $4 billion is going to come from. I know that the member opposite is quite adept when it comes to financial matters and when it comes to the economy, so he might want to explain to the benefit of all of us—and I will be glued to my TV in my office as I hear the response—how this government are going to deal with the massive debt liability that they have left the Australian people and, what is more, that they are continuing to make worse.

As I said, the current $145 billion in net debt is on its way to $265 billion of net debt—this being a $4 billion example of an unfunded commitment. The reason is, as I said and as all Australians know, this government is just about political posturing. It is just so he can have a brochure that goes out during the campaign that says, 'Look how much we care about dental health,' but does not actually talk about the fact that those kids who will not have access to dental services, those kids who might be undergoing treatment now which is about to stop, incidentally are the same children who will be paying off your debt for the next 20 years. Perhaps if we had lower tax rates and if their families were not burdened with interest repayments in excess of $10 billion per annum to pay for the largess that your government has had over the last five years then the families would have a couple of hundred dollars extra a year to pay to go to the dentist. Ever consider that as a policy approach?

The reality is that there are alternatives. This bill is so bereft of detail when it comes to fee-for-services and rebates that it just underscores the complete haste this government has adopted in trying to introduce this bill into the parliament. It is all about pushing it through the parliament even though it does not have the fine detail in there. They have got the announcement and they have got the legislation to back up the announcement even though they do not have the funds and even though the program does not start for at least 13 months.

On every measure this is a step backwards. This is the reason why the coalition remain steadfastly opposed to it. As we indicated through our shadow health spokesman on a number of occasions, we would be very prepared to work with the Labor Party to amend the CDDS so that it had a more focused scope of operations. But no, the Labor Party rejected that point-blank. No doubt we will hear from Labor members about how the coalition is obstructionist, how the coalition is so negative and how the coalition does not want to make a difference. Although, in this instance, once again we see the rank hypocrisy of that because we laid out an opportunity to amend the current scheme. We put before the Labor government an opportunity to change the current scheme to make sure it was better targeted, to make sure we had costs under control to keep it sustainable, but instead Labor said, 'No, we will stop it on 30 November,' and they will start their new program in a year-plus time.

This bill ought to be rejected because it is bad policy. More than that, it is a betrayal of the trust of the Australian people.

Andrew Leigh (Fraser, Australian Labor Party) Share this | Link to this | Hansard source

I rise today to speak on the Dental Benefits Amendment Bill 2012. In this context it is worth noting that human beings are the only species that smile to signal happiness. It is an evolutionary quirk that is unique. It is an integral part of being human. All of us in this place, whatever our political stripes, trade on those smiles. It would be a strange-looking political website and an odd-looking corflute that did not have a picture of us beaming happily at our constituents. That smile is such an integral part of human relations. But just imagine if the sight of your teeth made people recoil from you. Imagine the isolation, the sense of embarrassment and the erosion of self-esteem.

There are many things that divide us in this place, but I think we can all agree that the importance of healthy teeth is one that can unite us. I wrote in June last year in the Australian Financial Review on the relationship between teeth, economics and poverty. There has been plenty of speculation in the literature on the relationship between dental health and earnings, but few studies have actually managed to demonstrate causality. There is a new paper out though titled 'The economic value of teeth' by Columbia University researchers Sherry Glied and Matthew Neidell. They looked at the effect of fluoridation in the United States. Fluoridation was primarily driven not by the quality of people's teeth but by local politics. We see that very much in the differences in fluoridation rates across Australia, with Queensland holding out for so long on fluoridation to the detriment of the teeth of Queenslanders.

The study found that if you grew up drinking fluoridated water you are more likely to have all of your teeth as an adult. So using that natural experiment the researchers then went on to look at the relationship between good teeth and high earnings.

They found that women who drank fluoridated water in childhood earned more than women who did not, and the positive effect of fluoridation was concentrated among those from the most disadvantaged backgrounds. For women this effect was large. The estimate is that losing one tooth cost the typical woman three per cent of her hourly wage, and you can imagine how that adds up. Four teeth means 12 per cent of your hourly wage. Now you are talking about an effect that is starting to be of the magnitude of gender discrimination.

The study looked into why it is that bad teeth mean low earnings and concluded that it was largely due to people being discriminated against by employers and unable to work in those customer service occupations. I will talk later in my speech about some of the personal stories from my electorate of individuals whose poor teeth have impacted them in the labour market. Those bad teeth, indeed, are probably one channel through which physical beauty affects wages. This suggests that, if you care about reducing earnings inequality and raising the earnings of low-wage workers in Australia, a key point in which you can do that is improved dental care.

But the historic trend has been in the opposite direction. The University of Sydney's Edmund FitzGerald looked at whether people had visited a dentist in the previous 12 months. He found that, among teens from affluent households, the share who saw a dentist has stayed steady at about three-quarters of the population since the 1970s. But, when you look among the poorest teens, the share who had seen a dentist dropped from 56 per cent in 1977 to 33 per cent in 2005.

Another disturbing demographic trend was noted by the Brotherhood of St Laurence in their 2011 report End the decay. They cited data out of the Australian Research Centre for Population Oral Health that showed that children in low-socioeconomic areas have 70 per cent more decay in their teeth than those from affluent areas. It showed that children from poorer families with oral health issues go on to be adults with bad oral health—and, as I have discussed, unless treated bad oral health leads to serious employment and economic consequences.

The Australian Institute of Health and Welfare in another one of their terrific reports, their Child dental health survey, highlighted the following facts: the oral health of children has been declining since the mid-1990s; almost 20,000 children under the age of 10 are hospitalised each year due to avoidable dental issues; by the age of 15, 60 per cent of children have tooth decay; while untreated decay and fillings are similar across income ranges, there are substantial differences in the number of teeth—if you earn more than $60,000, on average you will have seven more teeth than Australia's poorest people, those who earn less than $20,000; 45 per cent of 12-year-olds have decay in their permanent teeth; and in 2007 just under half of children aged six who attended school dental services had a history of decay in their baby teeth.

End the decay cited the research of Stephen Leeder and Lesley Russell, who found that the total direct costs and lost productivity in Australia from poor dental health were in the order of $2 billion annually and every year there are a million lost workdays in Australia due to oral health issues. Data from the United States estimates that, for every 100 employed persons, 148 work hours a year are lost due to dental problems. In an Australian workforce of more than a million people, with an average full-time weekly wage of $1,340, that implies a productivity cost of more than $650 million per year. So each of these reports has shown that poor dental health is not just an equity issue and not just a health issue but also an economic issue.

In 2009 the Australian Research Centre for Population Oral Health found substantial disparity across public dental patients, who were three times more likely to have fewer than 21 teeth compared with the national average. For other conditions such as decay and periodontal pockets, the most disadvantaged suffered at twice the rate of the general population. All this highlights the human aspect of good oral health, and this government is taking action to address this.

The government has been trying to shut down the Chronic Disease Dental Scheme since 2007 because we want to replace it with more effective policies.

The Dental Benefits Act currently provides dental checks for 12 to 18 year olds under the Medicare Teen Dental Plan. This bill will extend eligibility for children to receive dental services to those aged from 2 to 17. The Child Dental Benefits Schedule replaces the Medicare Teen Dental Plan from 1 January 2014. It includes a schedule of basic dental prevention and treatment services up to $1,000 a child over a two-year period. For over three million Australian children going to the dentist will now just be like seeing a GP. You will be able to present your Medicare card and get basic dental work done. That can be done at private dental clinics or through public dental services. As well as the existing check-up, it will now be possible to get a descale and clean, fissure sealants and basic restorative work, importantly, including fillings.

There will be more services and more dentists where they are needed most, outside the capital cities and in large regional centres, such as the one you, Deputy Speaker, represent. We are putting in place $225 million for dental infrastructure to support expanded services and an additional $1.3 billion towards state-run public dental programs. And we are requiring states to maintain the existing level of dental funding, because we do not want them to take out their money as we put in additional resources for this needed group. That will fund 1.4 million additional services for adults on low incomes, including pensioners, concession card holders and those with special needs.

Earlier this year I sent out a letter to dentists in my electorate asking for their support with the Dental Support Program. It is a program run by the Salvation Army to help low-income Canberrans who sought food assistance and have untreated dental problems. Evaluation of that program has shown that clients who received treatment through the program reported increased confidence and self-esteem in employment and social situations. I wanted to call on my local dental community to put in pro bono hours to support those who would not normally seek out a dentist. Some dentists already do that important pro bono work, but I wanted to reach out to all dentists in my electorate and ask them for a few hours of their time. This initiative came from Liz Dawson, who is an extraordinary Canberran and a tireless worker for the Canberra community. She has worked for the Salvation Army and through the Common Ground project, for which her advocacy yesterday extended to bailing up the Prime Minister at a Canberra breakfast. She brings tenacity and passion to her advocacy for those from less fortunate circumstances. I remember Liz telling me about a client who came to her four years ago who had only one tooth in her top jaw. Liz's work ensured that the woman got the dental care she needed, dental care that in some cases can be life changing.

The Prevention and Population Health branch of the Department of Health and Ageing has linked poor dental health to inadequate nutrition, diet related ill health, cardiovascular disease and some cancers. Individuals who are using illicit drugs sometimes say they first started doing so just in order to take away the pain of their aching teeth.

Malcolm Gladwell, in an extraordinary New Yorker article, described the process of tooth decay—see if this makes the hair stand up on the back of your neck. He writes that the cavity 'blossoms' as it enters the dentin. When it hits the centre of the tooth an 'insistent throbbing' begins and the tooth 'turns brown'. Left unchecked the tooth eventually becomes soft enough that the dentist can ' reach into a cavity with a hand instrument and scoop out the decay'.

While Australia has a strong healthcare system, it is much less effective for those with dental health problems. If we had our time again it would have been the right decision, I think, to bring dental care into the Medicare system. But that is a horse that I believe has bolted. Now, the challenge for us in this place is to improve the quality of dental care for the neediest.

Before we means tested the private health insurance rebate, Australia had the absurd situation where high-income Australians, like those of us who serve in this place, had our health care and dental care subsidised to the tune of 30 per cent.

Millionaires were receiving a 30 per cent subsidy on their dental care, but low-income Australians could not get to the dentist. We are starting to change that by putting in place targeted reforms—not the untargeted Chronic Disease Dental Scheme that now costs about as much per month as it was originally projected to cost per year, but a scheme that is directed to those most in need.

I remember a dentist who came into my electorate office. I asked him how he felt about the Chronic Disease Dental Scheme. He told me it had to go. He told me the story of a patient who had been referred to him by a doctor on the basis that the patient, who was very well-off, was undergoing some dental work and the doctor thought this scheme could help him meet the costs. The dentist was outraged by this and went to the doctor and asked, 'Why are you referring patients who are not needy to me?' The doctor said, 'Well, that's not your business. I sign the form; you do the work.' That is the kind of scheme that the Chronic Disease Dental Scheme was: a scheme that did not go to the neediest. What we are doing with this bill is in the spirit of what we are doing with our multibillion dollar mental health package and with the National Disability Insurance Scheme: recognising that health care needs to be more holistic than it has traditionally been.

Our oral health as children is the best predictor of our oral health as adults. And because dental decay among children has been on the rise, we need to do something about it. One in five of the lowest-income earners in Australia has not been to the dentist in the last five years. Some of them may never have been to the dentist. By replacing the Chronic Disease Dental Scheme with the Child Dental Benefit Schedule we are addressing the cost overruns, the over servicing, the rorting and the administrative problems associated with the Chronic Disease Dental Scheme. It will make sure that we have better dental health for low- and middle-income families, particularly children. I commend the bill to the House.

Ken Wyatt (Hasluck, Liberal Party) Share this | Link to this | Hansard source

I rise today to talk on the proposed Dental Benefits Amendment Bill 2012. It was quite illuminating listening to the member for Fraser. I can now understand why the member for Eden-Monaro, who has a promotional position based on the proposition that if you have a good set of teeth you have a good opportunity of a higher position and the income that goes with it. I am not sure, with your smile, Mr Deputy Speaker, whether you fit the same category! Based on that logic, you are better off taking your teeth out and having dentures because they would look white and clean!

Tony Windsor (New England, Independent) Share this | Link to this | Hansard source

Order! That could be a reflection on the chair!

Ken Wyatt (Hasluck, Liberal Party) Share this | Link to this | Hansard source

No, it is not a reflection on the chair; it's just that your smile is like one of those Cheshire Cat smiles, Chair!

Can I start by making reference to the second reading speech by the minister, from which I will cite a couple of key sentences, because I want to build on that. There is $225 million for dental capital and workforce measures aimed to provide expanded services for people living in outer metropolitan, regional, rural and remote areas—interesting concepts.

This bill will establish a Child Dental Benefits Schedule for children from the age of two until they turn 18. Then the states and territories would also be able to provide services, as they currently do under the Medicare Teen Dental Plan for services provided by dentists and para-dental professionals, such as oral health therapists and dental hygienists.

Let me come to that notion of workforce. One of the major challenges that I hear constantly from the committees I am involved with is the lack of workforce, the lack of preparedness for those workforces to be part of rural and regional Australia. But often the referrals come back into capital cities, so that increases the cost of access. It also is about those factors that impact on families in terms of socioeconomic status, access to oral health services and also our dietary behaviours—which are always interesting. With the number of kids you see drinking Coca Cola but who never swill their mouths out with water, it is natural that they would end up with poor oral health in their early years. So, to that extent, the changes that are mooted being delayed for as long as they are, have consequential outcomes: if those services do not exist currently, for a period of up to 19 months, then we are creating a tremendous problem by ceasing funding in this area.

I have serious concerns about the rural and regional areas of Australia that have limited access to the type of funding that is required to provide the oral health services that they need.

It was also interesting that in her speech the minister said:

As part of the dental package, the Gillard government is providing $1.3 billion to states and territories under a national partnership agreement to expand public dental health services for low-income adults, including pensioners and concession card holders and those with special needs.

But when I read back through the speech I found something that the minister referred to fascinating.

In fact, she did not contact me herself; her neighbour contacted me and said that she could not go with her son on his first day because she did not have any teeth and she was too embarrassed and did not want to humiliate her son by turning up with her teeth having been extracted … bad teeth can exclude you not just from getting a job and not just from economic participation but also from social participation …

There is merit in what the minister presented. But it is no basis for ceasing funding for the Chronic Disease Dental Scheme.

I will now refer to the World Oral Health Report, entitled Continuous improvement for oral health in the 21st century, the approach of the WHO global oral health program. Comments in here are consistent with those of the Surgeon-General of the United States. The report says:

The interrelationship between oral and general health is proven by evidence. Severe periodontal disease, for example, is associated with diabetes The strong correlation between several oral diseases and noncommunicable chronic diseases is primarily a result of the common risk factors. Many general disease conditions also have oral manifestations that increase the risk of oral disease which, in turn, is a risk factor for a number of general health conditions.

Further on, the report continues:

A core group of modifiable risk factors are common to many chronic diseases and injuries. The four most prominent noncommunicable diseases (NCDs)—cardiovascular diseases, diabetes, cancer and chronic obstructive pulmonary diseases—share common risk factors with oral diseases, preventable risk factors that are related to lifestyle.

Hence my reference to the food factor. The report continues:

Moreover, control of oral disease depends on availability and accessibility of oral health systems but reduction of risks to disease is only possible if services are oriented towards primary health care and prevention.

The report later states:

If left untreated even for a short period of time, oral diseases can have adverse consequences. Oral infection can kill. It has been considered a risk factor in a number of general health conditions. The systemic spread of bacteria can cause, or seriously aggravate, infections throughout the body, particularly in individuals with suppressed immune systems. People with cardiovascular disease and diabetes are particularly vulnerable. Studies have suggested that oral diseases (e.g. dental caries and periodontal disease) are associated with other NCDs, and interrelationship which merits further investigation.

An Australian publication says:

Periodontal disease (affecting the gums) is caused by bacterial infection associated with poor oral hygiene, infrequent dental visits, age, smoking, low education and income levels, and certain medical conditions, especially diabetes. Current research is strengthening the association between periodontal disease and pre-term, low birthweight babies; cardiovascular disease; and rheumatoid arthritis. Poor oral health may exacerbate other chronic diseases. There are possible associations between early childhood caries and otitis media and blood borne diseases and infective endocarditis (associated with rheumatic heart disease).

It then goes on to explain the processes of poor oral health and the association with chronic diseases and then says:

They have difficulty eating (which might adversely affect their nutritional levels), and they may have low self-esteem from the appearance of their decayed teeth. Poor dental health can also cause impaired speech and language development.

One of the issues is that delayed access to treatment exacerbates chronic health conditions. My father-in-law over a period of time has had cardiovascular health problems. He has an artificial valve. When he has treatments his teeth are the first thing that his specialist looks at. If his teeth show any sign of poor conditioning or there is bacteria associated with the mouth, the gums or the teeth, they then undertake appropriate medical treatment. That is covered under the current Medicare program. Now that we have this gap, I wonder what will happen with that process? People will still have to have oral and gum treatment and probably the extraction or treatment of teeth before they can continue with surgery or other complex treatment associated with their particular health problem. If we have that gap in the provision of the NBS item, then I have some serious concerns about the some 400,000 adults who currently access dental health schemes.

The group that worries me more than any other are those who do not have the capacity to pay what is required by dentists for the treatment that they will need prior to their treatment in hospital. If that is the case, they are more likely to take the risk and delay treatments. If that is the case, then that will compound their health problems. On a DRG mix—which is the cost of hospitalisation and the services provided—that becomes an increased cost to the healthcare system and to the drawdown for both the state and the Commonwealth in the provision of hospital treatment because of the factors associated with oral health, gum diseases and tooth decay.

The other thing that is more insidious is raised in something that was put out recently—in September 2012—by the Australian Dental Association. That publication says:

There has been an increasing prevalence of 'dental tourism' where the strong Australian dollar is not only drawing Australians towards overseas travel, but also some travellers are undertaking dental procedures overseas in the hope they will 'save' money'.

…   …   …

Some packages offer 'prepackaged' accommodation, sightseeing tours and activities to 'facilitate the recuperation' of consumers after receiving their dental treatment.

They go on to say:

Teeth are for life. Obtaining dental treatment overseas can be incredibly risky to both your dental health and general health.

They also talk about something even more important:

Australia has recently recorded cases of a new superbug 'NDM-1', the most resistant to antibiotics yet seen to be on the rise in the UK. Like in the UK, the growing number of patients jetting out for 'medical tourism' has been blamed for the increasingly impervious bacteria arriving here in Australia.

If we have this gap in the provision of dental health care under a measure implemented by the Howard government and in particular Tony Abbott when he was health minister, that has serious implications for the health and wellbeing of many Australians, who may seek to go elsewhere, combining a holiday overseas with dental treatment that is much more risky and much more likely to cause some unintended consequences, such as antibiotic resistant bacteria getting into Australia. It is important that the minister reconsiders her decision in the context of this bill.

I do not have a problem personally with the need to provide comprehensive dental health care to children who experience levels of poverty and social disadvantage.

I do not have a problem with the fact that there is a reform factor being considered within the context of the bill, but I do have an issue with the fact that it is a bill that allows for a significant program to be put on hold, that was accessed by children in the context I just talked about, being delayed for such a lengthy period. We are putting at risk the lives of Australians in this process. It would be more important that this is not a budget measure for a saving but a budget measure to increase access to those who have a need for chronic disease dental health services, because that is one of the factors that will reduce the burden of ill health or, ultimately, in some cases, save a life instead of putting it at risk.

I certainly encourage the government to consider the delay in the expenditure: if you are proposing to change it in the way that you are then do not cease the funding, because the lives of individuals are far more valuable than a political expediency that takes us into the realm of the deprivation of services that are much needed. I encourage the minister in particular to look at some of her own documents from the Department of Health and Ageing and some of the research that goes to those critical issues of continuity of care, from the mouth to the blood system. I have seen Indigenous Australians and elder Australians die from septicaemia and oral health related diseases because they could not access the services or did not have them. My significant concern is for those in rural and regional Australia.

Mike Kelly (Eden-Monaro, Australian Labor Party, Parliamentary Secretary for Defence) Share this | Link to this | Hansard source

This afternoon I am very pleased to speak to the Dental Benefits Amendment Bill 2012 before you, Mr Deputy Speaker, because I know that your great concern has been health in rural and regional Australia, as it has been for me. Many of the points that were made by my friend the member for Hasluck have struck home to us. It is a declining situation that is much more severe than can be found in our urban environments. As we all know, that is part of the vicious circle we have in rural and regional Australia: if you do not have health services and good education you start to see people drifting away from country towns. You cannot even attract the professionals who would support a health system, such as doctors and dentists, because so many of them are looking for those kinds of facilities for their own families when they move to live in rural and regional areas. Sixty per cent of doctors now coming through the system are women and they are obviously much more cognisant of issues like supporting a family in a rural or regional environment. So this is critically important to us.

In an extensive survey I conducted of my constituents, I had over 7,000 responses. I am not sure whether many MPs have had such an extensive response to a survey. Of those 7,000 responses, 99 per cent indicated that health was their No. 1 issue. This was obviously something we have to come to grips with. Let's be frank about this: the Howard government dropped the ball on health. We saw the current Leader of the Opposition, when in the health portfolio, rip a billion dollars out of the system and change the mechanism for the proportion of Commonwealth contribution. We were also seeing a situation where health budgets in the states were becoming unsustainable. We knew that in New South Wales by 2045 the health costs will consume the entire state budget. So we are on a track that just cannot be sustained.

I am really proud of what this government has done in that policy area—biting off a huge public policy challenge for groundbreaking reform that has put us on a sustainable track and has broken up the funding responsibility. Mr Deputy Speaker, I know that in your area and in my area we are seeing huge advances in health services as a result. I will come back to that. This is another really important step in that process.

My friend the member for Hasluck referred to some important issues about the associated health effects of dental issues. There is a lady in my electorate whose husband died from septicaemia due to a dental health issue. A young fellow at Captains Flat, from a very low-income family, had been waiting two years to be seen by a dentist, and in the meantime the dental problem really exacerbated. Eventually, he had to drive to Sydney to get it sorted out, and of course there was the expense of driving to Sydney and paying for accommodation. He eventually lost a large number of his teeth as a result of the dental problem. That was a really reprehensible situation.

The Leader of the Opposition was responsible for throwing up this CDDS scheme at the last minute, in the last gasping days of the Howard government. What we saw out of it was a scheme that was intended to cost $90 million a year blow out to $1 billion a year. It was costing almost that yearly budget per month. Clearly that is unsustainable. But worse than that, we had a system that was not targeted—that was obviously being exploited for cosmetic dental surgery by people who did not need to be supported by a scheme like this. It was not means-tested, so we had wealthy people getting paid by the state for their cosmetic dental surgery. That is outrageous and is unsustainable. Obviously, something had to be done about that. We knew there were about 1,000 complaints being made about that old scheme and it was not getting to the people who really needed the help. We had a huge waiting list—400,000 people out there on dental waiting lists—and it was just not right.

In this area we know that an ounce of prevention is worth a pound of cure. You can save a hell of a lot of money down the track in our system if we invest more heavily in preventive health. The key to that in dental health is working with the kids. If you get the kids off on the right track with dental health, you are not going to have these exacerbated and amplified problems in the scheme down the track. So the beautiful thing about this package is the focus of it. We are seeing a $4.2 billion package—nothing to be sneezed at there, a huge commitment to bring us on the right track with dental health—which is broken up into $2.7 billion to address that preventive health measure for our kids and $1.3 billion for about 1.4 million low- and middle-income earners around the country who most need that help. Another component is $225 million for rural and regional issues in relation to both infrastructure and workforce. I will come back to that. In relation to my patch, Eden-Monaro, that is 17,114 kids who are going to be benefiting from that focus on their dental health in particular. Obviously that is going to achieve great health outcomes for them and get them on the right foot.

My friend the member for Hasluck need not worry about this gap issue. The only gap we are going to be fixing is the dental cavity gap. The system at the moment works in conjunction with the states. We are going to be putting $345 million into immediate employment to reduce that massive 400,000-person dental waiting list. That will take effect immediately, and in conjunction with the states we will see support for those receiving this dental support continue with the great alleviation of the state situation by not having to take responsibility for children through the $1.3 billion being injected to sort out their situation. They will be able to commit extra resources to continuing to sustain support for those under the CDDS scheme. So obviously the scheme is well designed to cater for the fact that we need to continue support for those people who most need it.

We know that the scheme needs to be efficient and easy to administer, and parents in relation to their kids will be able to make their claims through Medicare just as they do for normal doctor appointments, so there will be quite a lot of simplicity there. We are going to make sure that we bed down the scheme and take a great deal of care with it so that by the time 2014 comes it is a smooth, efficient system. In the meantime we have waged war on that waiting list and make sure that we have cleaned up the backlog of 400,000 as far as possible. Obviously there is very important targeting in the scheme to deal with the issues that are most important and essential in relation to oral health but not cosmetic surgery, as the current scheme was dealing with.

I come back to the point about investment in the rural and regional areas that I know is of concern to the member for Hasluck and me. It is $225 million. What does that translate to in my patch of Eden-Monaro? That funding is going to enable the expansion of existing dental services that are providing support to our community in Goulburn. A lot of my constituents from Braidwood and Bungendore go to Goulburn for support. There are also Yass, Queanbeyan, Cooma, Moruya and Pambula. Those services will be expanded. One of the big holes in health service in our region was the state of the C2 regional hospital in the Bega Valley. Now we have seen the Commonwealth commit $160 million, $10 million from the state, to build a new state-of-the-art facility.

Within that state-of-the-art facility will be a state-of-the-art dental suite that will be the recipient too of the support from this new scheme. Until then we will see services continue to be provided by Pambula and Moruya facilities on the coast, by Queanbeyan and Cooma facilities in the high country and by facilities in Goulburn and Yass. This is a great investment in our rural and regional services. Some of that money will also go towards helping workforce issues and towards attracting dentists to the region. Funding of about $77.7 million from the Dental Relocation and Infrastructure Support Scheme will provide up to 100 infrastructure grants to accompany that funding as well. These grants will support up to about 300 dentists in setting up practices in rural areas to meet the current shortage of services. My friends who have rural and regional electorates should be really pleased to welcome this.

I mentioned that this reflects the Commonwealth's investment in the lack of services in rural and regional areas. What we see in Eden-Monaro is effectively a package of $327 million to address what was a screaming gap, a gaping hole in those services, and I am proud of that. In addition to the state-of-the-art hospital I mentioned, $30 million is committed to establishing training and accommodation facilities in Moruya, Bega and Cooma to attract student doctors and nurses. If we develop them and their attraction to an area like mine, they will see the lifestyle advantages and then stay on and provide the services that we need. The facilities will attract them as well because we know that is a big issue. Our investment in facilities has helped us to attract extra doctors into the region.

We have seen a massive investment in primary health services right around the region as well. Lots of $500,000 grants have enabled the expansion of training facilities, rooms and services to attract additional doctors and students. Those grants are having a big impact in places like Cooma with the Bombala Street surgery, in Moruya with the Queen Street surgery and the just recently opened facilities at Pambula medical practice. It is really starting to have a significant effect. I am pleased to note the development application has been approved for the transitional care facility at the Moruya Hospital, which was another 2010 election promise delivered to the community. I am really pleased to see that.

It is a total transformation that is going on right across the Eden-Monaro landscape in health services. This is being mirrored and replicated right around the country, right around this nation and is getting us finally in the place we needed to be in supporting rural and regional communities.

The member for Hasluck also mentioned workforce issues as a big problem. It is only going to get worse in New South Wales as a result of the $3 billion slashing of health funding by the O'Farrell government. This is outrageous. This is in addition to the crime that is being perpetrated on our TAFEs and schools in the $1.7 billion cut there. But this $3 billion hit on our health facilities in New South Wales by the New South Wales government is going to be a major setback for what we are trying to achieve. The estimate is that from these cuts we will see something like 3,600 jobs lost in health services. That is on average more than 16 doctors, nurses and allied health professionals sacked from every hospital right across the state. There is no way you can cut $3 billion from the system and not affect seriously the delivery of frontline services. Unfortunately we are seeing a replication of the Sydney-centric approach by this government too. The bulk of the focus of the Infrastructure New South Wales report that has just been handed down is once again on Sydney. We saw very little reference to the needs of rural and regional New South Wales in that report, which is extremely disappointing.

As opposed to the New South Wales approach to cutting and affecting frontline services in health and education, the Commonwealth has achieved savings through efficiencies. We have achieved more than $13 billion worth of efficiencies in the public sector through reducing wasteful spending on travel, better ICT management and more efficient Commonwealth property management—that alone saved $1.2 billion.

There are things like taking greater advantage of online recruiting, instead of newspaper advertising. We have saved $30 million there. If the New South Wales government wants to save money, I accept that; we are all under budgetary constraints and tight situations right now. I would not for a minute complain about attempts to achieve savings to put more emphasis on frontline services, but that is not what we are seeing from this government. They have a lazy approach to cutting—slashing and burning—that is going to hurt not only our situation in relation to health.

We all appreciate how important our TAFE colleges are to rural and regional Australia. I have four of them in my region—in Moruya, Cooma, Eden and Queanbeyan. They are providing great support to the trade training centres that we have built at Bombala High, Eden Marine High and Bega High, supported by the TAFE colleges in Cooma and Bega. We just cannot afford to have this vandalism to our system. Education is an investment in our future and, in conjunction with better health facilities, it will be the way that we maintain our vibrant demographic balance in our rural and regional communities. So I would urge the New South Wales government to think again about these cuts.

But in relation to this dental reform I salute the minister for what she has achieved here. It will transform the landscape in relation to dental services in rural and regional Australia, as well as the nation generally, and I am extremely pleased to be able to support it.

Michael McCormack (Riverina, National Party) Share this | Link to this | Hansard source

The most important role for this parliament—for members who sit in this chamber and for senators in the other chamber—is to build a better life for the people of Australia. It is a shame that the disallowance motion on the Health Insurance (Dental Services) Amendment Determination 2012 (No. 1) was lost 71-69 last night in what was a tumultuous evening in the life of this chaotic government. We witnessed last night more of the slow and tortuous death struggles of this shambolic government; and this determination, while nothing to do with parliamentary procedures, processes and personalities, does say a lot about Labor and its approach to things.

Dental care is a major issue forming a big part of the overall health portfolio, which is of the utmost importance to this parliament and the people we as elected representatives serve. I say that because if you have good health everything else seems to follow; a good life is conditional on good health. That is why it is paramount that the government—whichever party sits on the treasury bench—places a priority on health. People must come first. Labor knows that and the coalition certainly knows that. The coalition is committed to investing in the dental health of Australians. The Gillard government's closure of the Chronic Disease Dental Scheme is abrupt and short-sighted but hardly surprising. With Labor's debts spiralling out of control the Treasurer has shown he will do anything to avoid a fifth straight budget deficit, which would be an appalling legacy given that he inherited an economy in such strong shape after such sound fiscal management during the Howard years. If Labor can scrimp some measure of savings from dumping a policy—no matter that it has worked and provided good health outcomes—then it will pursue it ruthlessly, relentlessly, recklessly. This is all in the name of penny-pinching, certainly not in the name of good government and certainly not in the name of sound health delivery. Cost-cutting and the Treasurer's wafer thin budget surplus are it seems more crucial for Labor than the oral health of many Australians who rely on the Medicare Chronic Disease Dental Scheme.

This determination ends the scheme on 30 November 2012. No new services have been permitted since 7 September—three days before the determination was tabled in the House and the Senate. The government announced a replacement program on 29 August and the new measures will cost $4.1 billion. But—and it is a big 'but'—the new scheme will not begin until 2014. Further, the new program is unfunded. That should not come as a shock to many, for Labor has recently racked up $120 billion worth of unfunded promises. There is a $120 billion black hole in the government's forward spending. It is pledging things it will never, if voters have any sense, roll out.

A toothache is one of the worst pains a person can suffer. I am sure everyone in this chamber has at some stage in their life suffered a toothache. The essence of this debate on the Dental Benefits Amendment Bill 2012 is precisely what this federal government is doing to dental care in Australia over the coming months. This government, which is responsible for continuity of care, has ditched it with this new program, a program celebrated and lauded at its launch but which, as I said, is completely and utterly unfunded. That is sadly the Labor way. No financial arrangements have been made for the dental package announced not that long ago. How can this be so?

This is a manipulative government which has run out of dollars but not ideas to savage key areas to save costs. This government borrows every dollar it needs from overseas because this nation is now $246 billion in gross debt and we, our children and our children's children will have to pay that off, and it will take years, decades. Our interest bill is $1 million an hour and increasing. Our gross debt went up by another $2 billion during the past week. Despite all this, Labor will keep making billion-dollar promises until the polls improve.

State funded public dental care has long waiting queues. As many as 750,000 people are waiting for care. With state funded dental care, unless you have a significant dental emergency, you simply do not get seen. Seniors who have chronic dental disease never get a chance—they have to access private services. Fortunately, Australia has a private dental model. Almost all of the nation's 10,800 dentists practise in the private sector. Why would a dentist want to work in the public sector when he/she can make so much more money in the private sector?

In Australia 600 dentists and 300 hygienists and oral health specialists and therapists are graduating each year. Those entering the profession are not enough to meet the demand and there has not been any effort on that side of the House to look at what jobs can be done by the people who work with dentists. As was pointed out recently by the member for Bowman, Dr Andrew Laming, the shadow parliamentary secretary for regional health services and Indigenous health:

If that work were done by allied health professionals, it would free up dentists to do the work which can only be done by them. This is a government which has abandoned that frontier.

This is also a government that has to its great discredit and shame shelved the chronic dental disease scheme. That scheme was introduced by the current Leader of the Opposition on 1 November 2007 when he was the Minister for Health and Ageing. It was his contention that, if people were genuinely sick and dental issues were part of that chronic disease, they deserved treatment. That is too true. It is about placing the needs of the sick first. But this Labor government, by dismantling the Chronic Disease Dental Scheme, is arguing that it does not matter how bad your teeth are if you are poor you go to the front of the queue.

In a developed country such as ours the reality is that dental disease is relatively evenly spread throughout the community. As Dr Laming so succinctly put it:

Having a concession card does not suddenly make your teeth bad. Earning a salary or getting a job does not suddenly make your teeth good. This is a government which has replaced a system designed to meet the needs of the sick with a system designed for the poor. The reality is that you have to look after both.

Well said, member for Bowman. Unfortunately, for adults who were previously protected, until their cover resumes in 2014 Labor's political pain will be put before their dental pain. Labor needs a surplus—as if that is going to happen!—so people will just have to wait. New South Wales and Victoria are the poorest investors in state dental care. Those are the states where you wait the longest. In fact, you do not wait because you never get the care. That is because the Labor state governments which set up those systems underfunded public dental care and have done so for years.

I listened to the member for Eden-Monaro talk about the fact that the coalition governments in New South Wales and Victoria were to blame. That is not so, member for Eden-Monaro. In 16 years we had very hard Labor. We had it under Bob Carr, Morris Iemma, Nathan Rees and then Kristina Keneally, who did not fund dental care the way it needed to be funded. Yes, there are cutbacks and they are hurting many communities. They have been brought about because of the need to make ends meet after those 16 years of terrible government by state Labor governments under Carr, Iemma, Rees and Keneally.

The answer is that federal Labor says it will find $1½ billion dollars two elections from now and hand it to the state governments and hope that the states spend it on dental care.

What did the opposition leader's scheme, when he was the health minister, do? Sure, the member for Eden-Monaro pointed out that it was brought in in the last days of the Howard government—a very good government, might I add, who were very fiscally responsible over 12 long years and who put many billions of dollars in the bank which have now been lost by the Rudd-Gillard governments.

What did the opposition leader's scheme do? A patient went to a general practitioner who established that they had a chronic disease and their teeth were fixed through Australia's 95 per cent private dental system immediately. It cost around $2,220 on average. For children with chronic disease, it cost $2,125 on average. What did the opposition leader's scheme do? His dental plan slowly worked its way through the sickest Australians, fixing their teeth. For mental health patients, the scheme put them at the front of the queue. They had their teeth done. They had their gingivitis fixed. They had their crowns and their bridges all fixed up. It enabled people with severe chronic dental disease to have a healthy mouth—and for some of these mental health patients for the first time in their lives.

Were there a few cosmetic procedures in the scheme conceived and introduced by Tony Abbott? Yes, there were. Was there a health justification for them? Yes, there was. Those on that side of the chamber have gone to great pains to talk about the rorting in the scheme which they have dismantled—one in 1,500 cases. Does it happen any less with doctors than with dentists? Surely it happens with Medicare and doctors. Of course it does; probably in roughly the same proportions. Doctors are no different from dentists in that respect. It is part of the trust built into a universal system.

When I last spoke on this bill, I spoke about the terrible healthcare system that they have in America, and we are so very fortunate here in Australia to have safety nets for people who get chronically ill—safety nets put in place by coalition governments, safety nets put in place by Labor governments. We on both sides of the House recognise how important health is and that we should be doing everything we can to ensure that we continue to have one of the best health systems in the world. Let me tell you: if you are in America and you get sick, if you are in the United States and you get a toothache, unless you have health insurance with dental health insurance built in, then it is just too bad. You put up with the pain.

The state public dental waiting lists were reduced by Tony Abbott's scheme. The waiting times in New South Wales were cut by 40 per cent, thanks to the now opposition leader's scheme. We have a GP centred health system. We allow the GPs to work out who is the sickest and who needs dental care the most. That was the justification for that particular scheme.

Getting your teeth fixed through the Chronic Disease Dental Scheme cost $2,220 per patient. But what was it this year? It had fallen to $1,117. Why is that so? Because all the serious work had been done. We were finally seeing the scheme drop to the level of performing the role of surveillance: monitoring the long-term care of Australians' teeth—those Australians who most needed it. The hard work had been done, and that had been done thanks to that scheme put in place by Tony Abbott and continued under Labor.

I know that Labor members opposite, the member for Parramatta and the member for Canberra, know how important oral health care is. I know the member for New England, who sits in the chair, knows how important it is, particularly in rural and regional Australia and those areas where we do not have as many dentists as in the metropolitan areas, the big cities. It is so much more important perhaps in regional areas that we have a system in place, because a lot of the patients there have to drive a lot further to get their oral health fixed up.

But that all stops now. That all stopped in early September, when a government with no money left evoked an image of dental care 19 months hence—because that is how long it is going to take now for those adults to actually get the proper care they need. This government criticises dentists for overcharging but then comes up with a scheme that gives $1,000 every two years to young people. Do you think that will not be open to abuse? Labor's scheme is precisely the same as the opposition leader's scheme, except that it is treating kids instead of the chronically ill seniors who most need it.

As I said, this is a scheme that needs to be continued. The funding will not commence until July 2014. The government has not said how it will pay for the measure. Many patients on the Chronic Disease Dental Scheme who lose access to treatment on 30 November will have to wait 19 long months to see if the government delivers on its promise and starts to provide more funding to state governments—state governments that have been bled dry by Labor governments for far too long. There is no detail on how much funding will be provided, with the possibility that the bulk of the money might not be provided until the end of the six-year period, and that is in 2018.

There are already 650,000 people on public dental waiting lists. We need to look after the people on those waiting lists who are in most need of dental care and most in pain. We need to continue to be able to provide good oral health care for those people because, as I said, health should be the number one priority for the government; it certainly is for the opposition. Therefore, I urge the government to reconsider this ill-thought-out idea.

Gai Brodtmann (Canberra, Australian Labor Party) Share this | Link to this | Hansard source

A week before I got married I went along to my dentist to get my teeth cleaned, because I am obsessed with my teeth. I used to get them cleaned every three months—I am not that regular anymore, Dr Sharma! But I would like to go more regularly to the dentist to get my teeth cleaned. I wanted to have beautiful teeth for my wedding photos. I went to my dentist and she sat me down in the chair and started to clean them. She asked me to tell her about my wedding dress. I said: 'It's a very plain dress. It's made from silk faille, cut on the bias, and it's a 1930s-type style.' She said: 'It's interesting you should say that. Do you want me to give you the wedding gift that a lot of fathers used to give to their daughters in the 1930s?' I asked her what that was, and she said, 'Taking all your teeth out.' I asked why they would do that, and she said that it was a huge investment by fathers in the 1930s to get their daughters' teeth taken out, because it meant there was no lifetime of expense for the husband. They would get dentures, and they were pretty easily managed.

That underscored for me how far we have come in dental health, dental hygiene and dental care and in the state of the nation's teeth. But it reminded me of my mother's experience and why my mother—and now my sisters, as mothers—are now obsessed with dental care. My mum—and I have recounted this story many a time—grew up in a housing commission house in Melbourne, with seven children in the family Her mum was a single mum who worked three jobs just to keep a roof over their heads and food on the table. They did it tough. Of course, dental care and dental hygiene was the last thing on my mother's mind or my grandmother's mind. At the ripe old age of 15, when my mother started working, she had rotten teeth. Before she started her new job she went out and had her teeth taken out. It took a month: one fortnight was spent getting the top teeth taken out, and the second fortnight was spent getting the bottom ones taken out. She spent the first nine months of her first pay packet as a 15-year-old on paying off that dental bill. To this day—and I actually had to ring her before I made this speech tonight—she still has great shame about the fact that she does not have her own teeth.

So to say that dental hygiene and dental health is an obsession in my household is probably an understatement. When we were little we were given fluoride tablets before there was fluoride in the water, and none of my sisters have fillings. I think that that is a great testament to my mother's obsession and the legacy of all those terrible things that she had to go through. So it probably comes as no surprise that I rise in support of this legislation, the Dental Benefits Amendment Bill 2012, which amends the Dental Benefits Act 2008 to establish the legislative framework for the Child Dental Benefits Schedule.

Dental care is critical in so many ways to our overall physical and mental health and our self-esteem, particularly in our youth. We know that there is a strong link between dental health and mental health. Just as an aside, I note that today is World Mental Health Day and I commend the minister for all the activities that he has been launching and taking part in, and the investments he has been making today. I also particularly commend the ADF for the fact that they are, for the first time, celebrating and acknowledging World Mental Health Day. I had a briefing last night, in a public hearing of the Defence Sub-Committee, from the ADF about the work that they are doing on PTSD and also on mental health, and there is a lot going on in this area. In the last five years they have really ratcheted it up, and not just for the soldiers who are coming back from operations but for veterans and, importantly, for families. So, as did the minister today, I commend the ADF not only for having their first mental health day today but also for the great work they are doing in this area.

According to the most recent data, 75 per cent of mental health problems occur in people under the age of 25. Some of these mental health conditions are indirectly related to dental care or, more precisely, the lack of proper dental health care. When you talk with mental health experts they will tell you of the links between good diet and good dental care and improved mental health outcomes. Some mental health conditions involve eating disorders which obviously have a connection to dental care. Other disorders may involve the misuse of illicit drugs, and they can result in poor dental outcomes and also complicate mental and physical healthcare treatment.

Another important aspect of good dental health care in young people involves self-esteem and social inclusion, because body image, as we all know—all of us having been through the teens—is a particularly sensitive issue for young people and growing children, and good dental health is critical in addressing issues of self-esteem. We know that there is evidence, too, that poor dental health and poor dental health care can lead to children being bullied, teased and socially excluded.

In a similar vein, I am also very concerned about juvenile diabetes and the alarming rise in the number of young people afflicted by this condition. Obesity is already identified as one of the leading health problems in young Australians, and there is no doubt that obesity and its causes are inseparable from the need for better dental care and better diet. So good dental health care is about more than just improving the teeth of children. Good dental health care can deliver many other mental and physical health benefits as well. As to obesity, you cannot eat a carrot if you do not have good teeth. That is why the bill we are debating tonight is so significant.

This bill will mean that, for three million children, going to the dentist will be just like seeing a doctor. As everyone here would agree, it is critical that children get proper dental care early on, and I believe that, by extending the range of people eligible to receive dental services, the government will be helping children in so many other direct and indirect ways. By getting access to dental care there is also much greater opportunity to help with diet. As I said, it is very difficult to eat a carrot without good teeth or with no teeth, and we know that an improved diet is significant in the path to better health.

I also want to talk about one of the programs that is operating here in Canberra. It is operated by a Canberra legend. I have spoken about this incredible woman in the House before. Her name is Liz Dawson. Liz is a tenacious and formidable force of nature and she is involved in a range of causes around Canberra—notably, Common Ground, which is trying to get help for people who have been afflicted with homelessness for many years and who also suffer some mental health issues.

Liz, bless her heart, is an extraordinary women. She was diagnosed with bowel cancer about a year or two ago. She went in for a preliminary op on it and came out with partial vision damage. Not only is she now advocating for homes for the homeless, as well as for another cause that I will come to, but she is also out there advocating for the vision impaired as well. She has been on my case about that ever since she suffered that terrible effect from the operation.

Liz Dawson also works closely with the Salvation Army here in Canberra to provide the homeless with dental care. She goes out and seeks funding for dental care for the homeless. She has come to me seeking funding for two sets of dentures. I have promised that. I need to get on her case now: the cheque is ready, so please come and pick it up. A number of the people whom she deals with have had illicit drug habits and so their teeth have rotted as a result of that. Some have been just affected by the poverty and disadvantage trap, and years of neglect and lack of access have caused dreadful dental outcomes. She, as I said, raises funds for these people to get their teeth looked at and treated, but usually, because their teeth are in such a bad state, these people unfortunately need to have most of them out. So she raises funds for dentures as well. She is, as I said, an extraordinary woman.

The stories that Liz tells me about what this means to these people are wonderful. They now have teeth, which makes their life a hell of a lot more comfortable. But it also means that they can start eating a healthier diet, because they can eat carrots and good fresh food, which they could not do beforehand. Most importantly, these people get their self-esteem back because they look good and can actually smile. As a result of getting their self-esteem back and having the ability to smile without feeling any shame, they can then go out and look for work. That has been the central outcome of the program that Liz Dawson is involved in. In getting these people teeth, she gives them a healthy diet and self-esteem and gets them a job. There are so many layers to having decent teeth. I have said many times to friends, family and others that it is the great social indicator. That is why this bill is so welcome and important.

Turning to the specifics of this legislation, it amends the Dental Benefits Act 2008 to set up the framework for the Child Dental Benefits Schedule. The schedule forms part of the Labor government's $4.1 billion dental reform package that was announced in August this year. The schedule will replace the Medicare Teen Dental Plan from 1 January 2014. I want to remind people about our new dental for kids scheme. About 3.4 million children will benefit from that scheme. This includes children in families who get family tax benefit A, Abstudy, the carer payment, the disability support pension, the parenting payment, the special benefit, youth allowance, the double orphan pension, the Veterans' Children Education Scheme or the Military Rehabilitation and Compensation Act Education and Training Scheme. To help families, they will be entitled to $1,000 per child every two years over the life of this package.

It is also important to note that parents will be able to take their children to either a private or a public dental service to access this program. Access can be a challenge. I know that the government dental service in Civic in the ACT is doing great work. But they have a long waiting list. That is part of the challenge with some of the homeless people that Liz Dawson has been dealing with. She has been using the funds to get people into private providers. As I have said, this program is an investment in prevention. It is an investment in decent and good health, good diet, good self-esteem and jobs. The Labor government understands the importance of preventative health. We understand that the dental health of children is the best way to ensure better dental health in adults.

In addition to the dental for kids program, our reform package will also provide 1.4 million additional services for adults on low incomes, including pensioners and concession card holders and those with special needs. That will give them better access to dental health care in the public system. The dental package will mean more services and more dentists in areas of most need outside capital cities and large regional centres. Finally, this package comes on top of the $515 million we committed in the last budget, which included a blitz on public dental waiting lists. This is a very important health reform that will benefit millions of Australian children. It will hopefully ensure that those children do not have the future those women in the 1930s had or that my mother had.

Louise Markus (Macquarie, Liberal Party) Share this | Link to this | Hansard source

On 29 August, the health minister, Tanya Plibersek, and the Greens health spokesperson, Senator Di Natale, announced a $4.1 billion dental program to commence in 2014. In principle, the promise to commit funds to dental health sounds like a good idea; indeed, the coalition strongly supports investment in dental health and does not oppose the intent of the bill. Yet this new dental scheme is just like all the other so-called initiatives of the Gillard government: it might sound okay as a news headline but upon closer inspection it is simply another underfunded initiative set to interrupt efficient community practices and put more pressure on hardworking Australian families. Labor promised a new dental scheme in the 2007 election campaign and yet did not deliver it. Now they expect Australians to trust a promise for 2014. This is yet another example of how adept Labor are at making announcements that only result in disappointment or failed delivery.

One of the key concerns I have is that the Gillard government's dental promise relies on closing the existing Chronic Disease Dental Scheme in November 2012 and yet the replacement schemes are not due to commence until 2014. I would like to reflect on the tremendous success of the existing scheme that was introduced by the coalition when it was in government and when the current opposition leader was the then health minister. What makes the existing scheme so effective and so accessible is that it is the only Medicare dental scheme that provides treatment for adults. In the last five years, approximately 20 million services have been provided to over one million patients. What does the Gillard government expect these Australians or others who need these services to do during that almost two-year gap?

The minister needs to explain what will happen to those who are currently receiving treatment under the existing program. Will these patients be forced to forgo treatment during the gap period? About the time of the introduction of this bill I was contacted by a Mrs Forwood from Mount Riverview in the electorate of Macquarie. Mrs Forwood wrote:

My daughter was accepted in the Medicare Chronic Disease Dental Scheme and promised $4,250 from the Government to fix her teeth. The problems she has are through no fault of her own. Shortly after she was accepted into the scheme she found out she was pregnant. She wants to wait until the baby is born until she has the work done on her teeth as she is afraid the dental work will impact on the baby.

Mrs Forwood goes on to say:

My daughter has received a letter from the Government saying that all dental work must be completed by 1st December this year. Her baby is due at the end of February.

After speaking with the department, Mrs Forwood and her daughter Danielle have been advised that there is no way to get access to an extension. Why is the federal government forcing Australians such as Danielle to forgo dental assistance for almost two years? Surely Danielle should not be forced to choose between getting dental treatment before the current scheme expires and protecting the needs of her unborn child.

I suspect that this gap in government-subsidised dental services is just another desperate attempt to reach a budget surplus. Why must the Australian community continue to lose vital services simply because this government have spent wastefully? The actions of this government, as they attempt to rush this bill through parliament, indeed suggest that this is the case. To date, the federal government has yet to provide a schedule of services, fees and details of how the scheme will be funded. Without these details, how can one suitably assess if the new scheme will be more efficient and beneficial to the community? Where is the concrete evidence that it will actually be delivered?

If this bill does not commence until 2014, that is after the next election. Why does the minister insist on rushing the bill through the parliament without making available these critical details for public and parliamentary scrutiny? The approach of the government in this regard suggests that the dental initiative is more about politics than policy. In fact, the Labor government has gone to great lengths to undermine the existing Medicare Chronic Disease Dental Scheme because it was established by Tony Abbott, the opposition leader, when he was health minister, and it has been a success in improving access to treatment.

Putting politics aside, I believe it is absolutely critical that the parliament does scrutinise the details that the government has made available in regard to the proposed scheme. Despite not detailing how the program would be funded, the recent proposal suggests that the amount of services to be provided over the full six years of Labor's scheme is just 20 per cent of what the existing program provided last year alone—just 20 per cent. How can the Gillard government argue that the new scheme will be beneficial for communities when a smaller number of people are set to benefit from the new program?

Furthermore, does the government anticipate longer waiting lists across Australian dental practices in order to accommodate the service gaps that will arise as a result of the new scheme? Already 650,000 people are on public dental waiting lists. Does the minister have any information with regard to how this may blow out while Australians wait for the new scheme? Longer waiting lists in public hospitals will be the direct responsibility of federal Labor.

In addition to longer waiting lists, a considerable lack of investment in the dental workforce and infrastructure, particularly in the public system, will hinder the capacity to deliver the projected number of services, and I can only anticipate that considerably fewer persons will have access to dental services under the new scheme. I understand that within the government's proposal it has allocated $225 million to develop infrastructure, yet the initiative to apply for funding under the flexible grants program for dental infrastructure will not commence, again, until 2014. Therefore, one can assume that projects are unlikely to be completed or provide tangible benefits until some years later. Alarmingly, I suspect that the service gaps that I mentioned previously will be extended beyond the two years, when there will be no federal government dental initiative.

As a result of these concerns, the coalition has moved to disallow the earlier closure of the existing Chronic Disease Dental Scheme. I believe that it is critical that we endeavour to protect patients who will now have to go without treatment—for at least 19 months for adults and 13 months for children—until Labor's proposed alternatives are due to commence. If we are not successful, or if this motion fails, this will inevitably be another Labor policy disaster, with detrimental consequences to the Australian community and Australian dental practices. It should be noted that 80 per cent of services under the Chronic Disease Dental Scheme have been provided to concession card holders. This suggests that dental services have been predominantly utilised by low-income earners who cannot afford premium care.

At an earlier time I have spoken on the scheme that was introduced by the coalition, and I have a number of dentists who work, particularly in the area of Katoomba in my electorate, with significantly disadvantaged sections of the community. They are deeply concerned about the gap in service that they will be able to provide. Without the existing scheme and during the period where there will be no assistance these people will be forced to go without treatment as they cannot afford private dental services. As a result, they may be added to considerable public waiting lists.

Many Australians have the perception that dentists provide a premium service and, as a result, they do not prioritise going to the dentist as they would, for example, going to a doctor. The expense is perceived to be too high and the services is considered to be inaccessible. By removing the existing scheme for low-income earners the government further builds on this perception and, as a result, further pressure will be placed on Australian dentists who seek to help those who do not have the resources to access dental care under normal circumstances.

The strategy and implementation of Labor's dental scheme is yet another example of how this government is good at making promises yet creates uncertainty about the potential delivery. The Labor government cannot explain how it will fund the new dental program or where existing patients will go during the almost two-year gap when no government services will be available.

In conclusion, the Labor government cannot explain how it will fund the new dental program, but one thing is certain: the dental scheme will further add to the underfunded and poorly delivered programs that this government is known for.

Karen Andrews (McPherson, Liberal Party) Share this | Link to this | Hansard source

I rise to speak on the Dental Benefits Amendment Bill 2012. Let me start by saying that I support investment in dental care for those who are suffering from chronic disease. I also support investment in dental care for our children. Australia had a Chronic Disease Dental Scheme, but in late August of this year Labor and the Greens announced that the scheme would end on 30 November, with access to the scheme closing on 7 September. In effect, there was about a month's notice given for when the Chronic Disease Dental Scheme would cease to exist.

The proposed new scheme for adult dental services is scheduled to commence in July 2014, which gives about a 1½ year gap between the closure of the former scheme and the commencement of a new scheme. The bill we are debating here today also seeks to replace the Medicare Teen Dental Plan with the Child Dental Benefits Schedule. This in turn will change the age eligibility for this particular scheme from the current 12 to 17 years to cover children from the age of two to 17 years. The proposed scheme will provide a $1,000 cap benefit to children over a two-year period. However, for all the supposed changes there is still no schedule of services, fees and details of how this new $2.7 billion scheme will be funded. Essentially, Labor is intending to implement a scheme without allowing for the opportunity to critique or view the details about how it will be funded or rolled out.

This scheme forms part of Labor's new dental proposal but it comes with a $4.1 billion price tag that at this stage is unfunded. Members of the Australian community are sick of being told by this government that it is introducing all these grand plans without there being the appropriate funding to back up those claims. However, aside from these very worrying issues the coalition does not oppose the intent of the bill. Continued investment in our dental system is critical to our development but we must all develop our dental system to ensure that those who are the most vulnerable in our community are being taken care of whilst making sure we have an efficient and fair system. So it is understandable that the coalition is highly concerned that Labor and the Greens have decided to take away the successful Medicare Chronic Disease Dental Scheme which has helped thousands of Australians.

We all know that a trip to the dentist is not always the most pleasant experience for each of us at any given time and, particularly for some of our children, it can be quite a traumatic experience.

However, for some people in our community, it is something that they desperately need. They need to go to their dentist because they need urgent dental help. They are particularly those Australians with chronic diseases, who require dental work to ensure that they have the best chance of maintaining their physical health at the best level they possibly can.

Many of these people have utilised the Medicare Chronic Disease Dental Scheme, which provides them with $4,250 in Medicare dental benefits over two years. Under the scheme there have been approximately 20 million services provided to over one million patients since 2007, including many children. This is an outstanding number and is a credit to the lasting legacy left by the Howard government. Yet Labor today is proposing to take away this great scheme, to the detriment of thousands of Australians.

The Leader of the Opposition introduced this scheme when he was the health minister in the Howard government. It is because of the Leader of the Opposition that many people with chronic disease can get the dental work that they need. In the face of the success that the Chronic Disease Dental Scheme has had, it appears that the government is attacking the scheme simply out of pure political motivation. This is a great shame because it truly is a scheme that has benefitted thousands of Australians and could continue to do so. Yet, since 7 September, this scheme has not been providing any new services. As I have indicated before, the scheme is set to shut down on 30 November.

This is where the shortcomings of Labor's policy become apparent. If this bill were passed and Labor is allowed to close the scheme, then those children who have a chronic disease and currently benefit from the assistance that this scheme provides will have to have their often complex dental treatment wait for 13 months until the new scheme proposed by the bill begins. This is a significant amount of time for anyone to have to wait to get proper dental help.

It is not just the children under this scheme who will be disadvantaged by having their access to proper dental work limited, as the adults who utilise the scheme will have to wait even longer to get access to the dental services that they require. The government instead has announced that it will provide the states and territories with $1.3 billion for public dental services, but those patients who want access to those services will have to wait until July 2014 before the funding commences. And, like the funding I mentioned before, this commitment remains unfunded at this point of time.

However, for all this talk of new schemes coming into place at different time intervals, it is all dependent on whether the government has the will to follow through on its word to fund them. This new system for adults will only be able to provide 1.4 million additional services over six years—and this is the admission of the health minister. Compare that with the service provision of the former scheme, which had seven million services in the last financial year alone. Labor's new system is well below the benchmark set by the Howard government. It just goes to show which side is more serious about delivering dental services.

Where do these child and adult patients go in the respective 13- or 19-month interim period? They have one of two choices. The first is to wait until the new scheme comes along and forgo any treatment until that time. The second is to place their name on the 650,000-plus public dental waiting list. This is an unacceptable dichotomy for any person with chronic disease, let alone any Australian.

The reality is that many people who utilise the current scheme cannot afford the dental treatment they need, and that is why they depend on it. For instance, concession card holders accounted for 80 per cent of services under the current scheme. Labor is asking people with a chronic condition to essentially put their road to recovery on hold because it has not been able yet to string together the money to fund this new system. It has not even offered to extend the current system to these people so that they can receive treatment in the interim period whilst the government, quite frankly, gets its act together.

It should also be noted that the $225 million that forms the proposal for the development of dental infrastructure through applications to the flexible grants program will not be available until 2014, with the benefits not set to come through until some years after that. All in all, if you have a scheme which is unfunded and provides service gaps, there is obviously much room for improvement.

The coalition in the past has committed—and I have heard the member for Dickson say this numerous times—to negotiate with the government on how best to refine the current scheme, including how to review the process for providing certain high-cost items. We have heard members opposite claim that the current scheme is rife with rorting. They also claim that there have been cost blowouts, even though the average amount that has been claimed under the scheme is $1,716 per patient, which is well below the allowable maximum. If these claims were true, then would it not make sense to identify the areas that need adjustment and make the necessary changes to them rather than completely scrap a system which is doing a very good job for Australians?

Investment in our dental health system is something that we need and I support such an investment. I do, however, have a huge issue with the problems that will come as a result of this bill and the government's new dental proposals, some of which include disallowing children who are currently benefiting under the current scheme to access those benefits until the new scheme comes into force, and that the $2.7 billion needed for it remains unfunded. Investment in our dental health system must be taken seriously and not be subjected to the political pointscoring that the government is only too willing to engage in. The Australian community deserves the detail on how this will be implemented and how the government will find the funds to do so. We must not underestimate the importance of dental health as part of maintaining our physical wellbeing. It would be disappointing to see people with chronic disease having to either go without or be placed on a waiting list to access dental services because of this Labor government, but I suppose that, as we wait for the details of how this scheme will be funded, we must also wait for the services that it will provide.

Paul Neville (Hinkler, National Party) Share this | Link to this | Hansard source

I rise today to speak to the Dental Benefits Amendment Bill 2012 and the Health Insurance (Dental Services) Amendment Determination 2012 (No. 1). These implement one component of the government's recent dental announcements, which include replacement programs that are targeted at low- and middle-income people and will cost $4.1 billion. The coalition does not oppose the intent of the bill; however, it does have legitimate concerns about a number of issues. Some of these concerns include the point that the programs will not commence until 2014—in the case of children, early in that year; in the case of adults, in the middle of that year—or how the programs will be funded. There are bland assertions that certain amounts of money will be required, but how that money will be raised and how it will be distributed, especially to the states, is another matter.

The main components of the announcement include revision of the existing Medicare Teen Dental Plan to establish the Child Dental Benefits Schedule and the abolition of the Medicare Chronic Disease Dental Scheme, the CDDS. The first is a program that covered teenagers at a time in their lives when they need to have dental work done. All their milk teeth are gone, they are going out into the world, they will need to have their secondary teeth attended to and they will be going to university, seeking jobs or whatever it might be. The plan covered the group from the age of 12 to 18. The new scheme will cover people from the age of two to 18, so that opens the door very wide to the number of people that potentially will be covered.

Let me state from the outset that the coalition supports investment in dental health, and this is evidenced by the introduction by the coalition when in government in 2007 of the Medicare Chronic Disease Dental Scheme, which has had an enormous success. It is the only Medicare dental scheme that provides treatment for adults. This service has already closed to new patients, and I think, quite frankly, that is a disgrace. We know that in many instances it will be 19 months before they can get any treatment—that is assuming they qualify then.

As I have said, the Chronic Disease Dental Scheme was introduced by the coalition and provides $4,250 in Medicare dental benefits over two years for eligible patients with chronic health conditions. It has delivered approximately 20 million services to over a million patients since 2007. That should say something to the government about where the need is. The government has said that this is a scheme for the rich, so when you get a really good scheme and you want to demonise it because it is a Tony Abbott scheme and you want to try to make it look not really successful and it is only playing to the top end of town, you call it a scheme for the rich. But the reality is that 80 per cent of the services under the CDDS have been provided to concession cardholders; four out of every five. Many of these people would have otherwise been forced to go without treatment or be added to the queue at public hospitals and public dental clinics, where the numbers on waiting lists at present are somewhere in the order of two-thirds of a million people; 650,000 people are waiting on those lists. I know of some hospitals where they are waiting for up to seven years. For God's sake, the tooth would be rotted and gone and irretrievable after seven years. So people who fall into that category may get dental treatment, if they are lucky, after seven years.

On 30 November patients will be left without access to treatment. We are talking now about the ones who are currently under the CDDS. Many are unable to afford the full cost of private treatment. Add to this, the government's vague promise of providing money to the states and territories for public services is not due to commence until mid-2014, July of that year, so we are looking 19 months out.

I have had a bit to do with the scheme and one case sticks in my mind. It is the case of a woman who had all of her top teeth removed. That is a pretty horrendous thing for a woman, pride in her appearance, femininity and all that sort of thing. She lost her top teeth. The mouth concaves into the top of her mouth and the fact that she had her bottom teeth meant it looked even worse. She was given a plate by a dentist and she had a defective palate. Because of that, the false teeth in the upper part of the mouth would not stay in. I got on to a person whose correct title I do not know but let us call her the chief dental officer in Queensland, in Brisbane. I told her of this case and asked whether there was money still available under the CDDS as we needed to do something for this woman. She was very good. She got on to the manager of the dental service in Bundaberg. I do not know exactly what they did but I have seen where those sorts of things occur where they built a plate that does not go over the palate but is locked into the jaw by two pillars. She would never in a month of Sundays have got that sort of treatment had it not been for the $4,250. She probably would have gone through the rest of her life with some incomplete solution or bulging or false teeth that fell out for the rest of her days. I think that the humanity of that scheme provided people with care.

As shadow minister Dutton said, there are people who are going through chemo treatment for chronic disorders now and they may not be able to get the dental work associated with that completed before November. What happens to them? You are going through the worst period of life with cancer and your mouth, which is essential to good health, is just going to be put on the scrap heap for 19 months. That is simply not acceptable by any standards. As I said, we are not against the principle of some of the things the government is doing but you cannot put people on the periphery, on some sort of scrap heap, and say, 'We might get to you further down the track.'

A man from Bargara and a woman from Harvey Bay contacted my Hinkler electorate office just in the last few days. They are in the same boat, perhaps not to the same extent as people with cancer but, nevertheless, they will not be able to get their treatment completed by 30 November. That is very sad for them. It is very disturbing to find people in the midst of their treatment not being able to complete that treatment. The end of November, I think, is an unrealistic deadline.

Labor's alternative to the CDDS, the National Partnership Agreement for Adult Public Dental Services, sounds all right on the face of it. They are going to give $1.3 billion to the state and territory governments. I spent 15 years on a hospital board where we had a dental clinic and we worked very hard on dental waiting lists. We considered that a very serious matter. We got the waiting list down to two years at one stage or it might have been under two years, but getting people through the system was almost impossible due to the combination of facilities in the hospital and getting dentists in.

The government says it will give $225 million to the states to develop the needed infrastructure. That will commence in 2014. But to get to there, you have got to assess the hospital or the current free-standing dental clinic, you have got to find out what the repairs or extensions are going to be like, how big they have to be and how many chairs you are going to have. Is it going to be two, three or four extra chairs? Then you have got to get the dentists. In country areas, let me tell you, it is not easy just to pluck dentists out of the air like that. So I would think that it could be 2015, perhaps even early 2016, before the effects of this $225 million—if indeed that is enough—come into play. As we said earlier, we already have 650,000 people on the list of whom 400,000 are adults. So all these other adults that will not be in the government's new program or have been cut out of the CDDS, what are they going to do? They are going to be on a scrap heap. As I said before, that is simply not acceptable. Worse, there is no guarantee that the workforce and infrastructure capacity to deliver the proposed services through the public system will be ready or developed in time for 2014. My prediction is 2015 or perhaps even early 2016. If you have worked on a public hospital board you know how slowly those processes work. They should not work slowly but they do.

When you sum up the scheme, there are some good features in it. I personally think this could have been even better delivered. I am a great believer in the school dental clinics, the caravans that go around to schools and some that are on a semi-permanent basis in schools, because you can get to young kids earlier. I believe we should also make more money available at the top end for adults. As I said, there are 650,000 and 400,000 of those are adults. The ones coming on that would normally have gone on to the CDDS, ones with chronic problems, should be seen immediately but they will be waiting at least 19 months and if they are the unlucky ones waiting for new chairs in some provincial hospitals they might be waiting even longer. I think the government could have done a lot better than this. We support the principle of it, but we think that, like most other measures in health and education, for example, they have made a hash of it once again.

Bert Van Manen (Forde, Liberal Party) Share this | Link to this | Hansard source

Following the contribution from my colleague from Hinkler, it is great to see the government's commitment to improve dental health for Australians. We in the coalition share that commitment and we have made numerous efforts over the last five years to work with the current and former Labor health ministers to improve outcomes for Australians. It was after all the Howard government that supported private health insurance to assist people in meeting the costs of dental care as well as the implementation of the Medicare-funded Chronic Disease Dental Scheme.

As my colleagues have ably touched on already in this debate, we are not going to oppose the bill before us today. However, there are a number of concerns with the government's six-year dental package. One of the key components of this package is providing some 3.4 million children aged two to 17 who are eligible for family tax benefit A with access to subsidised dental care capped at $1,000 per child over two years. In addition, there is funding of $1.3 billion for the public dental system so that around 1.4 million additional dental services can be provided for adults on low incomes including pensioners, concession card holders and those with special needs. There is also the funding of some $225 million of dental capital on a workforce to support expanded services for people living in outer metropolitan, regional, remote and rural areas.

The implementation of the dental reform package which requires the replacement of the Chronic Disease Dental Scheme is our big concern with this package of reforms. It is worthwhile looking at some of the stats for the Chronic Disease Dental Scheme. Approximately 20 million services have been provided to over one million patients under the scheme since 2007. Labor has repeatedly tried to close the scheme for political reasons. Labor has gone to great lengths to undermine the scheme, in all probability because it was established by Tony Abbott when he was health minister and it has been such a success in improving access to treatment and consequently a better life for those who have received that treatment.

First and foremost my concern is for the patients whose treatment will be compromised by the closure of the Chronic Disease Dental Scheme. It is not just the coalition that disagrees with the government's poor planning which will see patients, including children, left to wait between the closure of the Chronic Disease Dental Scheme on 30 November this year and the planned implementation of the new scheme in January 2014, for children, and 1 July 2014, for adults. For example, our friends at GetUp! have facilitated an online petition against the closure of the Chronic Disease Dental Scheme and that has reached some 13½ thousand signatures to date.

In addition, the Australian Dental Association has expressed their concern about the early closure of the Chronic Disease Dental Scheme, with President Shane Fryer observing:

Many of the patients being treated under the CDDS require complex care; some of which includes surgical procedures that need to be completed over a series of months, for example, periodontal treatment. It is unreasonable to expect patients to now be responsible for the cost of procedures they consented to on the understanding their treatment would be covered by Medicare.

Hans Zoellner of the Association for the Promotion of Oral Health also stressed his concern about the closure, paying particular attention to children who will not require services to the value of the new cap and, on the other hand, children who require more expensive procedures who will be significantly affected by the capping under this proposed legislation. The minister and the Greens should explain why these children must suffer for 13 months with incomplete treatment and no certainty of a schedule of services that are to be provided once the government actually delivers on its unfunded promise in 2014.

It is also worth noting that the majority of patients in the Chronic Disease Dental Scheme come from low-income families. Health Care Card holders represent some 80 per cent of the 1.5 million people who have accessed the scheme. On 7.30 last week many Australians will have seen one such case highlighted of a patient who had been accessing the Chronic Disease Dental Scheme. This man, who is in his late 20s, is on a disability pension and suffers epilepsy. He carries clove oil around with him to be used as pain relief while he waits for around 19 teeth to be removed. He joked that for as long as he has had teeth he has had problems with his teeth and had had nine teeth removed at the age of only three. He said he dreamed of the day he would have new teeth, because he wants to go to TAFE, get a job, give up the pension and move on with his life. This is just one example of how debilitating poor dental health can be on an individual and how improved dental health outcomes can and are being achieved under the current scheme.

There are already 650,000 people, or 400,000 adults, according the government, on the public dental waiting list. I have been told that in Queensland there is a five-year waiting list for services in the public sector. The question might be: why is this important? It is important that we get this right because we are not just talking about numbers here, we are talking about the real lives of individual people. We are talking about those people who suffer the broken and painful smiles of the underprivileged, and we need to be mindful of this rather than how a few dollars can be saved at their expense in between dental schemes.

I recently had the chance to meet with one of our constituents following an email he sent to my office with regard to his concerns about the closure of the Chronic Disease Dental Scheme. He writes:

I am writing to urge you and the opposition to take action to improve Australia's dental health care. Dental care, never included in Medicare, is underfunded, and disadvantaged people suffer the most severely. Poor dental health hurts quality of life. Bad teeth cause pain, impair the ability to eat and speak and they erode confidence. And all this can make it harder to gain and keep work.

Research shows that people on low incomes are much more likely to have few or no teeth, and children in poorer areas are more likely to have tooth decay. However, it is not just the disadvantaged who cannot afford treatment. Dentist visits are expensive, and many people struggle to pay for them; or they delay going to the dentist, which can result in worsening oral health.

As a result of this email, I took the opportunity to meet with the constituent. His proposal was that an extension of funding be granted for people already in the Chronic Disease Dental Scheme. The reason that he stressed the importance of this extension was highlighted when I was informed about the process involved in fitting dentures. New dentures need to be monitored and, as the patient's gums heal and the alignment of their gums changes, alterations need to be made to the dentures so that they still fit comfortably in their mouth.

With the closure of the scheme, this particular denture professional explained, there would be at least 12 patients in his particular clinic left in the lurch. Taking into consideration the number of other dentists around my electorate, there could be many more disgruntled patients left with poorly fitting dentures as a result of the closure of this scheme. It was also brought to my attention on the very first day after new referrals were cancelled—and on a daily basis since—that this constituent has been encountering patients who have become distraught when told that they are now required to attend a state government clinic and place their name on a waiting list—which, as I touched on earlier here, he advised is around five years.

He has forwarded me an image to highlight the real issue. It is an image of a patient who has no upper teeth and a small worn-out partial on the upper. Her lower teeth all need removal and replacement with an immediate denture. He stresses that this is just one example of the many thousands of people who will be in the same predicament, struggling with the full impact of compromised oral health. I seek leave to table that photo.

Leave not granted.

Well, it is far more important than an electricity bill. We are talking about somebody's health.

According to the report Public dental care and the Teeth Care trial: a history of decay, by Sharon Bond, inability to access dental treatment in a timely manner has significant impact on individual health and wellbeing, including: prolonged pain and suffering; increased damage to teeth and gums; the risk of the spread of infection to other parts of the body, resulting in other acute medical conditions requiring treatment in hospital emergency departments or by general practitioners; dependence on pain medication and the implications of their side effects; poor diet due to inability to eat fresh fruit or vegetables, resulting in other medical conditions, like vitamin deficiencies, digestive problems and obesity; other major health problems, such as cardiovascular disease, stroke, diabetes and low-weight babies; dental induced speech problems; and diminished self-esteem due to physical appearance.

In addition to the closure of the Chronic Disease Dental Scheme, we are also legitimately concerned about the unfunded $2.7 billion cost of these proposed changes. The question still to be answered is: where is this $2.7 billion to come from? And when you consider that this is on top of another $6.5 billion a year announced for Gonski education reforms, that is some $9.2 billion in government spending that Australian taxpayers have yet to be informed as to how it is going to be paid for.

In addition to the unfunded issue, we are also concerned that this is another bill being rushed through parliament without a schedule of services and fees and other essential details. The coalition renews its commitment to work with the government to refine the Medicare Chronic Disease Dental Scheme in the meantime, including reviewing the process for providing certain high-cost items such as bridges and crowns. As I said at the outset, the coalition supports investment in dental health and does not oppose the intent of this bill. However, we do remain concerned and oppose the closure of the Chronic Disease Dental Scheme for any of the many reasons I have outlined tonight.

Josh Frydenberg (Kooyong, Liberal Party) Share this | Link to this | Hansard source

I congratulate my colleague the member for Forde on that excellent speech and very thoughtful presentation about an important issue that concerns everybody in this House: the Dental Benefits Amendments Bill 2012. The coalition has sought to disallow the government's proposals not because we do not support further investment in dental health, because we do; not because we do not appreciate the need for reform to the Medicare Chronic Disease Dental Scheme, because we do; and not because we do not appreciate the value of Medicare funded dental treatment, because we do—but because this $4.1 billion dental program announced by the Labor Party is (a) unfunded and (b) is going to leave many patients who are receiving or would have received treatment under the CDDS out in the cold.

The government's new scheme does not commence until 2014—January 2014 for children aged two to 17 and July 2014 for adults. New patients to the Chronic Disease Dental Scheme will be unable to access services after 7 September this year. The Medicare Chronic Disease Dental Scheme will be closed from 30 November this year. This means that adults with dental problems will go without services for nearly 19 months and children for 13 months. This is just unacceptable. But do not take my word for it, I will read you a release from the Federal President of the Australian Dental Association from September this year. It called this policy short-sighted and stated:

… the mode of closure of the CDDS has given little consideration to the many patients currently receiving treatment.

…   …   …

… many patients currently accepted into the CDDS will be unable to complete their course of treatment by the closure date of 30 November 2012.

'Providing patients with only 12 weeks to complete treatment demonstrates a fundamental lack of understanding about dental care by the Australia government' …

They are not my words. They are not the words of the coalition leader; they are the words of the Federal President of the Australian Dental Association. The release goes on to state:

The ADA believes that at the present time too much attention has been given to achieving budgetary savings rather than focusing on maintaining government funded dental care before the implementation of the new programmes.

This is unacceptable. I have been contacted by constituents, like many of my colleagues on this side of the House, who also feel strongly about this issue and are worried about their inability to access sufficient and subsidised dental care. The shadow minister for health, the member for Dickson, spoke eloquently in the parliament on this issue, detailing how he was contacted by one of his constituents, a pension on disability support, who is struggling with throat cancer. Because of the radiation treatment this gentleman was receiving, his body cannot produce the saliva to properly open his jaw. This requires specific and intensive fluoride treatment. The cost of major surgery is prohibitive at over $50,000, leaving this person to require regular treatment and dental visits. But with the closure of the CDDS, this subsidised treatment will not be available. Who knows what this man will do?

The Minister for Health, who is now in this chamber, should answer that question instead of talking. She should listen to the coalition's enlightened concerns about this policy. This case, raised by the member for Dickson, must be one of thousands of cases across this country of people in need who will be denied care simply because this Gillard government have mismanaged the economy to such an extent that they are now desperate to cut essential services in a vain attempt to reach a budget surplus next year, which we know they will not reach. In the last five years, they have delivered the biggest budget deficits in the history of the Commonwealth.

Another major concern for the opposition is that this government is seeking to rush this bill before parliament—which, by the way, will not come into effect until 2014—without providing the schedule of services and fees that will apply. How can we proceed without that full information? The government's plan is to provide a $1,000 capped benefit over two years to eligible children under this new scheme.

When it comes to adults, funding will be directed towards state governments, with services for adults no longer carrying on via private dentists under Medicare. There is also, under the government's proposal, more than $200 million for dental infrastructure, also not to take effect until 2014. Such spending commitments may be all well and good for those who propose them, but if the money is not available then this is not the best outcome for the Australian people.

The truth is that the only reason this government and this health minister want to abandon the Medicare Chronic Disease Dental Scheme is that it was a creation of the Howard government. It was established by the current Leader of the Opposition, the Hon. Tony Abbott, as part of his successful tenure as health minister. Despite the government's claims of expenditure blow-outs, figures released by the Department of Health and Ageing show that the average claim per patient is $1,716, significantly below the allowable $4,250. What is more, 80 per cent of the more than 20 million services given to more than one million patients under the CDDS have been provided to concession card holders. These are the people with lower incomes in our community.

In conclusion—and the Minister for Health, who is now in the chamber, should listen to this—we have 650,000 people on public dental waiting lists, 250,000 of whom are children. Clearly, more needs to be done. But the government's proposal is not the answer. In a desperate attempt to balance the books, they are short-changing Australians—Australians who are most in need: Australians with chronic diseases. People young and old in this country will now be unable to access subsidised dental services for months on end—up to 19 months for adults—due to the imminent closure of the Chronic Disease Dental Scheme. This government must do better. And when we, the coalition, get our chance in government, we will do better. The sooner that happens, the better it will be for all Australians.

Tanya Plibersek (Sydney, Australian Labor Party, Minister for Health) Share this | Link to this | Hansard source

I rise this evening to sum up on the Dental Benefits Amendment Bill 2012. As I said when I was introducing this bill, investment in our children's teeth is an investment in the future. It will mean that, for millions of children, going to the dentist will be as easy as it is now to go to their GP. Children's oral health has been getting worse, not better, since the 1990s, and, unless we reverse this trend, a generation of children with poor teeth will grow up into a generation of adults with poor teeth.

A recent Australian Institute of Health and Welfare report tells us that 45 per cent of 12-year-olds had decay in their permanent teeth, and in 2007 just under half of children aged six attending school dental services had a history of decay in their baby teeth. This level of decay in children so young is a worrying trend, particularly as dental decay is so preventable. We know that the health and hospital system of the future will face increasing pressures from the ageing of the population and from the increasing prevalence of chronic diseases. Poor oral health would place even more pressure on the wider health system. Yet it is a source of pressure that can be addressed reasonably easily with early investments.

This bill will establish the framework for a new scheme called Grow Up Smiling, which will give children in low- and middle-income families access to affordable preventive dental care and basic dental treatment services. Grow Up Smiling builds on the government's existing Medicare Teen Dental Plan. It will make almost 3½ million children eligible for dental care subsidised by the Commonwealth government. Family tax benefit A eligible families will have access for their children from the age of two until they turn 18.

Throughout this debate we have seen a bizarre display by members of the opposition who, despite supporting this bill, have trooped in here one after the other only to criticise the government. Their relentless negativity means that they cannot even be positive about a bill that gives almost 3½ million children access to free dental care.

A number of false claims have been made through the course of the debate and need to be corrected. I have sought to correct these during the course of the debate but member after member opposite has ignored these corrections, it must be assumed deliberately. Although this bill is about establishing a new entitlement for millions of Australian children, those opposite have barely managed to speak about the benefits of investing early in the oral health of children. They have failed to mention that this bill will make it easier for parents to look after their children's teeth and keep them healthy. They have come in here and sought to whip up fear in the community and defend a bad scheme, the Chronic Disease Dental Scheme.

Unlike the range of measures that we have introduced, the Chronic Disease Dental Scheme does not target patients based on their dental needs. A patient with a chronic disease but with relatively good dental health can access around $4,250 of dental care, including work that can be largely cosmetic. On the other hand, a pensioner with a mouthful of rotting teeth but otherwise healthy gets absolutely nothing under this scheme. The vast number of Australian children whose parents do not have the money to take them to the dentist get nothing under the Chronic Disease Dental Scheme.

As I have said, there have been a number of fallacies peddled about the timing of this scheme's closure, including that there is a gap between the closure of the Chronic Disease Dental Scheme and the commencement of new investments in dental health. I want to assure members again, and I have done it while other members have been making this false claim again and again—I have talked about it in the parliament—that there need be no gap. New funding that we announced in the May budget—$515.3 million—can start to flow from 1 December and all I require of the states and territories to sign on to these National Partnerships is that they commit that they will maintain their effort in providing state dental services.

There is a $345 million blitz on public dental waiting lists. Those opposite continue to claim that there are 650,000 people on public dental waiting lists. The number is closer to 400,000—400,000 is way too many—but the Chronic Disease Dental Scheme has not addressed public dental waiting lists. This money, as I said, will be available as early as the beginning of December. There can be a seamless transition from the Chronic Disease Dental Scheme to the new scheme. As I said in the parliament at the time we were first discussing this, it has been a tribute to the number of members who have genuinely raised with me questions of their constituents and how they will continue to receive treatment that, consequently, we have put particular effort into ensuring that this money is available from the beginning of December rather than the beginning of January, as we had originally anticipated.

It has also been incredible in this debate to hear speaker after speaker crying crocodile tears about the lack of capacity in state public dental systems, yet failing to mention that it was the Howard government that axed the successful Commonwealth Dental Health Program in 1996. Our package will repair that damage and improve access to public dental services for those on those waiting lists, with a particular focus on Indigenous patients, patients at high risk of or from major oral health problems, and those from rural areas. The member for Kooyong was talking about a disability pensioner, exactly the sort of person who would benefit under this new scheme.

Importantly, states will be able to use our funds to use private dentists to expand their workforce in areas where there is not access to a public dental scheme. Where there are established medical services, community health organisations, states will be able to contract with any of these organisations to increase their capacity to deliver services on the ground.

Someone must have mentioned that this bill does not include the detail on the services to be provided under this scheme. That detail will come in a schedule. Grow Up Smiling will provide benefits for basic dental treatment like prevention, diagnostics, extractions, fillings and so on. The details and mix of these services will be developed in consultation with dental professionals to ensure that the schedule of services is designed and appropriate for the basic oral health needs of children. Once this work is complete, the schedule of benefits will be established under subordinate legislation.

As I said at the beginning of this debate, Medicare and free hospital care have been a basic right for Australians for decades under policies established by Labor governments. Yet millions of people in this country still go without adequate dental care because of cost barriers. We had the member for Kooyong talking about the media release of the Australian Dental Association. I want to quote that for the benefit of honourable members. It is dated 29 August 2012 and it says:

AUSTRALIA'S DENTISTS WELCOME TARGETED DENTAL REFORM

Today’s announcements by the Hon. Tanya Plibersek have been welcomed by the Australian Dental Association.

Closure of the Chronic Disease Dental Scheme (CDDS) and the Teen Dental Plan with a replacement scheme focusing on Australia’s youth and disadvantaged Australians is a significant initiative leading to a long-term improvement in Australia’s oral health. The ADA has long advocated for a targeted dental scheme as outlined in the ADA’s Dental Access proposal.

It is very favourable press release. On 9 October the Australian Dental Association said:

THE SOLUTION TO EFFECTIVE AND SUSTAINABLE ORAL HEALTH CARE

As parliamentarians continue to debate closure of the Chronic Disease Dental Scheme, the Australian Dental Association calls on members of parliament to listen to the dental profession when it comes to creating the solution to dental care delivery.

The investment of $1 billion per annum in the CDDS was like using a sledgehammer to crack a nut. It was wasting valuable funds on the delivery of care to those who could already access care without government assistance.

And on it goes. There has been a further and consistent deliberate misrepresentation now not only of me and of the government policy but also of the Australian Dental Association, which has been very supportive of these measures, because they know, as we know, that the CDDS was a scheme that was open to misuse, that went from being supposed to cost $90 million a year to costing $80 million a month, that sprayed money around like—well, we do not use sprinklers anymore with water restrictions, but we remember what sprinklers used to work like. It is unfair, it is wrong, it is unjust and it is dishonest to continue to frighten people by suggesting that this money does not start for 13 months or 19 months, as the member for Kooyong suggested earlier. There is $550 million available from 1 December, and all the states need to do is keep doing what they are doing to receive that money.

On this side of the House we believe that access to dental services should be targeted to those least able to access on the basis of need for dental care. That is what these reforms do. I was fascinated to hear the member for Kooyong say that when the opposition returned to government they will go back to the Chronic Disease Dental Scheme. That is the only interpretation of his words—

Josh Frydenberg (Kooyong, Liberal Party) Share this | Link to this | Hansard source

We will do better.

Tanya Plibersek (Sydney, Australian Labor Party, Minister for Health) Share this | Link to this | Hansard source

If you believe that your scheme is better, the scheme that we are closing, that means you will return to the old scheme. The member for Kooyong, and the shadow health minister yesterday, would not be drawn on this. It is a very interesting question for people to ask the Liberal Party of Australia, whether they do commit to returning to the scheme that they are advocating for now.

I want to commend this bill to the House and I want to say that it pleases me that at least the opposition have agreed to support these extra action measures for children and for low-income Australians through investment in our public dental systems. This is a proposal that serves many more people in a much more long-term way, preventing poor oral health in our children, meaning that generations of Australians will indeed grow up smiling.

Question agreed to.

Bill read a second time.

Message from the Governor-General recommending appropriation announced.

Ordered that this bill be reported to the House without amendment.

Federation Chamber adjourned at 19:21