Richard Colbeck (Tasmania, Liberal Party, Shadow Parliamentary Secretary for Health) Share this | Link to this | Hansard source

I move:

That the Health Insurance (Dental Services) Amendment and Repeal Determination 2008 made under section 3C(1) of the Health Insurance Act 1973 be disallowed.

The opposition has considered this question very carefully before taking the serious action of moving this disallowance. We did not move this motion capriciously, but we are strongly of the view that the enhanced primary care dental access scheme, colloquially called Medicare dental, has, since its establishment last year, been of immense benefit to many Australians suffering chronic and complex dental conditions. The leading peak professional bodies for the dental profession, the Australian Dental Association and the Association for the Promotion of Oral Health, have both criticised the Rudd government for the abolition of the EPC dental access scheme. Associate Professor Hans Zoellner, who is the current president of the Association for the Promotion of Oral Health, has condemned the government’s decision, pointing out the folly of replacing a scheme which provided significant care for chronic conditions with a plan that provides for check-ups and examinations but no funding for continued treatment if any significant problem is found. The Teen Dental Plan is in fact in danger of becoming a cruel hoax.

We all know how much the states have neglected their public health schemes, in spite of increased funding for the provision of such services through GST revenue. I do not think the prospect of a large group of young Australians adding to the long queues at these clinics will achieve anything. It is shocking to discover that there are people on state dental lists who have been waiting for three years for dental treatment and then, after they finally get to see a dentist, have to join another queue and wait for another three or four years if they need any significant work. If this sounds like an exaggeration, I assure the Senate it is not. In Australia, who should shoulder the bulk of the blame for this criminal state of affairs? The states should. They have criminally neglected their constitutional responsibility for public dental care over the last 30 or 40 years.

The EPC dental access scheme provided up to $4,250 over two years to chronic disease sufferers. Many of these are, as Associate Professor Zoellner has pointed out, people who suffer from cardiac irregularities or other conditions which are physiologically linked to oral care. Indeed, amongst the severest critics of the Rudd government’s decision to abolish the EPC dental access scheme have been groups representing HIV sufferers. One of the consequences of HIV is a major increase in the likelihood of significant dental decay, and the Howard government’s scheme was of great assistance to sufferers in this category.

The Labor Party, and in particular Ms Roxon, the Minister for Health and Ageing, have claimed that the Howard government’s Medicare dental scheme deserved, in their words, to be scrapped because few people were using it. The facts, though, shoot that claim right out of the water. It was reported in the Australian on 17 May that the number of services performed under Medicare dental had recorded a 25-fold increase in the previous five months. That merits repeating: a 25-fold increase. As Dr Hans Zoellner has said, these statistics make a lie of Labor’s claims that the scheme was not working.

I was very proud to be part of a government which, in recognising the link between oral health and general health, set up Medicare dental. Yesterday, in the debate on the Dental Benefits Bill 2008, I mentioned some of the uptake figures for Medicare dental. I will repeat those figures. The uptake in the firs two months, November and December 2007, was 16,000 services. In January this year, according to statistics provided by Medicare, 20,443 services were administered. In February the figure was 40,497 and in March it was 94,617. In total, over 300,000 services were provided under the scheme. It is therefore clear that not only is there a serious need for Medicare dental but the replacement of Medicare dental by a scheme which has no provision for post check-up care is woefully inadequate.

Under the Enhanced Primary Care dental access scheme, patients who are assessed by their general practitioners as having complex dental conditions are able to have a primary care plan. From this care plan, a patient is then able to be referred to a private dental practitioner and receive up to $4,250 worth of treatment over two years. But that would have been abolished by these regulations. The Labor Party will talk about the failure of the scheme since 2004, but we know that that was a different scheme. In fact, Senator Ludwig mentioned the statistics in relation to the scheme that was put into place in 2004 in his contribution on the Teen Dental Plan yesterday. But it is in fact a different program. What we are talking about is a new program that was announced in the budget last year and which came into effect in November. It is quite clear from the statistics that this program is needed and is having an effect. The Labor Party will try to confuse and mislead, but it is clear that this program is one that is required by the community.

At estimates, when we asked what happened to people who had not completed their treatment under this program, we were told that they could join the queues in the other programs that were available. That is clearly not good enough. During the election campaign, Labor promised to be the champions of dental health. In fact, they promised to spend $800 million on health. As we have heard a number of times since that time, we have had four different costings for the Teen Dental Plan. Prior to the election, when they first made their promise, they promised that it would cost $510 million. That is what they told us. Combined with their other dental program, for $290 million, they promised to spend $800 million on dental over the term of this parliament.

Jan McLucas (Queensland, Australian Labor Party, Parliamentary Secretary to the Minister for Health and Ageing) Share this | Link to this | Hansard source

It was $700 million over four years.

Richard Colbeck (Tasmania, Liberal Party, Shadow Parliamentary Secretary for Health) Share this | Link to this | Hansard source

No, Senator McLucas, it was over the term of this parliament, and I will come to that in a moment. The costings were then provided to the Department of Finance and Deregulation for costing, and the figure came down to $324.5 million and—

Jan McLucas (Queensland, Australian Labor Party, Parliamentary Secretary to the Minister for Health and Ageing) Share this | Link to this | Hansard source

Before the election.

Richard Colbeck (Tasmania, Liberal Party, Shadow Parliamentary Secretary for Health) Share this | Link to this | Hansard source

That is a very important point that you make, Senator McLucas, because before the election, in the Weekend Australian on 1 December, a spokesman for Minister Roxon said that Labor ‘yesterday stuck by the party’s commitment to an overall dental health budget of $800 million this term’. Not over four years or any other period; they committed to spending $800 million over the term of this parliament. Now, at this point in time, they are anything up to $186 million short of that commitment with their forward costings.

As I said, they have had four costings so far for their Teen Dental Plan. After it went down to $324.5 million in the accounts put out for the February estimates, there was a press release put out a few weeks later which said it would be $360 million. Then, in the budget papers, we find that it will be $345 million over the three years prior to the next election. So that is in fact the fourth costing that Labor has put out for the Teen Dental Plan.

We know that they had no conversations with the states prior to the election about how this scheme might work; we know that they are still negotiating with the states about how it might work and how it might fit into their programs. There are teen dental programs in every state. There is no understanding of how this program might interact or how in fact the states may decide to move out of some the services that they are currently providing. In the light of the complete confusion of the government with respect to the provision of dental services—complete confusion and a complete lack of knowledge about how their new programs are going to interact with the system—they seek to remove a program that has demonstrated demand, has support from the industry and is clearly providing much needed services. They have provided no sense of how they intend to keep their election commitment to spend $800 million. We are prepared to help them; we can help them by ensuring that this program continues into the future.

We do not believe it is acceptable that people who are currently on this program can effectively just go back into the public dental health system in the states, although only 10 per cent of the dentists who operate in the overall dental health system are in the public system. The government are expecting the people who are currently on this program to effectively just roll back into that system. We do not believe that is acceptable. This program provides people with chronic illnesses and significant issues to get over $4,000 worth of services over two years. We believe, quite fairly in my view, that it is a very responsible action on behalf of the opposition to deny the government the opportunity to close down a program. Yesterday we put in place some review programs to review the teen dental program. So there is an opportunity for the parliament and the community to satisfactorily scrutinise the operation of the teen dental program. The government have just passed off and said, ‘Look, if you want to know how well it’s working, just look on the website.’ But that will not tell us what the interaction will be with the states and their programs. It will tell us nothing of that. We have already started to see the government’s record in actually putting information on websites; that was demonstrated in question time yesterday.

There is a really concerning trend that is coming through with respect to the government’s actions. You really have to wonder whether they are moving down the path of nationalising health. We have seen concern with respect to registration expressed through the medical profession. We have seen the attacks on private health insurance. We have seen the government renege on promises at the Mersey hospital in Tasmania—in fact, through that process, they almost showed no faith in the private system. They are funding all their dental programs through the states. The medical profession are actually now talking; they are concerned about where this government is heading with its overall health program.

As I said at the outset, we do not take this step lightly and it is not a political stunt, as has been claimed. We see very good reasons to maintain this program which, as I have said, is being used and has strong demand. If the Rudd government had moved to replace the enhanced primary care dental access scheme with something which allowed the same sort of access then we would be likely to support it. But that is simply not the case. However many lies and mirrors the minister may use when she tries again to spin a different line to the media and the public, we believe that our actions in this particular case are well founded.

Lyn Allison (Victoria, Australian Democrats) Share this | Link to this | Hansard source

I will be very brief. I have been positive about the switch from dental services for people with chronic illnesses to, suddenly, teen dental care, as proposed in the government’s election platform and budget. I can see a good need for there to be a service for teenagers. But, as I pointed out the other day in our debate on that bill, I think it does not go far enough. I will be listening with interest to the minister’s response to this disallowance motion. I think it would be good to have some sort of policy substance behind these proposals. I am not even sure that the proposal on dental care for the chronically ill, the Enhanced Primary Care Program, was necessarily the thing that was most needed. Unfortunately, too often in this place major policy changes are based on how they will play out in the media and with the general population rather than being based on very sound evidence. Perhaps we should have had an inquiry into dental health in the Senate Standing Committee of Community Affairs. We could have come up with recommendations and we would have all known where we stood on what should have been the highest priority. To dance from one program to another without really having much by way of policy justification seems to me to be unwise. I am interested in what the minister has to say about why we should not disallow the repeal of this program which, as Senator Colbeck says, appears to be working. I do not know what faults the government has seen in the program, but I hope the minister can cover those in this debate.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

The arrogance and, more, the hypocrisy that the opposition have now outlined in their opposition to the teen dental program are really breathtaking. Even more breathtaking is the position that they are now advocating where they say they are taking a responsible course of action in respect of this disallowance motion. It is not a responsible position they are adopting at all. It was a matter that was clearly put before the Australian public prior to the last election, where the choice was stark. It was the choice for the future of Mr Rudd, the Prime Minister, or the opposition, who were out of touch and had completely lost their way. The public made their choice. They made it on the election commitments that the Rudd government put forward. This program was one of the central planks that the Rudd government put forward.

The opposition had their program on the plate. Their program did not meet the test. It did not win; it was a failed scheme, which they need to recognise and accept. Look at the hypocrisy that the opposition now try to confuse us with, when they say, ‘In truth, it’s a states matter.’ That is what the opposition started their argument with: dental health is a matter that should be dealt with by the states. What the Rudd government is doing is ending the blame game. What the opposition want to do is maintain the blame game, continue to blame states and continue to harp about the failure of states. But it belies the truth in the debate. It belies what the opposition did when they were in government—they ripped $100,000 out of the health and dental area and axed $100 million a year from the CDHP as soon as they were elected. That really ends the blame game because the states were left holding the can and had to deal with it.

Then the opposition argued that the states have behaved in a criminal way. But it was criminal the way the opposition axed $100 million out of the CDHP program when they were in government. What they are arguing now is: ‘We’ve jumped on our white horse and we’re now going to ride back in and save the states.’ That is not ending the blame game. Prior to the election they put their proposal before the Australian public, but the Australian public judged fairly that they had created the mess and that their white horse riding in to fix the mess was not a white horse but a donkey. It was not a process that was going to come up with an outcome, and the record is clear as to what their input was.

The disallowance motion today is an irresponsible act by an opposition that still cannot accept that they lost the election, that the reins have passed to the Rudd government and that they have to let go of the reins. They still cannot accept that the programs we put forward and outlined on 13 May in the budget speech, our election commitments that we are delivering on, and want to deliver on, are the way in which the Australian public have said we should proceed. The opposition are now saying, ‘We want you to continue our failed program. We want you to continue to look at the issues that we were running prior to the election.’ Well, wake up; the world has changed. What the opposition have to do now is to accept that the world has changed and stop beating the drum for yesterday.

The dental programs that we have announced will have a significant impact on Australia’s dental crisis. The government is providing a total of $780 million over five years for additional dental services. This government is getting serious about these issues, unlike the opposition when they were in government. They are in truth crying crocodile tears about dental health. If they really care about dental health, they need to explain why they ripped $100 million a year from the Commonwealth Dental Health Program and ignored dental health as an issue for more than a decade. I did not hear that in the opposition’s faint defence of the disallowance motion. It was not raised. The only defence that was raised is that it is not the former Howard government’s fault; it is the fault of the states—let us just blame the states again! They are playing the blame game, but the real issue here is the 650,000 people they left to languish on public dental waiting lists. That is the real issue here, which they did not face up to over 11 years. They blamed the states. They are now trying to say, ‘Oh, our last belated attempt might help.’ They have been judged badly on that.

The Howard government belatedly introduced a dental scheme—the now opposition were starting to champion the referral processes, if I heard it correctly in their contribution today—but it was rife with complexity, restrictions and processes and eligibility criteria that were complex and so restrictive that few people would have been able to access it. But let us just pause for a moment. It is a serious issue. We acknowledge that some people did get help from the program—that is true—if they could navigate the complex referral process and red tape. But the sad fact is that many who tried to access the scheme could not get the assistance they required.

A few people, the most needy in our community, were let down. They were not let down in the dying days of the Howard government but over the last 11 years of the Howard government. The poorest people with the worst dental health did not get access to the previous government’s failed scheme. If you did not have the means and you had bad dental health because of the circumstances you found yourself in, you could not get treatment under the program. However, if you were wealthy and you had a chronic disease with complex care needs, you could get access to the program. That meant that people who were well-off could get access but people who needed care—a pensioner with an excruciating toothache, for example—could not get assistance.

That was the scheme they were championing, but we did not hear that from the opposition. What we heard from the opposition was a pitiful defence: ‘Oh, it is a disallowance motion; we want to continue our scheme and we want to try to help those people in the dental health area.’ Well, recognise that this government is actually taking action and support the bill that has passed, support the continuation of our program and support the measures that we are putting in place. If you want to act like a responsible opposition, then hold us to account for our programs; hold us to account to ensure that we do deliver what we have set out to do and hold us to account to ensure that we help those people in the community who are most needy and do not simply continue on with your scheme from when you were in government.

With regard to the people that those on the other side were championing, over four years to 30 April 2008, for example, in the whole of the Northern Territory no services at all were provided to children and young adults aged up to 24, even though the Northern Territory had some of our poorest and most marginalised Indigenous communities. As I said yesterday, over the same four years in South Australia no services—zip, zero—were provided to children up to the age of 14. This meant that during the entire term of the Howard government no child born and raised in South Australia or the Northern Territory got any assistance at all from the previous government’s failed dental scheme.

The opposition have to realise that they had 11 years to act. We had no action from them over the 11 years; all we have had from them was a last-ditch attempt to resurrect their failed scheme and address their failures over the 11 years. It was too late. It was not well constructed and, more importantly, the Australian public recognised that they were being conned. The white horse to end the dental problems was nothing more than a con. The public recognised that the previous government had an opportunity to act over 11 years and did not. The public also know that the current opposition were the ones that took $100 million out of the system and axed the program so that they could start the blame game and blame the states. The public were not going to be fooled by that and they made their decision. The opposition really do need to move on from where they were.

If you look at other states, the picture is similarly poor in large states. Only 52 people in Queensland under the age of 20 accessed the previous government’s program over four years to April 2008. On average that is only about one young person a month over four years across the whole of Queensland. Only 94 people in the whole of Victoria under the age of 20 received services in nearly four years. On average, that is only about two young people a month over four years from the whole of Victoria. These figures are the opposition’s proud record. They should be ashamed of it. It makes it clear that the previous government over their four terms failed to address the real needs in the community.

The Rudd government are supporting up to a million additional consultations and treatments targeted at those most in need through our $280 million investment in the Commonwealth Dental Health Program, and 1.1 million eligible teenagers will have access to preventative health checks through our $490 million investment in our kids’ teeth through the Medicare Teen Dental Plan. In disallowing the closure of the failed chronic disease dental program, the opposition will be opposing the savings that will help pay for the Rudd government’s better targeted programs. They are undertaking a thoughtless opposition for opposition’s sake. It is opposition to say no to anything, to cling on to the Howard government’s failed programs, to cling on to the Howard government era. It is time that they moved on and behaved like a responsible opposition.

The Liberal Party have chosen between—and this is very clear—responsible economic management and responsible health policy, and short-term cheap politics, and they have taken the latter road. They have taken the low road, the road of cheap politics, by using the Senate to disallow this process so that their scheme cannot be wound up and closed. They do not want to debate a policy issue; they want to use Senate processes to keep their scheme alive. They need to understand that the time has come to move on and take the reins of being a responsible opposition. I wish you well in that task; you have not addressed it yet. You might get there ultimately. I hope that you do at some point because any government needs a responsible opposition to hold them to account, scrutinise their legislative agenda and scrutinise their policy initiatives—not one that is going to pursue cheap politics, particularly at the expense of people’s dental health.

We have also found that this is really just a cruel hoax by the opposition. They are not going to address it. They cannot address it from opposition. They should not try to cavil with the government’s policies on this; they should allow us to continue to roll out our policies to ensure that we can make a difference and work cooperatively with the states—unlike the former government.

Jan McLucas (Queensland, Australian Labor Party, Parliamentary Secretary to the Minister for Health and Ageing) Share this | Link to this | Hansard source

The opposition’s motion to disallow this determination closing the Howard government’s failed chronic disease dental scheme is a further example of an irresponsible, reactionary approach to policy. Essentially we saw that over the last 11 years, particularly in the former government’s approach to dental health. This opposition is crying crocodile tears about dental health—displaying a new-found interest in dental health, as the minister has just outlined.

If this opposition really cared about dental health, why did they take $100 million a year from the Commonwealth Dental Health Program as one of their first acts when they came into government in 1996? That program had been reviewed and found to be extraordinarily successful in reducing the waiting lists for public dental care, and yet one of the first things they did in 1996 was remove the Commonwealth’s contribution through the Commonwealth Dental Health Program. Why did they then ignore dental health as an issue for almost a decade? The shadow parliamentary secretary has just outlined their new-found interest in dental health, indicating that in November last year the first action of this program came into effect. Something else happened in November of last year that Senator Colbeck—

Richard Colbeck (Tasmania, Liberal Party, Shadow Parliamentary Secretary for Health) Share this | Link to this | Hansard source

Why are you talking about a program that’s four years old?

Jan McLucas (Queensland, Australian Labor Party, Parliamentary Secretary to the Minister for Health and Ageing) Share this | Link to this | Hansard source

I will talk about the four-year program, if you want to talk about an absolute failure, or we could talk about the EPC dental access program that started when? November 2007. That is when the current opposition finally realised that dental health was apparently somewhat important.

We have all received, over the time we have been in this place, letters particularly from pensioners explaining their difficulty in getting service for their teeth. One hundred million dollars a year over 11 years would have been an enormous assistance to ensure that pensioners, in particular, had some access to dental treatment. But, all of a sudden, this new-found interest in dental health was realised by the former Howard government—you are right, Senator Colbeck—about four years ago. If you want to go to real failure in public policy, let us go to the original dental scheme—or so-called dental scheme—that the Howard government introduced some four years ago. It was not a dental scheme at all; it did nothing to assist people in need in terms of their dental health; it provided very limited assistance.

Dental services could be provided under the scheme introduced four years ago to people if their GP considered their dental health was exacerbating other chronic diseases with complex care needs. The referral processes and eligibility criteria were so complex and restrictive that very few people—and Senator Colbeck knows this—were able to access it. It was not a dental scheme, because simply having bad dental health did not get you into the scheme. If you had poor dental health because you could not afford to go to a private dentist, your teeth had deteriorated and you were in pain, that was not enough; you had to wait until you developed a chronic disease as a result of your bad teeth before the Howard government would assist you. If you were wealthy and had a chronic disease with complex care needs, you were in as long as you could negotiate the red tape. Of course, we all know, those people with more assets are always able to negotiate red tape far more effectively than those with fewer assets can.

We acknowledge that some people did get some help from the program if they could navigate their complex referral processes and the red tape but many in the community, often the neediest in the community, did not. A millionaire could get access to the program if they had a chronic disease as a result of their poor oral health once they got through the red tape, but a pensioner who had excruciating toothache, but in every other aspect was well, could not. As a result, the scheme provided very little assistance to some of the neediest in our community. If you look at the access to the former government’s so-called dental scheme, you find that very few young people and children, even children with chronic and complex needs, had any access to the service.

For example, in the Northern Territory—and we have had a lot of discussion about the Northern Territory in this place over the last while—not one service was provided to a child or young adult aged up to 24 years over the four years to 30 April of this year. Not one. That is a terrific program, Senator Colbeck, and here you are defending it! Not one person under 24 in the Northern Territory had any access to your triumphant dental access scheme. In South Australia in the same four years, zero, not one person up to the age of 14 had access to that program. In the entire term of the Howard government, no child born and raised in South Australia or the Northern Territory got any access at all from that failed dental scheme. Fifty-two young people under the age of 20 in my state of Queensland accessed the previous government’s program over the four years to April 2008. Fifty-two young people out of my state and you are saying this is a good program! It is a bit hard to defend.

One person a month over four years in my state of Queensland had access to this program. Ninety-four people in the whole of Victoria under the age of 20 received services in nearly four years and two people a month in the whole state of Victoria under the age of 20. Those figures are nothing to be proud of. It shows clearly that the previous government’s dental scheme was a total failure and yet we have the opposition here trying to resurrect it. In total, over the four years to 30 April 2008, this scheme that the opposition is now trying to resurrect spent less than $50 million. If you want to argue about numbers, Senator Colbeck, we should talk about the numbers that the former government put in its budget papers about how much it was going to spend on dental health. If you design a poor program and put a big number on it, it sounds good in a press release, but it does not actually deliver services on the ground. It is a big saving when you have only spent $50 million on dental health over four years.

By contrast, the Rudd government will spend up to $780 million on dental health over the next four years. We will support the provision of up to one million additional consultations and treatments targeted at those most in need through the $290 million investment in the Commonwealth Dental Health Program and 1.1 million eligible teenagers will have access into preventative health checks through our $490 million Medicare Teen Dental Plan. This is a desperately needed program. According to the OECD, the dental health of Australian adults now ranks second worst in the OECD, with rapid deterioration in dental health observed in the teenage years. This is a crisis and this government is responding to it. According to dental health experts, there is a fourfold increase in dental decay between 12 and 21 years of age. Almost half of all teenagers have some signs of gum disease. Everyone recognises that having healthy teeth is important to teenagers’ self-confidence and is especially important at a time when many are seeking their first job. Just as importantly, good oral health is closely connected to a person’s overall health and well-being.

The Teen Dental Plan is an important social program, and I commend those opposite for their support of the legislation in this place yesterday. But let us be clear about this: that support for a broad based dental health program is a very recent development from those sitting opposite. The previous government and now opposition has an appalling track record on dental health. This government is implementing programs to provide assistance with dental health to hundreds of thousands of people, spending over 10 times as much a year as the Howard government did. This disallowance motion is not about protecting a dental health program that was making any sort of difference to people’s teeth; it is about causing mischief and budgetary disruption.

It is also important to note the fundamental difference between the Labor Party in government and the now opposition in government. There is a fundamental policy difference here. Labor’s focus when it comes to dental health is very much about prevention, and that is always recognised in the dental health sector as good, sound investment in long-term health outcomes. We are focused on prevention and stopping decay before it starts, stopping the need for extraction and stopping chronic illness as a result of poor oral health through a focus on prevention. That is a sound public policy position compared with the former government’s approach, which was: ‘Wait until you are chronically ill as a result of your oral health and then we’ll give you help, if you can get through all the red tape.’ That is the difference. That is the decision we are making today: do we support a program that potentially fixes up something after all the damage has been done or do we invest in long-term good oral health through a good prevention program?

This brings me to the second reason why this disallowance motion should be rejected. Those opposite who are proposing this motion have forgotten what happened on 24 November last year. Let me remind them: on 24 November the Australian people voted for a change of government. They chose to pass responsibility for the government of this country to the Labor Party, and an important part of that responsibility is the economy and the budget. We announced before the election that we would close the chronic disease program and use the savings to pay for our much better directed programs. It was on the public record—that is not in dispute. It was assessed by the Charter of Budget Honesty process; it was part of the platform we put before the Australian people, and they supported it.

Those opposite are now seeking to dismantle part of the elected government’s budget strategy, which was put before the people and supported. It is not only mischievous, bloody-minded economic vandalism; it is also sabotaging a clear policy that the government took to the election and was supported by the electorate. This is an irresponsible, reactionary opposition. It is opposition for the sake of opposition—on dental care, on hospitals, on alcohol, and on unfair tax slugs like the Medicare levy surcharge. The opposition is following a clear pattern: do nothing for 11 years and then attack the new government for pursuing the path of reform. The Liberal and National parties have to choose between responsible economic management and responsible health policy or short-term cheap politics, and today they are making a bad choice.

Claire Moore (Queensland, Australian Labor Party) Share this | Link to this | Hansard source

When Senator Colbeck was introducing this disallowance motion, he said that the opposition had thought long and hard about it before they brought it forward. I hope they did, but I am very concerned because, if they did think long and hard, they must have understood what the impact of this decision was going to be. Senator McLucas has just outlined the process around which the Australian Labor Party went to the electors last year and put forward a plan for making a significant and strategic change to the way dental health was to be conducted in this country. After years of asking questions from the other side—and I know I had to ask many questions in question time about dental services in this country—in this and in the other place about the way dental programs were operating in this country, we spent significant time consulting people across Australia: people who were seeking dental health improvements, people who were victims of the previous lack of dental health in this country, and practitioners—and we all know the absolutely critical need for trained professionals in this area at all levels. After years of consultation, the Australian Labor Party went to the electors with a plan—a plan identifying the absolute importance of an effective, preventive dental health strategy for our country.

We did not hide behind any of the processes across the absolute need for interaction between all states and the federal government. Minister Ludwig went into great detail about what he described as the blame game. We had to acknowledge that over many years there has been a tendency towards blame in all areas of health—in particular, dental health. It was never anyone’s fault when people had dental health issues. It was never anyone’s own responsibility; it was always someone else’s. It was the states’ if you were talking to the Commonwealth; it was the Commonwealth’s, if you were talking to the states. There was a lack of communication, responsibility and accountability to the community.

The Australian Labor Party worked with the community to come up with a plan that first and foremost acknowledged the need for there to be a cooperative plan working with the state, territory and Commonwealth governments to identify the gaps in dental health in putting forward a solution. Out of that process, we went to the electors of this country with a plan that identified the need for cooperation and highlighted the priorities for dental care. It also went very clearly with an absolute awareness of the need for young people to have supportive dental care at an incredibly critical time—as Senator McLucas outlined, when they are starting to take responsibility for their own future health—to remind young people about the critical importance of dental health and to ensure that they get good threshold treatment so that they can then put in place cooperatively, with the dental practitioner of their choice, be it a public or private practitioner, a plan for future action.

We never pretended that the dental program we were putting in place was going to fulfil all expectations. We never made false promises. We never set up expectations that were not addressed by policy. Consistently during the election process would-be Minister Roxon spoke with numerous people who had interests in this area. Mr Rudd himself also had discussions with the community about what was absolutely essential in dental health. Out of that came what we have publicly committed to. A Rudd government is supporting up to a million additional consultations and treatments, targeted at those most in need. That has always been the process under which Labor operates. We actually seek to support those people in our community who are most in need of services, through our $290 million investment in our Commonwealth Dental Health Program. And 1.1 million eligible teenagers, young people, will now have access to preventive health checks through our $490 million investment in our kids’ teeth through what is now known as the Medicare Teen Dental Plan.

Senator Colbeck went on about confusion, about numbers that were being bounced around. He was talking about commitments over particular periods of time. That is always the way people try and hide behind figures when they are trying to build alternative processes and trying to attack other programs being put out. There has never been confusion in our policy. We have talked about a four-year commitment—not three, not two and not any other number—to allow the process to be implanted, to allow the opportunity for things to be given a proper chance to be integrated into ongoing systems. The tendency consistently is to put things into small boxes that are separated, to build up this divided process of health care. Dental health care is an integral part of overall health care. We should not be taking that away and looking at it in isolation. What we need to do, and what we have asked for over many years, is to build our health issues to be considered together so that we are looking after the genuine health and wellbeing of people. Where better to start than by ensuring that young people have effective assessment, effective consultation with trained professionals, so that they can understand the importance of dental hygiene, dental maintenance and how valuable and very vulnerable teeth are. I know from working with my own nieces and nephews, who are a little bit too old for this program now, that making them understand that the confidence that they have now, and the work that they are putting into dental health when they are young, will ensure that as they age they will be able to have strong and healthy teeth.

One of the most confronting periods in community consultations that I have had in the last few years was when I was privileged to be part of the community affairs committee poverty inquiry, which was held over the 2003-04 period. We worked as a community affairs group, with members from all sides of politics, and we talked with people in many places about what their main concerns were about their futures and they were indicating what their needs were. One of the top issues that came out from people across the country was their dental health. Consistently, people told us that as they aged they were finding it increasingly difficult to be well and healthy if they had problems with their teeth. What we heard from a number of teachers was that it was so important that young people had access to effective dental support while they were young so that they would understand that and would be able to plan that effectively as they aged. When we were working with Minister Roxon last year, and in the many public meetings she had, those same issues that were brought out in 2003-04 were reinforced when she was talking about the development of an effective policy for a Rudd Labor government and how we would be looking at the issues of dental health in an overall health plan.

The figures that Senator McLucas and Senator Ludwig read out in relation to the previous government’s commitment to health and the very small numbers of people across this country who were able to benefit from any support from previous Howard programs were extremely confronting. The numbers are there. We see that under the previous systems access to dental programs was limited very much by where you happened to live and by how wealthy you were. That crucial divide was reinforced in the area of health and access to support. What we are planning is an effective program that will pick up on equity of access, will support those who are in the most need and will be transparent, so that people will know exactly what is available and will be able to work with practitioners at the state level, having that confidence that their needs will be met throughout their whole lifetimes. We are starting by focusing on the Medicare Teen Dental Program, responding to some of the information that we have had about the critical importance of those years for people to understand this issue, as I have said. We are starting with that and then building, in cooperation with state governments, a focus on dental services for the foreseeable future.

No-one pretends that this is going to be an easy issue. No-one pretends that one single program is going to be able to respond to the critical needs across our community. I think that has always been a danger. The responses we have had from the Howard government, the now opposition, show that they seem to think that promoting one program alone will respond to all the issues that are important. That is such a temptation when you are governing by media response or by getting out a good headline. Dental health will not be serviced by one program alone. What we need, as I have said, is the integrated, systematic planning which our dental health program is beginning to put in place. It is not there yet. It will take significant, targeted approaches over a minimum of four years to have the first building blocks in the ongoing plan, and then with the expectation that to really get the best value across the community you will be looking many years into the future. You do not solve issues of neglect that have been entrenched in the system for over 11 years with a first-round program of a four-year schedule.

When I was in the opposition and asking questions about dental health, there were consistent issues about needing to respond effectively. The program that Minister Roxon has put forward is a strategy to do that. There has been a transparent public process to put in place, with clear access to money, a program over a period of time, and now we have the opposition coming in and telling us that they have given considerable thought to the importance of the step that they are taking in blocking—disallowing—the regulations that will allow that to occur. It makes me think that there has been considerable thought given to the action that is being put before the Senate today. There has been considerable thought, but it is not about the effectiveness of our dental programs; it is ensuring that the opposition will now be able to impose their will on what is going to happen into the future. They will be able to stall the effective planning of the programs that have been passed in the lower house. They will be able to stall the strategic implementation of programs that have been on the public record since before the election. They will be able to stall and divide. Once again, the idea of building up an effective long-term strategy will be stopped by people who for 11½ years could not come up with a response to these issues.

I remember when the community affairs committee was looking at the then program, towards the end of the previous government’s term. We had a consideration of maybe one day or half a day of that particular program, and a number of questions came up: how would the program work? Would people have access to it? Is it the best way of operating? We had that ‘intense’ one-day consideration of such an important piece of legislation—very similar to some of the considerations we will be forced to have over the next week on trying to stall further budget initiatives. But, after that came through, what we were asking was how the wider community was going to benefit from this program. We had statistics about the number of people with chronic illness who may be able to benefit, and there was great discussion about where that fitted into the overall scheme. As people from this side of the house have said, we do not deny that some people did benefit from the previous program. But before the election we said that in our plan we were balancing the needs and the processes, and we never pretended that the former scheme was not one that we had doubts about. We thought it was too complex and we also had issues about just how many people would benefit from it.

Today we are facing a disallowance motion—on the record; we can see how it works. It will be an attempt to stop at this stage the effective budgeting for the dental programs which have been on record—about $780 million that the Rudd government is wanting to invest in dental health over the next four years. Those programs have been built around making sure that they are put in place as quickly as possible. We have already gone out to the community and given people an expectation of who will be able to benefit. I know that in my office in Brisbane people have been ringing up to find out exactly how this particular program will be put in place, in terms of how young people will have access to this process. What we will say now of course is, ‘Because of considerable thought by the opposition, it will now be delayed, probably’—if the vote goes that way. Considerable thought of the opposition has determined that this program will be delayed. And why? What are they asking, in terms of the process? They are asking that the programs that they want are put in place, not the programs that Nicola Roxon led ministry is wanting to put in place, has spoken to the community about, has talked to practitioners across the country about and has set up a strategic plan for the future for.

So, because of this considerable thought, we will go through a process now where there will be a blockage of the area and the delay will occur. And who will that hurt? It will hurt the people, the families, who have been without access to this kind of dental support for many years, who now believe that this will allow them to pre-plan and get into their lifetime plan of looking after their dental health. That will be delayed. Then we will go through this process of willy-nilly, argy-bargy discussion, at the very heart of which people will be hurt. That does not seem to me to be the result of considerable thought.

I remember particularly the people with whom the community affairs committee spoke from the area around Newcastle in 2003. A lot of young people came from schools to talk to our committee about poverty. I remember clearly that people said they just wanted their young people at that stage to have the security of knowing that they would have strong health support. In particular, they wanted to have dental support. I can see their faces while I am speaking; I know that sounds a little strange, but when I had heard about this dental health program—which actually responds to this need that was identified so many years ago—I was really pleased. Those young people are now midteens. They would be at the stage where they would be able to benefit from this program that the Labor government has put on the table. They would be able to be part of the solution, not just the complaint. And now we are able to put in place a process that, in years to come, would mean that we would not be able to read out the appalling statistics about how few people—and how few young people—had been involved in effective dental planning and effective dental services.

In these debates I have always said that it is not particularly valuable just to say, ‘This is what you did, this is what we are going to do, and we are better than you’—I am actually on record as saying that. But it is very disappointing when you actually come to a point where there is a genuine option—a plan that is on the table looking at the critical issues of dental health in our country, focusing on young people—and the ‘considerable thought’ of the opposition, which is just what I believe it is, is leading to a blockage, political advantage and a political point being made. I am disappointed. I think that the people who will be damaged by this decision to delay these processes are not the people who are sitting in this chamber; they are the people who actually expected more. Those people had an expectation that there would be a response, finally, to the very critical issues of dental health. They will not have that expectation met immediately—and there was an expectation that it would be put in place almost immediately. In the planning process there was the expectation that this would be able to be negotiated effectively and that there would be the opportunity for a genuine teen dental health program and also the continuation of a cooperative arrangement between states and territories, with the focus on our health and, in this case particularly, on having strong dental health into the future.

Richard Colbeck (Tasmania, Liberal Party, Shadow Parliamentary Secretary for Health) Share this | Link to this | Hansard source

Just quickly to wrap up the debate, the government went to the election promising they would spend $800 million on dental services. They later confirmed that they would be, but they have now admitted in this debate that they will not be. The way that they have argued in this debate has been completely predictable, as I said, in my initial contribution, it would be. Senator McLucas and Senator Ludwig made comments about young people accessing care for chronic dental disease, but their Teen Dental Plan will not address one single chronic dental case. It will provide a clean, a check and a scale. So, despite the fact that they have had four different costings for it and despite their protestations during this debate today, it will not address one single chronic dental case. It is to provide check-ups—that is all it does—and then if a problem is found you join the queue. They talked about this plan being over four years. They ignored the fact that it was enhanced in the coalition’s last budget and they ignored the fact that its take-up has meant that it has provided over 300,000 treatments since its enhancement—and if it is so difficult to get into why is it providing such significant treatment and why is it so popular with the public? As I said in my initial contribution, we did not take this action lightly. It was seriously considered. Senator Moore is right: the provision of dental care does need a broad range of measures. We in opposition are ensuring that one measure of that broad range of measures stays available to the Australian public.

Question put:

That the motion (Senator Colbeck’s) be agreed to.