Ms Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

I rise to speak on the Dental Benefits Legislation Amendment Bill 2014 and note that this is the first time this bill has been debated for second reading since the minister's second reading speech on 26 March, which is quite some time ago—well before the budget. The bill amends the Health Insurance Act 1973 and the Dental Benefits Act 2008 to waive debts for dentists under the former Medicare Chronic Disease Dental Scheme, which was closed in 2012. It will also make a number of amendments for the operation of Labor's Child Dental Benefits Schedule to bring the compliance framework of the scheme into greater alignment with Medicare's compliance framework. This bill amends both acts so that the Professional Services Review scheme can be applied to any dental services provided under the Child Dental Benefits Schedule so that suspected cases of inappropriate practice can be investigated.

The bill amends the Dental Benefits Act to enable the chief executive of Medicare and relevant employees of the Department of Human Services to obtain documentation from a dentist to substantiate the payment benefits under the Child Dental Benefits Schedule. Finally, the bill makes a number of machinery amendments to both the Dental Benefits Act and the Child Dental Benefits Schedule. I will say at the outset that Labor will not be opposing this bill but I will have a second reading amendment on the bill as well.

While the contents of this bill are of themselves not too contentious, the remarks of the minister when he introduced it are of great concern to Labor, especially in relation to the concern that he flagged at the end of his second reading speech about the operation of the Child Dental Benefits Schedule. This is a government that, frankly, came to power promising no cuts to health and no new taxes and then, when elected promptly set about smashing public hospital funding and announcing a new tax on visits to the doctor. When a minister has not been up-front before the election about how he planned to rip $50 billion out of public hospitals and slug patients with a tax every time they visit a doctor or attend an appointment for a scan, I think we have some very strong grounds to be deeply concerned when this same minister flags his so-called 'concerns' with another scheme that he supported in opposition.

It is worth discussing here a little of the history of Commonwealth funding for dental schemes, which we are debating here today. The great missing link in public health in Australia has been in dental care. It was left out of Medicare back in 1984 reputedly because of both cost and the politics of having to tackle both doctors and dentists at the same time, which was considered a bridge too far. This is especially so when one recalls that the Liberal Party was then, as it always has been, implacably opposed to Australians having access to decent, affordable health care regardless of income—a battle we are fighting again today over the GP tax. It is good to know your history when it comes to these matters.

Labor has to fight two elections, a double dissolution and a historic joint sitting of parliament to introduce universal health care in Australia with Medibank only to see it promptly torn down by the Liberals after 1975. In 1983 we were elected again on a promise of introducing universal health care and, despite ferocious opposition, again from the Liberals, succeeded in introducing Medicare in 1984. The Liberals promised after every election that they were going to tear it down, and they finally learnt their lesson in 1996, when John Howard promised, if elected, to retain Medicare despite having once called it 'the greatest disaster ever to befall the health system'. It is important to know your history when it comes to these matters. I know some on the opposite side are parroting the same lines, they are staying on message, but this is your history. The history of the Liberal-National Party is to get rid of Medicare, and now you are just trying to do it by stealth.

So Labor has had to fight the Liberals every step of the way to introduce Medicare and to protect it from those who have thought decent health care should only be available to those who can afford it. Throughout that period we have sought to improve and extend Medicare. Previously when we are in government we did have a Commonwealth Dental Scheme, a very important scheme that was actually seeing public waiting lists in dental going down. What was John Howard's first act when he came into this parliament as Prime Minister? He got rid of that scheme and introduced a very limited scheme that then blew out. It was very limited scheme that was never designed to do what it was ending up doing back in 2012. It is important to know your history when it comes to dental health and when it comes to Commonwealth funding for dental health.

The former Labor government was able in 2012 to provide the most significant Commonwealth investment in dental care since Federation. There has never been any logical reason for why health care should stop at our teeth and why Australia should care about every part of the health of a person's body, apart from what is in their mouth. The abolition of the Commonwealth Dental Scheme by John Howard was, frankly, something that saw public dental lists blow out in this country. He was responsible for that.

We know that dental care is, of course, not just about teeth, but poor dental care is a good determinant of poor general health care; that poor dental care is linked to chronic disease; and that if teeth are not properly cared for poor dental care too often leads to much greater health problems. So it was with some pride that as a member of the former Labor government I was involved in the steps we took to advance our universal system of health care to dental care with the announcement of a $4.1 billion Dental Reform Package. As far reaching as this was, it still the not fully extended to dental care the same level of support that Medicare provides for just about every other area of health care. As always, the budget had to be taken into account. We had to ensure that the steps we talk to extend Medicare to dentistry could be afforded and, indeed, justified against the competing demands of so many other worthy areas of health. So we targeted the areas of dental care that were most likely to deliver the greatest return of that investment and was most deserving of funding. In other words, children and low-income earners.

The $4.1 billion Dental Reform Package we announced back in 2012 comprised $2.7 billion for around 3.4 million Australian children who will be eligible for subsidised dental care. Ours was 'Helping kids to grow up smiling'; the government has now changed it to the Child Dental Benefits Scheme. There was $1.3 billion for around 1.4 million additional services for adults on low incomes to have better access to dental care through the public dental system; and $225 million for dental capital and workforce was to be provided to support expanded services for people living in outer metropolitan, regional, rural and remote areas. The centrepiece, of course, was the Child Dental Benefits Schedule, which commenced on 1 January this year—the program that meant that for over 3 million children aged two to 17, going to the dentist now has become like going to see the GP.

We introduced the scheme because of disturbing evidence that the oral health of children has been declining since the mid 1990s. According to the Australian Institute of Health and Welfare, in 2009 the proportion of children who had experienced decay in their baby or deciduous teeth ranged from 42 per cent of five-year-olds to 61 per cent of nine-year-olds. The proportion of children with permanent teeth affected by decay ranged from five per cent for six-year-olds to 58 per cent for 14-year-olds. That is a damning indictment on what was happening in dental for children.

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. So the scheme sought to tackle that by providing a capped benefit of $1,000 per child over a two calendar year period targeted at low- and middle-income families by tying eligibility to those receiving family tax benefit part A or an equivalent Australian government payment—trying to put money where it was most needed: preventative health of children's dental and for low- and middle-income earners. The program is a crucial investment in the long term health of children, because we know that dental health in children is the best predictor of dental health as adults but also a predictor of overall health. In just the first two months of this scheme's operation, more than 84,000 children have received dental treatment under the Child Dental Benefits Scheme, and that includes some 26,000 children outside of major cities. As those figures show, it is a scheme that has been desperately needed, and Labor was very proud to deliver it.

In addition to dental for children, the Dental Reform Package provided extra funding for 1.4 million additional services for adults on low incomes, including pensioners and concession card holders and those with special needs to have better access to dental health care through the public dental system. It also meant more services and more dentists in areas of most need—outside capital cities and large regional centres where, again, we know there are higher rates of poor dental health and chronic illness. Again here the funding was driven by the evidence about who was most in need of government support. According to the Australian Institute of Health and Welfare, while untreated decay and fillings are similar across income ranges, if you earn more than $60,000 a year you have on average seven more teeth than those earning less than $20,000 per year. That is, again, pretty damning statistic and evidence that, sadly, in Australia, while we have a health system that guarantees first-class care for people who have an accident or get cancer or heart disease, the state of a person's teeth are still a very good determinant of income.

Importantly, this package was in addition to the $515 million announced in the 2012-13 budget, which included a blitz on public dental waiting lists. In the 2013 calendar year, over 20,000 public dental patients received treatment because of Labor's funding of the public dental waiting list blitz. It is because of Labor that over 280,000 adults and children have better oral health now resulting from free or subsidised care under our Dental Reform Package. And just as it was only Labor that introduced or defended Medicare, so it is only Labor that would advance Medicare to improve the health of all Australians. And just as this government seeks to tear down Medicare, so it is, we suspect, with Labor's dental health programs. Whereas Labor sought to extend and improve the health services available to all Australians, the Liberals demonstrate that time and time again they see decent health care as something that should only be available to those who can afford to pay. Indeed, in introducing this bill, the Minister for Health told this parliament:

I put on the record some early concerns about the way in which the Child Dental Benefits Schedule was structured … we will continue to monitor that program very carefully because I do have some concerns about the way in which this scheme was designed …

The truly bizarre thing about this is that this scheme, although conceived, announced and funded by a Labor government, actually commenced its operation under the Abbott government in January this year. The Minister for Health, if he had concerns about the scheme's structure or its design, had the opportunity to amend it prior to its commencement in January. But he waited until March to drop his concerns into the back of a speech, making a series of technical amendments to the child dental benefits scheme and amendments to the issues around debts for dentists following the abolition of the Chronic Disease Dental Scheme. He drops it in at the tail end of a speech. So despite not opposing the scheme in opposition and then actually presiding over its introduction—being in government for several months, having the opportunity, having representations from dental associations across the country about the scheme—it seems the minister is already planning to make changes to the Child Dental Benefits Schedule for millions of kids. When a minister who promised no cuts to hospitals and then slashes $50 billion from hospitals says that he has concerns about the child dental health scheme, the warning lights are flashing bright red and the sirens are sounding even louder as to what they are intending to do with this scheme.

This has all the hallmarks of yet another example of the Abbott government laying the groundwork for cuts and destroying universal health care in Australia. They are pulling the same trick that they did with their new GP tax and Australian families should not fall for it. They can see the evidence about this government's commitment to dental health right before their eyes in the budget. Before the election the Prime Minister, as the then opposition leader, declared in January 2013 that there was an aspiration to extend Medicare to cover dentistry. Fitting with this government's dedication to saying one thing to get elected and doing an entirely different thing in government, rather than extending Medicare to dentistry, they instead slashed the commitment of the Commonwealth to fund dental care.

In just its first few months in office we saw the Abbott government reverse the proposed expansion of the Voluntary Dental Graduate Year Program, cutting $40 million. The budget itself saw nothing but cuts to dental programs: $229 million was cut from the dental infrastructure scheme for rural, regional and outer metropolitan areas—the scheme that was designed to provide more dental chairs for public patients across the country, more capacity for clinical training places for dentists across the country; another $15 million was cut from Charles Sturt University's program to establish dental clinics on the New South Wales Central Coast; and $390 million has been cut by putting on hold a program for the states to shorten adult dental waiting lists by delaying the second national partnership agreement with the states, with no guarantee that money will ever be returned into the public dental system down the track.

The first two cuts show the contempt this government has for the people in rural and regional Australia, and, frankly, the complete inability of the National Party to stand up for its constituents against a Liberal health minister determined to slash and burn health, particularly in the regions. Rural and regional Australia only has about half as many dentists per capita as metropolitan areas, and these programs, while not fixing that overnight, would have gone some way towards improving the number of dentists practicing outside our capital cities. Indeed, just this month I attended, with the Assistant Minister for Health, the opening in my electorate of a new student accommodation facility designed to help universities train medical students locally, giving them a taste of living and working in regional Victoria. As the minister then correctly noted, the investment, which came from the former Labor government, ensures more medical students not only live and train in regional Victoria, but those who do have that experience are much more likely to want to practice in those areas when their training is complete. Knowing that, this government still cut those programs to the detriment of people in rural and regional areas who are in desperate need of more dentists and better dental care.

The deferment of the national partnership agreement means hundreds of thousands of people with poor dental health, many of them in constant pain, will continue to wait for treatment. An estimated 400,000 people are on dental waiting lists around the country, and in some states that program has helped to cut waiting lists by up to half. As Griffith University Professor of Dental Research Newell Johnson told the ABC, these cuts will be a disaster for dental health and could double or treble waiting lists. He said:

Then the waiting lists are going to grow and you are going to have people sitting there in pain once again …

Dr Melanie Hayes, National President of the Dental Hygienists' Association of Australia, correctly nailed this as the Abbott government abandoning 'continued investment in preventive oral health, demonstrating contempt for those Australians who rely on public dental services'.

And already we see these cuts have had an impact on real people. The budget cuts have now placed in doubt the work of the community dental programs operating out of a clinic in Light Square in central Adelaide. The Light Square clinic was set up with government grants, support from the Australian Dental Research Foundation and significant donations from medical companies; it gives free care to a range of people otherwise unable to afford a dentist. It is also an important training ground for final year Adelaide dental students and provides simple restorative work like fillings as well as extractions, cleaning and preventive care. But its funding will wind up at the end of the year, possibly leaving only donations as a funding source. The clinic is working on strategies to see how it can keep going, but it has made it clear the loss of federal government funding means it will be treating many fewer patients with no guarantees of how long the organisation can survive. And that is a pattern that will be repeated right the way across the country for hundreds of thousands of Australians unable to find the money for dental care, many of them waiting years for public clinics to treat them.

So that is the record of this government when it comes to dental health: it is as mean and deceitful as it has been in all other areas of health. It is no surprise then that these bills are not about improving dental health, but are, instead, simply technical bills designed to pick up a number of issues with various dental programs, including some long gone, such as the Chronic Disease Dental Scheme, which Labor closed in 2012. This scheme was poorly targeted and was failing to address the problems in the existing dental scheme such as public dental waiting lists, infrastructure, workforce distribution and of course the appalling state of children's dental health in Australia. The scheme did not deal with those issues and we believe very strongly that the money for the Chronic Disease Dental Scheme would be better targeted at hitting those areas: children's dental health and poor and middle-income Australians who are reliant on public dental schemes. That money was better spent in that area.

The Department of Human Services conducted audits of the Chronic Disease Dental Scheme and found that there was a high rate of noncompliance with the provider-reporting requirements set out in section 10(2) of the determination. Debts were raised against dentists found to be noncompliant through the audit process.

Andrew Nikolic (Bass, Liberal Party) Share this | Link to this | Hansard source

It was a witch-hunt!

Ms Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

The same government department bureaucrats who engaged in that so-called 'witch-hunt' are actually here, so you might want to be a bit more respectful of those people. Further, more than 20 per cent of recipients were not pensioners or concession card holders, and more than 20 per cent of spending was on high-cost restorative services.

Following representations from the Australian Dental Association and other groups, which outlined that dentists had not been aware of their obligations until April 2010, the government has decided that debts due to the Commonwealth solely as a result of noncompliance with section 10(2) before this time should be waived. Labor supports that approach. The government has further decided that debts due solely to noncompliance after April 2010 should be waived as long as the dentist can demonstrate an intention to comply with their obligations. Labor, again, supports that approach. The minister describes this as 'dentists who did nothing more than make minor paperwork errors and who have been waiting for way too long for adequate resolution.' It is worth noting that debt waivers are already proceeding under section 34 of the Financial Management and Accountability Act 1997; however, the government thinks this is a slow and unwieldy process that requires unnecessary administration and processing in both the Department of Human Services and the Department of Finance.

Some dentists have already paid debts to the Commonwealth that fall under this waiver, and this bill provides for those amounts to be repaid to the dentist. Again, we support that. Labor takes very seriously the issue of inappropriate professional behaviour and supports the application of compliance powers as well as the operation of the Professional Services Review scheme. We will not be opposing this section of the bill, but we note the minister's assurance that:

… this amendment will not excuse those dentists—a small number—who did not comply with other legal requirements of the scheme or, in particular, who committed fraud. Only those dentists who provided services in good faith will be eligible to have their debt waived.

That is as it should be. The bill also amends the Health Insurance Act 1973 and the Dental Benefits Act 2008 to introduce what the minister describes as 'critical changes for the efficient operation of the child dental benefits scheme.' These changes bring the compliance framework for the Child Dental Benefits Schedule into greater alignment with Medicare's compliance framework and include the power to compel a provider to comply with a request to produce documents to substantiate the payment of benefits. This is aimed at ensuring this scheme is targeted at those it was intended for—the low- and middle-income earners who qualify for family tax benefit part A or similar payments. This bill amends both acts so that the Professional Services Review scheme can be applied to any dental services provided under the child dental benefits scheme so that suspected cases of inappropriate practice can be investigated.

The Professional Service Review is an independent authority which has operated under the Health Insurance Act since 1994 to examine suspected cases of inappropriate practice under Medicare referred by the Department of Human Services. Dentists providing services under the MBS are covered by the Professional Service Review and it would be appropriate that dentists providing services that attract a benefit under the Dental Benefits Act are also covered by the PSR scheme. This bill also enables the Chief Executive Medicare and relevant employees of the Department of Human Services to obtain documentation from a dentist to substantiate the payment benefits under the child dental benefits scheme. Again, as these changes appear to be designed to reinforce Labor's intent when we introduced the scheme, Labor will not be opposing this.

Finally, the bill makes a number of technical amendments to the Dental Benefits Act, including: clarifying provisions related to the disclosure of protected information; allowing the delegation of ministerial powers to the Secretary, or an SES employee, of the Department of Health; amending the definition of dental provider; and correcting a minor technical error in section 4. Again, Labor will not be opposing these changes.

But I want to finish back where I started. We have serious concerns not so much about what is in this bill, but what the minister said when introducing it—namely his so-called concerns with the way in which the child dental benefits scheme has been structured, and that he is keeping a watching brief on these concerns. We have seen this before. This government's concerns are wholly manufactured excuses to lay the groundwork for cuts. Well, minister, Labor has concerns about what you have had to say and what you plan to do to this scheme and rest assured, we will be keeping a watching brief on you as well.

As I flagged earlier, I would now like to move an amendment to this bill. Therefore, I move:

That all words after 'That' be omitted with a view to substituting the following words:

'whilst not declining to give the bill a second reading, the House notes that the bill is one in a range of changes the government is proposing that will increase the cost of healthcare for all Australians.'

Don Randall (Canning, Liberal Party) Share this | Link to this | Hansard source

Is the amendment seconded?

Ed Husic (Chifley, Australian Labor Party, Shadow Parliamentary Secretary to the Shadow Treasurer) Share this | Link to this | Hansard source

I second the amendment.

Andrew Nikolic (Bass, Liberal Party) Share this | Link to this | Hansard source

I welcome this opportunity to address the House on the Dental Benefits Legislation Amendment Bill 2014. In particular, I would like to highlight a trifecta of equally important issues that address some of the revisionist history that we have just heard from the member for Ballarat. Firstly, the omissions and even injustices of the previous government in relation to policy in this important area; secondly, to focus on the benefits of this amendment bill to the dental profession, the very same professional community which were so unnecessarily harried by our predecessors; and finally, but perhaps most importantly, the practical benefits of this amendment bill for many Australians. This is most especially the case for those who have not been able to access adequate dental care because the former government had so mismanaged, then abandoned altogether, the practically-functioning and effective dental architecture enshrined in the then Chronic Disease Dental Scheme.

Now to the first of these issues: egregious former government oversight, occasioning negligence. The previous government's policy, operations and management of the Chronic Disease Dental Scheme, prior to formally closing it in 2012, was manifestly inadequate and unjust. This included, most particularly, their vindictive pursuit of dentists under the thinly veiled guise of Labor's purported commitment to recovering overpayments. This vindictiveness was directed at dentists who had treated in excess of one million patients. Yet, in reality, these financial transfers were, in the main, the result of minor technical errors in paperwork and administration. In this more balanced context, Labor's vocal condemnation and sometimes McCarthyesque pursuit and condemnation of dentists was overwhelmingly without substance—and even bordered on being slanderous. It was in equal parts, cynical, shameful and wholly manipulative.

What then, might you ask, was the real motive that impelled Labor's duplicity? It was the removal of a scheme to which they were, and remain, ideologically opposed, and in which the then Prime Minister had an obvious close personal interest. In a nutshell, Labor chose to forsake the collective public good because it presented the opportunity to attack the work of former health minister and current Prime Minister. By their actions, Labor sought to undermine an altogether effective dental scheme which was doing much good for many Australians, particularly those who were economically disadvantaged.

That Labor's pretext of choice was related to minor clerical errors says much more about the nature and quality of the opposition than about the largely innocent targets of their fault finding—the hardworking dental community. Yet again, as has so often been the case with our opponents, this saga showed them to be more focused on parochial self-interest than on the broader and much more substantive issues of national strategic improvement and social wellbeing. This is a case of Labor not seeing the wood for the trees, of exaggerated attention to paper error rather than to the widespread alleviation of chronic dental disease and the pain and other health consequences that follow. Surely, in the interests of the very best social policy, all of us in this parliament must strive to elevate our thinking, well beyond the deadening hand of retrospective bookkeeping to a plane of higher, even enlightened, possibility to identify and seize ways in which the lives of our fellow Australians might be improved. During its period in office, from 2007 to 2013, over the issue of dental care, Labor fell very far short of this laudable standard.

I would like to add a very human dimension to the consequences of Labor's action. In early 2013 I was approached by a young women, in her 20s, from Launceston, who was suffering from a very serious chronic dental condition. It was a condition that was badly affecting her lifestyle in every way, including her confidence. This young woman was at risk of losing her teeth from this chronic condition. Remember, this is a woman in her 20s. She only worked part time and did not have private medical cover and was simply unable to pay up-front for the desperately needed treatment she required. So desperate were her circumstances that she had sought loans and even tried to get an early release of her very modest superannuation to get the treatment she needed.

The tragedy here is that, under the Liberal Party's Chronic Disease Dental Scheme, established under the former Howard government in 2007, her condition would have been covered because it was the only Medicare dental scheme that provided chronic dental treatment for adults. Under John Howard's dental scheme she could have accessed benefits of up to $4,250 over two calendar years.

It is instructive to note that 80 per cent of people who received treatment under the Howard government's Chronic Disease Dental Scheme were those who needed it most—namely, concession card holders. It was a scheme that provided more than 20 million services to over a million patients—that is, before the Labor government closed it down for political reasons at the end of November 2012. No new patients were allowed to access services after 7 September 2012. You can do the maths. This left a 13-month gap in services, meaning that the young lady who approached me in Launceston, sadly, fell through the cracks. She was not the only one. There were children in the midst of treatment who were unable to have their treatment completed by 30 November 2012, when Labor arbitrarily changed the goalposts.

The young lady I speak of was a victim—a real-life consequence of Labor's ill-considered, knee-jerk policy changes. We also saw ill-considered policy changes to border protection, pink batts, the live cattle trade, the NBN, overpriced school halls, with their never-ending appetite for borrowed money. It is a very long list and Australian taxpayers are bearing the consequences.

In relation to the young woman I mentioned, I managed to get her the help she needed by pleading her case to a local service club. They came up with the $3,000 needed to start her treatment. We got the money, paid the dentist and her future health is now looking much brighter today, but all of that stress and pain should not have been necessary. We should not have had to rely on the goodwill of a Lions Club in Launceston.

That is why I am particularly pleased to add my voice to a bill that amends the Health Insurance Act 1973 and the Dental Benefits Act 2008 in order to introduce critical changes for the efficient operation of the Child Dental Benefits Schedule. It will also bring about an improved process whereby those dentists who have unknowingly erred clerically and/or administratively—but certainly neither knowingly nor deliberately—as part of the former Medicare Chronic Disease Dental Scheme, will have these debts waived.

The detailed implementation of this effort will include two important things: a move to secure the appropriate waiver of these debts by the Minister for Finance, under section 34 of the Financial Management and Accountability Act 1997; and the requirement for the Chief Executive Officer of Medicare to waive the debts of those dentists concerned, thereby saving both them and others, including indirectly the wider Australian public, much time and angst in the process.

These intended steps by the government are only fair and reasonable, and are also in keeping with this government's strong desire to differentiate between genuine error and deliberate financial misappropriation. To do otherwise—as did Labor's bull-in-a-china-shop approach—would be to continue to waste time, energy and emotion, not least of which on the part of our valued dentists. Such a course would also be contrary to that most rare commodity on the other side of the chamber—a welcome outbreak of common sense.

Perhaps, most important of all for dentists is that these actions and initiatives will go a long way in matters which are other than financial in nature. By and through them, this essential and important professional body will be provided certainty of action, faith that their concerns have been patiently listened to and taken seriously, and some increased measure of professional esteem and self-respect by the constructive erasing of what many reasonably feel to be the former government's widespread tarnishing of their professional reputation, conduct and competence.

This bill also foreshadows additional improvements for the Australian community, including improved auditing and compliance mechanisms, the guaranteed independent examination of alleged or suspected future malpractice and enhanced efficiency measures. I will outline here how that will be achieved. Firstly, for auditing and compliance, in order to ensure that taxpayers' money is spent appropriately and that compliance audits are made as efficiently and effectively as possible, this bill introduces amendments which will more closely align the compliance frameworks of the Dental Benefits Act and Medicare. This will include the power to compel a provider to comply with a request to produce documents to substantiate the payment of future benefits.

Secondly, for guaranteed independent examination of alleged or suspected malpractice, the Professional Services Review, or PSR, is an independent authority which examines suspected cases of inappropriate practice referred by the Department of Human Services. The PSR protects patients and the community from the risks associated with inappropriate practice, and protects the Commonwealth from having to meet the cost of medical and health services provided as a result of inappropriate practice. The PSR can currently investigate cases of inappropriate practice under the Medicare program and the PBS, the Pharmaceutical Benefits Scheme. This bill will enable the PSR to also investigate cases of inappropriate practice under the Dental Benefits Act.

In conclusion, this bill establishes a provision requiring the chief executive of Medicare to waive debts raised against dentists in limited circumstances for services provided under the former Medicare Chronic Disease Dental Scheme. It will allow the Professional Services Review scheme to apply to dental services provided under the Dental Benefits Act 2008, consistent with other Medicare services. It will ensure powers under the act enable the chief executive of Medicare and relevant employees of the Department of Human Services to obtain documentation to substantiate the payment of dental benefits in a similar way to Medicare benefits. The bill also makes a number of technical amendments to the act, including to support the framework for the Child Dental Benefits Schedule.

Dental health care may appear rather prosaic to some—doubtless amongst this body are members of the former government whose collective efforts on it were so singularly unconstructive. Both their actions and their selective inaction in these areas impacted negatively on the provision of improved dental care for many Australians, including the distressed young woman about whom I raised the attention of this parliament. At the end of Labor's six years in office, the system was manifestly more inferior than it had been at the start. In no way were many Australians any better off—neither the highly qualified and dedicated professional dental community entrusted with providing this service nor many members of the long-suffering public, many of them whom should have been its fortunate beneficiaries.

By our efforts on this bill, the government has, just as it has been compelled to do on so many other policy fronts, confronted a mess inherited from Labor—and, in this particular case, a mess exacerbated by a financial witch-hunt against dentists for a cynical ulterior motive and purpose. The government's efforts on this issue will be to the longstanding benefit of many Australians, regardless of their social circumstances. I, therefore, have much pleasure in commending the Dental Benefits Legislation Amendment Bill 2014 to the House.

Stephen Jones (Throsby, Australian Labor Party, Shadow Parliamentary Secretary for Regional Development and Infrastructure) Share this | Link to this | Hansard source

The bill before the House deals with two particularly important schemes—the Medicare Chronic Diseases Dental Scheme and the Child Dental Benefits Scheme. They both deal with the way in which the Commonwealth government supports public dental services. In the case of the CDDS, it is about chronic diseases—or it was about chronic diseases. In the case of the CDBS, it is about children's dental services and, particularly, what the Commonwealth can do to prevent the onset of chronic diseases within children at a very young age. There is agreement before the House on the passage of these bills but there is a very different approach between the major parties on how we deal with dental health and dental health care, and the public support for dental health care in this country.

Before addressing some of these issues, it is worth going through some of the key facts around dental health in this country. Many may not be aware that in 2010 government survey data showed that more than one-quarter of people aged five or older avoided or delayed visiting a dentist due to cost—that is, more than one in four aged five or over delayed visiting a dentist because of cost. From 1994 to 2010, there was an increase in the proportion of adults avoiding a visit to their dentist from 25 to 30 per cent—again, because of cost.

As we contemplate health policy in this country and the introduction of price signals into the primary healthcare space, if we want to see the impact of a price signal on the delivery of health care in this country, we need look no further than the delivery of dental care. Here you have a fantastic dataset on the impact of a price signal when it comes to people accessing affordable health care, in this case dental care. What is the result? One in two 12-year-olds are experiencing tooth decay in their permanent teeth. In 2010, the proportion of children who visited a school dental service who had decayed, missing or filled baby teeth varied from 48 per cent for five-year-olds through to a massive 63 per cent for nine-year-olds. That is the Australian Institute of Health and Welfare data.

Normally when you see an improvement in the wealth and incomes of a country and improvements in health standards overall, you would expect that to flow through to all areas of health. But in dental care, we are not seeing that. Clearly something is going wrong. Only two in three people aged five and over visited a dentist in the last 12 months. Clearly we have some issues that we have to deal with.

If you look at the links between dental health, oral health and chronic health conditions, the research is quite clear. Dental decay is the second most costly diet related disease in Australia with an economic impact comparable with heart disease and diabetes. We know that there is a clear link between oral health and other chronic health diseases. Indeed, more than 63,000 Australians are hospitalised every year for preventable dental conditions. It is the third highest reason for acute preventable hospital admissions. Oral cancer is the eighth most common cancer in Australia. Dental disease has been linked to cardiovascular disease, diabetes, respiratory illness, stroke, dementia and low birth weights in babies.

Dental Health Services Victoria CEO Dr Deborah Cole has told that National Advisory Council on Dental Health:

Oral health can no longer be ignored. We have to protect natural teeth from decay and disease because these diseases are not limited to the mouth, they affect people's general health and wellbeing.

That is a national survey, but if you attend your mind to the situation in rural and regional Australia, the numbers are far worse. It might surprise you to know, Deputy Speaker, that over the last two decades we have actually increased the number of dentists who are practising in this country. Unfortunately, over 79.7 per cent of those are employed in our nation's major cities. Just like in all aspects of the health system, people who are living in rural, regional and remote areas are at a disadvantage when it comes to access to a dentist and when it comes to affordability. Less than one per cent of dentists are employed working in remote parts of the country. People in rural and remote areas also suffer the highest rates of gum disease—36.3 per cent compared to just 22 per cent in our major cities. The same goes for tooth decay—a massive 37 per cent in remote areas compared to just 23.5 per cent in major cities. When you look at the Indigenous demographics in remote Australia and compare that to non-Indigenous in both remote and rural areas and major capital cities, the gaps are greater still.

This is an issue that the parliament needs to grapple with. Clearly, we cannot just simply leave it to the market. If the market was going to fix this, we would not have the glaring gap in services between rural and city. We would not have the glaring gap in health outcomes between rural areas, remote areas and city areas. Clearly, the market is not going to be the solution to resolving these chronic health issues.

Perhaps mindful of this issue, former Prime Minister John Howard set up the Chronic Disease Dental Scheme in 2007. Perhaps it was this massive problem that we had with chronic dental disease issues that moved the former government to set up the scheme in 2007. The scheme paid up to $4,250 over a two-year period for dental treatment for people whose teeth had become so bad that it was affecting their general health. A good idea in addressing chronic health issues, but unfortunately the CDDS was fundamentally flawed, poorly targeted, open to rorts within the system and did not provide support for the majority of Australian families struggling to afford dental care.

The Department of Health conducted an audit of the CDDS and found that there was a high rate of noncompliance with provider-reporting requirements. Debts were raised against dentists found to be noncompliant through the audit process and indeed some of those debts have led to the legislation before the House today. We know that there were rorts going on. More than 20 per cent of the recipients were not pensioners or concession card holders. That is not a rort and I make no criticism of dentists for that. That is just an incidence of bad design. Each and every member of this House would have had constituents come before them over the period of the operation of the scheme and have complaints raised with them—complaints such as overcharging, poor workmanship on the design of dentures.

I have had people come to me in my electorate office on no less than a dozen occasions with problems that they had in accessing services and problems with the services that were provided under this scheme. It might have been a good idea, but it was certainly very poorly targeted. The checks and balances were not in place. You can only imagine: if it were a Labor government scheme, we probably would have had a royal commission into the matter by now. It was these reasons that led Labor in government to review the system and then to transition it to a closure.

We have a proud legacy when it comes to dental health care. In government, we announced the biggest dental package ever, the $4.1 billion Dental Health Reform Package, introduced by the then health minister, Tanya Plibersek, which came on top of nearly half a billion dollars in measures committed in the 2012-13 federal budget to address the oral health needs of Australians and to be provided over six years. The scheme Labor put in place was endorsed by the Australian Dental Association, the National Rural Health Alliance and the Australian Medical Association. It recognised the flaws in the previous schemes and targeted, on the one hand, preventive measures in young people providing a scheme to look after school aged kids and putting in place additional funding to reduce the waiting lists on the state-run public health systems, putting in place improved funding and assistance for capital works and training for future dentists.

What did the Abbott government do on winning office? You might recall I mentioned the big gaps we had in the number of dentists practising in rural and remote areas when compared to those practising in the cities. One of the first things the Abbott government did when coming into power was to cut $40 million from the Voluntary Dental Graduate Year Program, designed to assist people take up the option of practising in rural and regional Australia—$40 million, one of their first acts, axed out of that program. That was only a curtain raiser for what was to come in the subsequent budget because then we saw over $390 million cut from the national partnership agreement struck to help reduce the public dental waiting lists. It was designed to deal with the sorts of chronic diseases that the member for Bass spoke about in his contribution to this debate.

Whenever I hear the member for Bass give one of his fiery retorts in this place I have to wonder whether it was as fiery as the intervention he makes in his own caucus room. I wonder whether he got up in his own caucus room to denounce the $390 million cuts to dental programs ushered in by his own health minister and his own government as one of their first acts. I suspect the answer is no.

Before entering a debate on health, I always have a look at what the National Party has had to say on this issue because, as the so-called champions of rural and regional Australia, we always expect them to always have something to say and then to follow through with their actions. I looked at the policy platform which they took to Australians before the last election where they said at page 49:

We will give priority to the states in their efforts to improve the current public dental services and expand their ability to provide services beyond the basic emergency care.

There you have it: a commitment, a promise to expand the current public dental services. They go on to talk about their long-term goal being extending Medicare into dentistry services. You have to ask yourself: where are the National Party members today. Are they going to stand up and condemn their coalition partners for the $390 million worth of cuts to those programs, which they were talking about defending? I look forward to those contributions. The Liberal and National parties have good form around this issue. If you are going to deal with dental health you have to do deal with prevention and fluoride is the key. A former Queensland Premier had put in place a program to ensure fluoridation to Queensland. One of the things you are going to see in Queensland in about 20 years time is a phenomena known as the 'Campbell Newman grin' because one of his first acts when he became Premier was to axe the $14 million set aside by the former Labor government to introduce fluoridation to Queensland water. As a direct result, we are going to see dental health for Queenslanders, who have one of the poorest outcomes anywhere in the country, going backwards. I am looking forward to the contributions from the Queenslanders and the National Party members to this important debate on dental health care.

Andrew Laming (Bowman, Liberal Party) Share this | Link to this | Hansard source

It takes a special contribution to debate dental care for 10 minutes and not to mention the private dental sector who represent 98 per cent of the dental profession, but after all we are dealing with the Labor Party tonight—that is right, with the massive scotoma they hold towards the private sector. They are just determined to funnel dental resources into an overstretched, under resourced public sector which cannot recruit dentists in the first place to do the work as the anathema for all dental challenges.

We need to go back to 2007 to start this story and I will be brief because a lot of water has gone under the bridge. We have had some technocrat Labor health ministers in that time making a mess of the dental system. They never found a sector of medicine where they could not stick their finger in the hive and upset the professionals. They managed to do it in eye surgery. I recall the then member for Gellibrand deciding that she would arbitrarily halve the rebates the cataract surgery and being airlifted out of the red zone by then Prime Minister Kevin Rudd when it all fell to pieces very early in 2010. The Labor government was determined to kick every part of the medical profession for the simple reason that they earn too much money. That is right—the fundamental sin of the medical profession in the eyes of this Labor opposition is how much money they ear. No matter how they try to couch the terms, that is really what they are trying to say to their voters. Of course, there is no problem with union reps earning enormous salaries; that is okay. In the six years they were at the helm the Labor Party were determined to chase those nasty doctors and dentists, those beleaguered professionals as far as they possible could and to make life a bloody misery for them. That was the intention. The Medicare Chronic Disease Dental Scheme was held above their heads as the Howard legacy with which they were intent to haul dentists over a barrel. That is right: line them up and make life a misery—for no greater sin than they failed to fill out the form correctly.

Let's just step back a bit. We have got chronic disease initiatives for doctors, and there was no problem there with poorly filled-out forms. But it was not so for the dentists. For the simple reason that they were carrying out a former coalition government policy, they were chased to the end of the earth on every indiscretion and every incomplete piece of paperwork. Make no mistake: this service was almost always performed; it was just that the forms were not filled out correctly in the majority of cases. What the previous Labor government did was sinful—in pursuing dentists who were just doing their job under the law of the day and treating the sickest Australians for their dental disease.

We just heard a Labor speaker tell you how the burden of dental disease is second only to one other cancer and that is responsible for a whole range of other diseases around the body. He was reading out the talking points from the Minister for Health's office. Isn't that chronic disease to which the dental program set up by the coalition was targeted—those with chronic disease? That is exactly how you reduce morbidity. There is no point filling a tooth that is not causing a problem; it is filling the tooth that is leading to the heart disease. That was the essence of John Howard's problem. Often the good that men do is interred and the evil lives on after them. But I come here to simply say: the CDDS did many good things.

When you remember that about 60 per cent of people have concession cards, and that program delivered 80 per cent of the services to high-need Australians, the only sin of that program is that some people who did not have a concession card had the hide to line up and get that service. They had the hide to line up and get their teeth fixed. Having paid a progressive tax rate, having contributed to the country because of your higher income and having not taken a welfare cut, how does that dare to disqualify you from dental care in this great country? Dental care should be provided on clinical need.

Here you have the division. Forget all of this Labor preoccupation with not filling in forms correctly. You have got a Labor Party that wants to treat the poor and you have got a coalition that was treating the sick. The last time I checked, you pay tax according to your ability and you should have access to services according to need. To hear the previous speaker lamenting that 20 per cent of people had the hide to go and access dental care without having a healthcare card is appalling.

To those Australians who pay their tax, who do not have a welfare care and do not collect a family tax benefit A, I say thank you and, if you are sick, you deserve to be cared for equally and on the basis of triage—on the basis of your health or the severity of your illness. But, of course, the Labor Party is utterly blind to that.

The second great hypocrisy in the Labor approach is that, having vilified the chronic disease scheme of the coalition and worked to close it down until they succeeded in late 2012, remember this: there was a coalition opposition then very willing to work with the Labor Party to reform the CDDS. Owing to how popular it was, we were quite willing to sit down with the Labor Party. So what did they do? They refused all advances. They refused all offers to reform the CDDS. Why? Because they wanted to hold it up above their heads unreformed, point to it and vilify it as a failed scheme. They spent five years doing just that without acknowledging that a few easy tweaks could have significantly improved it.

We could have looked at some forms of means testing. We could have looked at better targeting. We could have even carved some of those CDDS resources out and treated children. But, no, to make the political point they denied treatment for children for six years and instead allowed the money to pour into the CDDS and preferred to make the political point by blaming the coalition predecessors.

Let's go back a step and think about chronic disease for a moment. Doctors can treat it without being harassed by a Labor government using chronic disease schemes but, no, dentists are different purely because it was set up by John Howard in 2007—no other reason. You can be a billionaire and go and get a chronic disease assessment—team based arrangements and allied health care—under Medicare, but the minute you do it for your dental health, that was anathema to Labor.

What did they do? They set up a Child Dental Benefits Schedule—the CDBS—in which they have simply allowed $1,000 over two years for what? Exactly the same system that was under the Howard scheme still open to all forms of abuse, overtreatment and overcharging except you are treating a child instead of an adult. There is no difference, so they were quite happy to do that for kids and say it was a great reform but what have they done? Sure, they included the family tax benefit A eligibility criteria—I have no problem with that—but overcharging and overservicing still happens with the child scheme. The very reason they undermined the adult scheme lives on to this day thanks to the Greens and the Labor Party proposition for child benefit dental care. I have no problem: the scheme should have been around years ago, but the very criticism they held was never addressed in their own scheme, and that is hypocritical to say the least.

Second, in order to bring that $4,250 available for seniors and those with chronic disease down to $1,000, the Labor Party started to make certain dental care ineligible for their new scheme. So to get it to $1,000, the first thing that the Labor Party said—and we are talking about technocrat health ministers. We had a smart technocrat in the member for Gellibrand and then we had a not-so-smart technocrat in the current member for Sydney: the Latham without the loyalty. Under her and her predecessor's care, what we ended up with in that program was large amounts of money funnelled to state public dental systems that cannot recruit dentists and completely closing out private dentists from offering any form of public care, so you lose 98 per cent of your carers. Then last of all they said: You can't have bridges done. You can't have crowns done. They actually ruled out advanced and highly technical dental care from this child benefit dental scheme. That might be fine for my kids and yours but, if you go to an Aboriginal community where there is severe disease, that kind of treatment is absolutely necessary. But it has been obliterated from the Labor scheme.

This was a Labor government with no understanding about Indigenous dental care, because those children need significant dental work. The alternative to a bridge and a crown for those that actually have not spoken to a dentist before is extraction. That means losing teeth instead of conserving them. The last time I checked in the last 10 years the great push in children is to conserve teeth, but this is a Labor government that actually excluded crowns and bridges from that care, obviously to save money—and I can see that imperative—but that does not work in Indigenous care. We needed a voucher system that provided the dental care that would absolutely conserve teeth in this most serious of situations.

The final point to be made is the exclusion of private dentists from the scheme. What I have said here is simple: the Labor Party hated that private dentists could access these payments. They then hated that the paperwork wasn't filled out completely but had no problem with doctors who did not. This bill finally brings those indiscretions under the PSR, which is a way more commonsense approach to examining these areas. Where dentists delivered the dental care but did not fill in the form, why can't they get at least part payment? No, they had to pay the entire amount back and that was so ridiculous. We had dental bodies around the country basically queueing up to beg the Labor government of the day not to take this action against dentists. But, for the Labor Party, it was not about the dentists or the patients; it was just about making a political point and bagging the coalition.

I am not for a moment going to say to you that the Chronic Disease Dental Scheme hit the nail on the head and delivered a comprehensive and complete scheme. But it targeted the most expensive, the sickest and the most complex cases and ensured that you were treated, whether you were rich or poor—remember that. I thought the previous speaker from Tasmania gave an excellent example—that of a young working women, earning barely the basic minimum wage. This woman, in her late 20s, had decay through 20 of her teeth and was facing extraction of all of them and dentures. It was that Labor Party over there who said, 'Because you hold down a job, you can't have dental care. You shouldn't be eligible for it because you don't have a concession card.' That was their only concern—'You work; so you are not eligible to go to a state dental facility and we do not care about you.' Under the coalition's scheme she would have had her teeth fixed, based on clinical need. The problem is that those opposite have never had a clinician of any quality over there to help them with their policy. You are driven by technocrats who care only about cost-cutting and niggling the professions who deliver this valuable care. I say to the opposition, 'You have a chance to rethink this.' The opposition now have a chance to rethink it and to get it right.

We obviously support satisfactory arrangements for seniors, for those in need and for children. It should go down in the records that, while these are only minor amendments that take an enormous pressure off dentists, for six years it was the Labor Party who held up dental reform for no better reason than to have a target to shoot at in the form of the CDDS. They left us with no dental care for 13 months—in that almost fallacious fight to find a surplus that they could never deliver. People who were half treated with dental care were told, 'By the end of the month, there will be no more services that are public funded.' It was a disgrace at nearly every level. It is amazing to think that a party that pride themselves on social policy could get it so utterly wrong and, in the end, criticise us because a few rich people got their teeth fixed. That was apparently the sin of the CDDS—that a single dollar went to someone who did not have a concession card.

Let me say thank you to those Australians who pay their tax under a progressive system, who work hard and who are self-reliant. If tough times and poor health befall them, they deserve some care from the state—and that is a situation that has not been occurring in Labor state governments around the country. Under the CDDS they were denied that care. I look forward to a day when those people can get comprehensive dental care regardless of their age.

Shayne Neumann (Blair, Australian Labor Party, Shadow Minister for Indigenous Affairs) Share this | Link to this | Hansard source

I speak in support of Labor's position in relation to the bill currently before the chamber, the Dental Benefits Legislation Amendment Bill 2014. The coalition has a shameful record of consistent and continual opposition to dental health reform in this country. We heard the hyperbole and insulting cant—theological at times—from those opposite and particularly from the member for Bowman, who is in the same political party as Campbell Newman, who has given no credit, by the way, to the Labor government's reforms which have made a difference in my home state of Queensland. Successive federal coalition governments—from Menzies to Abbott—have failed to deliver fair, affordable and accessible dental care to all Australians. Conservative governments have never prioritised dental health. It does not interest them; you only get a half-baked policy from the coalition. I will go through a bit of background of what we saw before we had the CDDS, to see what the situation was. The member for Bowman talked about the history of this legislation. Indeed, in his second reading speech, the minister also talked about the history and the background to it. So I intend to deal with that.

But, before I deal with that issue, I would note that the budget ripped $390 million from dental care by delaying the funding for the expanded national partnership agreement for adult public dental services for a year, from 2014-15 to 2015-16—with no reason. If you want to talk about caring for those in need, why did you do that? This NPA funding is desperately needed to reduce adult dental waiting lists. The member for Bowman said that we were about helping the poor but not necessarily the sick. So let's have a look at what the experts have said about this measure. Griffith University Professor of Dental Research Newell Johnson described the funding delay as a 'disaster' for dental health. Australian Dental Association President Dr Karin Alexander warned that the delay would cause waiting lists to 'double or treble'. This $390 million, which should have helped people getting off waiting lists, will instead end up in the never-never of the Treasurer's medical research future fund. The Abbott government's budget also ripped $229 million by axing Labor's dental flexible grants program.

So let's not get this hyperbole and cant from those opposite about their concern and compassion for people in this country with dental problems. If they were so compassionate, why did they undertake those budget measures in May this year? The dental flexible grants program provided for new dental infrastructure in outer rural and regional areas, but there was not a peep from the Nationals opposite in relation to that cut. No longer will that money be available to reduce the access barriers to dental treatment that people face, particularly in regional, rural and remote areas. In addition, the Abbott government cut $15 million from the Charles Sturt University dental health program—funding needed to help the much-needed dentists of the future.

The Dental Benefits Legislation Amendment Bill provides a handy reminder of the coalition's dental policy failures and raises serious concerns about their future intentions. The bill deals with both a failed coalition dental scheme—the Chronic Disease Dental Scheme—and the landmark Labor dental reform, the Child Dental Benefits Scheme. The Chronic Disease Dental Scheme is one of the health disasters that we inherited back in November 2007 from the Howard government. This has a bit of a potted history, and it is worth reminding the public about it.

In 1996 the Howard government cruelly and callously cut the Keating Labor government's Commonwealth dental-health program. This program provided federal government assistance to those Australians who could least afford it, so they could have their teeth fixed at public dental clinics—another great Labor reform, echoing Medibank before and Medicare of the Hawke and Keating era. This particular program followed the Whitlam Labor government's Australian school dental scheme, which was eventually and inevitably gobbled up by the Fraser coalition government. It is important for the edification of those opposite that they be reminded about this. The Commonwealth dental-health program worked—it was a terrific success. In 1997 the Australian Institute of Health and Welfare reported that the program had reduced dental waiting lists for the most disadvantaged people. Before that program, 47.5 per cent of people with health dental cards waited for less than a month for dental treatment, and 21.1 per cent waited for more than 12 months. While that program was operating, 61.5 per cent waited less a month for dental treatment, and only 11.3 per cent waited for more than a year.

Just as the Fraser government had abandoned Labor's Australian school dental scheme, the Howard government ignored the expert advice and abolished that particular program—the Commonwealth dental-health program. And it did not just abolish it, it left no replacement for that superior program. They did not even have an alternative dental plan. They did not really care that disadvantaged Australians suffering health pain and dental pain lingered on the waiting list. Predictably, after the CDHP was abolished, the public dental waiting list blew out until 650,00 Australian people were on waiting lists for relief. People were waiting four or five years to have their teeth looked at.

A 2005 Health Policy Institute research paper found there had been a polarisation of oral health in Australia. It recorded that people disadvantaged by their socio-economic status, Aboriginal and Torres Strait Islander peoples, older people, migrants and people living in rural and remote areas were disadvantaged. In other words, they were exactly those Australians who had previously benefited from Labor's Commonwealth dental-health program. In that same year of 2005, The Sydney Morning Herald investigated the impact of the ongoing dental crisis on people in New South Wales. It reported what everyone knew—that oral health had declined since the federal government withdrew its funding for public dental programs after the 1996 election. Nine years after the cut, the impact was clear in New South Wales, where: 'There are only about 250 public dentists to cater for more than 2.5 million health-card holders, children and the elderly, while there are more than 3,000 private dentists available to treat the rest of the state's population.'

People in New South Wales—the largest state in the country—were waiting eight years to see a dentist. And what was the response of the then-health minister, Tony Abbott, the now-Prime Minister? He said: 'The federal government has no plans to take control of public dentistry. I would not encourage you to think it is likely to happen.' His message was: 'If you want your teeth fixed, take it up with the states'—there was no need for the Commonwealth to be involved in it. There was not an ounce of compassion or commitment in relation to the oral health of disadvantaged Australians. At the time, I was the chair of the health reference committee in Esk in the Brisbane Valley as a representative of the West Moreton Health Community Council. Esk is a little town that is now in my electorate—it was in the electorate of Dickson before. During the Howard government and until redistribution in 2009, it had been in the member for Dickson's electorate. There was not a peep from that prominent frontbencher during that time, while the Esk waiting lists for oral health were blown out. It was the issue that was raised again and again by consumers, by patients and by residents in the Brisbane Valley at the time.

Eventually, however, the pressure got too much, and this is where the gold-plated chronic-disease dental scheme came in—because the Howard government did it when the political pressure was on in 2007. It was a dismal disaster from the start. Right from the start it was a poorly-targeted mess that failed to address public dental waiting lists, provided nothing in terms of dental infrastructure and was silent on the workforce distribution. Shamefully, it did not even address the issues in relation to children's dental health, but it provided $4,250 over two calendar years for private dental services for those with a chronic medical condition and complex care needs. You might say, 'That sounds all right,' but the trouble was that a Department of Human Services audit found that more than 20 per cent of those benefiting were neither pensioners nor concession card holders. It was poorly planned. What we saw was that over 20 per cent of dental treatment was provided for high-cost restorative work without means testing. The scheme was a dental slush fund, and it was corrupted. This was budgeted for at a total sum of $90 million per year, but it quickly became a cost to the taxpayer of $80 million a month—not $90 million a year, but $80 million a month.

By June 2008 the former Labor finance minister, Lindsay Tanner, and his department had assessed it as costing $248 million, and it was estimated to rise into the billions in the next few years. What a shambles! This is from the Liberal Party that prides itself and poses and preens as the party of responsible economic management. This is a program that was going to cost the taxpayers $90 million a year and cost $80 million a month and was blowing out into the billions. That is the mess we faced, and what we also discovered when we came in was that a high rate of non-compliance for reporting requirements for dentists had been detected. That involved failures, and that is what has been dealt with in part by this legislation before the House.

The Department of Human Services identified $21.6 million in incorrectly paid benefits for debt recovery from dentists. When I was newly elected in 2007, one of the issues that was raised with me was the debt problems with this scheme, and I was pleased to speak on this scheme. Those in the government think—this is what the minister said in his second reading speech—that we are doing this for political reasons and solely because the architect of the scheme was Tony Abbott, the now Prime Minister, then the minister for health. It is because it was not means-tested, it was unfair, it was wasteful, it was a slush fund and we saw noncompliance by dentists. It did not address the real issues. That is why we brought to an end, over the opposition of the now government, the CDDS and brought in the Medicare Teen Dental Plan. As part of our $4.1 billion dental reform package, that was replaced and we ended up with a landmark reform like Medicare, like the National Disability Insurance Scheme. There was eligibility for children between two and 17 years to access subsidised basic dental care worth up to $1,000 over two years—eligibility based on means-testing the family. We did the heavy lifting in relation to this. Thanks to that scheme, over three million Australian children will benefit from regular visits to the dentist.

In addition to that, we put a massive amount of funding towards cleaning up the waiting lists. In that effort we provided funding to the states to clean up the long lists. Let me give an illustration in my electorate. In February 2014, the West Moreton Hospital and Health Service reported that this had reduced their list of those waiting for more than two years from 3,500 people to zero. There are amendments in relation to this legislation which we will support—and other speakers have gone through the legislation—but it is important that the people know the facts. The facts are that we have seen, in my home state of Queensland—it was mentioned by the member for Bowman—the LNP state government trying to take the credit for the national partnership arrangements, including the more than $500 million that we put towards reducing the public waiting lists. What the current government in Queensland have done is issue vouchers to patients who have been on public waiting lists for more than two years or those who require urgent care. There is a time bomb coming in Queensland because of their attitude to fluoridation, as the shadow assistant health minister mentioned before. But there is a day of reckoning coming with the cuts that the government are making. They have demonstrated that they have got no commitment to oral health in this country.

Steve Irons (Swan, Liberal Party) Share this | Link to this | Hansard source

I rise to contribute to the debate on the Dental Benefits Legislation Amendment Bill 2014, in which we have heard various speakers from both sides of the House getting quite passionate and giving their version of the facts as they have gone along the way. It just amazed me listening to the member for Blair talking about $80 million a month, when the previous government foisted on the current government $1 billion a month in interest payments. His crocodile tears in worrying about $80 million a month, after they foisted on the Australian people $1 billion a month in interest payments, just amazes me. Then he talked about the CDDS system, which was scrapped, and which he had started getting complaints about in 2007. If it was such a bad system, why did the Labor Party wait until 2012 to scrap it? The reason they scrapped it was, as the member for Bowman said, to try to achieve that impossible and elusive surplus, which they still have not managed to deliver since 1989.

Let me get back to my contribution on the bill. Mr Deputy Speaker, as you know, we on this side of the chamber have a long history of supporting and implementing healthcare policy initiatives that benefit all Australians. Where the coalition have worked to develop various policy structures that reflect the areas where Australians have indicated service delivery and support is needed the most, those opposite have taken schemes that were established or extended by the coalition and have shut them down or reduced their level of support, despite their high success rate. This is not because the schemes were ineffective or were not meeting their objectives, unlike many policy initiatives implemented by those opposite; it is because the Labor Party needed to find ways to pay for all their other policy failings and the enormous debt that seems to follow every Labor government throughout the history of Australia.

I cannot mention Labor failings without highlighting some of the worst policy catastrophes in our recent history, like the pink batts scheme, their attempt to roll out the Building the Education Revolution and, of course, the fiscally unstable mining tax that generated barely any revenue. Now, apparently, the concept of learning from your mistakes still has not been caught onto by those opposite either, since, within days of the government scrapping the mining tax, the Leader of the Opposition announced that, if elected, the Labor Party plan to bring it back. These are of course just a couple of Labor's policy failings, which those in this place could simply unify under one umbrella and entitle: 'How not to run government'.

Those opposite have criticised this government's budget measures to put Australia's healthcare system and other policy portfolios back on a sustainable path, yet what we saw under the former government were a series of broken promises on health and the removal of fully funded initiatives that benefited the chronically ill. Those in this place would know that the Howard government introduced Lifetime Health Cover in 2000 as part of reforms that significantly increased private health insurance coverage in Australia. Yet what we saw under the former government was a series of changes to private health insurance that made it more expensive for the almost 11 million people that hold some form of private health insurance. Despite repeated promises that they would not change the private health insurance rebate, Labor means-tested it in 2009 and 2011, made changes to the indexation arrangements last year and removed the 30 per cent rebate on Lifetime Health Cover in 2012.

In six years of Labor being in government, household health costs increased by 35 per cent, and hospital waiting times for elective surgery grew from 34 days to 36 days. Let us also not forget Labor's attempt to roll out their $650 million GP Super Clinics Program, where 64 clinics were promised in 2007 but only 33 had been delivered when this government was elected last year to fix the mess of those opposite. Most recently, the true extent of Labor's hypocrisy was also highlighted in the government-commissioned Australian Institute of Health and Welfare report which clearly identifies a slowdown in health funding in 2012-13 under those opposite, despite their claims that they were spending more on health and their criticisms of this government's plan to put spending measures back on a sustainable path.

Of course, if this were not enough turmoil for our healthcare system, those opposite sought then to discredit and shut down a scheme that delivered much-needed treatments for those who were already suffering from other serious health conditions. The scheme I am of course referring to is the Chronic Disease Dental Scheme, a scheme that was set up in 2004 and expanded in 2007 by the current Prime Minister as then health minister to provide capped Medicare benefits for dental services for people with chronic medical conditions and complex care needs and whose oral health was impacting on or exacerbating their condition. Benefits of up to $4,250 over two years were available to all Australians on a referral from a GP.

Despite the high level of support this scheme provided the chronically ill, those opposite sought not only to discredit its delivery but shut it down in 2012 and left patients with no Medicare benefits for dental services for dental services for 18 months, from 30 November 2012 to 1 January this year. The coalition fought hard to keep this scheme, with the now Minister for Health, Peter Dutton, moving a disallowance motion in September 2012 to disallow the closure of the scheme. I supported the motion in this place on the need to retain a scheme that had great success by the standards of any government, with more than 20 million dental treatments provided during the life of the scheme to more than one million patients, 80 per cent of whom were concession card holders.

I have a relationship with the Forgotten Australians, and during that period after the Chronic Dental Disease Scheme was down I met with quite a few of them. Many of them who had been under that treatment from the CDDS were extremely disappointed with the Labor government for having shut that scheme down, as many of them were in the middle of treatment and it was chopped off with them unable to get their chronic oral health problems fixed. Many of them were totally disappointed with the efforts and implementation of the destruction of the CDDS.

Although the chronic diseases under this scheme were not prescriptive, chronic conditions are generally deemed as those of at least six months duration and include such conditions as asthma, cancer, cardiovascular disease, diabetes, arthritis, mental illness, musculoskeletal conditions and stroke. I highlight this because the three most common chronic conditions typically managed by GPs are arthritis, diabetes and depression, according to the Australian Institute of Health and Welfare. Yet, instead of those opposite working to fix the issues raised in this scheme and assist sufferers with their condition, their answer was to put it in the too-hard basket and shut it down. They shut it down despite arthritis and other musculoskeletal conditions affecting an estimated 6.1 Australians and diabetes affecting about one million Australians in 2011-12.

Not only did the scheme have a high take-up by patients; it was also universally accessible, just like other Medicare schemes, and was appropriately funded under the policy framework—just another thing those opposite never seemed to manage. It is also peculiar that those opposite continue to say they are a party that supports universal health care; when they shut down the Chronic Dental Disease Scheme they claimed it should only be available to concession card holders, which does not really make it universal. I agree that supporting our most vulnerable should be the priority of any government; but, last time I checked, universal health care includes everyone who seeks to access it. I guess we can just put that down to yet another policy contradiction by those opposite.

Despite their inability to appropriately fund or manage policy initiatives, those opposite also attempted to discredit this dental scheme by claiming that there were massive cost blow-outs and the scheme was flawed. Considering the scheme was always funded appropriately under a coalition government and the average claim was $1,760, well under the $4,250 cap, I think we can also safely say that any blow-outs were once again the result of those opposite mismanaging—mismanagement that resulted in household health costs increasing by 35 per cent, education costs increasing by 39 per cent, gas prices increasing by 71 per cent, water and sewerage prices increasing by 79 per cent and electricity prices increasing by a massive 101 per cent in the six years those opposite attempted to govern. If we want to talk about blow-outs, perhaps those opposite need to remind themselves of the $91 billion of deficits between 2008-09 and 2012-13 that they left as their legacy to the Australian people.

Unfortunately, despite the coalition's best efforts to retain the scheme, it was shut down on 30 November 2012, with one of the reasons cited by those opposite being alleged rorting by dentists. The reality, however, was once again very different from what those opposite claimed. This alleged rorting stemmed from the scheme's requirement that dentists provide a written treatment plan and quotation to a patient before commencing treatment for the services to be eligible for Medicare benefits. A copy of the plan was also required to be given to the referring GP. A compliance audit did, however, reveal that dentists were not meeting these administrative requirements, which prompted the Department of Human Services to pursue repayment of the full amount of benefits paid by Medicare to these dentists. This non-compliance was, however, far from the rorting those opposite claimed, with the majority of these cases simply being due to minor paperwork errors.

It was the view of this government while in opposition and remains our view today that to pursue the recovery of the full amount of the paid Medicare benefits was an excessively severe punishment. Thankfully, following the hard work of our colleague Senator Bushby, who introduced a private member's bill in the Senate to have this recovery action dropped for those dentists who were deemed to have only made administrative errors, common sense eventually prevailed. The private member's bill prompted a Senate committee inquiry which resulted in those opposite acknowledging what those on this side of the chamber already knew: a harsh and unfair line had been taken with this matter, and these actions needed to be resolved. The former minister for human services subsequently sought to have these debts waived under section 34 of the Financial Management and Accountability Act 1997, which leads us to the purpose of the bill before the House today.

A statement by the former minister was issued on 12 October 2012 outlining how debts would be waived. This stated that debts would be waived for:

The late or non-provision of treatment plans and quotes for audited dental practitioners' claims made before April 2010; and in cases after this time where an audited practitioner has shown their intent to meet the Scheme's requirements.

In these instances the Department of Human Services and the Department of Finance were required to assess these cases and make a determination. This has resulted in a lengthy and time-consuming process for both departments and has left dentists waiting two years for an adequate resolution.

The bill before the House today seeks to finally lay this matter to rest. It will waive debts for those dentists who made minor paperwork errors while providing a much-needed service to chronically ill patients and remove the unwarranted stigma that has for too long been attached to this scheme. It will achieve this by amending the Health Insurance Act 1973 to allow the Chief Executive Medicare, or CEM, to waive debts raised against dentists, as per the former minister's determination, rather than requiring the departments to assess all individual cases. In the majority of cases this will have no financial impact on dentists or the Commonwealth, as most dentists who incurred a debt due to noncompliance are yet to make this payment.

The bill does, however, include a provision that repayment be made to the small amount of dentists who have already paid their debt to the Commonwealth. I acknowledge that there were a small amount of cases where evidence supported claims that dentists had committed fraud. This bill will not excuse those dentists from repaying their debt; it will only serve to waive the debt of those who acted in good faith and provided this much-needed service, but did not adequately fulfil the scheme's administrative requirements.

I now turn to another key aspect of this bill which seeks to amend the Dental Benefits Act 2008 and the Health Insurance Act to bring the operational procedures of the Child Dental Benefits Schedule in line with other Medicare programs. By way of background, the Child Dental Benefits Schedule commenced on 1 January and is an extension of the former Medicare Teen Dental Plan. It provides eligible children aged two to 17 with access to up to $1,000 in benefits over two years to cover the cost of basic treatment. The scheme is means tested, requiring a child's family to receive family tax benefit part A or a relevant Australian government payment to be eligible. Currently, compliance powers for dental services are different to other Medicare schemes and investigative processes for inappropriate practice are not cohesive.

The amendments proposed in this bill seek to rectify this by aligning the two acts' compliance powers to ensure appropriate Medicare claiming is occurring. The changes will provide the CEM with the power to obtain documents from dentists to confirm that amounts paid under the schedule are accurate. Additional amendments will also provide the CEM with the power to enforce compliance and to impose civil penalties or recover any imposed debts on behalf of the Commonwealth in the event of noncompliance. Civil penalties would be imposed in those instances where the requirements detailed in written notices are not complied with. For an individual the civil penalty is 20 penalty units, and for a body corporate it is 100 penalty units.

I commend the bill to the House.

Clare O'Neil (Hotham, Australian Labor Party) Share this | Link to this | Hansard source

It is a real privilege tonight to speak on the Dental Benefits Legislation Amendment Bill 2014 and I want to thank the member for Ballarat for moving her second reading amendment, which allows me to speak a little bit more about what is an incredibly important area of public policy in Australia. It is one that concerns literally thousands of people that live in my electorate, one I am often contacted about when I talk with the people that I represent.

All of us in this House know that dental care in Australia over many, many years has really been a poor cousin of health care. Many Australians who are able to privately paid their own dental care probably do not realise that there are thousands of people around the country who are having to bear very substantial costs which they are often not able to meet; living in intense pain that comes from issues with their oral health; and, importantly that the burdens of the way that the legislation has worked in this area have fallen so unfairly on different groups within the community.

I know that Australians who are struggling with dental problems have watched over many years while the problem has been passed from government to government, some of them making real attempts to reform and change in this area and others who have, unfortunately, gone backwards. I know that the situation that we are dealing with—particularly that the Rudd government was dealing with—was a situation in Australia where we had these very significant and very fundamental divides between the funding of health care. We saw completely different dental care being provided for people who had private means in Australia versus those who were relying on government services. We saw staggering differences in the dental health of people whether they were lived in the city, whether they lived in outer metro areas or the country, Even between young and old there were different sorts of policies that applied.

Indeed, I think that one of the fascinations of public policy in Australia when we come to these points is really that there is no reason why it is that the kind of overall profound strong foundation that we have for health care in Australia has not extended to mouth care, just by one of those little quirks. It is a bit of quirk because we know that the health of people's teeth is actually incredibly important to their overall health. So issues with tooth care can lead to lots of other health problems in the individual. It is associated with some specific conditions around poor nutrition, stroke and diabetes—even cardiovascular disease. We also know that poor dental health is an incredibly important social issue in the sense that it is tightly linked to socioeconomic status. I think there is no accident there, because we all know how expensive it is to go to the dentist. We also know that those costs have increased, when we look back in time, much, much quicker than the cost of living has increased. So in that sense for people who are struggling or living in poverty, that is a thing that often just falls off the agenda—the thing that they just cannot afford.

Labor has some incredibly proud reforms that it put in place when it was in government. I know that all of us in this House, if we had all the budget in the world, would probably want to make the perfect system—universal, top-quality dental care like we often see in our health system. But obviously that is not a situation we usually find ourselves in when in government. So that last government made a really strong commitment to do what it could with the limited funding available and made some very important reforms that really moved us in the right direction at least. I want to talk a little bit about those reforms. I want to just mention that it is important to see that they were done in the Labor way—that is, accepting that we do not have all the money in the world and accepting that because of that we need to target reforms very tightly, put dollars where they are going to count the most, make sure that those dollars are going to the people who are most in need. And that was certainly how this issue of trying to fix the dental care system was approached.

In 2012 Labor announced a dental reform package of $4.1 billion, which was the biggest investment in dental care since Federation—a really amazing achievement. It was essentially set out in three large elements. The first was the Child Dental Benefits Schedule; $2.7 billion for 3.4 million Australian children. That is fantastic for 3.4 million Australian children. A lot of the motivation to focus on children was not accidental; it was linked to some very disturbing evidence that came to light around 2009 when the Australian Institute of Health and Welfare showed that the dental health of young people in Australia was going backwards. So while we had so much prosperity and while we were growing much wealthier as a country, dental health in young people was actually going backwards. The Australian Institute of Health and Welfare reported that 58 per cent of 14 year olds had permanent tooth decay and 20,000 children under the age of 10 were hospitalised each year because of tooth decay—it is an absolutely astounding fact. So the centrepiece of this beginning, of trying to fix this big issue in Australian public policy, was a program for three million Australian children aged between two and 17. The idea was that for those children going to the dentist would be just like going to the doctor, with the same level of ease and support.

The first element I mentioned was the Child Dental Benefits Schedule, but there was also the $1.3 billion for additional services for low-income adults. That was for 1.4 million low-income adults around Australia to get the dental care that they so urgently needed. I mentioned before that we know there are links between people's dental care and their socioeconomic status. You would be interested to learn that if you earn more than $60,000 a year you have seven more teeth on average than Australia's poorest people. Now that is fundamentally unfair and I do not think we want to see that situation in Australia. That was the big second tenant of this reform package—that is, services to low-income adults.

The third element was a very important piece that I do not want to get lost, which was about workforce planning. It is much harder—and I think remains much harder despite these efforts—to get good, affordable dental care outside of the inner areas of our major cities around Australia; It is even hard to get it in the outer metro areas, much less regional, rural and remote areas. It is just simply much harder to find a dentist there. We know in Australia that the number of dentists in our major cities is actually double those in outer regional areas and triple those in remote areas, so we have to accept that the funding element is very important here. It is a critical piece of the puzzle. But it is also important that people who need to go to the dentist are able to find one. I know that for people living in outer metropolitan electorates like the Lalor electorate, whose member is sitting here behind me, these would be big issues that are facing her constituents. These are the things that Labor was really focused on when it was in government and putting in place this huge reform package.

Of course that was not all that was done on dental. We know that when the Rudd government was elected public dental waiting lists were absolutely ridiculous. We are talking years and years that people, often pensioners, were waiting for help with dentures and other types of things like that. It was just absolutely untenable that we saw this sort of thing in our system. In the 2012-13 budget, Labor committed $550 million in funding of the public dental waiting list. In 2013, 200,000 patients around Australia received much needed dental care just because of that funding.

You can probably tell that I am very proud of these reforms. I think it was some of those really pivotal things that that government was able to do that affected the lives of literally millions of Australians and, in many instances, Australian children. When we look at all of the different areas we deal with in this parliament, it really is Labor that goes forward and makes these reforms. Those on the other side of the House talk a little bit about reform, but they really do only move in one direction—that is, making cuts. They sometimes increase services, often looking to improve supports for the wealthy; however, what we do see time and time again is moves to take away supports that are needed for those who need them most. And not surprisingly we do see this when we come to dental. The coalition have had to be dragged by their heels into supporting moves to progress and enhance the sustainability and the level of dental care that is provided around the country.

As it stands, most dental care has historically been funded by individuals, and we know, unfortunately, that is how the coalition likes it without regard to whom that person might be. I will digress for a moment: we really see this in the cuts that have been attempted on Medicare at the moment. We were absolutely promised in the election there would be no cuts to health, no new taxes, and yet what do we see? At the very first opportunity the attempts to put these additional costs into the system—always pushing the burden onto individuals when we are trying to get public services to world-class standards. We know there are changes to pathology and changes to other tests, all of these types of things. We see it in Victoria: the ongoing industrial issues with ambulance workers, with nurses; there is not a health worker that that state government has not picked a fight with at some stage in the last couple of years.

I digressed to that topic because I fear that this is where we are going to go on the dental question, and we heard some very concerning rhetoric from the minister when he first presented this legislation into the parliament. He talked about 'early concerns that he had with this program', saying things like 'we will monitor this program very carefully'. We have all heard this story before: we heard it on university funding; we heard it on school funding. The truth is that you just cannot trust these guys with anything because, as I said, unfortunately the coalition only know how to do one thing. When you look at Labor's very proud record in this area, we can see that dental care and the terrific reforms that were made are absolutely worth protecting. They protect many of your constituents, Madam Speaker, and they protect many of mine.

I will turn to some of the specific provisions in the bill itself. Much of what is in this bill is tidying up elements of the existing scheme. Of course we are very happy to support moves to do that. So the Medicare Chronic Disease Dental Scheme was closed from December 2012.

Debate interrupted.