Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Link to this | Hansard source

I was speaking on the last occasion about Labor's proposal under its national partnership agreement for adult public dental services. Of course, we know it proposes funding of $1.3 billion for the states and territories for public dental services, but this will not commence until July 2014. The government has not said how it is going to pay for the measure, but many patients on the CDDS will lose access to treatment on 30 November and will have to wait 19 months to see if the government delivers on its promises and starts to provide more funding to the states.

There is no detail of how much funding will be provided by year, with the possibility that the bulk of the money will not be provided until the end of the six-year period which is in 2018. This is what is prompting headlines such as one in the Daily Telegraph of 11 October 2012: 'Two-year wait to get in the dentist's chair'. This is the human face of the government's decision in relation to what is going to happen in this area. There are more and more stories, like that of Mr and Mrs Rapisadra which was reported in the same article in the Daily Telegraph. There are already 650,000 people, 400,000 of them adults, on public dental waiting lists, according to the government. But the Minister for Health has said that Labor's plan will only provide 1.4 million additional services over six years. The scheme that is being abolished has provided approximately 20 million services, including seven million in the last financial year alone.

In 2008, Labor proposed the Commonwealth dental health program which it never delivered. The program promised one million services by providing funding to the states and territories. It was revealed in Senate estimates that the Commonwealth did not assess the capacity of the public dental workforce to provide the projected services and the number delivered may have been significantly less than promised—surprise, surprise. The number of services to be provided over the full six years under Labor's recent proposal is only 20 per cent of what the Chronic Disease Dental Scheme provided last year alone. Worse, there is no guarantee that there is capacity to deliver the proposed services through the public system in terms of workforce or infrastructure. Of course, the lack of infrastructure, particularly in the public system, will impede capacity to deliver the projected number of services.

The $225 million measure to develop infrastructure will not be available prior to the commencement of the new initiative, because an invitation to apply for funding under the flexible grants program for dental infrastructure—that is, capital and workforce—will not commence until 2014, and projects are unlikely to be completed or provide tangible benefits until years later. Even if Labor deliver on the funding promised to the state and territory governments, the cutting of the CDDS and the delay in delivering the new commitment is likely to lead to a deterioration of waiting times for public dental patients. We are very concerned that many patients who are currently or who have been receiving treatment will be forced to forgo treatment during the gap period between the closure of the old scheme and the proposed commencement of the new one. Labor are creating a gap in treatment for patients. Had Labor not squandered so much money on pink batts and Julia Gillard memorial halls, they would not have to be making this sort of decision.

This is only one of a number of cuts to health by Labor. The Gillard government want to cut $1.6 billion from state hospitals over the next four years, and these cuts come as elective surgery waiting lists continue to grow.

As indicated, $1 billion will be cut from dental care by closing the coalition's scheme. The government's means-testing of the 30 per cent private health insurance rebate will mean a cut of $746 million to the rebate this financial year alone. Private health insurance funding will be cut by a further $700 million over four years as government funding is linked to the CPI rather than the average industry premium increase that is set each year. Of course, the 30 per cent rebate for the Lifetime Health Cover component of private health insurance will no longer be rebated and again there will be another cut, $386 million over four years. And, in my own area of mental health, the Better Access program will be cut by at least $550 million as the rebates are decreased and the number of referrals is reduced. As I indicated, the coalition is very concerned that many patients who had been receiving treatment will be forced to forgo treatment during the gap period between the closure of the old scheme and the proposed commencement of the government's measures.

This whole debacle just goes to show that for those opposite it is really just about politics. Two-thirds of the people who are going to be affected are people on concessions, the people on lowest incomes. Clearly if this government had not wasted so much it would not be needing to shut down the scheme. (Time expired)

Richard Di Natale (Victoria, Australian Greens) Share this | Link to this | Hansard source

I am very proud to rise to speak to the Dental Benefits Amendment Bill 2012 today. It is the first step in a major reform of dental health in this country. It represents a huge investment, one that will pay handsome dividends in the coming years. And it is an outcome in which the Greens played a critical role, a package that will make a real difference in the lives of most Australians. We are very lucky in this country to have a good healthcare system. Good health is a fundamental part of a happy and fulfilled life, and we can take comfort in the knowledge that we live in a country where if we get sick help will be available. There is room for improvement, we can do a lot better than we are currently doing in some areas of our healthcare sector, but we can take comfort in the fact that we can get help with common illnesses when we need it and we can do that without the threat of bankruptcy or a threat to our financial security.

There is one exception to that, though, and that is if you have a problem with your mouth. For some reason we treat the mouth separately from the rest of the body, and there is no good medical reason for this. The mouth is connected to the same circulatory and nervous systems as every other part of the body. An oral infection can spread just as easily as any other kind of infection. The experience of pain is the same. Ultimately poor oral health is a medical issue. The fact that dental care is not part of Medicare is purely a historical accident. As a consequence we have seen decades of neglect in this area. The public health situation regarding oral health is an erosive one and in some areas it is actually getting worse. We have made some improvements in oral health: fluoridation—for example, better nutrition and technical progress in areas of dentistry mean that people do have more teeth now than they would have had during our grandparents' generation. That is all good news. The bad news is that the oral health of some young kids is actually getting worse and that the oral health of Australian adults is nowhere near as good as it should be for such a wealthy country.

The reason that Australia's oral health is so poor compared to that of similar countries is reasonably straightforward: people simply are not getting the care that they need. Only 39 per cent of Australians have favourable visiting patterns. What that means is that a little more than a third of the population go to a dentist as often as they should do to maintain good oral health. If you do not go to the dentist regularly, you are four times as likely to get an extraction as somebody who is getting regular treatment and you have got nearly four times the rate of tooth decay. You might have fewer teeth with fillings but that is only because you will have fewer teeth.

The lower your income the worse situation gets. By almost any measure of dental health, income is a great predictor of status—the number of decayed, missing or filled teeth doubles as you go from the highest income bracket to the lowest. If you are Indigenous the situation is even more dire, and unfortunately that is a recurring theme when it comes to health care in this country. By the time an Indigenous person is in their late teens they have eight times the level of decay and 11 times the incidence of periodontal disease compared to the non-Indigenous population. Older Australians and people living in rural and regional areas also suffer disproportionately. If you are in an aged-care facility there is a one in five chance that you are in pain or discomfort right now because of untreated dental issues. What this means for individuals is clear: about one in six people avoid foods due to dental problems and a similar number experience toothache. Of course, problems with the teeth do not stay in the mouth and there are serious complications that can occur when a chronic condition is left untreated. Oral health issues can translate into life-threatening infections. It is well documented that dental issues can complicate or exacerbate heart and lung disease, raise the risk of stroke and lead to low birth weight and premature births.

Untreated dental disease also has a huge social cost. Like any chronic disease, the impact on quality of life for an individual can be devastating. The pain and discomfort of untreated dental disease spreads to all aspects of life. It can lead to poorer nutrition and to interrupted sleep. It can affect, for example, a child's ability to study and to thrive at school. It leads to people becoming self-conscious about their appearance. People avoid going out and socialising with others. People become depressed.

Imagine going for a job interview and sitting in front of a prospective employer with your two front teeth missing. Imagine trying to find rental accommodation without being able to talk properly, or being too self-conscious to smile because of your poor oral health. How do you think it would affect your chances? Oral health is as much a social justice issue as a health issue.

I want to say a few words about the history of this important reform, because the Australian Greens have made dental health a matter of the highest priority. We recognise that there is nothing more important than the health of a nation. Getting dental care into Medicare is a long-term reform that will make a real difference to people's lives. That is why we made dental health a priority when we negotiated with the Labor Party over who would form government following the last election. Reform to Australia's oral health care sector was one of the key parts of the agreement we signed with the Labor Party and we made sure that there would be significant action in this area in order for them to gain our support. When I reflect on that historic agreement signed between the Labor Party and the Greens, and I reflect on some of the key achievements of this parliament, action on climate change—including a price on pollution and the huge investment in renewable energy—as well as getting dental care for kids into Medicare, I think they will be remembered as two of the most significant reforms that have occurred in the life of this parliament. They are a reflection of what can happen when people with different political viewpoints work together for a common cause and achieve good things. It is a testament to what power-sharing governments can achieve.

To advance the cause of dental reform, the Greens worked closely with the government to establish the National Advisory Council on Dental Health. The council was comprised of experts in a range of fields, a range of disciplines: we had health professionals, academics, people from the social services and people from government, all working together. They were given the task of sitting down and coming up with a blueprint for reform, and they were told to focus on some practical steps in the coming budget and beyond.

The final report does make very interesting reading. It is thorough and damning in its assessment of the state of oral health in this country. It also takes a long-range view of where we should be heading. Before setting out any clear options for reform, the council spelt out some long-term aims. That, of course, was sensible; there is no sense in taking the first step without having a very clear idea about what the final destination should be. The council agreed on the long-term goal of an integrated national oral health system that is part of the broader health system. They wanted one that provided equity of access to prevention, promotion and clinical treatment to all Australians.

So the first goal that the council identified was integrating the oral health system into the health system proper. They noted that ordinary people do not make a strong distinction between two kinds of medical issues. Toothache or earache—there is not much of a difference when you just want some relief. And separating these two aspects of health care has led to a real confusion in health policy that has lasted for decades. Just as oral health is linked to overall health, the two systems for caring for these parts of our body must also be integrated.

Improving equity of access was also a top priority, and the report made it very clear that there is a huge inequity in who gets adequate care at the moment. One of the things the report made very clear was that universality is what should underpin our system over the long term. That means that, no matter what our income or standing in society, we should all get access to a good standard of oral health care—and I will talk a little bit more about the principle of universality in a moment.

The council also made the point that looking after the oral health of kids is one of the best investments we could make in the nation's health. It is true that kids often do get to go to the dentist more frequently than adults, but recent declines in the oral health of kids do sound an alarm bell. Childhood dental health is a good predictor of adult oral health, and so sending children into adulthood with healthy teeth and good habits is sound public policy and a good long-term investment. Those of us in the public health community know that sending kids into adulthood with good habits is the most efficient way to influence their health as adults; it will pay huge dividends in the future.

Let us spend a moment reflecting on the details of this bill before the chamber. I think it represents an important part of the implementation of the reforms envisioned by the council. It is a result of the focus that the Greens have brought to bear on the issue. It is part of a broader dental reform initiative. The $4-billion-dollar reform package announced in August also includes $1.3 billion in new money for public dental services administered by the states, and they are services that many low-income Australians rely on. In many cases, they have been underfunded, and for far too long we have had an underinvestment in infrastructure and, as a result, we have unacceptably long waiting lists. The extra new money will fund the building of more infrastructure—chairs—and will employ more dentists and pay for hundreds of thousands of additional services. The reform package also includes $225 million in new money for grants to ensure that all Australians can benefit from this package. Where there are gaps in services, particularly in rural and remote regions, this money will be available to fund projects that address areas of particular need.

But the biggest part of the reform is a new Medicare entitlement for children: 3.4 million kids in families that receive the family tax benefit A will be entitled to Medicare-funded dentistry that covers all essential preventative and restorative dental care at the dentist of their choice.

All kids from the age of two will be covered until they turn 18. Each child will be able to receive up to $1,000 in treatment in every two-year period. So for the first time Australian families will be able to take out their Medicare card and get dental treatment for their children, just like at the doctor.

This bill allows for the creation of the Child Dental Benefits Schedule and specifies eligibility. The government has undertaken to consult with the profession on the range of services included. All essential preventative treatment will be covered. The Greens also agree with the members of the Community Affairs Committee, which examined this bill, that under special circumstances children should have access to more complex procedures, when they are clinically necessary. We will do what we can to advance this as the schedule is developed and implemented. This focus on children is a good investment in the future dental health of the country. It establishes patterns that research indicates will pay off in adulthood.

Australia was once a leader in child oral health, but it has been slipping. The latest report on child dental health from the Australian Institute of Health and Welfare tells us that, in the last year, one in six children experienced pain or avoided some foods because of dental problems. Children whose parents reported difficulty paying a $150 dentist bill were more than twice as likely to have experienced problems as those whose parents did not. This just reinforces what we knew: the health of Australian children is suffering because of the cost barriers that result from this nonsensical exclusion from Medicare. This reform goes some way to closing that gap.

This reform has the backing of many experts. The Australian Medical Association, the Australian Dental Association, the Australian Health and Hospitals Association and the Australian Health Care Reform Alliance have all spoken out in support of this scheme. The Australian Council of Social Services recognises that it is a big step forward in healthcare equity and has praised the new reform package.

An amount of $2.7 billion is allocated for the first years of the Child Dental Benefits Schedule, and over $4 billion in new money has been set aside for these reforms. This initiative and others in the reform package come on the heels of over half a billion dollars allocated for dental health in the 2012-13 budget—money that was negotiated with the Greens. This is the biggest reform in dental health in the nation’s history, but it is just a beginning. The Greens take dental health seriously and will continue to work towards a universal Medicare funded dental scheme.

Part of the scheme does involve the closure of the Chronic Disease Dental Scheme, which was instituted by the Howard government and was aimed at providing treatment to a small number of patients suffering chronic diseases. The health minister described this as one of the worst pieces of public policy she has seen. While we do not agree with the extent of those statements, it is true to say that the scheme was hastily designed and did contain some significant inefficiencies. It was also inequitable. It was not means tested, meaning that sometimes people who were on extremely high incomes could get thousands of dollars in treatment while others who were concession card holders and had very poor oral health were not eligible for care. Nevertheless, the CDDS did provide some measure of publicly funded dental care and provided some treatment to people who otherwise would have struggled to get that treatment. We would have liked to have seen it continue on until the start of these new reforms. We kept the CDDS running for four years because we wanted to negotiate something more significant in its place—something that would be fairer and a better investment for the future and that we could build on over time.

As part of the reform package the $1.3 billion we have secured for services in the public system will go some way towards covering many of the people who were receiving treatment under the Chronic Disease Dental Scheme. They will now be eligible to receive treatment under the expanded services offered through the public system.

As far as the Greens are concerned, the establishment of the Child Dental Benefits Schedule Medicare funded dentistry for children is just the first step. The Greens vision is for a universal dental scheme. Our plan, Denticare, is consistent with what the medical experts say: we need to have universality enshrined in oral health, just as we have it enshrined in general health care. We know that it is a popular initiative, and most people understand it intuitively because they value their experience with Medicare. We also know that it is affordable. It is simply a matter of priorities.

Universal dental care may not happen quickly. It is true that for it to be brought in over time we need to start with those people who need our help most urgently. Children are an investment for the future, and that is why we begin with them. But we also know that low-income earners have a high burden of disease and need extra help. We are pleased that this initiative will make significant inroads into this problem. But over time we would like to see them become the next cohort who receive access to Medicare funded dentistry.

I am pleased that significant reform is being implemented. It is a huge start. It is the first step towards universal dental care and I commend it to the Senate.

John Faulkner (NSW, Australian Labor Party) Share this | Link to this | Hansard source

I am very pleased to speak in support of the Dental Benefits Amendment Bill 2012, and I am particularly pleased that Senator Bob Carr is in the chamber tonight, given his longstanding interest in oral health and dental care.

I think it is fair to say that much has changed in Australia over the past couple of decades—certainly since I first became a senator in 1989. Australia is clearly a more egalitarian place than it was, with fewer class divides and significant progress made towards equality of opportunity for Australians. Education has become more accessible. Access to employment for migrants, women, the disabled and many other disenfranchised groups has improved. Indigenous Australians have more opportunities than they had before. There is more access to education, employment and many health services than we have seen in Australia previously. But oral health is one area where the social divide is unchanged. Dental health has the same correlation to a person's wealth and social standing as it did in 1989. It is true that some of the statistics in relation to dental health do really tell the tale. Tooth loss amongst those who earn less than $20,000 per annum is five times greater than for those who earn over $50,000 per annum.

It is a fact that the Commonwealth government has not done enough in the past period of time, the past 20 years, to close the gap on dental health. This bill, as part of a $4.1 billion investment in the dental health of Australians, is, I think, a very important and very significant step forward. This bill targets children's dental services. Studies have shown that children with increased decay in childhood do need much more intensive dental care later in their lives. This bill will provide $2.7 billion for around 3.4 million Australian children who will be eligible for subsidised dental care, and those benefits, as we have heard, will be provided to children aged from two years to 18 years.

From 1 January 2014 a child dental benefits schedule will see the Commonwealth take responsibility for funding basic dental care for children in families receiving tax benefit part A. Funding will target children from low- and middle-income families, children who are beneficiaries under Commonwealth welfare programs such as family tax benefit part A, Abstudy, disability support pension, youth allowance, double orphan pension, the Veteran's Children Education Scheme and the Military Rehabilitation and Compensation Act Education and Training Scheme. The child dental benefits schedule will mean that kids in eligible low- and middle-income families will be able to access dental services—including check-ups, fillings and extractions—to a benefit of $1,000 over a two-year period for those basic dental services. This is a very important reform. It is going to make a big difference to the lives of many Australians.

As we saw from the minister's second reading speech, the larger package of the government's dental reforms includes $1.3 billion for additional services for low-income adults and $225 million for dental capital and infrastructure measures for regional and remote parts of Australia. As I was just discussing with Senator Carr, this is of particular importance because, as senators would be aware, there are still many rural and remote areas in Australia which do not have fluoride in town water.

I would say in concluding my remarks on this important legislation that, unfortunately, it is true that dental health in this country has been a luxury for the haves and a dream for the have-nots. So I am very pleased to speak in support of this important legislation which I believe will make that concern a thing of the past. This is an important bill, and I am very pleased to support it strongly.

Sean Edwards (SA, Liberal Party) Share this | Link to this | Hansard source

I too rise tonight to speak on the Dental Benefits Amendments Bill 2012. This bill presents me with an opportunity to talk about the terrible decision Labor is making in closing the Chronic Disease Dental Scheme. It also gives me a chance to highlight the inferior dental healthcare outcomes people in rural Australia have, compared to their urban counterparts.

We on this side of the chamber know how important dental care is. It was Tony Abbott, when he was health minister, who established the Chronic Disease Dental Scheme. It has helped countless people with chronic diseases access dental care. These chronic diseases include: asthma, cancer, cardiovascular illness, diabetes, arthritis, mental illness, musculoskeletal conditions and stroke. I support investment in dental care for those who are suffering from chronic disease.

I also support investment in dental care for our children. We all know how important good dental care is, especially for our young, and ensuring that they establish good dental care early can help prevent more serious conditions later on in their lives. I know that people out there in rural South Australia need assistance. Any research you care to look at shows that people in the country have poorer dental health outcomes than their city cousins. My close friend is a dentist in the Clare Valley and he can attest to this anecdotally—and I am sure we could get him to write it down and prove it for us. And that is only 150 kilometres from the city, before you go out to the mining areas of South Australia, Western Australia and Queensland, where I am sure that the health outcomes are far less satisfactory than their city cousins. People living in rural areas stand alongside Indigenous Australians and low-income earners, who are regularly cited as having the worst oral health outcomes in Australia.

As with access to most services, rural Australians are at a disadvantage when it comes to oral health. The research shows that economic disadvantage and living in rural areas are two of the greatest risk factors for poor oral health in Australia—and I agree with you, Senator Di Natale, on those very matters. The Australian Dental Association states that in rural South Australia there are only 27 practicing dentists per 100,000 people, which is well below that found in Adelaide, where there are 66 per 100,000 residents. The problem is particularly clear on the York Peninsula and in the lower north of South Australia, where there are just over 22 dentists per 100,000 residents.

A report from the National Advisory Council on Dental Health shows that rural residents have a higher incidence of unfavourable visiting patterns: 38 per cent compared to 27 per cent for the urban residents. It states that these visiting patterns increase the risk of poorer oral health in rural residents, compared to urban residents, which is supported by survey data. For example: 31.7 per cent of rural residents have untreated decay, compared with 24.8 per cent of urban residents; and 32.8 per cent of rural residents have moderate to severe periodontal disease, compared to 26.1 per cent of urban residents. Everywhere you look, the rural people of Australia are at a disadvantage. Of the total dentate population, 18.5 per cent of rural residents have fewer than 21 teeth, compared to 13.8 per cent of urban residents. There are a lot of figures in there. But it does point to a lack of focus on the rural areas of Australia.

I reiterate how important dental care is for our children, and establishing good dental hygiene from an early age is critical. I remember having to continually nag my four children to brush their teeth before bedtime. Obviously it was not a pleasant task for them—until they finally worked out that it was a good way to stall bedtime. Needless to say, they now have some nice pearly whites to go through life with.

However, not all children have such good teeth. A report released on 25 October by the Australian Institute of Health and Welfare, called Families and their oral health, showed that 16.7 per cent of children surveyed had experienced dental problems in the past year. In families where children had such dental problems, some 23.2 per cent of their parents reported similar dental problems over the same period. Children who experienced an oral health impact in the last 12 months were more likely than children who did not, and they are likely to be from the families who report difficulty in having to pay the $150 dental bill.

Clearly, we have some problems to address in this country when it comes to rural people and children's dental health. Those two areas are standing behind the door when it comes to this bill. This government is going to make matter worse by shutting down the Chronic Disease Dental Scheme—go figure!

This scheme operated by allowing someone with chronic disease to be referred by their GP to a dentist, where important work was undertaken by that dentist. The scheme has been used with incredible success; millions of Australians have accessed essential dental services because of it. The end of the Chronic Disease Dental Scheme would put the health of many older and low-income residents at risk. Eighty per cent of patients under the Chronic Disease Dental Scheme are concession card holders, and they are being left stranded by this government. The government has said it will replace the scheme with a more limited program, but that will not start for adults until July 2014, which is a 19 month wait, in anybody's order.

Once again, Labor is going down the path of mismanaging a program. If you have serious dental treatment underway that will not be concluded by December this year, you lose out—either you pay or you do not finish your treatment. Those who can afford it or who can get family support for it will get the treatment to ease the pain and improve their health. For everyone else who cannot afford major dental treatment, this is a serious problem. The news is a little better for sick children who are using the scheme. They will have to wait only 13 months, until January 2014, when they will have their benefit cut from $4,250 to $1,000 over two years.

The coalition has repeatedly offered to work with the government to achieve bipartisan reform of the scheme to ensure that it is sustainable and better provides for all Australians. The government is refusing these offers perhaps because it cares more about some political point-scoring than it does about the dental health of Australians. More likely, it is a case of looking a bit like a rabbit in the headlights in trying to achieve the Treasurer's rolled-gold promise of a budget surplus this year. The Gillard government has chosen to abruptly close the scheme on 30 November 2012, just weeks away, regardless of people having incomplete treatments and no alternative treatments likely for years. The government has offered an alternative that is little more than an election promise, with the following flaws. Under Labor, adults will have to wait until at least July 2014, and even then the public dental clinics could never match the prompt personal care of a local dentist. Under Labor, children with chronic disease will have their benefit cut from $4,250 to $1,000.

I would like to address some of the unfunded plans that Labor are promising to implement—just more unfunded plans with the promise in the never-never time of the future. This bill will replace the Medicare Teen Dental Plan with the Child Dental Benefits Schedule. It will change the current scheme where the age eligibility is 12 to 17 years to one that covers children from the ages of two to 18 years—on the surface, this would be a plus. I have four children and they are now all in their teenage years, and not too many of them had problems with their milk teeth. What you are seeing is a benefit. What you are being sold seems to be a wonderful thing. But very little dental work is done on children from the ages of two to 12. Again, it is the smoke and mirrors which we see so often from this Gillard Labor government regime. They will give you a little bit extra, but the reality is that it does not mean much at all. For all those supposed changes, there is still no schedule of services, fees or details of how this new $2.7 billion Child Dental Benefits Schedule will be funded. It is a bit like the NDIS, it is a bit like Gonski—again, we have no idea of how this is all going to be funded.

The scheme for adults will not commence until July 2014. There is only a 19-month wait, as I have already highlighted. The government has said that it will provide the states and territories with $1.3 billion for adult public dental services. This new system for adults will provide only 1.4 million additional services over six years. Labor has also announced $225 million for the development of dental infrastructure, capital and workforce measures through applications to the flexible grants program; but, of course, there is a wait. These grants will not be available until 2014. There is a theme here, isn't there? It is called the budget in May 2013—and that just happens to be an election year. The funding for all of these schemes has been rolled out to 2014, with the benefits not set to come through until some years after that.

Taken as a whole, this dental package comes with a $4.1 billion price tag and, at this stage, is unfunded. This is in stark contrast to the lived reality of the many people who have access to the Medicare Chronic Disease Dental Scheme, which provides them with $4,250 in Medicare dental benefits—

Debate interrupted.