Helen Polley (Tasmania, Australian Labor Party, Shadow Parliamentary Secretary for Aged Care) Share this | Link to this | Hansard source

I, and also on behalf of Senator Di Natale, Senator Griff, Senator Lambie and Senator Hinch, move:

That item 2 of Schedule 1 of the Dental Benefits Amendment Rule 2016 (No. 2), made under the Dental Benefits Act 2008, be disallowed [F2016L01986].

Fifteen sitting days remain, including today, to resolve the motion or the instrument will be deemed to have been disallowed.

There is no clearer example of the overwhelming rejection of these cuts than the fact the government have announced they will be dropping them before this place even gets to vote on the motion before us today. That is right: they knew that this place would strike out the cuts to the Child Dental Benefits Schedule which took effect on January 1 this year. Backed into a corner, they announced they would drop the cut and restore funding per child to the original level of support. Make no mistake, the government did not do this because it was the right thing to do or because they wanted to; they did this because they were forced to. Though they had indicated they will drop the cuts, we are yet to see this legislative change. So not only are we proceeding with this motion, we are asking the government to vote for it as a sign of good faith. If they are serious about dropping this cut which will leave 250,000 children worse off then they should vote for this motion today.

As I said, there has been cross-party support for this motion to disallow the government's cuts to the Child Dental Benefits Schedule, and I thank my fellow senators for their cooperation. We united against the government's attempt to cut the Child Dental Benefits Schedule for a simple reason: they have always been unfair cuts that, at the government's own estimates, left one in four children who used the scheme worse off. The Prime Minister has done nothing but attack successful and established dental programs for both children and adults. Malcolm Turnbull originally planned to abolish the scheme completely, only backflipping after Labor fought to have the cut removed from their omnibus legislation last year. Their latest cuts were yet another attack on the successful program.

To understand why protecting this program has been so vital, it is important to look at why it was established in the first place. Firstly, it is important to recognise that dental care is not just about teeth. Poor dental health is linked to chronic disease. If teeth are not properly cared for, it often leads to much greater health problems. People often think that in children oral health is not as important because baby teeth will be replaced. This could not be more false. The primary teeth play a particularly important role in in a child's development, aiding in speech development and nutrition. In addition, untreated dental pain can impact on a child's ability to pay attention and learn.

That is why the former Labor government took steps to advance our universal system of health care to dental care with the announcement of a dental reform package, the centrepiece of which was the Child Dental Benefits Schedule. Labor introduced this scheme because of disturbing evidence that the oral health of children has been declining since the mid-1990s. According to the Australian Institute of Health and Welfare in 2009, the proportion of children who had experienced decay in their baby teeth ranged from 42 per cent for five-year-olds to 61 per cent for nine-year-olds. The proportion of children with permanent teeth affected by decay ranged from five per cent for six-year-olds to 58 per cent for 14-year-olds. Almost 20,000 kids under the age of 10 are hospitalised each year due to avoidable dental issues. By age 15, six out of 10 kids have tooth decay.

This scheme sought to tackle that by providing a capped benefit of $1,000 per child over a two-calendar-year period, targeted at low-income and middle-income families by tying eligibility to those receiving family tax benefit part A or an equivalent Australian government payment. This program was a crucial investment in the long-term health of children because we know that dental health in children is the best predictor for dental health as adults, but also a predictor of overall health. It is a tightly targeted program to ensure that the kids and families who most need help accessing dental services are the ones who get it.

But the Liberals have been determined to axe the scheme ever since they came to government. First, they refused to promote the scheme, leaving many parents unaware of the important dental services that their children could access. In fact, a review by this government's own health department said that the scheme's only failing was the Abbott-Turnbull government's refusal to promote it. In a review of the program, the health department said:

In particular, the Panel noted the success of the CDBS in targeting the oral health of young Australians at an age where preventative measures can be most effective.

The health department made several recommendations to improve awareness of the scheme, which this government has never implemented.

Then, in April last year, the government announced its plan to abolish the Child Dental Benefits Scheme. Parents, dentists and experts were outraged, and Labor was proud to stand with them in the fight for the scheme. When they could not pass through the Senate their plan to abolish the scheme, the government instead applied a cut across the board, cutting the entitlement of every child who was eligible under the program. On New Year's Day, the government cut the cap on CDBS benefits from $1,000 over two years to $700. That is a cut of up to $300 a child, or $600 for a family with two kids. Late last year, the former health minister admitted that the new cap would hurt more than one in four of the children who use the scheme. That is over a quarter of a million kids who would have been worse off.

To understand how nonsensical the decision to cut the scheme was, the government need only have spoken to any dentist. The opposition visited countless dental practices, who reiterated how important the scheme was. In practice after practice dentists said they were seeing kids from families who never before had come to see a dentist, and, as a result of this government's attacks on the Child Dental Benefits Scheme, they feared that these kids would either never see a dentist, or would have to wait years if they were thrown back onto the endless waiting lists of the community dental schemes. Attempting to scrap a proven program to help children access affordable dental care was always in the running for one of the Prime Minister's cruellest cuts. It might have taken over a year, but Labor is pleased that the scheme has been protected and the government has finally dropped their cuts altogether.

Unfortunately though, this announcement does nothing to restore the massive $300 million-a-year cut to adult public dental services that will see 337,000 Australians lose access to dental services. When the government announced in December their latest cut to children's dental services, they also announced a paltry sum of money for adult dental services, after leaving the states and territories in limbo until the 11th hour. As a result of this government's cuts to adult public dental, disadvantaged and vulnerable Australians will lose access to life-changing dental services as a result of long waiting lists, and they will grow across the country.

The funding allocated to the states and territories for public adult services is an insult when the Liberal government have ripped hundreds of millions of dollars out of adult public dental services since 2013. In government, Labor budgeted $391 million a year for the national partnership agreement on adult dental services. The Abbott/Turnbull governments have cut this time and time again. Also, the announcement last year of a further cut means the Liberals are ripping $300 million out of public dental services every year. As a result, every year around 337,000 Australians will miss out on critical public dental services. The states themselves said what an insult the funding that was allocated was. The Queensland health minister said that it was a 75 per cent cut to federal dental funding for Queensland on what was promised in the Member for Warringah's first slash and burn budget, in 2014-15. So there are still serious unresolved questions about the future of adult public dental services funding, and the impact on waiting lists, that this government needs to address.

Looking at today's confirmation, it is both a victory for children's dental health and an embarrassing backflip for this government. Let us remember that it has been only about a month since these cuts took effect on January 1. They kicked off the new year by slashing the amount of dental assistance eligible children could receive under the scheme by $300 a child. They pursued these cuts despite admitting that one in four children who use the scheme would be negatively impacted, leaving a quarter of a million children worse off. What a lousy New Year's present indeed.

You might be asking what has happened to make the government change its mind in such a short amount of time. Why the sudden backflip?

The answer is in this place. They knew that today we would vote and throw out their cuts. So, backed into a corner, they scrambled to claim back some credibility. If those on the other side have seriously had a change of heart about this cut, they should vote for this motion and throw out their own decision. Labor has never given up fighting for this program against Malcolm Turnbull's cuts, and we are pleased to have been able to protect it.

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

I also stand to support the disallowance of the government's cuts to funding for the Child Dental Benefits Schedule. Let me begin by outlining the problem that we have here. Australia is a very wealthy nation, but we have young people, and people right across the board, who are suffering from very poor oral health. When you look at Australia's level of wealth, you see a disproportionately high number of people who suffer from poor oral health—dental disease and so on. Often people assume that having the odd cavity and having problems with dentures and so on is a minor issue, that it is not as important as other health burdens, but increasingly we are starting to understand just how critical it is to have very good oral health. Apart from the obvious things like infections and pain that poor oral health can sometimes cause, and apart from the issues associated with cavities that can be resolved through fillings and so on, having poor oral health has a very significant impact on people's general health and wellbeing. We are learning now that poor oral health is linked to heart disease and to stroke—a whole range of cardiovascular illnesses are a direct consequence of suffering from poor oral health. Indeed, it is associated with adverse outcomes for women who are pregnant.

It is a very serious problem, and it is not just a matter of the direct health impacts. It has a huge impact on people's wellbeing more generally. If you are missing teeth and do not have dentures, it can be highly stigmatising. If you are sitting there in a job interview, for example, it is automatically a marker that puts you behind the eight ball—likewise if you are looking for a rental property. Having very poor oral health compromises your ability in all these sorts of areas. So it has very serious impacts, both directly through the pain caused by infections and the very serious health impacts of diseases like cardiovascular disease but also through the impact on people's self-esteem—their ability to achieve things in life more generally. It can be highly stigmatising, and people with poor oral health will often find that they do not go out in public because they are worried about what people might think of them. As a GP, I would often see people coming in as a result of a tooth abscess or something similar. They could not afford to go and see dentists, so they would come in knowing they would get Medicare funded treatment. But as a doctor there is not much you can do. You would often give some antibiotics and maybe some pain relief, but what they really needed was specialist dental care. One of the big problems in this country is that for too many people dental care is unaffordable.

So that is the problem. In terms of Australia's approach to dental care, one of the great tragedies, in my view, was that oral health and dental care were excluded from Medicare when Medicare was constructed in the 1970s. We decided for some obscure reason, and people will argue about the history of this, that we would somehow treat the mouth as separate from the rest of the body. So if you have an infection on your forehead, for example, you will get Medicare funded medical care but if you have an infection in your gum or your tooth you will not get Medicare funded dental care; you have to predominantly pay for that dental care out of your own pocket.

What is the solution to all of that? If we were designing the system again, the Greens would have Medicare funded dental care. We would do what the Child Dental Benefits Schedule attempts to do. There is a bit of history here that is worth reflecting on. The Child Dental Benefits Schedule is effectively Medicare funded dental care for children. If you are a kid and you want to go and see a private dentist, you have $1,000 to spend over two years that can be basically funded through Medicare. If you present your Medicare card the dentist will provide up to $1,000 of treatment. So, it is Medicare funded dental care. I am very proud of it, because it was one of the outcomes of the power-sharing government involving the Labor Party, the Greens and the Independents. It is one of the outcomes that we achieved through that period of government—and that period of government is starting to look better every day, when you reflect back on that period and then look at what we are seeing at the moment. It is starting to look more like a golden age of stable government. The Child Dental Benefits Schedule was one of the agreements that we struck with Labor. It was something we put to them and we made it really clear that we wanted to see the start of Medicare funded dental care in this country, and, to the Labor Party's credit, they agreed with the proposal and we now have Medicare funded dental care for 80 per cent of kids. It is the only Medicare funded dental program in Australia. Basically, if you have access to family tax benefit part A—which the families of roughly 80 per cent of kids do—you get $1,000 worth of essential and preventative dental treatment over the two years.

Basically, this allows kids to go to private dentists. We know that 80 per cent of the dental workforce comprises private dentists. Families can access the scheme through the dentist of their choice. It allows you to have a relationship with your local dentist and also, importantly, allows you to avoid those huge waiting lists in the public dental system, which I will get to in a moment. It is really important for those people in regional communities. If you live out bush, waiting lists make access to public dental services nearly impossible. People in regional communities who otherwise would have had to travel for hundreds of kilometres to go to a public dental clinic are able to go and see their private dentist for their children's treatment. All in all, it was a really significant win. If the Greens were in government, we would make sure we expanded it. We would expand it so that we would have Medicare funded dental care for all people. That is what we took to the 2016 election campaign.

To the 2016 election campaign, we took a plan to build on the CDBS—or what I think should be called 'Medicare funded dental care for kids'. We would bring in people from disadvantaged backgrounds. And there are ways of doing that—through concessional status and so on, people who have got health care cards—but ultimately we would like to see a universal dental health care system funded through Medicare. The same way you go to your GP, you could go and see your dentist. That is our long-term plan, and that was the plan we took to the election campaign.

Unfortunately, what we have seen is a government that is ideologically opposed—and this is really important; I think this is a ideological attack. It makes no sense on the basis of evidence. This is a good long-term investment. Having people maintain good oral health is good, as I said earlier, for their sense of self-esteem, but it is also good in terms of productivity. Billions of dollars are lost in productivity because of people who have poor oral hygiene. We would go some way into improving the health debate in this country if we recognised that these preventative interventions actually have a long-term pay-off.

But what we saw was the government moving to cut the funding to the CDBS, or Medicare funded dental care for kids, by $300 per child through this regulation. That was basically one-third of the $1,000 that was taken off. It is a direct attack on those kids in regional communities and those people who are unable to access a private dentist because they simply cannot afford the up-front cost or they do not have private health insurance. It was really an attack on those people. I now understand, from a press release from the minister, that they have effectively read the writing on the wall—one of those rare moments of self-awareness from this government—and they are planning to restore the funding back to the $1,000 per child and to restore the scheme as it was originally designed by the Greens.

I know that the minister has been under some pressure from stakeholders. It is good that the new health minister has listened, and I commend him for that. I would also like to congratulate those stakeholders within the dental community who have put the case to the minister and indeed made their views very clear on this. So, given the minister's announcement, I assume that he will support this disallowance motion—given that he has said he will restore that $1,000.

I have to say, it is very clear that the government has been keen to scrap the Medicare funded dental scheme all along. One of the more disgraceful chapters in this saga was when the government on multiple occasions released fact sheets and sent out information to families and to dentists saying they would no longer be able to receive dental care for their children under the scheme because they had a plan sometime in the future to get rid of it, despite never having the agreement of the Senate.

So on one hand they are saying one of the issues with the scheme is that it is underutilised; and then on the other hand they are telling people they cannot utilise it because they are going to scrap it. What do you expect? They have undermined it at every turn. They have consistently fought to scrap this scheme. They have done nothing to promote it. In fact they have done the opposite. They have provided misleading information to the community to say the scheme will no longer be funded and therefore you will no longer be eligible. At Senate estimates time and time again we have caught the department out with false and misleading information being sent to individuals. Each time they corrected it, and then they returned to their dark old ways of providing people with misleading information.

I have to say that, while we are pleased that the government has finally listened—and certainly the new health minister appears to have listened—and while this is an important scheme for children, and 80 per cent of kids have now got access to dental care through a private dental provider funded through Medicare, one of the real concerns here is what this government has done when it comes to funding for public dental health care.

For those people who do not know, the states and Commonwealth jointly fund public dental health clinics. There are many of them around the country, and they are very important because adults who cannot access this Medicare funded scheme, who cannot afford to pay the up-front cost to go and see a dentist, at least have the comfort of knowing that there is a public dental scheme waiting for them.

One of the other significant achievements through that period of power sharing government was that we got a massive injection in funding into the public dental scheme. We had a significant injection, which brought down waiting lists, which in some places are up to three years. We have people who are waiting for dentures, who cannot afford to pay for them out of their own pocket, who have to wait for three years on a public dental scheme to be able to get dentures so they can just have a quality of life that most of us take for granted. Just reflect on that. We are not talking about cosmetic dental care here. We are talking about people who have chronic abscesses; some of them simply do not have any teeth and are waiting for dentures, and waiting for years. We went some way to addressing that through working with the Labor Party and Independents to ensure that we got a big injection into the public dental system.

What have this government done? They have ruthlessly attacked public dental services. In the 2013-14 budget they promised $391 million for 2016-17 public dental services. How much are we seeing now? $107 million per year. So last year the amount was reduced to about $155 million per year, from that $391 million that was promised. Now they have cut it again and they are saying it is $320 million over three years. That is one-third of what was promised in the 2013-14 budget. They have slashed funding for public dental care. Of all the things, all the priorities, all of the areas where we could make savings—and I could list a huge number of those areas ripe for savings.

We have to decide in this country whether we are going to try and balance the budget on the back of this nation's most vulnerable people, some of the poorest people here, or whether we recognise there is a huge and growing gap between the super-rich and ordinary people and start to recognise what our priorities are. Let's talk about the diesel fuel rebate that goes to the mining industry worth billions of dollars. Let's stop propping up investment in the housing market by subsidising people who want to buy their third, fourth or fifth home. Let's tackle negative gearing and reform the capital gains tax discount.

They are the sort of areas where we can make changes. How about a levy on the big banks to ensure that they pay for the guarantee that they get from government, rather than trying to squeeze a few million dollars out of health budgets, attacking vulnerable pensioners and doing what we saw in today's changes to family tax benefits, where the government is saying that the only way we are going to be able to help families is by hurting them.

We have some choices to make in this country. We have to decide whether we as a nation want to ensure that we have a more equal, more caring society. That means cracking down on multinational tax avoidance and ending the rorts that exist in the property market that inflate home prices for young people, who are being screwed at the moment, and see them continue to be left out of the property market and basically denied an opportunity to own their own home. They are the sort of measures that we as a nation could take, rather than what this government is proposing to do, which is to cut essential services that I think are the foundation of a decent society.

The good news is that the government has seen the light today on the Medicare-funded dental scheme for kids, the CDBS. We are pleased about that. What we would like to see is a move to restore funding for public dental care. As I said, the Greens have said now for many, many years that we think the mouth should be considered like the rest of the body. Going to the dentist should be just like going to the doctor: produce your Medicare card, which is effectively a universal health insurance scheme that means we all get access to decent health care, which includes decent dental care.

The Senate is rejecting this cut to the CDBS. As Greens, we will continue to fight not just to protect this scheme but to build it up; to make sure it is available not just to children but indeed, one day, to all Australians. We will challenge this government to restore that funding to public dental health care and to start balancing the budget by ensuring that we tackle that big and growing gap between the rich and ordinary people in this country. There are so many areas where we could make savings, where we could ensure that we have a sustainable budget position. You do not do it by balancing the budget on the back of this country's poorest and most vulnerable people.

Fiona Nash (NSW, National Party, Deputy Leader of the Nationals) Share this | Link to this | Hansard source

The Turnbull government is committed to ensuring that children right across Australia, both in cities and in remote areas, have access to the dentist when they need it. Under the scheme, on average only $312 of the rebate has been claimed per child per year. In light of this, the government has previously set the cap at $700 per child over a two-year period, which would still allow children to visit a dentist regularly. However, following consultation with the Australian Dental Association, the Minister for Health has decided to reinstate the cap at $1,000. We are also providing $11 million over two years to the Royal Flying Doctor Service to delivered dental outreach services to rural and remote communities. The Turnbull government is delivering on its commitment to improve the dental health of all Australians through the Child Dental Benefits Schedule and to contribute to better public dental services through a national partnership agreement with the states and territories.

Stirling Griff (SA, Nick Xenophon Team) Share this | Link to this | Hansard source

I am pleased to be co-sponsoring this motion. Cutting health treatments for children and low-income families is definitely not good policy. Inevitably, it just leads to deferred health costs for the public health system. The money saved today would merely be spent many times over in the future to deal with escalating problems that may have been prevented through early intervention.

We do not support cutting $300 per child from the Child Dental Benefits Schedule because it is short-sighted and, I feel, poorly considered. Ensuring that children have healthy teeth helps set them up for a healthier adulthood. We know that poor dental health is linked to bigger health problems, such as heart disease, so moves to scale back dental services should not be taken lightly.

The CDBS scheme has been in operation since January 2014 and provides basic dental services such as cleaning, fillings, X-rays and root canals to eligible children aged between two and 17. The government had originally proposed scrapping the scheme and creating a new one that combined funding for both adults and children; however, several states rejected the proposal over concerns that they were being short-changed and thousands of people would miss out on treatment. In December the government instead announced a modified Child Dental Benefits Schedule that cut the scheme's cap from $1,000 per child over two years to $700 per child, claiming that this reflected user patterns. This could not be further from the truth. Last financial year more than one million children accessed free dental treatment through the scheme. This was slightly more than the previous year, costing $312.7 million in benefits. The government has budgeted for 2.4 million children to use the service each year, representing a substantial saving on paper. Despite this, the government feels the need to rip money out of the scheme to the detriment of the children who do use it.

The Chief Medical Officer's review of the scheme administration, released in March last year, suggested the government's target of 2.4 million users was optimistic, and that the poor uptake was probably because the program was poorly promoted. Families getting Family Tax Benefit Part A are only made aware of their entitlement through a single letter from Centrelink. The scheme's low profile is compounded by the fact that most services across Australia are delivered privately. The jurisdictions where it was delivered through public dental services enjoy very much greater utilisation of the scheme. For instance, in my home state of South Australia almost 40 per cent of eligible children took up free dental care, the highest rate of use in 2014, and the review noted that the South Australian Dental Service was particularly proactive in accessing the scheme. In New South Wales, where it is almost solely delivered privately, the uptake was closer to 30 per cent. Regardless, the fact that one million children a year use this free dental care is no small thing. Because the scheme is so highly targeted, the children who need it most do use it. The states with the highest degree of use also had the highest number of disadvantaged children. About one in 10 children who used it in 2015 went over the $700 limit proposed by the government in just one year.

The government has not made a sound case for cutting the dental care subsidy. In fact, it has made no substantive case at all. For this reason we do not agree with this measure and we support the disallowance motion.

Question agreed to.

Barry O'Sullivan (Queensland, National Party) Share this | Link to this | Hansard source

I indicate to the Senate that, in accordance with standing order 86, business of the Senate notice No. 4 will not be called on as it is identical in terms to the motion just passed.