Mark Coulton (Parkes, National Party) Share this | Link to this | Hansard source

It gives me great pleasure to rise this afternoon and comment on the report Bridging the dental gap: report on the inquiry into adult dental services. There is a list of recommendations and information in this report that I do not need to go into. But I would like to comment on some of the things that came out of this report upon the investigation of the committee; in a nutshell, it would probably be the need for cooperation between the federal government and the state governments and private providers to make sure that we have a network of dental services as far across the nation as we can and that we also get the services to where they are needed.

I was very pleased that the committee came to my electorate. Actually, the only hearing that this inquiry held outside Canberra was in Dubbo. What was interesting about our day in Dubbo was that we actually saw some of the issues whereby people are suffering from lack of dental services. We heard great evidence from the Aboriginal Medical Service at Walgett. We heard from the prosthodontist Peter Muller. Peter is very passionate about serving the people of New South Wales. He spoke about the changes since the cessation of the chronic disease scheme and how that has impacted on his clients. He also spoke of his frustration in terms of being able to service those clients as well as he might, and the difficulties that these clients have in funding the treatments. Many of the people he deals with are in a bad way with their general health because of their lack of suitable dentures with which to eat.

The other thing that was of interest to the committee when it came to Dubbo was the work of the Flying Doctor. Their plane, which is affectionately known in the west as the 'tooth fairy', is now delivering dental services right across western New South Wales. It has been a major step forward for the people of the west to have those services delivered, and there is a need for ongoing funding for that service. But probably the highlight of the day was seeing the work Charles Sturt University is doing in its School of Dentistry and Health Services at the Dubbo campus. We were able to see students and dentists working side by side delivering services to members of the community while these students were actually undertaking their training. It is a magnificent facility. It was funded in the last days of the Howard government and constructed in the early days of the Rudd government. Those young dentists are trained in the bush and have a good experience there. They probably have a superior training opportunity because of the ratios of staff to students and the fact that they will probably stay in that area. There is also a private clinic operating from the same facility.

So I do endorse this report. There is a lot of information in there about the relationship between the state and the federal government. This report also touches on the need to elevate the status and responsibility of dental hygienists and raises the possibility of a trial for Medicare provider numbers for hygienists. Certainly I would not like to see, as a stopgap measure, hygienists and dental nurses replacing dentists in country areas. I think that people in the country are entitled to the same level of service as everyone else, but I think that there is an argument to be had for some funding for hygienists to work throughout the school network in a preventative way. There is certainly a lot of scope to improve that.

I thoroughly recommend this report, and I acknowledge the work of the secretariat. This was possibly one of the fastest reports that I think the health and ageing committee has ever undertaken and printed, and hopefully the minister and subsequent ministers in following governments can use this and look at implementing a program that will fill in the gaps and ensure that people right across the country do get the adequate services that they need.

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

by leave, I wish to address the chamber. Thank you to my colleagues. It is great to see that there are four colleagues from the health and ageing committee here in the chamber tonight. I would like to express my thanks to them for the constructive contributions that they made to this report. This is a report that is probably more difficult than a lot of reports that we have dealt with in the health and ageing committee, but we managed to reach a position where we had a unanimous report that we could table in parliament. I think that was a credit to the secretariat, who always do a wonderful job on the health and ageing committee, and to the members, because of the mindset that they had towards delivering a report that is unanimous and is one that we can all get behind and argue from different perspectives in relation to it.

The day in Dubbo when we took evidence was really special. It is very important that members get out into rural and regional areas. I come from a regional area, but it is a regional metropolitan area. In that area, yes, there are challenges in relation to dental. There are real challenges, but they are nowhere near the challenges faced by the people in Dubbo, and they are nowhere near the challenges faced by people who live even further out in rural and remote areas. The needs that they face and their inability to access services when they need them are very great. The committee recognised the fact that in an area like mine there is a shortage of dentists, but with the introduction of the national partnership agreement on dental I have found that there has been a massive reduction in the number of people who are waiting to access dental treatment. But in the member for Parkes' electorate you do not have that same turnaround because he does not have the dentists or the dental professionals to deal with the problems that people experience with their teeth. That remoteness and the rural and regional aspect of it really does impact on a person's ability to utilise services.

In Dubbo, I found it really refreshing to see the approach of all the people who gave evidence to the committee. They had one mindset. You could see that they were a team and you could see that they worked together on issues. We had the Flying Doctor, we had the Aboriginal Medical Service, we had the hygienists and the dental prosthesis and Charles Sturt University—a fantastic facility. What it has delivered to the community is a credit to the Howard government and to the current government. A thing that is really special about it is that you have Charles Sturt University working alongside the Western New South Wales Local Health District. You have dentists who are funded one way, through the university, working on one side, and dentists who are funded through the health system working on the other side of the facility. But they are sharing their expertise. They all go out to those rural and remote areas, and they are prepared to give their support to their communities, so there is a real sense of community. It is not the same level of services that are available in a city, but they certainly have a total commitment to the people that they are servicing. The Royal Flying Doctor Service shared with us their perspective of how they will go out and help people and, once again, gave that other aspect of what it is like to live in a rural and remote area.

The member for Parkes said that, for him, the thing that came across, the thing he got the strongest message about, was the need for state, Commonwealth and private dental services to work together. It is always a problem with the states and the Commonwealth. There is always that tension that exists between the levels of government, and there are always issues around the interface between government and the private sector. I think that is a very important issue, but for me the most important issue is the lack of consistency. In 1996, there was the Commonwealth Dental Health Program. The Howard government did not continue it. Then there was the Chronic Disease Dental Scheme, and this government did not continue that. Now there is the national partnership agreement which, as I mentioned, has already made a big dint in the waiting lists in my area.

It is important that people in Australia have certainty that there is going to be a continuation of dental services, that it is not going to constantly change and that, if they are eligible for assistance under a particular scheme, that that eligibility will continue. From my perspective, I felt that the chronic dental health disease program was poorly targeted, but members on the other side of the parliament did not agree with that. Even given that, we were able to work around it and come out with the recommendations that we have here before us today.

It is fair to say—isn't it, Member for Hasluck?—that we all felt that there was a lack of consistency in the way dental services had been delivered over the years. We all acknowledge that the Commonwealth does have a responsibility for it. I feel that our underlying feeling was that we would love to see a health system in which dental care was covered by a similar scheme to Medicare, where, if you had problems in your mouth and you were really ill, you could go and have that treated, without it being treated as a secondary, non-important type of illness. It is oral disease. Anyone who has had an abscess or a really chronic dental problem will know that there is nothing more painful or more debilitating than having a problem in in your mouth. In fact, I had a constituent come to see me who ended up in intensive care in the public hospital system because he had had an abscess on his tooth. That abscess had infected his whole system. That was a massive cost to our health system, because he was fighting for his life for a couple of weeks. It was only through the fantastic medical care that you can get in this country that he was able to get over that illness.

There are a lot of new programs that are starting up. There is the Grow Up Smiling campaign that will be good for young children. When I was younger—and I suspect you will remember, Deputy Speaker, and member for Hasluck, and maybe all of us in this room—there was a Commonwealth dental scheme where the dentists came around to the school and looked at our teeth.

An honourable member: All of those pink tablets.

Pink tablets. I lived in the country where they did not even give us pink tablets. We did not have fluoride. We did not have any of those scientifically advanced procedures. That program in place, and then it was removed, and we have had various other programs, such as the Teen Dental Health program which I do not think has had the take-up that other programs have had.

Overall, we need to have a continuous approach to dental care. We need to recognise that dental care is important, and we need to recognise how important it is to access dental care. Also, the national partnership agreement is an excellent scheme for people that have health care cards. They are the people that really need to access dental health through the public system. They are the people that are on the dental health waiting list. They are the people that will be assisted by the national partnership agreement. There is an interim agreement in place now, and the full agreement starts in 2014.

There is a group of people that are on incomes just above the health care card level, where it is very hard for them to afford the dental treatment that they need. This is a very complex issue, and it is an issue that, as a nation, I do not think we have dealt with well. I think it is time for governments of all persuasions to recognise that our dental health is important and that our dental health influences our overall health. It will not be the current government that responds to this report. It will be the next government, whatever political persuasion it is, that gets to respond to it. I hope that they take into account very seriously the need for consistency and recognise that dental health is very important.

Geoff Lyons (Bass, Australian Labor Party) Share this | Link to this | Hansard source

I am reminded of my growing up, which was in the fifties. We did not have reticulated water; I remember we had tank water. Amongst the people in my neighbourhood there were lots of false teeth and teeth that were not too good.

Honourable Member:

An honourable member interjecting—

Geoff Lyons (Bass, Australian Labor Party) Share this | Link to this | Hansard source

Yes, my front ones are gone, but they were knocked out playing footy. The interesting thing is that we do have, on the whole, much better teeth now than we used to have. I know that our society is better, we are a healthy people, and we actually live longer. Part of the reason is that we have much better teeth as a result of fluoride. I notice that the Queensland government have dropped the requirement to have fluoride in reticulated water, which is to the detriment of the people of Queensland, and I hope they rectify that.

I rise to add my remarks to the report, Bridging the dental gap, of the House of Representatives Standing Committee on Health and Ageing. In this inquiry the committee considered: demand for dental services across Australia and issues associated with waiting lists; the mix and coverage of dental services supported by state and territory governments, and the Australian Government; availability and affordability of dental services for people with special dental health needs; availability and affordability of dental services for people living in metropolitan, regional, rural and remote locations; the coordination of dental services between the two tiers of government and with privately funded dental services; and workforce issues relevant to the provision of dental services.

Improving dental health will help relieve the pressure on hospitals. I know this from my personal experience through being in the health system in Tasmania for 20-odd years. A number of cases came along that had to get taken into theatre for what were, in fact, dental problems. It does show that we are not on top of this issue. As I said, improving dental health will help relieve the pressure on hospitals and broader health systems, which is why this inquiry is so important. We know that one in five of our lowest income earners have not been to the dentist for over five years, if ever. This is a serious concern. Poor dental health has wide-ranging impacts on speech, sleep and eating.

The committee heard from a number of parties who stated that there are many groups of people in Australia who are struggling to receive adequate dental care. This can lead to a range of poor dental health outcomes which often result in patients requiring more extensive medical treatment. This includes low-income earners, the elderly, people living with a disability, those living in regional and rural areas of Australia, and homeless and Indigenous Australians. Because low-income earners are less likely to receive preventative care they are more likely to have extensive treatment, for example, tooth extraction rather than fillings. The reasons for the increased risk of oral disease in these populations are complex, but are generally associated with poor visiting patterns to dental and oral health services. For some, this may be indicative of poor availability of dental services outside metropolitan centres thus making access difficult. For others, a significant barrier may be the cost of accessing services.

The committee heard evidence that public dental waiting lists also represent a barrier to care, with eligible patients often unable to afford access to local services and unable to access services elsewhere. Treatments through the public health system usually focus on providing emergency treatments rather than preventative or restorative services. Even so, the demand for limited public dental services is such that there are significant waiting lists in all states and territories with the average waiting time of 27 months. For adults who are not eligible for access to public dental services, treatment is only available through the private system.

The Australian government understands the importance of timely access to affordable, high-quality, oral health care for all Australians, and in particular for low-income earners and disadvantaged people. The government knows that many Australians on low incomes miss out on access to dental care, and a number of those missing out are children.

On 29 August 2012, the government announced the landmark $4.1 billion dental reform package. This package will build a fairer dental system. The package includes $2.7 billion for Grow Up Smiling, a children's dental scheme that will start on 1 January 2014; $1.3 billion to states and territories from 1 July 2014 to expand services for adults in the public system; and a $225 million flexible grants program beginning from 2014 to provide dental infrastructure, both capital and workforce, in outer metropolitan, rural and regional areas. The government allocated $5.5 million to Tasmania in 2013-14 to cut the public dental waiting lists, which will make a real difference for Tasmanians and people with dental concerns.

The committee heard that a highly skilled health workforce is critical to the backbone of the health system. Projects such as the construction of a new purpose-built clinical training facility in Launceston with six additional dental chairs is fantastic for Northern Tasmania. Work is currently underway on the $4 million extension to the public dental services in Kelham Street, Launceston, to allow for dental student work placements in our region. This will be a state-of-the-art facility which is vital for Northern Tasmania.

The importance of good dental and oral health to general health and wellbeing is well recognised. There are well established associations between poor dental and oral health and acute or chronic health conditions such as heart disease and diabetes. Furthermore, the pain associated with poor dental and oral health, coupled with social anxieties about appearance and the avoidance of certain foods, can impact significantly on the quality of life.

This inquiry has certainly been worth while. I encourage MPs and senators to read the report and the recommendations from this committee. I was particularly impressed by the service provided in the Dubbo area. There was a fantastic service training new doctors and also providing a private clinic, which I think is fantastic. It was my first trip to Dubbo and I was very impressed by the service provided in that area.

In closing, I wish to thank all those who took the time to put in submissions and appear before the committee. I also thank my fellow committee members and, in particular, the secretariat for the valuable work they provided.

Debate adjourned.