Sue Boyce (Queensland, Liberal Party) Share this | Link to this | Hansard source

I was thinking earlier that perhaps we should retitle this bill. I do not think that it is a bill about dental benefits at all. It should be called the 'over the rainbow dental benefits amendment bill 2012', because of course there is absolutely no funding whatsoever for the promises that the government has made here.

I had the opportunity over the weekend to speak to a number of people who work in dental practices as assistants, administrative staff or as dentists, and all of them expressed sincere concern about the effect that this gap in service provision that the government have developed will cause. It is complete rubbish for this government to claim that what they are trying to do is improve dental services. It is not funded. There is a gap of up to 18 months in the provision of services and it is clearly just about going after that ever more elusive budget surplus that they are so desperate to get.

And we have another classic example brewing at the moment, with regards to chemotherapy drugs, where the government is simply trying to push costs off the federal government budget and onto state governments by clogging up public hospital systems with people who are undergoing chemotherapy and cannot afford to pay what will be the significant difference between the cost of the preparation and infusion of the drugs. We see a similar campaign to the campaign that was launched by this government against the dentists involved in the very successful Chronic Disease Dental Scheme, whereby they tried to characterise dentists in the scheme as money-grubbing people who were simply interested in further improving the dental care of millionaires. We have a similar situation developing yet again with this government trying to claim that it is only greedy pharmaceutical companies who are concerned about the changes that will happen with the chemotherapy drugs when they go on the price disclosure system.

Of course that is not the case. There are more than 14 organisations and not just those representing drug companies, but also researchers, private clinics, people with cancer, and cancer advocacy organisations. People like Professor Ian Olver have spoken out about this terrible attempt the government are making to just simply cut off funding for the infusion costs of drugs, the 10 most popular chemotherapy drugs, on 1 December. Once again, it is simply a disgusting money-grubbing effort by this government to get their alleged surplus.

Even the thinking behind the government's processes here in terms of the so-called Dental Benefits Amendment Bill is completely flawed. The only people who will benefit from the government scheme long term are children between two and 17. They will be able to have treatments that cost up to $1,000 over two years, although they will not be able to do that for well over 12 months. What will happen for that small group of people who require more than $1,000 worth of work? Basically, all they will know is that they need more than $1,000 worth of work. That is as good as it gets.

None of this legislation comes into force until 1 July 2014. We already have 650,000 people on public dental waiting lists in the states and the Labor plan will only provide 1.4 million more services over the next six years. Yet the Chronic Disease Dental Scheme, which will close down completely and be not replaced for more than 18 months, provided 20 million services and seven million of those services were in the last financial year and, contrary to what the government wants us to believe, whilst that scheme allowed people to have up to $4,250 over two years, the average cost was about $1,100 per treatment. So it was not a massively expensive scheme and 80 per cent of people using that scheme were concessional cardholders. So it was not a millionaires' scheme either.

It is interesting to look at the research from the Australian Institute of Health and Welfare. I refer to a report of theirs from October this year entitled 'Families and their oral health'. They make the point that parental factors are a serious and major influence on children's oral health. If parents do not get dental services and do not have dental treatment, then it is quite likely that their children will not either. This is partly about cost and partly about availability. Of course, this government is doing nothing until after July 2014 to improve the availability in the public system within the states and territories. It is partly about that and it is also about people understanding the need for good dental health.

The report says that on average about 10 per cent of Australian children experience toothache in any one year and about 13 per cent avoid some foods because of oral problems. All up at least 17 per cent of children either experience toothache or avoid some foods because they cannot chew them properly. Older children, those between 11 and 17, were more likely than younger children to be affected. Children who had had a problem in the last 12 months were more likely than children who did not to: have a perceived need for dental care reported by their parent, have their oral health reported by their parent as fair or poor, have parents who avoided or delayed visiting the dentist themselves due to the cost, be from families who report difficulty having to pay a $150 dental bill and have parents who had also experienced the same sorts of problems as their children—that is, toothache and in particular the need to avoid some foods because they cannot chew them properly. So the oral health of parents is a good indicator of the oral health of children.

Of course, everyone supports the idea of improving our dental services to children—there can be no dispute about that—but $1,000 over two years is a cruel joke in terms of properly assisting those with real dental health issues. The money will run out before the toothache does. This government has not even told us how it will go about funding its $4.1 billion dental health pie in the sky. It is a serious issue that this government is simply and cold heartedly, in my view, completely avoiding because it is so desperately keen to do something about the problems that it has in balancing the budget.

The Chronic Disease Dental Scheme is exactly what it says. It is available through Medicare, which all taxpayers fund, to children or adults with chronic disease that might affect their teeth. This is a very large group of people. It includes diabetics and heart patients—and the list goes on and on. All this government is going to do is put them at the bottom of the public dental health lists for at least 18 months. They will be waiting to be seen after the 650,000 already on the waiting lists in the states and territories. It is unbelievable that, out of the $4.1 billion dream the government is proposing, there will be $1.3 billion given to state and territory governments to improve their public dental services. Of course, this is another pie in the sky. That funding will start to flow, if these opposite ever find it, in July 2014. That is when they will open the funding exercise to allow for the building of new clinics, for the purchase of new equipment and for, one hesitates to say, the training of new dentists. We are short in that area as well.

In many ways the huge number of people on the public dental health system is not just about the lack of funds; it is also about the lack of infrastructure within state dental services at the present time. But, goodness no, delay the funding until July 2014! It reminds me of the Redcliffe superclinic, which was absolutely, definitely going to be operational in August 2008 but which is not yet operational. The same thing will happen here. At least 12 months, if not years and years, of work will need to be done to create the infrastructure if and when they find the money to do it.

It beggars belief that this wonderful new system is going to fix teeth. It beggars belief that the Greens are prepared to support this bill in its current state. It is not really a matter of concern apparently to them that there will be varying amounts of time—to January 2014 for children and to July 2014 for adults—when there will be no services. The Chronic Disease Dental Scheme stops on 30 November, which is less than a week away, and there will be nothing until the beginning of a scheme, if they find the money, in January 2014. I cannot believe that this is a better system than that that currently exists. On that basis, I cannot understand the Greens' support for the system.

The Gillard government has already cut $4 billion out of private health insurance and has managed to hide $1.6 billion of cuts to public hospital services in the October MYEFO.

I am genuinely concerned that the same thing will happen, if we get a budget in May next year, with the funding for this scheme. It has got to come out of some other cuts that the government has announced or, of course, it can stay on the wish list, like so many other things that are currently on the wish list like the National Disability Insurance Scheme, which must go ahead but can only go ahead if this government funds it properly and adequately. It is yet another example of the complete inability of this government to implement any sort of system that actually helps people in Australia rather than hurts them.

Fiona Nash (NSW, National Party, Shadow Parliamentary Secretary for Regional Education) Share this | Link to this | Hansard source

On 29 August 2012 the Labor Party and the Greens announced they had agreed to significant changes to government policy on dental health. The package of measures included an expansion of private dental treatment subsidies for children from January 2014, increased funding for adult public dentistry from July 2014 and the immediate closure of the current Medicare Chronic Disease Dental Scheme. The Dental Benefits Amendment Bill 2012 replaces the current Teen Dental Plan for children aged 12 to 17 with the new Child Dental Benefits Schedule, which would subsidise private dental treatment for children aged two to 17 by up to $1,000 over a two-year period. The national partnership agreement for adult public dental services promises to increase funding to the states and territories for public dentistry for adults by $1.3 billion starting in the 2014-15 financial year. However, the deal negotiated with the Greens also included the immediate closure of the Medicare Chronic Disease Dental Scheme, or CDDS.

The CDDS has provided up to $4,250 in Medicare dental benefits over a two-year period for patients with a chronic medical condition and complex care needs and whose oral health was likely to impact on their general health. Patients who presented to a general practitioner required a referral from that GP to a dentist and the work was then performed to the satisfaction of the patient. The Labor-Greens government's closure of the Medicare Chronic Disease Dental Scheme categorically proves two things. Firstly, the Labor Party has long stopped caring about the most disadvantaged Australians. Secondly, you cannot trust a word the Greens say. The previous coalition government established the scheme because we believed that people with chronic diseases, such as cancer, diabetes and heart conditions, should not be left to languish on public dental waiting lists. There are currently 650,000 Australians, including a quarter of a million children, on public dental waiting lists.

The government is not only closing the scheme for future patients but leaving thousands of current patients in limbo. The decision was announced on 29 August, new admissions to the program were stopped on 7 September and current patients only have until next Friday to complete their treatment. If your teeth are only half-fixed by then, tough luck. You either have to fund the rest of the treatment, which was never in your family budget, or carry on suffering. It is a disgrace.

The CDDS was the creation of one of Australia's best-ever health ministers, Tony Abbott. It is not surprising that it is being axed by one of Australia's worst-ever health ministers, Tanya Plibersek. It seems that is the only reason the program is being shut down. The Labor government cannot stand the fact that it has to administer a successful scheme created by the current Leader of the Opposition. The Minister for Health has repeatedly asserted that the CDDS benefits millionaires. 'Tony Abbott needs to stop standing up for his millionaire mates,' the minister keeps carping. This shows an astonishing level of ignorance. The CDDS is a Medicare scheme. If you are going to deny higher-income earners access to the CDDS, why not also deny them access to GP Medicare rebates, free public hospital treatment or the PBS? In any event 80 per cent of the one million people who have been provided with treatment under the CDDS are on concession cards. By contrast, the government has not produced any evidence of millionaires having claimed CDDS subsidies. Why would those opposite bother? Closing the scheme is not going to hurt them but it will certainly hurt the 800,000 low-income earners who cannot afford $4,200 to have their teeth fixed.

If the government is so worried about the other 20 per cent of claimants who are not on concession cards—very few of whom, I suspect, are millionaires—why would it not try a means test? Why did the government repeatedly decline coalition offers to work with it to reform the scheme? The only possible reason is that it was the Leader of the Opposition's baby. What possible hope is there of delivering decent health policy when the first consideration seems to be jealousy of the Leader of the Opposition?

Let me introduce to the Labor and Greens senators on the other side of this chamber who are supporting this legislation some of the Gillard government's so-called 'millionaires'. Mrs Kathleen Curtis is a 68-year-old widow who lives in Banora Point, on the New South Wales north coast. Mrs Curtis suffers from a rare disease, called Sjogren's Syndrome, which causes her to experience an extremely dry mouth. This disease has affected Mrs Curtis's overall health and wellbeing and she has also suffered other effects of the syndrome. That is why she signed up to the coalition's CDDS. However, after next Friday she does not know where she will find the money to complete her treatment. Mrs Curtis told her local newspaper:

… the government should introduce some help for people with chronic illnesses especially the ones that cause tooth decay.

"That's not an unreasonable request."

It is certainly not an unreasonable request, Mrs Curtis. Your local Labor member of parliament, Justine Elliot, who presumably enjoys top-level private health insurance perhaps, should hang her head in shame.

Dr Glen Hughes is a dentist who runs a private practice in Alstonville and also works in public dentistry at the Aboriginal Medical Service in Casino. Both communities are in the electorate of Page. The oral health of Indigenous Australians is a national disgrace. Dr Hughes is determined to do something about that and he is incredibly passionate about his work supporting the local Indigenous community, and I commend him for the work that he is doing. He takes photos of the teeth of every patient he treats at the Aboriginal Medical Service. When I visited him there, he showed me before and after pictures of patients he treated under the CDDS, and the results were astonishing. This is some of what he had say to me when he heard of the government's decision to abolish the CDDS:

The closure of the CDDS, with no similar replacement, is going to wreak havoc amongst the adult Indigenous population. I currently have 258 clients with EPC referrals that remain untreated and incomplete. The closure of the scheme could potentially remove a funding stream of a million dollars from my clinic alone. I know you're extremely busy and appreciate it may be a done deal with Greens-Labor agreement. However, please protest loudly and long on behalf of the most needy Australians, who will be adversely affected.

To be fair, Dr Hughes did get a hearing from his local Labor member of parliament, Janelle Saffin. Ms Saffin told Dr Hughes that she was sympathetic. I am sure Ms Elliot too would have been sympathetic to the plight of Mrs Curtis if she had known about it. But what use is sympathy for people suffering in those electorates when those members of parliament fly down to Canberra and vote in parliament to make their constituents' plights worse? If those Labor members of parliament had voted for the National-Liberal disallowance motion to stop the closure of the CDDS, Dr Hughes's Aboriginal patients and Mrs Curtis would still be getting the treatment they deserve.

I said earlier that this bill shows that you cannot trust the Greens. This is what the Greens Senator Siewert told the media the first time that Labor tried to close down the CDDS in 2008:

Since it started … the Chronic Disease Dental Scheme has helped thousands of Australians suffering from chronic health problems directly related to dental problems.

The Government says it is essential to close down the chronic disease dental scheme and redirect funds [for] a program that will not be operational for months to come.

… it's ‘wait and see' for sick people in dire need of support.

What happens to the thousands of people who are currently receiving help through this scheme? The Government has been unable to assure us that people currently receiving treatment will receive the same level of dental health care under the CDHP.

…   …   …

This issue is not about programs or money - it is about people with medical need. The Government is trying to force the Parliament to choose between two dental programs that benefit people in need. The Greens are not prepared to make that choice, and leave these people out in the cold.

As late as the 2012 May budget, the Greens were saying:

The reforms we've negotiated for the 2012-13 Budget will mean:

So what have the Greens apparently negotiated to replace the CDDS with? Children with chronic disease will have their benefits cut from $4,250 to a thousand dollars and adults will have to wait until at least July 2014. Talk about a breach of trust. You would think that the Greens would be embarrassed about their betrayal of needy Australians but they actually seem to be boasting about it. The Greens website now claims full credit for closing down the CDDS that it supported only six months ago. Senator Di Natale said that this achievement, 'shows how power-sharing governments can make a real difference to people's lives when parliamentarians work together constructively'. The Greens achievement, so to speak, is certainly making a real difference to the lives of people like Dr Hughes's Indigenous patients but, unfortunately, colleagues, it is not a good one.

The Greens and Labor argue that it is okay to close the CDDS because the new systems, one for children and one for adults, are better. But the government is ripping a billion dollars out of dental health with the change, so it seems unlikely that it will provide better outcomes. Let us test the theory. The first problem is the timing. The new plans do not begin until 2014, so why are the Greens letting Labor close the CDDS in 2012? The fact that nothing will happen until after the election shows that this is not really a new law but an unfunded $4 billion Labor election promise. The new schemes are no more l-a-w law than Paul Keating's undelivered tax cuts.

The Prime Minister can stand up and say, perhaps, 'There will be a dental scheme under a government I lead,' but nobody is going to believe her. Labor's promised means-tested scheme for children will leave many parents out of pocket. Over 60,000 services have been provided to children under the CDDS. Apart from the fact that children will have to wait for 13 months before they get any treatment at all, the help they will get is capped at a thousand dollars over two years, compared with $4,200 under the CDDS. From the government's own figures, the average cost per person is $1,716. This means that families on the lowest incomes will not be able to afford to have their children's teeth fixed. That is ironic because it is exactly the complaint that Labor is levelling at the CDDS.

The scheme for adults is not really a scheme at all. It is a promise to throw a bucket of money, $1.3 billion, at the states and hope for the best. That is the same strategy that Labor used with the $16 billion school halls program, and is likely to be just as ineffective. Notwithstanding some of those schools being so pleased to see those buildings, the waste and mismanagement we saw through that program were just extraordinary. The new scheme is not set to begin until July 2014.

The Medicare CDDS allowed patients to be treated by their private dentist in the same way that Medicare rebates allow patients to be treated by their private GP. The Labor-Greens plan would see all funds go towards public dentistry. Remember that there are already 650,000 people on public dentistry waiting lists. So what will be the outcome of the government's plan for a massive shift from the private to the public system? Let us go back to the Casino Aboriginal Medical Service and Dr Glen Hughes, who said:

The public sector waiting lists will skyrocket and reducing waiting lists by simply doing more extractions and emergency dentistry is to the detriment of oral health. Unless the private sector is included in sharing the oral health burden, the next two years will be a nightmare for any low-income adult needing dental work.

There is simply no capacity within the public sector to meet demand. In my public clinic I have at least 250 clients who are eligible for care under the CDDS. To meet this demand within the public sector would require the equivalent of five full-time dentists and ancillary staff. I am currently funded by the state government to work only two days per week. It is so difficult to recruit and retain public dentists in rural areas that the current policy focuses on teams of dentists being flown from Sydney to remote locations for 12-week rotations.

Every public dental clinic I know is able to only barely meet emergency demand. The dentists working at those clinics as a general rule have become de-skilled in providing comprehensive care. There is simply no infrastructure, personnel, scope of practice or capacity within the public sector to take on the workload that, up until now, has been provided in the private sector. It won't matter how much money is thrown at the public system, there simply aren't enough dental chairs or dentists to provide the treatment, and without huge structural change at a state level it cannot happen.

Dr Hughes is no partisan scaremonger; he is just intensely passionate about the oral health of disadvantaged Australians, particularly those in the regions. I implore Labor and Greens senators to heed his well-informed views.

I particularly appeal to the Greens. While it is too late now for them to change their view on this, I can only say how disappointed and absolutely appalled people must be out there in the community to see this change of view from the Greens. They actually had it right when they were continuing to support this. They had it right, even when they said 'until something equivalent is in place', until those needs can be met. But they have simply rolled over to do the government's bidding, and that is going to have such an impact on these people. This is a shoddy piece of legislation, leaving so many Australians in the lurch. The time frame is appalling and, again, we see that the government is not able to deliver decent, reasonable policy for Australian people. And this piece of legislation in particular is a detriment to those in regional communities.

Jan McLucas (Queensland, Australian Labor Party, Parliamentary Secretary for Disabilities and Carers) Share this | Link to this | Hansard source

As was said from the introduction of this bill, investment in our children's teeth is an investment into the future. Children's oral health has been getting worse, not better, since the 1990s and unless we reverse this trend a generation of children with poor teeth will grow up into a generation of adults with poor teeth. We know that the health and hospital system of the future will face increasing pressures from the ageing of the population and from the increasing prevalence of diseases such as diabetes. Poor oral health will place even more pressure on the wider health system, yet it is a source of pressure that can be addressed reasonably easily with investments in children's oral health.

The Dental Benefits Amendment Bill 2012 will establish a framework to allow children in poor and less well-off families to access affordable, preventative dental care and basic dental treatment services. The Child Dental Benefit Schedule builds on the Medicare Teen Dental plan, which was one of our election commitments in 2007. It will make more than three million children eligible for dental care subsidised by the Commonwealth government. The schedule is only part of our unprecedented commitment to improving dental health. In the 2012-13 budget we allocated $515 million for a blitz on public dental waiting lists and additional training and support for people in rural and remote areas.

On 29 August Minister Plibersek announced a further package of measures, including spending of $2.7 billion on the Child Dental Benefit Schedule Grow Up Smiling. That package also included a further $1.3 billion to assist the states and the territories in providing access to public dental services to low-income adults. This funding will provide about 1.4 million additional adults with a complete course of public dental care, including multiple dental services. The package also included $225 million for dental capital and workforce infrastructure to support expanded services for people living in outer metropolitan, regional, rural and remote areas.

Some of the senators opposite have insisted that the government's dental reform policies are 'underfunded'. I draw their attention to the 2012-13 Mid-Year Economic and Fiscal Outlook published last month on 22 October. This clearly outlines the allocated funding and expenditure for each measure in the package. Some of those opposite also claimed that there is a gap in funding for dental services for up to 19 months. Let me make it very clear: there will be no gap in Commonwealth funding for dental services for low-income patients. Funding for the government's blitz on public dental waiting lists will start flowing from next month. Any delay in dental service provision under this measure will be because the states and territories either delay in signing up to the funding agreement with the Commonwealth or delay in rolling out the services.

As we have said throughout this debate, Medicare and free hospital care have been a basic right for Australians for decades under policies established by the Labor Party, and yet millions of people in this country still go without adequate dental care because of cost barriers. I believe governments have a responsibility to assist in overcoming these barriers and supporting low-income Australians in accessing affordable dental care. The dental reform package is an important part of meeting this responsibility. I commend the bill to the chamber.

Question agreed to.

Bill read a second time.