Monique Ryan (Kooyong, Independent) Share this | Hansard source

I rise to speak in support of the Health Insurance Amendment (Prescribed Dental Patients and Other Measures) Bill 2023. The purpose of this legislation is to amend the Health Insurance Act 1973 to improve access to the Medicare Benefits Schedule for eligible people with cleft and craniofacial conditions by removing the age restrictions, as well as making changes to rules around the Register of Approved Placements and rules around the administration of the Bonded Medical Program for medical graduates.

Schedule 1 of this bill is my main interest today. It amends the act to improve access to Medicare benefits for eligible persons requiring ongoing treatment for their cleft and craniofacial conditions. To be eligible for Medicare benefits under the current arrangements, people with cleft and craniofacial conditions have to be under 22 years of age. This limit was established on the basis that patients with cleft and craniofacial conditions would generally have completed most specialist dental work associated with their condition once their facial maturation was complete. However, those age limitations have created difficulties for some patients who have not reached facial maturity by the age of 22 or who have experienced a need for ongoing therapy.

The removal of age limits does not change the policy intent of this scheme. Services provided for cleft and craniofacial conditions under the Medicare Benefits Schedule must still be associated with major dental or skeletal treatment to correct or improve primary growth and developmental irregularities, or to undertake repairs that are in connection with that course of treatment. The bill allows a small cohort of patients who, based on their age alone, are currently denied Medicare reimbursement for treatment to access Medicare benefits for the treatment they need. The bill also confers eligibility for Medicare benefits to disadvantaged patients who have been unable to access treatment before reaching the age of 22—sometimes because of the wishes of their parents—or who have had their treatment delayed beyond the age of 22 for reasons such as COVID-19. The bill will not significantly alter average patient numbers, and it will support improvements to patient treatment plans.

I've been aware of this issue for some time. In fact, members of the CleftPALS Victoria support group approached me about this on the day that I declared my intention to run for the seat of Kooyong. As a nascent politician, they were the first lobby group I had ever met, and they've been back several times since the May election to make sure that I don't forget this important cause. CleftPALS has welcomed the changes in age and circumstance for the ongoing management of dental and orthopaedic treatment under the cleft lip and cleft palate Medicare scheme, as do I. It is important that we extend surgical support to all people affected by chronic and severe cleft and craniofacial conditions. They do deserve our support and our care, not just in childhood but throughout their lives.

But I think also of patients with muscle diseases who I used to look after when I worked at the Royal Children's Hospital. Some of these patients had facial and jaw weakness so severe that they couldn't effectively blink. Their facial development was affected in such a way that it changed its bony structure because they didn't have strong muscles which pulled normally on the temporal, maxillary and mandibular bones. Some were unable to close their mouths to chew. Some were utterly unable to manage their own saliva. Their speech could be very difficult to understand due to the weakness of the tongue and the jaw muscles.

These conditions are very severe and they are lifelong. They affect individuals every moment of every day of their lives. Arbitrary cut-offs for access to specific Medicare funded services are perverse, and we shouldn't have them in a generous and inclusive health system.

Similar changes also apply to people with other craniofacial conditions. These people are also affected by lifelong disability, requiring not only surgical intervention but other forms of support as well—support like speech therapy, dental and orthopaedic services. They require that support throughout their lives, not just in childhood, and it would be best to receive it in the context of coordinated multidisciplinary care. That is the issue with this bill; this amendment does not go far enough.

Persons requiring ongoing surgical support for facial clefts and for craniofacial conditions need more support than just surgery. All should have access to essential speech pathology services. Speech pathologists are vital to the care of patients with clefts. They provide advice regarding communication skills and how to stimulate normal development at home. They evaluate feeding and swallowing, general development, speech, language, resonance and velopharyngeal function, and they make recommendations for treatment when problems are identified. The speech therapist can then provide therapy for communication problems and for disorders of feeding and swallowing. It's an anomaly that speech pathology services are not routinely available to children with clefts in this country. The two peak bodies, CleftPALS and Speech Pathology Australia, have been campaigning for this since 2009.

It's a false economy to deny critical speech treatment to children with cleft and craniofacial conditions at clinical stages of their development. That funding might be best provided as part of a package provided by the NDIS on the grounds that these individuals should qualify for the NDIS because they have a disability caused by a permanent physical impairment. There are two issues with these patients not qualifying for the NDIS. Firstly, it creates a two-tiered structure in which some patients with clefts in association with other medical conditions will be granted packages for multidisciplinary care, while most will not. Secondly, the existence of a specific scheduled fee for speech therapy under the NDIS has raised the price of those services to a point where they are now beyond the reach of most families who have to pay for them privately. Without NDIS funding, children will be put on never-ending waiting lists for speech therapy. Therapists will prioritise children with secure funding because they are secure clients. We know that access to publicly funded support for communication and swallowing problems is a long-term concern in this country. Our number of speech pathologists is inadequate to meet the needs of Australians with communication and swallowing problems. There are too few publicly funded speech pathology services in too few segments of the health, disability and aged-care sectors.

Access to speech pathology services varies considerably across states and territories. It varies in relation to underlying diagnoses and conditions, and it varies in relation to whether patients live in metropolitan or rural locations. Speech pathology patients often have extremely limited access to publicly funded speech pathology services. There are, almost invariably, long waits for services which then have a limited number of funded sessions—limits which are based on the rationing of resources rather than evidence based protocols for treatment or because of the restrictive eligibility that limits access to a very limited number of people for very high need categories.

I urge the government to reconsider treatment and support for children and adults with cleft and other craniofacial conditions, and to enable multidisciplinary care, including appropriate allied health support. This should include lifelong speech pathology services where these are warranted. This could be within or without the NDIS, but it should ensure that we provide optimal care for all Australians with these serious health conditions in order to enable them to have optimal medical, dental, orthopaedic and speech outcomes. I commend this legislation to the House.

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