House debates

Tuesday, 18 September 2007

Health Insurance Amendment (Medicare Dental Services) Bill 2007

Second Reading

Debate resumed from 17 September, on motion by Mr Abbott:

That this bill be now read a second time.

4:25 pm

Photo of Brendan O'ConnorBrendan O'Connor (Gorton, Australian Labor Party, Shadow Parliamentary Secretary for Industrial Relations) Share this | | Hansard source

I would like to continue where I left off last night in responding to the government’s claims that the Health Insurance Amendment (Medicare Dental Services) Bill 2007 will somehow properly respond to the dire need to improve dental health in this nation.

I have to say that I am not of the view that this government has the wherewithal or the political will to address this challenge. One of the reasons this is not within the capacity of this government is that for more than a decade now there has not been any interest or inclination by the Commonwealth to attend to the growing queues in every electorate across the land of people who are looking to get their teeth fixed or to maintain the health of their teeth.

There has been little or no attention paid by the Prime Minister, the Minister for Health and Ageing or any minister of this government who has held portfolios related to this very important area of public policy since 1996. We can argue, if we like, about the semantics of whether a policy or a program was abolished, axed, withdrawn or expired; the fact remains that this government, upon election on 2 March 1996, set about removing the Commonwealth dental plan that had been put in place by the previous government. And from that point on, for years hence, the government has denied that it has any responsibility whatsoever for mitigating this crisis in our health system.

I am not one to suggest for a moment that the state governments do not have a role, but I do not find it at all logical or rational for every government member to blame state legislatures and state providers of services as if they do not have a role. As the Leader of the Opposition pointed out in question time, there is a constitutional provision that refers to the Commonwealth’s capacity to undertake provision of dental health care. There is history, where previous governments—prior to the election of the Howard government in 1996—undertook the care of dental health and outlaid enormous amounts of Commonwealth funds to ensure that queues would go down.

In the electorate of Gorton there have been increasing queues. I now have constituents who have been asked to wait more than two years—indeed, they have been asked to wait for three years—for basic dental care. That is why I think it is important for this House to consider the weight of the announcement made by the Leader of the Opposition and the shadow minister today of the dental health plan that Labor would like to introduce if elected.

A Rudd Labor government would fund up to one million additional dental consultations for Australians needing dental treatment, by establishing a Commonwealth dental health program. Indeed, the Leader of the Opposition today pledged to invest up to $290 million to a Commonwealth dental health program—one of the first programs to be abolished by the Howard government 11 years ago. As the shadow minister indicated during the debate on the matter of public importance after question time, this is the first instalment of Labor’s Commonwealth dental health program.

It is important to note, and it was conceded by the Minister for Health and Ageing, that there are 650,000 Australians on public dental waiting lists around the country. A 2007 Australian Institute of Health and Welfare report concluded that 30 per cent of Australians reported avoiding dental care due to cost, 20.6 per cent said the cost had prevented them from having recommended dental treatment and 18.2 per cent reported that they would have had a lot of difficulty paying a $100 dental bill. Over the last 11 years, this government has withdrawn $1.1 billion in dental services. Under the federal Labor plan—and, as I have indicated, it is part of a series of announcements that will be made from this point on—up to one million Australians will finally receive much needed dental treatment.

Last night in this debate I indicated how important it was for us to prevent problems in other health areas by tending to people’s dental health. It is important to realise that there is a correlation between a person’s dental health and their overall health. Therefore, not only would we be looking after people in need of care; we would be preventing consequential health problems that are occurring now because of neglect. The neglect is because of the lack of provision of services, and the government has to take some responsibility for the failure, for its abrogation of providing services in this area.

Tooth decay ranks as Australia’s most prevalent health problem. Of the Australian adult population, 25.5 per cent have untreated dental decay. During the last year, one in six Australians aged over 15 have avoided certain foods because of problems with their teeth. Fifty-thousand Australians a year are hospitalised for preventable dental conditions. Between 1996 and 1999, five-year-olds experienced a 21.7 per cent increase in deciduous tooth decay. Between 1994 and 2005, the hospitalisation rates of children aged under five for dental conditions increased by 91 per cent. Between 2000 and 2005, there was a 42 per cent increase in children being treated in private hospitals for dental cavities.

In 2004 the Howard government made dental care available through Medicare to people with chronic illnesses, but, as we know, the scheme has assisted only 7,000 people, at a cost of $1.8 million over three years. One of the problems we have with the government in relation to this area is that it has never seen this area of public health as a matter for concern. For 10 long years, we have had the Prime Minister and the minister for health denying any responsibility for the need to attend to this matter at a Commonwealth level. But in the shadow of an election, when the government is having some internal problems, when the government is seeking to convince the Australian public that it is fair dinkum about the future, it announces a policy on this—a policy without proper consideration, a policy that has been introduced against the backdrop of the government refusing to accept, up until now, any responsibility whatsoever for dental health. You have to wonder about the genuineness, the sincerity, of the government’s intentions in this area when it announces such a policy prior to an election. It throws millions of dollars—yet to be spent, of course—at a problem that it said for one long decade was not its problem to fix.

I am very sceptical about the interest that this government shows in people in my electorate who have dental problems. As I have said before, people are sick to death of hearing the two levels of government blaming each other for the deficiencies. It is now time to end the finger pointing by one government against another. It is now time for governments at every level to commit to fixing this particular problem.

I am yet to be convinced, from the efforts of the minister for health today, that the government is fair dinkum. It looks like a deliberate stunt to get past the next ballot. The government hopes to be re-elected, and it is a 50-50 proposition that it will be re-elected. It worries me that, having failed for so long now to concede that it has responsibility in the area, the Howard government might not implement this policy—one that is deficient by comparison to Labor’s—if it were to be re-elected.

This is just another example of the way in which the government has responded to the agenda that has been proposed by Kevin Rudd and Labor generally over the last 12 months. The government has sought to catch up with Labor in the area of climate change. It has sought to respond to issues in the area of industrial relations. Indeed, it has sought to introduce a fairness test into its extreme and unfair workplace laws. But it has not clearly convinced the owners of Spotlight, who today in the papers have announced that they are entering into a collective union agreement because they can no longer understand the policies of the Howard government.

What we have in the area of dental health is a government not serious about concerning itself with the concerns of those that have been affected, not seriously convinced that it has responsibility in the area of dental health. I think the voters of Australia will know that and will challenge the government’s intentions in this regard. (Time expired)

4:37 pm

Photo of Trish DraperTrish Draper (Makin, Liberal Party) Share this | | Hansard source

I rise in support of the Health Insurance Amendment (Medicare Dental Services) Bill 2007, but I ask the indulgence of the Speaker of the House to present my valedictory speech to the chamber.

As a member of the class of ’96, with over four elections, 11½ years of service and over 13 years on the campaign trail in an extremely marginal seat, I am truly blessed to be able to stand here today and honestly say that I am most grateful for having had the opportunity to serve the electorate of Makin and the Australian people. It has been a great honour and a privilege and an extraordinary journey. I am extremely conscious that the electors of Makin have continued to support me as their local representative over the past four elections, and I thank them from the bottom of my heart.

I would like to take this opportunity to pay tribute to the greatest Prime Minister in Australian history, the Hon. John Howard MP, member for Bennelong, and of course the greatest Treasurer Australia has ever had, the Hon. Peter Costello, member for Higgins. I would like to thank them both for their guidance, friendship, support and leadership since my election. Through my close working relationship with the Prime Minister and the Treasurer, I can testify to their genuine and great passion for the Australian people.

I have witnessed firsthand the admiration and affection of the electorate towards the Prime Minister during his many regular visits to the Makin community. As I mentioned in my maiden speech, in the lead-up to the 1996 election, parents expressed to me that they had worked hard for many years to give their children better opportunities in life but, after many years of struggling and ‘the recession that we had to have’, their children were left without jobs or hope for the future and were becoming yet another statistic. What the former Labor government managed to achieve, even with the much-heralded accord, Working Nation, the infamous unfair dismissal laws and a so-called justice platform was a lost generation of youth—lost not to a war or a catastrophe but to the despair and hopelessness of unemployment. That was one of the many legacies left by the Hawke-Keating Labor government, and what will be wreaked upon us again if Labor, heaven forbid, are elected at the next federal election.

It seems to me that some people have forgotten what it was like when unemployment figures were measured in double digits, mortgage rates were 17 per cent and business loan rates were above 20 per cent. People believed Mr ‘l-a-w law’ Keating, when he promised that he would deliver and that he was ‘bringing home the bacon’. Well, he did not bring home the bacon. In fact, the cupboard was left bare, with an $8 billion deficit to boot. Fast forward 12 years and there could not be a more contrasting picture. Unemployment continues to remain at record lows of around four per cent, and real wages have increased by 19.8 per cent. The Howard government not only has repaid Labor’s $96 billion legacy but is now saving for future generations.

A strong economy creates optimism and hope for individuals. I am proud to have been a member of the Howard government, which has seen total spending on health increase from $17.9 billion in 1995-96 to $51.8 billion in 2007-08. As someone who places great importance on support for families, I am delighted to see GP and specialist bulk-billing rates at a national all-time record of 73.4 per cent. As a mother, it gives me great comfort to know that, under the Howard government policies, child immunisation rates have improved from 52 per cent in 1995—it is incredible and unbelievable to look back and see that only 52 per cent of children were immunised in 1995—to 91 per cent now. What a great policy, what a great achievement, by the Howard government.

As a former aged-care nurse, I am delighted to see such tangible benefits to older Australians as the exponential increase in aged-care places which has occurred in the past decade, ageing in place and home care packages. The Medicare safety net and the increase in the Medicare rebate for GPs were policies that I had the great privilege of working on as Chair of the Government Committee on Health and Aged Care.

I am also proud to have been involved with another hugely successful program, Work for the Dole. In my electorate, we have had some excellent community projects with this program, which have given participants valuable skills to assist them in moving into employment. I would like to congratulate David Garrard, his family and staff, in my electorate, for their recent win of the Supervisor of the Year award.

The Howard government’s Investing in Our Schools program is another policy which I am proud to have contributed to. This program has funded schools where the states once again have failed. Mr Rudd talks the talk about the education revolution, but parents who have sacrificed and chosen to educate their children at an independent school are sweating even as we speak about the possibility of the return of Mark Latham’s infamous hit list.

I believe one of the government’s greatest successes is its continued zero tolerance approach to combat illicit drugs through the Tough on Drugs initiative. Since its introduction in 1997, when it was launched in my electorate of Makin, this very important government initiative has seen more than $1.4 billion invested to combat the evils of illicit drugs and has prevented more than 14 tonnes of illicit drugs reaching our streets. I would like to congratulate Bronwyn Bishop on her recently released report entitled The winnable war on drugs: the impact of illicit drug use on families. We must continue to fight drugs in our community to stop the destruction of families and their lives. As the Prime Minister recently said in question time:

We are making progress in the war against drugs, but we have a long way to go.

The government will never give up in the fight against drugs. We will never adopt a harm minimisation strategy. We will always maintain a zero tolerance approach. I would also like to thank and congratulate my friend and colleague Ann Bressington, MLC for South Australia, for her work in this area. Very well done, Ann. Her comments are on the back of that terrific report.

There are several challenges that we must confront if we are to provide opportunities for future generations. South Australians, as members of the downstream state, are parochial about their water security. That is our No. 1 priority. The Prime Minister’s $10 billion National Plan for Water Security, which was announced in January 2007, is the most significant reform of water management in our nation’s history. For over a century this issue has languished in the too-hard basket. It has taken the vision and courage of the Howard government to take action and end the political squabbling of the states and territories, which all have competing interests.

It is so disappointing to me as a South Australian that the Labor Rann government has neglected South Australian water for too long. Another important challenge will be to keep employment high and continue to move towards full employment. A record 10½ million people are employed in Australia and more than 2.2 million new jobs have been created since the Howard government came into office.

I said in 1996 that many people in Makin believed that the main achievement of the ACTU over the years has been the elevation of union officials into safe federal parliamentary seats. Rather than looking after the blue-collar workers and the unemployed, they looked after former ACTU presidents, treating the Labor front bench as a retirement home. Truer words have never been spoken.

So if Mr Rudd wins the next election—heaven forbid—he will not have a say in the industrial relations policy or any other policy. Instead, it will be left to the union bosses, who still control the Labor Party. The existing 70 per cent of the current frontbench, who are likely to be joined by union bosses Greg Combet, Don Farrell, Mark Butler, Dougie Cameron and Bill Shorten at the next election, are keen once again to ‘run the country’, if I can quote Mr Combet.

As I look back over the years, I cannot help but recall how my political journey began. Two catalysts got me involved in politics: firstly, the student campaign I was involved in to save Salisbury Campus after the announced closure by the then Minister for Employment, Education and Training, Simon Crean, and, secondly, the reversal of the longstanding ban against the film Salo. My very public stance against Salo led to my interest in classification issues, which I have continued to work on in my career in politics. Over the years, I have spoken up for my community, which continues to raise concerns about the content of films, television shows and video games. It has been a great honour to have been elected and to have served as chair of the coalition classification issues group during the last few years, and I thank my colleagues for their support.

I strongly believe the community faces new concerns with the growth of reality television, and I hope that community standards are able to be most vigorously defended. Music video clips, incorrectly classified TV shows and movies and the continued exploitation of young women and men are exposing our children to inappropriate behaviour, which is then replicated in our schools.

It has been a great honour to serve as the Chair of the House of Representatives Standing Committee on Publications. During this term we held an inquiry into the parliamentary paper series, as well as releasing a report entitled Printing standards for documents presented to parliament, which will be tabled in the House on Thursday.

I have also enjoyed my time on the House of Representatives Standing Committee on Procedure, the Joint Standing Committee on Foreign Affairs, Defence and Trade, the Trade Subcommittee and numerous backbench committees and my involvement in a number of reports. I am very proud of the inquiry that the House of Representatives Standing Committee on Family and Community Services held in the last term. The report produced by that inquiry, entitled Every picture tells a story, ultimately led to the changes in family law and the Child Support Agency. I acknowledge the great work of Julia Irwin, the member for Fowler, and also Jennie George, the member for Throsby, both members of that committee. I am also proud of the report entitled Road to recovery: report on the inquiry into substance abuse in Australian communities, which was produced by the same committee in August 2003.

While our parliamentary work is important, looking after constituents at home is of the upmost importance and is my greatest priority. I am so proud of the achievements locally, in partnership with local people in my electorate of Makin. Without the hard work of all the volunteers, these projects would never have happened, so thank you to you all.

I have also been reflecting on the major historical and significant events that have occurred since my election in 1996. Domestically, the Port Arthur massacre in Tasmania rocked all Australians and led to the Howard government introducing tougher gun legislation. In 1998 the government went to the election with the most fundamental reform to the Australian taxation system: the introduction of the GST.

Throughout the last decade, Australians have suffered the worst drought in 100 years, not to mention international economic recessions and the Asian economic crisis, which we were able to weather here in Australia due to great economic management by the Treasurer, Peter Costello—with a little bit of help from the Minister for Finance and Administration and Leader of the Senate, the Hon. Nick Minchin.

Events also include the liberation of East Timor and, six years ago last week, the sixth anniversary of 9-11, when democracy was attacked when terrorists targeted innocent Americans at the World Trade Centre. Five years ago next month, 88 Australians lost their lives in the Bali bombings. On Boxing Day 2004, Australians were called into action when the Indonesian region was hit by a tsunami which killed over 200,000 people and devastated the country. Stuart Diver beat the odds in the Thredbo landslide. Brant Webb and Todd Russell, great survivors of the mining accident, captured the nation with their courage and determination in April and May last year. Sadly, Larry Knight lost his life in that accident. We had the terrorist bombings in London and the plane crash in Indonesia on 7 March this year, in which DFAT officials, Australian journalists and others were tragically killed and horrifically injured. As recently as Sunday, there was a plane crash in Phuket. These memories will always be with us as Australians and are among a range of memories from my time in federal politics.

On a lighter note, most of my constituents would be aware of my admiration of the greatest team in the AFL, the Adelaide Crows. I congratulate Andrew ‘Bungy’ McLeod, who, last night, was named the All Australian Captain. I was looking forward to wearing my Crows scarf as I have in the past—and have been disciplined several times for doing so; however, we were robbed once again in our finals match this year. Rest assured that the Crows will be back in the hunt for the flag next year. Although I do not have my scarf, for the benefit of non-South Australian members I have circulated a photo of my three boys, with Graham wearing the blue, red and yellow colours of the Crows with Tony Modra. I have also distributed a photo of Graham with his lovely fiance, Lisa-Marie.

Like everyone in this place, I would not be here today if it were not for the continuing support of members of the Makin FEC and of the Liberal Party. I have been extremely lucky to have had wonderful members and a local network of volunteers, who have worked tirelessly both for me as the federal member for Makin and for the Liberal Party. I would especially like to acknowledge and thank Colin and Mary Kelly; Ben and Jeanette Martin; Lawrie and Jan Moon; Tom Javor; Trevor Johnson, who was my first campaign manager together with John Dawkins and set the standards for the campaigns to follow; and Bob Day, our wonderful new Liberal candidate for Makin. I am absolutely certain that he and the Prime Minister and the coalition government will win the next election and that Bob will be on his way here to Canberra. I also acknowledge the Hon. John Dawkins MLC, South Australia, and Senator the Hon. Nick Minchin for their friendship, advice, hard work and support.

All members would agree that we would never look after our constituents without the help, patience and care of our staff. I would like to thank my current staff members: Chris Evans, Todd Hacking, Jill Andrew, Shani Matheson and Maddie Jane. I would also like to thank my former staff members—in particular, Leonie Prosser-Haynes, Kirsty Haylock, Kim Murray, Alison Packer, Heidi Harris and the late Glenn Jarvis for their dedication and loyalty throughout their service. Glenn Jarvis passed away in July 2006 after losing a courageous battle against myeloid leukaemia. Glenn worked in my office for many years. He was loyal and such a wonderful electorate officer and friend and we all miss him greatly. He was a great loss not just to me and to his family but to the wider Makin community.

I could not leave this place without paying tribute to a few of my closest colleagues and confidants who over many years have always been willing to listen to me and assist me in my parliamentary endeavours. I understand that this is dangerous but it is something I want to do. Thank you to my wonderful flatmate, De-Anne Kelly and also to Kay Elson, Jackie Kelly, Sophie Mirabella, Kerry Bartlett, Alan Cadman, Warren Entsch, Gary Hardgrave—a lot of Queenslanders here—Margaret May, Senator Grant Chapman, Don Randall, Senator Guy Barnett, who does a fabulous job for Tasmania, Bronwyn Bishop, Malcolm Turnbull, Peter Dutton, Greg Hunt, Louise Markus and Bruce Baird, who has done a fabulous job for Friends of Tourism. Well done and thank you, Bruce.

Thank you also to Brendan Nelson, Julie Bishop, Barnaby Joyce, Steve Fielding, Brian Harradine—before he retired—Patrick Secker and the Barker FEC, who have been a great support to Makin. Thank you to all of my South Australian colleagues—in particular, Alexander Downer, arguably the greatest foreign minister in our history and a legend in his own time; Steve Ciobo; Alby Schultz—thank you, Alby—Kym Richardson; David Fawcett; Barry Wakelin; Andrew Southcott; and my paired senator for many years, Nick Minchin; and former Minister for the Arts and Sport, Rod Kemp—a legend in his own time and I thank him for his service to the country and hope that he enjoys his retirement from July next year. I congratulate Alan Ferguson on his election as President of the Senate, Christopher Pyne for his elevation to the ministry and Amanda Vanstone for her great achievements for South Australia. I also welcome our newest South Australian senators: Cory Bernardi, Simon Birmingham and Mary Jo Fisher. Thank you to all of you.

I am now running out of time so the most important thing I have to do is thank the electors of Makin, the community clubs and sporting organisations, staff, Comcar drivers, security staff, the Clerk of the House, John Anderson, Jimmy Lloyd the Minister for Local Government, Territories and Roads, the Parliamentary Library Staff, the Hansard Staff and Pastor Rod Denton of the Clover Crest Baptist Church. But, most importantly, I want to thank my family. I would not be here without them. This speech is for my sons, Christopher, Graham and Michael, and for my husband, Don. Christopher, Graham and Michael were 5, 7 and 10 respectively when I was pre-selected. The going rate at that time for folding and stuffing envelopes was 50c per 1,000. So, guys, without you I would never have made it. For many days and many nights those kids worked their hearts and souls out for all of us.

I say to my constituents and to our defence forces, our nurses, our doctors, our police, teachers and to everybody who contributes to the community and to our great Australian nation: it has been an honour and a privilege to serve you all. Thank you and God bless.

4:58 pm

Photo of Tony WindsorTony Windsor (New England, Independent) Share this | | Hansard source

Before addressing the Health Insurance Amendment (Medicare Dental Services) Bill 2007, I wish the member for Makin the very best for the future. Obviously, she has made in this parliament a great contribution to public life.

The bill that is before the House today is about a very important issue, dental health, and makes modifications to the Medicare legislation. I bring to this debate a petition that has been initiated in my electorate but has been taken up in other electorates. It relates to the provision of dental care as part of the Medicare process.

One of the things that have struck me about oral health, particularly during a period of time when the economy has seen massive surpluses from the budgetary process, is that essentially dental care has been neglected. Whether we like the blame game or not, we should review this issue, which concerns the state provision of dental care services to our constituents, who are members of the Australian public. The Prime Minister has made a number of comments recently about the performance of the states and he has made moves about this in Tasmania, and in the parliament he has endorsed moves over the local government initiatives in Queensland and the legislation for Aborigines in the Northern Territory, which is another one of the issues. So there have been a number of questions posed by the Commonwealth about responsibilities that have previously been those of the states.

Rather than get into the issue of who is at fault here and into the two competing policy approaches that we spent most of today’s question time on and which we also discussed in the matters of public importance debate today, I would rather encourage both sides of the parliament to do what should be done on oral health. Oral health has been the responsibility of the states for many years other than during that period of time when the Keating Labor government initiated an assistance package for the states. There was debate today about whether it was axed or terminated but I do not want to go into that at this particular point in time. I think the important thing is that Medicare has evolved over a period of time and that process has not really included oral health, other than through the arrangements that have been put in place in recent years whereby people with chronic diseases have references from their medical practitioners that they need additional assistance. Even today’s legislation refers to the fact that it is only by references for people having a chronic illness, a process that involves patients’ medical practitioners, that people can access the Medicare arrangements. So even though I will be supporting this legislation, I see it as not going far enough to deal with the total problem.

It is not good enough for both sides of a parliament of a developed nation in the economic shape that we are in—and I congratulate the government for its efforts as to some of the budgetary measures that have taken place and for the massive surplus that is there now—to just accept that some tinkering at the edges of oral health is in fact good enough. We need to include oral health in with all other bodily health. Irrespective of whether it has been a constitutional anomaly or an arrangement between the states and the Commonwealth as to who has been responsible in the past, we are living in a new century and to leave oral health out of all other bodily health functions in the Medicare arrangements is, in my view, an absolute disgrace. It is disgraceful that in a developed nation of this size 650,000 Australians are not having their teeth looked after adequately!

If we leave this parliament—and there are people leaving this parliament as they are giving their final speeches—quite comfortable that 650,000 Australians, in a nation that has had enormous growth and prosperity in recent years, cannot have basic dental care treatment provided under our health system, that is an absolute disgrace. As I said, I will be supporting the bill before the House because it does raise the bar slightly, but when you are coming from a very low base to start with a slight rise really does not achieve much at all. I will be watching very closely to see what the Labor Party does on this issue.

If there were ever a need to spend money on the provision of a basic government service, surely this would be it. It is a great shame on all of us to see people in Australia—people who have worked hard for Australia, people on pensions, young people, middle-aged people and old people—quite deliberately not eating some particular foods and quite deliberately not going to the dentist because they cannot afford it. To say that we are a greatly developed nation while we have that shame sitting there is a disgrace. Irrespective of the cost, that should be the function of government. We have spent the last decade or two removing government from various functions, but if the major function of government is not to provide basic health services to the constituency I do not know what is. It is always No. 1 on an election platform. But I do not see this particular piece of legislation addressing it, because it still revolves around a process involving medical practitioners and chronic illness for people to have access to basic dental care.

There are reasons that we are given from time to time as to why it cannot be included, and one reason is that it will be a massive cost; it will cost billions of dollars to achieve. But today we are talking about health insurance and the Medicare arrangements, and a dollar a week from every Australian would raise a billion dollars in a year. I would have thought that that sort of magnitude of spending, given the massive surpluses that have been in the budgetary processes for some years, would be quite small to actually address this issue over a period of time—a very basic issue of dental care as part of our health system. To suggest that that is not part of our responsibility in this place, because it is something that the states have looked after for some years, is wrong. Obviously, they have been incompetent or they cannot afford it. But if we are in an era when the Commonwealth can interfere where it sees a need, there is no greater need in terms of the delivery of health care, in my view, than basic oral health. Oral health, and there are a number of doctors in this place, and I am pleased to see there is one here now—

Photo of Mr Tony BurkeMr Tony Burke (Watson, Australian Labor Party, Shadow Minister for Immigration, Integration and Citizenship) Share this | | Hansard source

A good doctor.

Photo of Tony WindsorTony Windsor (New England, Independent) Share this | | Hansard source

Yes, he is a good doctor, as the member interjects—and a good member of parliament, if I may suggest. Obviously, neglecting oral health can and does lead to other complications. If there are other complications, the patient enters the health care system and Medicare arrangements kick in. I have said that I will support this legislation, but it seems fanciful when you read in the minister’s second reading speech that it is for those who have chronic illness. In this bill, we are presenting to the Australian public a magnanimous gesture of money for those who have chronic illness. If they have a chronic illness that is left unattended, then, quite obviously, they will enter the medical system and Medicare will provide. So, in a sense, the bill does not really provide anything that would not be provided if you left the chronic illness alone and did not tend to the person: they would end up in hospital and Medicare arrangements would apply.

I think we have to go much further than that and include normal oral health in Medicare arrangements. That is not to say that cosmetic dental health should be included; I believe people should pay for that. But, if there is normal treatment which in the long term can produce enormous saving to the health budget, we should look seriously at it and provide the funding. I am hopeful that one of the major parties will take that issue to the election, because it is something that is much needed and it has the potential to be a vote winner with the public.

Mrs Ruth Mathews is a constituent in my electorate. I do not know how old Mrs Mathews is but she probably would be in her 70s. She has been a very active woman all her life and her husband, Charles, is equally active. Mrs Mathews has taken it upon herself to create a petition. I think something like 4,000 signatures have been presented to the parliament to this date. This lady is not a wealthy woman, but she has taken it upon herself to stand in the streets of Tamworth to get people to sign the petition. She has a solution to the problem. She believes, and I believe, that people would be prepared to pay something for the solution. People are not just demanding of government; they would give up something to have dental care provided to everybody—to their grandchildren and their grandparents. I have questioned many people in my electorate, and they would rather see something like this taken care of than get a tax cut. We have had plenty of room for tax cuts in recent years, because of the surplus, the economic management et cetera—we have heard it all before. People are saying that they would rather have more money spent on health and dental care than receive those tax cuts, so I think it is important to take those views on board. I return to the petition of Mrs Mathews, which says:


The Petition of Citizens of Australia.

Draws attention of the House of the inadequacy of DENTAL HEALTH CARE which can lead to life threatening diseases.

Your petitioners therefore request the House that we, the undersigned, implore you to introduce a National Dental Health Scheme, as a matter of urgency, to be funded by a 1% levy of taxable income, this amount to be added on to the Medicare levy.

I do not know the mathematics, but my guess would be that a one per cent levy would raise an enormous amount of money, far in advance of what is actually required to address the problem. Mrs Mathews is quite simply suggesting, and I think the majority of Australians would support her, that we will pay. We have a problem. The states have not taken care of it in the past. Keating had a go for a while and then it was axed, or terminated, depending on which side of the fence you want to listen to.

The problem is back: 650,000 Australians cannot get basic dental care. We have heard about the waiting lists. We have heard about people with chronic illness and we have heard about people with pliers. A lady in Uralla, in my electorate, this year pulled out a tooth with a pair of pliers. So the problem is there, and rather than find out who is to blame or who has the biggest amount of money in town, whether $290 million equals $384 million or vice versa—the complexities of these arguments do not fascinate the electorate. People want the problem solved. They see the role of government as providing the basic needs of constituents. As members of parliament we all know that health is No. 1, health is No. 2, health is No. 3 in terms of issues of importance.

This is an enormously important issue that can be addressed, given our budgetary circumstances, and should be addressed. Even if it cannot be addressed under those budgetary circumstances, I guess the message of Mrs Mathews is that people are prepared to pay a bit more if basic services are provided. In my view, there is an underlying reason why these services are not being provided: neglect.

The Commonwealth does have responsibility for this issue, which cannot fobbed off to the states—that is, dental training. Some years ago, Dr Alec Noble, who is a retired dentist in my electorate, came to me and indicated—and I forget the actual numbers—that about 60 new dentists come into the market in New South Wales each year. Some of them come from overseas and will return to their places of origin, probably 15 will go into research and the majority of those left will practise in the major metropolitan areas, and there are very few who come into the regional areas, in this case, of New South Wales. They can go anywhere in Australia, but there are about 60 who come onto the market in New South Wales each year. I think the average age of dentists in Australia at the moment is probably higher than the average age of farmers, which is about 56, so there is a real problem in relation to placement.

If, suddenly, the basic oral treatment became a basic Medicare item, where would people get treatment? Where are the dentists who could actually provide that treatment? I think that whatever is going on is a fairly cute reaction to a problem that has been there for many years but not addressed. We cannot allow these people to access Medicare because it will show a failure in the training of dentists, and that will create a greater problem. That in itself is a very distressing conclusion to arrive at.

So what do we do? The government has, to its credit, initiated training. We not only have a lack of numbers being trained; we also have a lack of professionals wanting to go back to regional areas. We all know the arguments that a regionally trained doctor will more likely find school teachers—

Photo of Bob KatterBob Katter (Kennedy, Independent) Share this | | Hansard source

Hear, hear!

Photo of Tony WindsorTony Windsor (New England, Independent) Share this | | Hansard source

The member for Kennedy has arrived. I must say, what a lovely set of teeth he has!

Photo of Bob KatterBob Katter (Kennedy, Independent) Share this | | Hansard source

All the better to bite you with.

Photo of Harry JenkinsHarry Jenkins (Scullin, Australian Labor Party) Share this | | Hansard source

Order! Honourable member for Kennedy!

Photo of Tony WindsorTony Windsor (New England, Independent) Share this | | Hansard source

Yes, I think it is highly out of order, Mr Deputy Speaker, that someone should suggest that people would bite each other in this place! Obviously in regional areas there is a double issue in that a lot of the people who are trained may not go back into country areas to practise, even though a lot of the need is there.

The government has initiated a new dental school at Charles Sturt University, and I congratulate the government for that. That is exactly what is needed, but it is not enough and it reflects the recognition of neglect over the last decade, at least. There is a need for more dental schools. I know that the University of New England—and this is not an ad for their cause, even though I am a great supporter of the initiative—is negotiating with the University of Sydney and others for the extension of that sort of program. We must start training more people, because it is quite obvious that if 650,000 people were suddenly allowed into the dental chair there would not be enough dentists to deal with the problem. That is a problem that has been aided and abetted—partly because of the costs of the degree and other factors as well—at the Commonwealth level.

The message I would send is that, while this is an issue, there is a solution. We have to stop blaming each other for this issue—the states blaming the Commonwealth. It should be addressed. It is a basic issue of the provision of services to people within all our communities. If this election goes past and the issue is ignored or tinkered with with a mere $200 million, $300 million or $400 million over a period of years, it will be an offence to all Australians, particularly our elderly Australians, and a recognition that we are prepared to neglect those who have devoted years of work to the development of this nation. I think it is an issue that we should take on board and address immediately. (Time expired)

5:18 pm

Photo of Mal WasherMal Washer (Moore, Liberal Party) Share this | | Hansard source

I thank the member for New England; I share his passion about dental care. That is terrific. The purpose of the Health Insurance Amendment (Medicare Dental Services) Bill 2007 is to amend the Health Insurance Act 1973 in order to increase access to dental treatment under Medicare for people with chronic conditions and complex care needs. In the 2007-08 budget, the Commonwealth government announced an expansion of the current enhanced primary care dental items to provide higher Medicare rebates and more services to eligible patients.

From 1 November 2007, eligible patients will be able to access Medicare benefits for dental services of up to $4,250—including any Medicare safety net benefits, where applicable—over two consecutive calendar years. This arrangement further enhances the measure announced in the budget which provides for patients to receive a diagnostic consultation and a maximum of $2,000 in Medicare benefits for dental treatment each calendar year. A limit of $4,250 over two calendar years will give more flexibility for patients to receive dental assessment and treatment when they require services. This amount may be used for any combination of dental services covered by Medicare under this measure, depending on the clinical needs of the patient.

This bill also enables Medicare benefits to be paid for the supply of dental prostheses, such as dentures, under the new dental items. This will be of particular help for older Australians, many of whom have chronic and complex conditions and require dentures to eat a balanced and healthy diet. The Medicare dental items will be targeted at people with chronic conditions and complex care needs where the person’s oral health is impacting on, or is likely to impact on, their general health. To be eligible, a person needs to be managed under a GP management plan and team care arrangements. Residents of aged care facilities can also access the dental items if they are managed by a GP under a multidisciplinary care plan. All patients will need to be referred to a dentist by their GP.

People with chronic conditions, such as diabetes, cardiovascular disease and cancer, often have poor oral health, which can adversely affect their condition or their general health, so this bill will certainly address this. However, it is generally accepted that you cannot be healthy without oral health. Historically, we have separated medicine from dentistry, and many people are suffering ill health as a result of this terrible decision. If you have infected gums or gingivitis, you can have episodes of bacteria flowing through-out your blood stream. Porphyromonas gingivalis, an important bacteria involved in periodontal disease, has been linked to cardiovascular disease. This bacterium has four identifiable genes which enable it to invade and infect human arterial cells. Oral pathogens can also damage heart valves, infect prosthetic joints and increase the risk of pneumonia—all potentially life-threatening conditions. The Australian Dental Association has challenged that the bill implies poor oral health is important only insofar as it affects a chronic medical condition or its management. This is certainly not the intent. The Medicare dental items will target people with chronic conditions and complex care needs where the person’s oral health is impacting on, or is likely to impact on, their general health.

The importance of this bill is that it helps the most vulnerable. The most vulnerable, often people in our aged care system, do not necessarily get onto waiting lists for the state government to look after them. Many of them have chronic conditions and complex care needs. Certainly the dental treatments of those that are financially disadvantaged and that are currently sitting on lengthy state dental waiting lists are important. However, the states need to pick up their act. The Commonwealth has committed long-term, record funding through the Australian health care agreements. States and territories will receive up to $42 billion under the 2003-2008 agree-ment to meet their commitments including delivery of dental services.

Currently the Commonwealth is directly involved in oral health services through veterans affairs programs, providing dental care for around 300,000 people; the Armed Forces and Army Reserve Dental Scheme; university training for dentists, dental therapists, dental hygienists and oral health therapists—this was further enhanced in the recent budget with a new school of dentistry and oral health; dental scholarships for Indigenous students; subsidised drugs prescribed by dentists under the PBS; dental services provided through community controlled Aboriginal medical services; specialist oral surgery and oral radiography through Medicare; the cleft palate scheme; and dental services on Christmas Island and Cocos (Keeling) Islands.

The Commonwealth also subsidises private health benefits. The Commonwealth’s 30 to 40 per cent private health insurance rebate has enabled private health insurance to be more affordable for many Australians. This has certainly been reflected in the figures. Statistics released last month by the Private Health Insurance Administration Council showed private health hospital insurance has increased for the eighth consecutive quarter with more than 76,000 additional people covered in the June quarter. A record 9.7 million people, or 46.1 per cent of Australians, are covered for private health insurance general treatment, including dental treatment. In the 2007 March quarter over six million dental services were claimed with over $300 million in benefits being paid.

The Commonwealth also recently contributed to an innovation that could have an enormous positive impact on the dental care of Australians, especially those with complex needs such as those in our aged care system. Dr Patrick Shanahan’s innovative antibacterial gel, DentaMed, received $64,000 through an Ausindustry Commercialising Emerg-ing Technologies grant. Historically, the prevention of dental disease has relied on the mechanical removal of plaque using dental floss, a toothbrush and abrasive toothpaste, not on antibacterials. Toothpastes are formulated primarily to improve tooth appearance, freshen the breath and deliver fluoride benefits. They have minimal antibacterial activity. There are several antibacterials that do have an effect on plaque and oral pathogens. These antibacterial mouthwashes are often used immediately after brushing to improve oral health. But dental research has shown they have limited benefit when used like this. The abrasives in toothpastes temporarily remove the tooth pellicle, preventing attachment of the antibacterials and, because these mouthwashes and toothpastes are chemically different, the residual effect neutralises the antibacterials.

Developed and refined over a period of 18 years, DentaMed gel’s technology synergistically uses the saliva, antibacterials, fluoride and a nanoparticle healing and coating agent to maintain the whole mouth. The saliva is the body’s natural mouth protector, coating the whole mouth, including the teeth, with a protein-like material. The gel’s delivery system retains the saliva and uses it to attach the antibacterials. The introduction of nanotechnology further increases these benefits. The nanoparticle chitosan—sourced, incidentally, from crayfish shells—delivers two critical functions. In addition to accelerating healing, it provides a slow-release system for the antibacterials, zinc and fluoride. This provides continuous protection between treatments.

The product has undergone successful clinical trials and is now readily available. It will greatly assist not only those in care and their carers but anyone wanting to improve their dental health. It is thought that around 200,000 patients will access the new enhanced primary care dental items over the first four years of this measure, with an estimated cost of around $384.6 million. There are concerns that some patients may not receive dental treatment under the scheme as most people under a GP management plan could be eligible—around 400,000 patients. However, if the uptake is greater than expected the department has advised that outlays would be increased to cover the level of take-up, much as is the case with any other Medicare item. The expansion of the enhanced primary care dental items proposed by this bill will dramatically improve the dental and therefore overall health of many Australians. I certainly hope that we can get medicine and dentistry back together again.

5:27 pm

Photo of Bob KatterBob Katter (Kennedy, Independent) Share this | | Hansard source

In my 33 years, or whatever it is that I have been a member of parliament, and in my 62 years on the planet in my homeland—which is the mid-west area of North Queensland, the area between the Mount Isa badlands, if you like, the mineralised areas, and the coast—we have always had a dentist in Cloncurry and a dentist in Hughenden. And in my time as a member of parliament for the area we have always had at least one dentist to cover Julia Creek and Richmond. So there have always been at the very least three dentists on the ground in that area.

I cannot remember whether it was last year or the year before—but it certainly went into last year—when we had not a single dentist covering those 10,000 people. Since Hughenden is almost 300 kilometres away from Charters Towers, people in Hughenden would have to travel a 500-kilometre round trip to see the nearest dentist. As for Cloncurry, it is 110 or 120 kilometres to Mount Isa, and people would be looking at a 250-kilometre round trip—most certainly over a 200-kilometre round trip—to Mount Isa to go to a dentist.

This has never been the case before. The money market of course is always a good indicator and I was told the other day by a very authoritative person that a new doctor starting up in Mount Isa gets paid $125,000; a new dentist starting up in Mount Isa gets paid $230,000—and this represents the desperate shortages that we have in Northern Australia.

As the honourable member for Herbert will tell you, there are nearly one million people living in North Queensland, and we quite rightly will take out the premiership in the NRL and so we should. We are an area on the rise. We are moving forward with great aggression, in population and on every other front. Per head of population, we have maybe a quarter the number of dentists that the rest of Australia has. Our situation with doctors is that—and I do not want to be quoted on the figures—where the rest of Australia have one doctor per 400 people, in North Queensland we have one doctor per 2½ thousand people. That is a huge difference.

We thank this government very much. We thank the coalition government of Queensland and also the subsequent Labor government for assisting us to get the medical school in Townsville at James Cook University, the first medical school in some 44 years. We acknowledge the hard work of the member for Herbert. I had the privilege of forming the committee which  subsequently secured the medical school.

While in four years time we will have 150 doctors coming on stream each year—and this will address the lack of doctors in North Queensland—it will be a decade before we really come to grips with the problem. With dentistry, we have no answer at all. All of us at one time or another have been beaten down with a terrible toothache. That certainly is terrible, particularly when you get it on Friday night and you cannot get to a dentist until Monday. A lot of these people do not have vehicles and they most certainly do not have the money to jump on a bus—buses are not all that frequent through the area anyway—to go to the coast or near to the coast to get dental attention.

So our situation in dentistry is diabolical and the necessity for a dental school in North Queensland is an absolute imperative. Once again, paying very great tribute to that wonderful Executive Dean of Medicine, Health and Molecular Science at James Cook University, Dr Ian Wronski, one of the giants of the profession in Australia and one of the great giants of all time of rural medicine in Australia, we would urge the government to listen to Ian on the issue of the absolute necessity for a dental school in northern Australia. Nearly one million of us live in North Queensland and we have to send our sons and our daughters down to Brisbane to become dentists. The chances of them coming back to North Queensland are very small indeed. So we plead with the government to act just as they did in the case of the JCU medical school—and we thank them for that—to act similarly in the area of dentistry.

We must add to this the situation concerning the elderly, which was referred to by my honourable colleague from New England. There are difficulties, which I have referred to previously, for a person living in the mid-west region or even living in substantial towns on the coast and on the Atherton Tableland, trying to get in to see a dentist—it is like trying to win the casket in these situations. In fact, on a number of occasions my own office simply could not get appointments anywhere within the space of weeks—including in the coastal towns of Innisfail and the Atherton Tableland area, as well as Charters Towers and Mount Isa. So we have had our dentistry done in Canberra because it is the only place we could get in. It is infinitely more difficult for our elder citizens (a) to afford it and (b) to physically secure it. So there are myriad problems of distance, isolation, the cost of the actual medical care and also getting to where the medical care can be provided. We are looking at 150 bucks for a round trip in a bus from Hughenden to Charters Towers to see the dentist—an older person is looking at $150 on the cost of the dental problem.

In Normanton, we have had enormous difficulties. There were a couple of notorious cases where the dental problem became a very serious health problem. In one case it overlapped and was attributed to cancer, which I did not think was a medical reality, but we were assured by the doctors that it was, because the issue had been left completely neglected and it may well have been that it was cancer in the first place. A dentist would have picked it up but of course that person had no dental care whatsoever. They were waiting for the dentist to arrive two or three months later. It was about six months by the time he got to see the dentist and it was too late to save him.

We applaud what the government are doing here, but we plead with them to look at the real problem for our older citizens, even if they are in big cities. The northern beaches area of Townsville is a classic case in point where it is very difficult for people, retirees in the main, to get back to Townsville for dental care. Even though they are only two hours drive away, many of them are not of an age where they are able to drive any more. Many of them do not have cars and have to rely upon relatives or the generosity of neighbours to get them back to Townsville. But there is no way that, if we have a northern medical school, dentists will not be moving into areas such as the northern beaches area of Townsville. They will have to go there because they cannot all sit on their seats in Townsville; they will move into other areas.

We plead with the government to look at the very serious nature of this problem. We call ourselves a developed country but, in fact, when I was a young man, we had an aid program—I am trying desperately to think of the name but it is not coming to me—whereby we brought people out to Australia from developing countries in Africa and Asia and paid for their training here as doctors, dentists or as members of other professions, and they went home to practise in their own countries. Eighteen of the 28 doctors in the mid-west—Mount Isa and the Gulf Country—were not from Australia; they were from Africa and Asia. So, whereas when I was a young man we used to train their people in our country, they now have to train people to provide us with doctors and dentists.

The last time I did the figures, 18 of the 28 doctors fell into that category. A lot of them have enormous difficulties communicating in English but it is not their fault. In some cases their degrees are very deficient; in other cases their degrees, I am informed, are better than our degrees. Be that as it may, there is something dreadfully wrong with a country that cannot supply its own dentists and doctors. If Australian cities have shortages of doctors and dentists and difficulties with supplying those services, those shortages and difficulties in country Australia are infinitely worse. For the near million of us who live in North Queensland, with the nearest dental school 2,000 kilometres away, it simply is not possible for us to get those dentists to come back and practise in North Queensland. No matter how beautiful and paradisiacal North Queensland is, we still cannot entice them back. We plead with the government to realise that Ian Wronski is right. There absolutely must be a dental school in Northern Australia for the exact same reasons there had to be a medical school there.

I conclude on this note. When I spoke to Mike Horan, who was a minister in Queensland, he said, ‘Look, Bob, the answer can only be provided by a North Queensland medical school.’ I said, ‘I absolutely agree.’ I also spoke to Michael Wooldridge, whom I often called the ‘angel of the bush’—and, because he did so much for rural medicine in Australia, I think he deserves that title. Michael Wooldridge said, ‘The problem for Australia would be solved substantially by having a medical school in Townsville because at least 40 per cent of this problem of doctor shortage is a Queensland problem.’ He said that it was a problem to a lesser extent in rural Victoria and rural New South Wales and not so much a problem in Western Australia and South Australia. I do not know whether that was true, but both of those ministers at that time agreed that the solution to the problem of the shortage of doctors in rural Australia would be substantially solved by putting a medical school in Townsville. Exactly the same arguments apply to dentistry.

The situation is—I will use myself as an example—that my office in North Queensland simply could not get me an appointment and had to make one here in Canberra. We plead with the government to take those things into consideration. An election is coming up and we would like some sort of commitment to having a dental hospital in Northern Australia. The government still has time to do it and to be applauded for doing it. As I stand here today, applauding Michael Wooldridge as the angel of the bush, I would like to be able to say the same thing about our current Minister for Health and Ageing, Mr Abbott. I give him the opportunity of doing that before the government ceases to be the government in the sense that there will be an election.

5:42 pm

Photo of Ken TicehurstKen Ticehurst (Dobell, Liberal Party) Share this | | Hansard source

The purpose of the Health Insurance Amendment (Medicare Dental Services) Bill 2007 is to amend the Health Insurance Act 1973. This will implement the 2007-08 budget measure to increase access to dental treatment under Medicare for people with chronic conditions and complex care needs. The Commonwealth government has announced an expansion of the current enhanced primary care dental items to provide higher Medicare rebates and more services to eligible patients.

The measure is targeted at patients with chronic conditions—for instance, cancer, diabetes and cardiovascular disease—who also have complex care needs, such as requiring care across a team of health or care pro-viders. Patients whose oral health is impacting on or likely to impact on their general health will be referred by their GP to a dentist who is registered with Medicare Australia. In order to be eligible, these patients must have a GP management plan as well as a team care arrangement in place. However, for residents in aged care facilities their GP must have contributed to the multidisciplinary care plan prepared for the resident by that facility.

It is estimated that approximately 200,000 patients will benefit from this measure over the first four years, as they will have access to dental services provided in the community. From 1 November 2007, eligible patients will be able to access Medicare benefits for dental services of up to $4,250, including the Medicare safety net benefits they may be entitled to over two consecutive calendar years. This limit was introduced following consultation with stakeholders after the budget was handed down, providing more flexibility for patients to receive dental assessment and treatment when they require those services.

Patients will be able to access benefits for any combination of dental assessment and treatment services covered by the new dental items, based on a patient’s clinical needs. These new dental items include services from dentists and dental specialists, and dental prostheses. The new Medicare items are likely to include dental assessments, preventative services, extractions, fillings and other restorative work—for example, crowns, bridges, implants and dentures. Dental services that are of a purely cosmetic nature will not be covered by a Medicare rebate, which will ensure that the people who really need dental health care will be able to receive the treatment.

This arrangement further enhances the $377.6 million over four years announced in the budget, which provided for patients to receive an initial diagnostic consultation and a maximum of $2,000 in Medicare benefits for dental treatment each calendar year. The measure now represents a $384.6 million investment over four years. The new dental items will be introduced under the Medicare Benefits Schedule, replacing the current enhanced primary care dental items. It is expected that GPs and patients will find it easier to locate a dentist as more dentists are willing to participate in this scheme under these enhanced arrangements.

The Department of Health and Ageing is also working with the professional bodies representing dentists and GPs to improve information resources and to improve communication between individual dentists and GPs at a local level. Patients who access this scheme will greatly benefit from the increased communication between doctors and dentists locally, as it will provide for appropriate referrals and regular feedback between dentists and GPs on clinical matters. In fact, all patients will greatly benefit from the increased collaboration between doctors and dentists, as doctors will now have greater understanding of oral health and will be able to make more accurate referrals to help their patients.

Many patients with chronic and complex conditions are often really ill and are undergoing other medical treatments which may not be subsidised by Medicare, creating a large financial cost for patients and their families. This bill will ensure that these patients who also need dental health care will have access to it at an affordable price, helping to relieve some of their financial burden. Under this scheme, the only costs eligible patients will need to pay is the gap, which Medicare does not cover and which will depend on how the dentist chooses to bill for their services. If the dentist bulk-bills, the patient will not be charged a copayment for dental services covered by Medicare. If the dentist charges above the Medicare rebate, any out-of-pocket costs for those services will count towards the patient’s or the family’s threshold under the extended Medicare safety net. Once a patient or family reaches the annual safety net threshold, 80 per cent of the out-of-pocket costs will be met by the government under the Medicare safety net. This will apply up to the limit.

To further help patients, Medicare Australia will operate a telephone helpline to provide patients and dentists with a progressive total of dental benefits paid to those patients. Dentists will also be required to provide patients with a quote or cost estimate prior to commencing a course of treatment, to further assist patients to understand the potential cost of treatment. Patients will also have the option of choosing whether they will use Medicare or their private health insurance ancillary cover to pay for these services. However, patients cannot use their private health insurance ancillary cover to top up the Medicare rebate paid for the services. While topping-up is not permitted for an individual service, where a patient has reached the two-year benefit limit for dental treatment services under Medicare, additional dental services can be claimed under private health insurance arrangements, within the rules and limits of the person’s ancillary cover.

In Australia, the different levels of government have different and complementary roles in assisting Australians with their dental health. The Australian government and the states and territories must do their fair share for the system to work properly. The planning and provision of public dental services, including services to concessional patients and children, is the state and territory governments’ responsibility. Currently, all states and territories have programs of universally available, free or reduced-cost school based dental care, ensuring that all schoolchildren have access to dental services at affordable prices for their families. State and territory governments are also allowed to levy a patient charge for dental services which varies across Australia.

There is no denying that there are presently lengthy waiting lists for some public dental programs. However, this situation could readily be changed were the states and territories to fund these services adequately, as is their acknowledged responsibility. In 1994-96, the Commonwealth Dental Health Program provided limited funding of $278 million over four years to the states and territories to reduce excessive waiting times and to improve access to public services. While the program was part of the Australian Labor Party’s election platform in 1993, Labor made no commitment to keep the program beyond 1996. With evidence of substantial reductions in waiting times around the country, the government took the decision to abolish the dental program in the 1996-97 budget. Funding ceased from 1 January 1997.

Beyond the one-off nature of the program, there were problems with it. Most significantly, the states and territories were not encouraged to invest in improving their public dental services. The states and territories continued to shift their own dollars from dental care to other areas, effectively cost-shifting public dental health to the Australian government. The most recent figures from the Australian Institute of Health and Welfare show that state funding for dental care has increased from $373 million in 1999-2000 to $503 million in 2004-05.

Federal Labor, on the other hand, do not have a coherent dental policy. They should be supporting the government’s approach and encouraging their state and territory mates to take their share of responsibility for dental services rather than trying to fob off people in need on the Commonwealth government. Federal Labor continue to makes excuses for the failure of the state and territory governments, which just shows again that they are patsies for the states, as well as, of course, for the union movement.

On the Central Coast, the federal government has recently funded places for the Bachelor of Oral Health at the Ourimbah campus of the University of Newcastle. The number of new enrolments for this course has increased from 55 in 2005 to 77 in 2007. A total of 180 students are currently enrolled in the course. These university places are greatly benefiting the residents of the Central Coast, as they are offering students the opportunity to study dentistry on the coast, with students conducting practical work experience with local dentists. The Ourimbah campus is also home to a fantastic initiative funded by the federal government: an oral health clinic run by the staff and students of the Bachelor of Oral Health. The oral health care clinic provides students studying dentistry with the unique opportunity to gain on-the-ground experience of working in a dental clinic in a supported learning environment.

The clinic also greatly benefits the local community as it provides free check-ups and teeth cleaning to concession card holders, which helps them to prevent tooth decay. These services are also offered to the general public for a small fee. By enabling third-year university students to carry out these vital consultations it enables local families to keep their teeth healthy at affordable prices while providing students with experience and confidence for when they graduate. During these consultations students are also able to identify any other oral health issues patients may have. For instance, if a tooth needs a filling they are able to recommend that patients go and see a dentist. A few months ago I had the pleasure of visiting this centre with the Minister for Science, Education and Training to show her first-hand what a great facility the Ourimbah campus has, as well as the vital work they do in our community. I would like to congratulate the staff and students of the oral health unit for doing a tremendous job.

This bill also provides another avenue for dental services for people with chronic and complex conditions, which will be particularly helpful for those who would otherwise have to wait for services. In order to accurately assess who will be eligible for these provisions, patients must be referred to a dentist by their GP, as they are the primary care provider and care coordinator for these patients. Other Medicare items targeted to people with chronic conditions and complex care needs—for example, allied health services such as podiatry and physiotherapy—will also operate on referral from a GP. Professional associations representing dentists and GPs are working together to ensure that GPs have a better understanding of oral health issues and the relationship between oral health and general health.

The new Medicare dental items will replace three dental items introduced in 2004 under the enhanced primary care arrangements. The existing Medicare dental items allow eligible patients access to up to three dental services per calendar year, with a Medicare rebate of $77.95 per service. This new scheme will entitle eligible patients to unlimited visits to the dentist. This will effectively increase the access to dental health services for patients, at more affordable prices. It will also greatly benefit patients as they will have more flexibility to get dental work done under the Medicare system, which was previously not something afforded to them. The new schedule of Medicare dental items will more closely reflect the way that dental providers currently practise and bill private patients and veterans.

Mr Deputy Speaker Somlyay, it was great to see that under your chairmanship the House of Representatives Standing Committee on Health and Ageing inquired into health funding and released The blame game report, which made some important recommendations. Recommendation 3 has been taken up by the government in this bill. That recommendation was:

The Australian Government should supplement state and territory funding for public dental services so that reasonable access standards for appropriate services are maintained, particularly for disadvantaged groups. This should be linked to the achievement of specific service outcomes.

It is great news that a report that has only recently been handed down has already been enacted into legislation.

In closing, the Health Insurance Amendment (Medicare Dental Services) Bill 2007 will greatly benefit the people of Australia with chronic and complex conditions who need dental health care. These items will provide a significant increase in Medicare benefits for eligible patients and will make it more attractive for dentists to provide a wider range of dental care to more patients. The new items will be more consistent with the way that dentists practise and will cover a broader range of services to help ensure that Australian people have access to dental health care. I commend this bill to the House.

5:56 pm

Photo of Harry JenkinsHarry Jenkins (Scullin, Australian Labor Party) Share this | | Hansard source

The opposition opposes the Health Insurance Amendment (Medicare Dental Services) Bill 2007 because we believe that it is not the right way for the Commonwealth government to involve itself in dental health. Mr Deputy Speaker Somlyay, I note that the member for Dobell made mention of a report entitled The blame game. I am wondering whether, as the member for Fairfax, you would claim the credit that was given by the member for Dobell, because the quote that he gave is open to interpretation. While this piece of legislation talks about those patients with oral health problems arising from chronic health problems, it does not necessarily mean that those who find themselves in disadvantaged economic circumstances are being totally catered for. That is the greatest concern that the opposition has with this piece of legislation.

In a debate like this, often too much attention is paid to the detail and specificity of the piece of legislation concerned. One can still be relevant to the piece of legislation if one steps back from it and poses this question: could the expenditure—and with this piece of legislation we are talking about an expenditure in the order of $380 million over four years—perhaps be targeted better? A debate like this is also the time to look at the effort of the Commonwealth government in relation to the problem before the chamber. I was a little surprised at the figures about trends in dental care expenditure. While today there has been a great deal of argy-bargy about public health and whether this is totally the province of the states or whether it should be a shared responsibility, we have not really looked at the way in which oral health expenditure is apportioned. I was a little surprised at the figures in Australia’s health 2006, the publication of the Australian Institute of Health and Welfare. In table S37, the institute indicates that total recurrent health expenditure is in the order of $69.8 billion.

The institute indicates that individuals contribute $14.486 billion of this expenditure. By my calculations that is in the order of 20.7 per cent. But the institute indicates that in the year 2002-03 individuals contributed $2,969 million of the $4,362 million spent on oral health. So individuals contribute 68 per cent of the cost towards oral health. It is something that has developed over time, but the contribution by individuals, especially since the creation of Medicare, has been a considerably larger percentage of the expenditure than for any other aspect of health expenditure.

Another problem, if we look at the contributions by the federal government, is that we see the largest slice of contribution by them to oral health is the 30 per cent private health rebate. In the earlier debate on a matter of public importance, the member for Boothby I think said that that was in the order of $400 million. That is a considerable amount a year, but does it really go to those whom we would expect the government to target? Therein lies the real problem in the way in which the resources for oral health have been allocated at a federal level. This debate has gone on for many years, but when the government were challenged that this perhaps showed an inconsistency in their stance that dental health was not their problem they said, ‘It’s a state problem; we don’t get involved.’ When we indicated by way of debate, quite rightly, that through the 30 per cent private health rebate of course the Commonwealth government are involved, Minister Abbott, the Minister for Health and Ageing, came in and said: ‘We are involved. We’re involved in oral health; we’re involved in dental health through the 30 per cent rebate.’ So why can’t we see the extension of that into public dental health? Because traditionally, before the rebate, the Commonwealth were not involved in oral health.

Another little sleeper that is even more disturbing is the way in which the Commonwealth government contributes to people’s health expenses—that is, the health rebate, which is paid back to people at tax time if they are over a threshold. In 2002, John Spencer from Adelaide university did a paper, ‘What options do we have for organising, providing and funding better public dental care?’ He produced a graph—figure 4, ‘Public subsidy for dental expenses taxation rebates, private dental insurance rebates and public dental care’. He showed the public dollar spending per household in dollar units against income groups of various householders. Regrettably, the graph showed that the highest income households had the highest public dollar spending per household. Why was that? Because of the combination of the private dental insurance rebate and the dental expenses taxation rebate. So in this 1998-99 graph it was in the order of $70 a household for households on about $120,000; the figure for a household on $35,000 was in the order of $35; and for a household on $0 to $10,000 the public dollar spending was a little over $50.

But this begs the question: are we getting the assistance packages wrong? Have we skewed them so that we are not properly directing the public resource towards those that are most in need? As I said, I acknowledge that dental health for Australian families, on the basis that private expenditure on oral health is something like 68 per cent of total expenditure, is a very difficult impost. So there is no threat to the rebates that I spoke about. But, when we are in a debate like this, we should step back and think about what the resources that we are talking about are and where they are directed.

When I visit the community health services in the electorate of Scullin—and all the community health services are involved in delivering dental health—and I see the waiting lists for some treatments in the public system, which can blow out to as long as four years for proper dentures and things like that, it begs the question: when the Commonwealth government intervened and involved itself in public health and we got the waiting lists back to zero, why is it that there was a reluctance from those opposite to continue with a scheme that was so successful?

I remind the House—because sometimes it gets lost in the argy-bargy of the debate—that, back in the Keating era, the scheme delivered services to those on the public dental health waiting list by providing additional resources to the public oral health providers and by buying in the time of private practitioners. In fact, that was one of the reasons that the Keating government did not strike much opposition from the profession itself—we recognised that, to tackle the backlog, a partnership was required with all those involved.

Many people have mentioned workforce issues in the debate on this legislation. Labor acknowledge that. If we want to get into a fully-fledged political debate, we could have an argument about whose fault it is but, at the end of the day, I think that both sides of the chamber agree to an extent about the opening up of places at rural and regional university campuses, because those who train at those campuses are more likely to stay and practise in rural and regional areas. But let us get the argument in perspective. The honourable member for Dobell quoted figures I was going to use in respect of the increased effort by the state governments in directing resources. I am not in a position to know whether an increase in funding from $270 million to $500 million would mean an increase in output in the order of that magnitude.

Mr Deputy Speaker, because of your interest in matters to do with proper financial administration, you would understand why I say often in debates that it is not about the quantum of money. We should really not rest on our laurels in this place. You could throw a host of monetary resources at a problem but, if you throw it in the wrong direction or you do not package it the right way, it might be completely useless. On the basis that there has been an increase in resources, one assumes that that is indicative of the increased effort. What Labor has proposed is a return to a scheme that was successful. I have heard some of the criticisms of that scheme in respect of whether or not the states’ efforts continued at the same rate. There is some evidence that should be a concern. That is why the Leader of the Opposition, Mr Rudd, and the shadow minister, Ms Roxon, today said that, if elected, a Labor government would make additional resources available for public dental health on the condition that the efforts by the states continue. If that gets us involved in the blame game, we will have to wear it. But this is not about blame; it is about sitting down in partnership to tackle a problem. And clearly there is a problem here.

There are 650,000 people on a national waiting list. If each of us went around to the local providers of public dental health services, we would know that those waiting lists exist. I do not wish to be churlish, but I do want to mention something which the Prime Minister said. I do not know whether it was an omission by the Prime Minister when he talked about public health being just the public dental hospitals, but I would hope that he does not really think that. I hope that he understands that this is a wider problem. The world has moved on. Now, the disadvantaged and healthcare card holders do not have to go into the public dental hospitals, which are usually only in the major cities. We have encouraged the provision of services in public oral health at the community level throughout Australia. That is proper and appropriate. It has been very successful, and it needs to continue.

I am not really interested in the debate about whether this is a Commonwealth responsibility or a state responsibility. There is another aspect of the health debate that we have not really dealt with. If we step back from these pieces of legislation, which are like jigsaw pieces from different puzzles, and look at the way in which we provide resources for health, there is a lot of overlap. When the government talks about chronic health in respect of this legislation, it means that it recognises the tie-in between a person’s health circumstances and their oral health and often it is a bit hard to say which follows what. It is really a chicken and egg thing: is a person’s demonstrably bad oral health a result of their chronic diseases or is it not? I was really interested in the contribution from the honourable member for Moore about the way in which somebody’s oral bacterial health can affect their heart, their circulation system, replaced joints and the like. We have to recognise that all these things are intertwined.

In providing resources to address the needs of those people who are on the public health waiting lists, there are likely to be savings in a whole host of areas—for example, where they do not have to go to the GP as often or where their oral health does not contribute to the extent that their general health deteriorates and they require hospitalisation. And that is when the arguments put forward in the report from the inquiry that the member for Fairfax chaired are important—because, on those occasions, it does not matter which sector of government is paying the bill. What really matters is that we have a first-class system that gives a member of our society who is going through health problems the opportunity to get the best outcome.

Another aspect which I found interesting—and I must admit that I have not really looked at the knock-on circumstances of this—was a comment by the member for Moore about how we have dentistry and medicine separated. There is a need for a holistic approach to people’s health, involving not only medicos, general practitioners and specialists but also other allied health professionals, dentists and the like. We have seen this done very successfully in other areas, and we really need to get back to models that combine those services. That is why things like community health centres and public dental health schemes are very important. (Time expired)

6:16 pm

Photo of Kay HullKay Hull (Riverina, National Party) Share this | | Hansard source

I rise in the House today to support the Health Insurance Amendment (Medicare Dental Services) Bill 2007. We have heard myriad discussions, but it was interesting to hear the contribution of the previous speaker, the member for Scullin, because it was not so much about the blame game. We have had a barrage of issues and allegations directed from both sides of the House—they did this, you did that, and somebody else did something else—but I do not think that that is what this debate is about. This debate is about a piece of legislation that is going to provide services and facilities to enable people with chronic conditions and complex care needs to be treated. The dental system and the way it works across Australia in every state are very difficult issues. I really do not know how people can afford to have dentistry work done. It is extraordinarily expensive. That is why there is a need to look at various options in coming up with a suite of measures to respond to the longstanding issues that dentistry has presented us with for a number of years.

This bill provides some much needed services. From 1 November 2007 new dental items will be introduced to the Medicare Benefits Schedule. This will enable people who suffer with chronic conditions and have complex care needs to receive Medicare benefits for a broad range of dental services. To resolve the problems regarding the shortage of dentists and the cost of dentistry to the general public is going to take us a long time—it is going to take the nation a long time—and it is going to take cooperation between the states and the Commonwealth. I often wonder about the cost of dentistry, though I am not at all accusing dentists of profiteering—because I do not really think they do.

When you go to a surgeon, a surgeon diagnoses your need for a knee replacement or a hip replacement, or diagnoses your kidney disease or whatever, and they generally then send you to a hospital where they will utilise the technology and the equipment that has been put inside the private hospital or public hospital. This equipment and technology is generally paid for from the public purse or by the institution if it is private. To be able to deliver their professional services, a surgeon needs a set of rooms and a secretary and they need to see and diagnose patients at appointments and send them off to hospital, where they will be able to utilise the hospital’s equipment, which they do not have to purchase. A general practitioner generally has a small bag—a little black bag—and diagnostic equipment. He might have something to check your reflexes and he might have a thermometer, a stethoscope and other diagnostic equipment. But if you require further treatment—X-rays or the use of some kind of technology—you will go off to a medical imaging centre or a hospital where all of that equipment is in place.

A dentist has to equip their surgery and they have to provide up-to-date technology. They have to be able to see to every aspect of oral hygiene care and dental requirements. They have to be able to diagnose, for example, whether it is a cancer related illness affecting the jaw, teeth, bones et cetera. No longer does your dentist just pop you in the chair and, if you have a cavity, whip a drill around and fix it up in a few minutes or pull out a pair of pliers and take the tooth out. That is no longer the way dentistry is performed. It is very precise and technical, requiring an enormous amount of fit-outs in surgeries. It is extraordinarily costly. I am wondering whether there should be an option whereby dentist surgeries can be fitted out so that dentists do not have to meet the costs of all that equipment, thereby making their services a little cheaper for the general public to access. There have to be different ways of thinking about how dental services can be financially accessible to the majority of the public.

Then there is a workforce issue, and maybe that brings up competition. It is a strange thing for me to stand up here and say maybe we need competition and that that may reduce prices. Let me say to you that I do not for one second believe that dentists are profiteering. They have to pay extraordinary overheads in order to be able to run a surgery. If there are not enough dentists around to be able to meet the demand then surely there is an option for some people to be able to charge higher prices. You are really captive to the market. Yes, if you have private health insurance, you can get a rebate on some of those dental works if you have been in your health insurance for a period of time. But if you are just the average worker who is earning, say, up to $35,000 a year, and maybe you are even a one-income family—my electorate is full of people in those circumstances, as I am sure are the electorates of many members—and you are sending children to school, trying to feed and clothe them and do all of the things that you have to do, the thought of spending $1,000, $3,000 or $6,000 on your child’s braces is almost unacceptable. You would love to do it, but it is almost impossible. Just going on regular checks to the dentist to keep your oral hygiene up to date and to have early intervention is even more difficult. So it comes back to the days when we did not have fluoride, when we had tank water—that may be an issue again in the future, with the issue of bottled water, which I raised this afternoon. It comes back to the fact that you only take a trip to the dentist when it is a chronic or acute issue—you have decay in your teeth and they need to be pulled or filled or something. It is such an extraordinarily expensive thing to do.

We have to think outside the square. We have to determine that we need to work as a team across Australia. We have to address the workforce shortage. And the government has done that. I am very proud that the government has funded Charles Sturt University with $65.1 million to open a school of dentistry and oral health in my electorate and in the future electorate of the current member for Macquarie. I think it goes into the electorate of the member for Parkes as well as the electorate of the member for Farrer. But the primary structures will be in Wagga Wagga and Orange. I am very proud to have been a part of delivering that. We are now giving rural students an opportunity to become a rural professional in a rural setting, which will almost guarantee that many of those students will then practise in a rural area. That is where there is an enormous shortage of dentists and access to dentistry. That is one measure.

I appreciate the government’s budget announcement this year, wherein they provided this $65.1 million, and we are just procuring all of the requirements that we will need into the future. As I said, there is a significant range of interest being shown in that program, with more than 300 calls from prospective students from across inland and rural Australia. That is without any marketing campaign. But that school will open in 2009. It will have a preclinical and clinical facility in Orange and Wagga Wagga. There will be education clinics in Albury-Wodonga, Bathurst and Dubbo in New South Wales. There will be 240 new training places for dental and oral health students over that five years, training in a rural setting—which, as I said, will go a long way to providing the supply to meet the demand.

But then you have to work out how you are going to actually enable people to afford to access the supply, rather than standing in the chamber debating the rights and wrongs of a 1992 or 1993 program that was put in place to try to assist the waiting times in the states—which, might I add, from the feedback that I have had, was not a successful outcome. As they typically do, the states, whether they be coalition or Labor, if the Commonwealth is going to put in money, withdraw their money and use it on something else. So you really are just robbing Peter to pay Paul and you are not progressing very far at all. So I am not interested in that scenario. We have done it to death. I have done it to death myself in this House. I have raised dentistry a number of times. I have played the blame game. But it really does need us to sit down as a team and work out how we are going to move forward.

These are significant steps forward. These are significant moves being made by the government. They do not deserve criticism. Nobody has the answer at the moment. The states do not have the answer, except to put bucketloads more money into public dental health practices or school dental health. But how does that really affect the man on the street, or mum or the children, who want to go to their local dentist and keep their teeth healthy but who are not able to access public dental services? Those services are primarily there for low-income earners like pensioners and disability pensioners—and so they should be.

What we should be doing is saying, ‘Okay, this is an excellent measure,’ because, at the moment, we do not have enough dentists to meet the demand, particularly in rural and regional Australia. We know that we have to train a workforce, so we are going to put 240 training places at Charles Sturt University. We are going to give them $65.1 million in order to establish their campuses so that this can be successful.

The second thing is this. We know we have got people out there in every electorate across Australia with chronic conditions and complex care needs who require some urgent assistance to be able to access dentistry. This is what we are here to deal with tonight through this bill, because it does enable eligible patients to receive a Medicare benefit of up to a specified amount of $4,250 over two consecutive years for dental services. This is for those people with chronic conditions and complex needs. It will also enable Medicare benefits to be payable for the supply of dental prostheses, including dentures, to those many people who are elderly and have chronic conditions and complex needs. They need dentures to be able to have a normal balanced and healthy diet. In my view, this is a good positive move that does not deserve to be run down or criticised because it is supposedly not dealing with the whys and wherefores of every dentistry problem across Australia. It is a good measure that deserves attention and consideration as going a long way towards achieving some of the outcomes. It does not achieve all of the outcomes but it gives some choices and options, so it is a good measure that does not deserve criticism.

Having started on the workforce issues, we then started to put in place measures to address the complex care needs of those people with chronic conditions. Now we want to move forward so that in the future we will look at how we manage to provide cheaper access to a dental service so that it is within the realm of the majority of the people who are on incomes of less than $35,000 in my electorate—and, believe me, they do represent a significant part of my electorate. Many receive even less than that, given the drought and the current state of disarray that the Riverina is facing with its seven consecutive years of dry land, three catastrophic frost events and four years of crop failures—and irrigators have also entered into this same predicament. That means that more and more people are on lower and lower incomes and on government benefits, support which they are not used to being on. So how do you make dentistry more affordable so that they can have a real form of oral health management that will offer early intervention and prevent further invasive treatments being required? I recall that when I was a young mother my three sons were in a dentist’s chair every three months. I now feel quite cross sometimes that they, having grown into adulthood, have not been taking care of their teeth, given how during their young lives I struggled and scrimped and saved to be able to cash my Medicare receipts for them to be at the dentist’s. Now they have their own money but they will not spend it on their own teeth, which is a real problem.

What we have here is the scenario of the majority of families where accessing a dentist is a luxury because of the way in which the families’ income is structured and because of the costs of dentistry. I think more attention will have to be paid to this in the future. If we must think outside the square as to how dentists can be provided with all the technology that they require in their surgeries in a way so that they do not have to pay it off and so that they do not have to get so much back from consumers in order to meet their costs, so be it. These are things that we should consider, given that most medical practitioners are not required to provide all of that technology. They use technology that has been provided by state or Commonwealth governments in another place, whether it be a private hospital or a public hospital. They are able to go in and use that technology. I think that is where we should be heading.

I commend this bill to members, not because it is a panacea that is going to bring to an end all the dental problems across Australia but because it deserves to be given support. It deserves not to be criticised. It deserves to be dealt with in the context of the purpose for which it is intended: to resolve some of the problems that we can resolve at this time. You cannot resolve in one fell swoop all the dental issues across Australia through any election campaign announcements, because they are simply difficult and complex things to deal with and we need to be honest in the way in which we assess and deliver programs. I support the bill that is before the House. I believe that it is a good bill that gives people the capacity to have an opportunity that they have not had before. Is it the Commonwealth’s responsibility or is it the states’ responsibility? You know what: people really don’t care. All they want is to be able to afford on a regular basis access to a dentist in their community, so we have to address the workforce issues, address these chronic care issues and address, somehow in some way, how dentistry can become more affordable in the future. I commend the bill to the House and I urge everyone to support this bill because it is before us with the right intentions. It always has been considered with the right intentions. Coalition members have as much heart and compassion for their constituents as opposition members have. We also lobby hard along the way for these types of initiatives because we care as well. In fact, if the truth be known, every member in this House cares for their constituents, so I am hopeful that this legislation will be allowed to provide people with some much needed access to dentistry. It is not a panacea, as it is not going to solve all the problems, but it will go a long way to resolving the problems of some people with chronic conditions and complex care needs who will be able to access this package.

6:36 pm

Photo of Jill HallJill Hall (Shortland, Australian Labor Party) Share this | | Hansard source

As the member for Riverina has finished her contribution to the debate on the Health Insurance Amendment (Medicare Dental Services) Bill 2007, I would like to say that, while I know she is a member who cares for her constituents and would get in there and fight for them, I disagree with her that a bill deserves to be supported just because having it is better than nothing. The bill before us today seeks to extend a policy, which was in legislation previously brought before this House by the Howard government, that has failed abysmally in the community.

This is the government’s attempt to make unworkable legislation work. It is legislation that addresses a very small proportion of the problem that we have in dental care, and it provides services only to people with chronic illnesses. So those 650,000 Australians who are on dental waiting lists throughout this country will not get to first base under this legislation unless they suffer from a chronic illness. I think that is a really important point to make up front.

At the beginning of my contribution I would also like to point out that today the Labor Party has made an announcement that I believe will address the issue for all Australians who have been on the dental waiting list for years—those 650,000 Australians. The Labor Party’s announcement today will provide almost $400 million for one million new dental consultations. This will address the backlog that exists—a backlog that has been created by the Howard government.

The Prime Minister said in question time today that when the government came to power there was a Commonwealth Dental Health Program. The Prime Minister said that the government got rid of that because the dental waiting list was under control. Well, Mr Prime Minister, I say to you that by getting rid of the Commonwealth Dental Health Program you have created an uncontrollable dental health waiting list. This has created great hardship, angst and misery for a number of people, because dental health is a very important component of a person’s overall health. Because dental health has been allowed to blow out in this way—through the Prime Minister, his health minister and all the members of the government saying, ‘It’s a state issue that’s got nothing to do with us’—there are now 650,000 Australians who cannot access dental treatment when they need it.

To be honest with you, it is not good enough. It is very easy to come into this place and blame the states for the problem. The role of the federal government, the Australian government, is to take responsibility, show leadership and deal with the problem. This legislation provides a monetary limit of $4,250 over two consecutive calendar years, which will be set out in a ministerial determination which we have not seen yet. Under the new dental items, Medicare benefits will be paid for the supply of dental prostheses such as dentures. That will be welcomed by those few people who qualify for it.

The government’s Medicare dental program is for people with chronic conditions and complex care needs. It was first established in July 2004. It has been hampered by a low take-up rate and by the complexity of the system—both from an administration point of view and from the point of view of being able to access it.

About three months ago I had a constituent come to see me. He had a very severe medical condition—mouth cancer—and, because of the ray treatment that he had had for the cancer, he had to have very specialised dental treatment. This person needed to have all his teeth removed and had big problems with infection and decay of his teeth, but no dentist would touch them. He had been on a waiting list for over one year when I first met him. He had a letter which the doctor had sent to the dental clinic saying that this was an urgent matter and this person’s health was starting to deteriorate because of the problem he had with his teeth.

I pointed out to my constituent that there existed a Commonwealth dental health program, under the Enhanced Primary Care Program. I had to download all of the information from the computer and give it to my constituent, who then took it to the doctor, who was very surprised to find out that this scheme existed and had existed since 2004. Subsequently, my constituent was referred to two different dentists for opinions. He is still waiting for treatment and is over $100 out of pocket. He will probably benefit from this scheme but I argue that he will still be significantly out of pocket because the scheme will not cover his complex needs. This is a prime example of how the scheme, which has been in place since 2004, has not worked, how doctors do not know about it and how it is an administrative nightmare. I argue strongly that we are expanding a scheme that has failed in the past and is destined to fail in the future. It is a scheme that will provide a service to a very small group of people.

Whilst I am talking about the ineffectiveness of the scheme I will give you another example. I was talking to another constituent at a seniors forum I held. This constituent had heard about the Enhanced Primary Care Program for dental care. His doctor had referred him to a dentist. He had had the dental treatment and he paid for the treatment—it was itemised under Medicare—and then he took it to the Medicare office.

The Medicare office said, ‘We can’t pay this; this isn’t covered under Medicare. Dental care is not covered under Medicare.’ I have now picked up this case and will follow it up with my local Medicare office. But, once again, this shows how the current system does not work because the people who work in the Medicare offices do not understand how the scheme works. Firstly, we have doctors who do not understand how it works; secondly, we have Medicare officers who do not understand how it works; and, I suppose, thirdly, we have people that we represent in this parliament who can only find out about it through contact with people like us. I think that the two cases I have raised here in this parliament tonight demonstrate how the current system is failing Australians dramatically.

In question time today the shadow minister for health asked the Minister for Health and Ageing whether he could inform parliament why the government’s chronic disease dental program has assisted only 14 preschoolers since its inception and only 70 children between the ages of 14 and 15. I must say that the answer that was given by the minister was less than satisfactory. I put it on the record that, between 1994 and 2004, hospital rates for children under the age of five increased by a staggering 91 per cent. Over the decade there has been a hospital rate of 91 per cent for children with dental health problems. Recently MBF released figures that showed a 42 per cent increase in children being treated in private hospitals for dental cavities. This shows a system that is not working. The government would argue that people who do not have chronic illnesses are being assisted to obtain dental care through private health insurance or through the 30 per cent rebate. We on this side of the House support the retention of the 30 per cent rebate, but there are still many people who cannot access dental health care because they cannot afford private health insurance. If they do have private health insurance the gap is enormous, and they are left with large bills.

I am a member of the House of Representatives Standing Committee on Health and Ageing, and in November 2006 we tabled a report called The blame game: report on the inquiry into health funding. In that report there was a section on dental care. Initially, we were not going to look at dental care, because we were looking at health costing, but we were overwhelmed with submissions and evidence in relation to dental care. The recommendation was:

The Australian Government should supplement state and territory funding for public dental services so that reasonable access standards for appropriate services are maintained, particularly for disadvantaged groups. This should be linked to the achievement of specific service outcomes.

This legislation deals only with people with chronic health problems. This does not go to assisting those people who are particularly disadvantaged. The Healthy mouths healthy lives: Australia’s national oral health plan 2004-2023 report was endorsed by the AHMC on 29 July 2004. This report identifies a range of issues, particularly relating to funding arrangements for a dental workforce. That brings us to the point of highlighting the chronic shortage of dentists in Australia. We have an ageing dental workforce, a workforce that will go nowhere near meeting the needs of Australians as they go forward throughout this century. In 2003 research highlighted that there would be a shortage of 1,500 dental professionals by 2010, and in 2004 dental graduation levels were found to be at their lowest level in the last 50 years. We took evidence from dentists when we put together this report. In addition, I have been strongly lobbied by dentists who work within the public system who pointed out to me that there is just not enough money put into the training of dentists and not enough money put into funding dental care in Australia. It has been argued by many people in our community—professionals and people who need dental health care services—that dental health care should be no different from any other service. I cannot see why a constituent of mine should have to go without dental treatment and because of that be forced to live on soft foods for long periods of time, as was a constituent who lives in Toukley, whose plight I raised in this parliament last year.

Recently, I received a letter from a constituent that I found particularly moving. This person lives in the Lake Macquarie part of the electorate and has a son who is on a disability support pension. She explained that her son had had his molars removed but was still needing additional dental treatment. Initially, he was told that he would have to wait several months for the treatment. Then, within the last three weeks, his mother called the dental health clinic and was told, ‘No, it is not several months; it will be over a year.’ Her son has significant health problems. It is not only the problems that he has with his teeth but also the whole-of-body problems that are being caused by his dental health problems. He can only eat softish food, and he is gaining weight because the kinds of foods that he can eat make him gain weight. He has to take vitamin supplements to enable him to maintain a state of semi-healthiness. It only enables him to maintain his health at a very low level. He has had very bad flus and has been very sick. His mother attributes this to a large extent to the fact that he has been unable to get the dental care that he needs.

I think the government stands condemned for its inaction in the area of dental health. It stands condemned for ripping out the Commonwealth Dental Health Program in 1996. At that time I was in the state parliament and I saw the difference that program made. People who were previously able to get dental treatment when they needed it were coming to my office because the waiting time had blown out. Prior to going into state parliament, I worked in rehab, and many of the people that I worked with there were able to access that treatment. In one fell swoop, the government turned the insignificant waiting list that the Prime Minister talked about today in question time into the situation that we have today with 650,000 people on the waiting list. That is just not good enough.

Each and every day, members of the Howard government stand up in this parliament and refuse to take responsibility for their actions by blaming the states. That is not leadership; that is abrogating your responsibility. It is about time that the Prime Minister, his health minister and other members of the government took this issue seriously. It is not only people with chronic health problems that have issues with dental health; everyone does. We should ensure that each and every Australian can access quality dental health treatment when they need it. That is what the ALP’s policy announcement today will allow them to do.

6:56 pm

Photo of Bruce ScottBruce Scott (Maranoa, National Party) Share this | | Hansard source

It is with great pleasure that I rise this evening to speak on the Health Insurance Amendment (Medicare Dental Services) Bill 2007, because it is this government which recognises that, through Medicare, we can address some issues of dental health care for people with chronic health conditions.

I was interested in listening to the member for Shortland as she was winding up her contribution to this bill. We hear a great deal from the other side of the House about this issue of the ‘blame game’, and here we have the member for Shortland, a member of the opposition, blaming the federal government for what has been for many decades a state responsibility. It was only during the previous Labor government that for a very short period of time—I think it was when Paul Keating was Prime Minister—the Commonwealth introduced a limited dental scheme because of the failings of some state governments in addressing dental health care at the state level.

For decades and decades, dental care has been a state government responsibility. I ought to know because my father-in-law was a dentist and my brother-in-law is a dentist—in other words, I married the daughter of a dentist. Dental health care and dentistry have been very close to my wife’s family and to her right throughout her life and even now. It is very important to understand in this House that the public side of dental health care has for decades been the responsibility of state governments.

I welcome the new items that will come under the Medicare banner because it will enable patients who have chronic conditions to have $4,250 of Medicare funded access to dental care. The $4,250 relates to two consecutive years. For instance, if a person needs dental care and is referred by a doctor to a dentist, as is required under this bill, they will have access over two calendar years to the $4,250 funded through Medicare.

That is a significant step forward, which recognises that there are people out there with chronic and complex health conditions that need some medical treatment which would help them with their quality of life. Some of these people may be cancer patients. Others may have other health conditions that, in the opinion of their doctor, without this dental care could further deteriorate. The federal government has recognised that need and funded up to $4,250 worth of dental care for those people who need that care on a fairly urgent basis because of their medical condition.

This legislation does not replace the responsibilities of the states and territories. We have to ensure that our state and territory Labor governments across Australia accept their responsibility for the funding of public dental health care of the people of their state and territory. The state and territory governments are receiving a massive influx of revenue from the GST—GST revenue that three, four or five years ago they were not budgeting on. It is almost like a windfall which has come their way. With that revenue, if they were responsibly managing their state and territory economies, they would be ensuring that the public dental health system was funded and was meeting the needs of their respective residents.

This bill would not be necessary if the state and territory governments were meeting their just responsibilities. That is why this federal government, concerned for the health and welfare of those people with very complex health conditions—some may be suffering cancer or may be on complex drugs for their health condition—is ensuring that they will be able to access this dental service, which should have been the responsibility of the state governments and funded by them. But time and time again we come into this place and we as the federal government have to deal with the failings of the state and territory Labor governments across this country.

The federal government initiated a dental health care program that is helping people in rural and remote Australia. In my electorate of Maranoa, the federal government provided some $384,000 to improve dental services in Barcaldine, Longreach and Winton. That money will be used to utilise teledentistry technology. It will certainly make a big difference to the dental health care of those communities. The Coopers Plains dental surgery in Brisbane will be able to look at very high-definition pictures of people’s teeth. That procedure will be conducted by a dental nurse or a practitioner nurse who would be seeing these people in the relevant public hospital, in this case in Barcaldine. In fact, about 12 months ago I visited the hospital and spoke to the dental nurse who was there full time. She is able to describe and also transmit the image of someone’s teeth or their dental condition to the dentist who will be visiting. They come about one week in every four weeks. So when they come to the hospital on their monthly visits they will know, in advance, the sorts of dental treatment that they have to deal with. They will know if there are extractions or fillings or other complex dental work that has to be conducted on someone’s teeth and the length of time it will take because they would have had a very clear video image of someone’s mouth and the dental problems that will have to be addressed when the dentist visits, in this case, Barcaldine.

This technology will also be extended into the public system in Longreach and Winton, where the dentist would utilise those dental surgeries. The federal government has funded this technology to improve the dental services of people living in rural and remote Queensland where they do not have a full-time dentist and where a dentist comes on a monthly basis. Sometimes they spend a week in one town. Sometimes they spend a few days in one town and then they move to Longreach for the remainder of the week. They provide a service but, importantly, because of this federal government’s funding this dental service is improved. It is better able to utilise the good technology that is available today to provide the dentist with a very clear picture of what sorts of conditions they will have to address when they come to a town. It also means that the dental nurse in a town can anticipate the number of patients who can be seen on a particular day. That is all possible through teledentistry, which this government has been able to fund. I am very proud of this federal government’s initiative because it is helping people in rural and remote parts of my electorate.

Under the Rural Medical Infrastructure Fund this government is providing funds for health care. In my electorate of Maranoa we have seen some $400,000 recently provided to the Aramac shire. That shire will put in that medical infrastructure, which will include dental facilities in the rural medical infrastructure building. It will enable doctors and a dentist to visit—because the federal government will have provided the purpose-built building, which is not there today—without them having to put money of their own into the infrastructure, which obviously will be used not every day but on demand.

The rural medical infrastructure that is to be provided and will be funded by the federal government, in conjunction with the local government, is now at real risk because of the forced amalgamations of local shires in Queensland—which was Premier Beattie’s initiative, but Premier Bligh does not now want to visit the mistakes of the Beattie government—because that shire is to be amalgamated with two other shires in their region. I really fear that that rural medical infrastructure building will not be needed in that community because the shire will be abolished and the shire workers will no longer have jobs in the community. Those shire workers will have to move to the bigger town, which will leave a community without the rural medical infrastructure because of the decimation of that community through the forced amalgamation of local shires by the Beattie Labor government.

I congratulate Premier Bligh on being the first woman Premier of Queensland but, if she wants to govern for all Queenslanders, I appeal to her to revisit this issue of forced amalgamations of local shires in Queensland. I know that this week she will be out in Charleville in my electorate and she will probably go up to Longreach. When any Labor member goes into my electorate in outback Queensland they always go to Barcaldine, which we acknowledge is the birthplace of the true Labor Party, not the one we see today because that very symbol that brought about the Labor Party when it was born in Barcaldine, the tree of knowledge, died recently. Some say it was poisoned but there are many out there who say that it died of shame because of the actions of the Labor state government in forcing amalgamation of shires against the will of the people and in denying them an opportunity for a free vote on whether they agree with the proposition.

Photo of Duncan KerrDuncan Kerr (Denison, Australian Labor Party) Share this | | Hansard source

Order! Although I am a beneficent and tolerant Deputy Speaker, it would be useful if the member would address the subject of this bill on the odd occasion.

Photo of Bruce ScottBruce Scott (Maranoa, National Party) Share this | | Hansard source

Thank you, Mr Deputy Speaker. The Premier of Queensland, Anna Bligh, is travelling into rural Queensland this week. I know that she will be in parts of my electorate. In the interests of the health of Queenslanders, including dental health, I appeal to her to visit those communities. On her watch, she will now be amalgamating those shires against the will of the people and that is going to have a dramatic impact on the health care and particularly the dental health care of people in towns like Aramac, where the medical centre that was to have a dental surgery would have been built, funded by the Aramac Shire and the federal government. Mr Deputy Speaker, I respect your call but I want to acknowledge that we have a new Premier in Queensland—the first woman Premier in that state.

Photo of Christopher PyneChristopher Pyne (Sturt, Liberal Party, Minister for Ageing) Share this | | Hansard source

She was not elected.

Photo of Bruce ScottBruce Scott (Maranoa, National Party) Share this | | Hansard source

She was not elected, as the Minister for Ageing, who is at the table, has suggested. I appeal to her as the leader of the Queensland government to look at the forced amalgamation issue of those local shires in Queensland. Think of the health care of people in communities where the federal government has put in medical infrastructure, including dental surgeries, such as Charleville and Birdsville in my electorate. I hope the list will soon include Bedourie, where there are many Aboriginal families who certainly need good dental health care. At present, the Royal Flying Doctor Service of Australia services these areas. I ask Anna Bligh, the Premier of Queensland, as she travels into western Queensland this week to look at these communities, to think of the people outside the south-eastern corner of Queensland and then to go back to the drawing board on the forced amalgamation of local shires because it is going to have a dramatic impact on them. If you continue to proceed with that foolish plan it will affect the mental health of people and will put stress and strain on many small Queensland families. I commend the bill to the House.

Photo of Duncan KerrDuncan Kerr (Denison, Australian Labor Party) Share this | | Hansard source

I thank the honourable member for his close focus on the terms of the bill.

7:12 pm

Photo of Jennie GeorgeJennie George (Throsby, Australian Labor Party, Shadow Parliamentary Secretary for Environment and Heritage) Share this | | Hansard source

I am pleased to have the opportunity in this debate on the Health Insurance Amendment (Medicare Dental Services) Bill 2007 to speak on the important issue of dental health because it is an issue of major concern to the constituents of Throsby. People need to be aware that in the Illawarra-Shoalhaven region we currently have over 7,000 people waiting on the public dental waiting list. Some have waited year after year without a proper and adequate response.

Today in question time we heard another classic example of the blame game. This time it was on dental health. There was a finely orchestrated introductory interjection on the eminently sensible and reasonable questions from the Leader of the Opposition to the Prime Minister. In the staged uproar that occurred after the first question from the Leader of the Opposition, the Minister for Ageing was expelled from the chamber for a period because the Leader of the Opposition was not allowed to continue stating what everybody in the community is well aware of—that is, in 1996 the Howard government abandoned a Commonwealth dental program which had been introduced by Labor to deal precisely with the problem we are witnessing in Australia today: the enormous growth in the number of people in our community waiting for urgent medical treatment, in many cases, and of people waiting for access to preventative dental care.

Today the ministers and the Prime Minister played the game that Australians are getting tired of—the blame game. This time it was about dental health, with the Prime Minister trying to deflect criticism from the federal government, which axed the Commonwealth program, by saying that it is all a matter for the states and territories and not a federal responsibility. It was quite an amazing performance. Despite the fact that the Leader of the Opposition quoted directly from the section of the Constitution in which there is a provision for the federal government to exercise its power in the area of dental services, it maintained its typical blame game attitude. I think people are starting to see through it. They know there is a problem out there. The 7,000-plus people in the Illawarra and Shoalhaven know that the blame game is not going to address the problems that they are experiencing in a very acute manner.

The economics of the government’s response is totally inadequate. What we see happening in our community is that, if people cannot get access to treatment, their simple dental problems escalate into much more complex health problems. In turn, that presents pressures at other points of our health system. People with mild dental problems have to wait for years to get them treated and end up seeing GPs and being hospitalised for preventable dental conditions. I understand that up to 50,000 hospital admissions are occurring each year for preventable dental conditions. We see an increased reliance on prescription drugs and anaesthetics for pain management and treatment.

All this is not only at an enormous cost to the wider health system but at an intolerable cost for many individuals. I have referred to our local media many cases of people who have waited year after year and in desperation had to resort to numbing their abscess pain with alcohol or, in many cases, pulling out their rotting teeth with pliers. They know that the solution to this issue is much more than the typical blame game that they are so accustomed to from the Howard government. It was in fact the government’s decision to scrap a Commonwealth dental scheme that had operated successfully under Labor and had cleared the backlog of people waiting for treatment. They know that this has been the cause of the huge growth in the number of people unable to access dental care when they desperately need it—let alone have any chance of getting any preventative care.

We have a national crisis and we have a deterioration in the standards of Australia’s oral health. Tooth decay today ranks as Australia’s most prevalent health problem, and gum disease is not far behind. Untreated dental decay in the Australian adult population stands at around 25 per cent. That is a shocking indictment of this government’s lack of concern for this problem, with a quarter of adult Australians not getting the dental care they need.

I am horrified when I read reports in the Sydney Morning Herald of young people having to be admitted to hospital to have all their teeth pulled out under anaesthetic. A recent study found that one in six Australians aged 15 or more were forced to avoid certain foods because of problems with their teeth. I had a situation in my own electorate where a man in his 40s whose teeth were crumbling was not able to get access to dental treatment and in the end had to resort to buying himself baby food to prevent the further decay and crumbling of his teeth. That is a shocking indictment of a country as rich as ours and a government whose surplus is huge. There are 650,000 Australians—and you know who they are: the low-income people, the pensioners, the people on fixed-income in retirement, the people who cannot afford to have private dental health insurance—who are missing out. If you are lucky enough to be able to afford private health insurance you can get some reimbursement from your private health fund, and the government does pay out for people who are privately insured. But a lot of the people in my electorate, probably around 60 per cent, do not have private health insurance, and they are the people who are feeling the impacts of this situation most intensely.

To get public treatment in my area at the moment you need to present with a swelling, an abscess or pain and bleeding. Even then, you might wait three days before you can get access to a dentist. It is not unusual in my region for people to be waiting for five or six years before they can get dentures. Of course, you can forget about any preventative treatment. And we have seen quite a wind-back of dental services for school-age children as well. It is a fact that the average cost of dental treatment has increased well in excess of inflation, and that puts it beyond the reach of many low-income people, who rightly deserve a proper public dental system to attend to their needs.

A recent study by the Australian Institute of Health and Welfare found that 30 per cent of Australians reported avoiding dental care due to the cost factor. In other words, they knew they needed to get treatment but a third of them said, ‘I just can’t afford to pay it.’ Twenty per cent said that the cost had prevented them from having recommended treatment, and 18 per cent reported that they would have a lot of difficulty paying a $100 dental bill. Well, $100 at the dentists these days does not get you very far at all. It is appalling that the cost of dental care is preventing many of the families whom I represent from being able to access proper services.

The other thing that is very important in this debate is to recognise that the government has done very little about the huge dental workforce shortages and the maldistribution of public dentists across the nation. It is exactly the same story as we have with GPs. If you are in urban Australia, if you are in a major capital city, your chances of seeing a practising dentist are far greater than if you are in a regional area like mine—and it is even more problematic in remote and rural Australia.

This government has known about the shortage of dental professionals for a long time. The neglect of the government in this area is longstanding, and surely no government minister would deny that it is a federal responsibility to train an adequate number of dental professionals. A national oral health training strategy for oral healthcare providers was recommended by the Senate Community Affairs References Committee as far back as 1998. But the Howard government, year after year, failed to act to ensure that we had a reasonable intake and graduation of dental professionals to service the needs of our community. Back in 2003, researchers were telling the government and the opposition that there would be an estimated shortage of 1,500 dental professionals by 2010 unless urgent action was taken. In 2004, just a few years ago and in the midst of this crisis, dental graduation levels were at their lowest level for over 50 years.

Belatedly, the government finally recognised that they needed to increase the number of places. As our shadow minister indicated in her contribution today, we welcome the recent budget announcement of a new dental school at Charles Sturt University. But much more needs to be done. Comprehensive and strategic policies are required to ensure a long-term solution to the dental crisis in our nation. After all, it is real people we are talking about. When we discuss the facts and figures about waiting lists and preventable hospitalisation and when we look at the statistics about workforce shortages and clinics that are closing their lists to people who need to see a dentist, we must always keep in mind that these are real people, real families. They are not just statistics, but real people with real concerns that need to be seriously addressed.

I want to say something about the response of this government to this crisis in our nation. No-one on our side of the chamber would begrudge people suffering chronic disease and illness having priority access to proper dental treatment. The government recognised, in a very limited way, that they needed to move on this issue because the com-munity—not just constituents but the professionals, the peak bodies and the dental associations—were saying quite clearly that something urgently needed to be done. The government’s response to the 650,000 people on the waiting list was to put forward a very limited scheme. It has helped some people. As I said, you do not begrudge the fact that people have had access to the government’s restricted scheme.

But people need to realise that the government’s scheme is limited to assisting those who have a chronic medical condition, such as heart disease or diabetes or malignancies of the head and neck. You have to have poor oral health or a dental condition which is exacerbating this chronic disease to even get a look-in to the government’s program. On top of that, your GP needs to be treating you under a multidisciplinary care plan. If you satisfy those criteria, you may be eligible for assistance. But it is very limited. As I indicated, eligibility is very tight. We can see that in the data that is on the public record. Since the introduction of this scheme by the government, only 7,228 Australians have had their dental needs attended to in the three years between July 2004 and June 2007. Only 7,228 people got access under this program—which is now going to be expanded—out of 650,000. So what about the hundreds of thousands of people who are not going to be able to access the government’s scheme under the tight eligibility requirements that exist?

In my state of New South Wales, 4,236 people with chronic illnesses got access to the government’s dental assistance scheme through Medicare in those three years. I do not begrudge any of those people that access, because they were in desperate situations, and I am very pleased for every one of them who got access. All of those 4,236 would have been very deserving cases. But that number for the whole of New South Wales is less than the number on the waiting list in the Illawarra and Shoalhaven region, so you can see that the scheme has not been a great success. What we have in the government’s announcements is additional money being poured into a scheme which, on the statistics and data available, has had very poor outcomes to date.

The poor take-up of the government’s program has been due to complex and restrictive eligibility criteria. As I said earlier, it limits coverage to those whose oral health exacerbates their chronic disease. The eligibility criteria announced by the government in the budget remain totally unchanged by the legislation before us. The minister did not challenge that argument when it was put today. The government has also failed to address the additional problems with this program: namely, the high out-of-pocket costs for patients and the very complex and restrictive referral process required before a patient can see a dentist under the health care plan. Fiddling with the detail of how this failing program is to work in the future in my judgement will do little to address the overall national problem: the 650,000 people languishing on the public dental waiting list. It will do nothing to make dental care more affordable and accessible to Australian families across the board.

Given the poor take-up rate to date, we on this side of the House have no confidence that the extended program will fare any better. Pouring money into a failing scheme will not solve Australia’s dental crisis. Today, the Leader of the Opposition and the shadow health minister outlined details of Labor’s proposal. Our Commonwealth dental health program will work in combination with the efforts of states and territories. Today, we committed up to $290 million to this combined effort. It is very important that people understand that this was only the first instalment. We wasted a lot of time in question time with this phoney argument about the so-called loss of $100 million between the government’s commitment and that of the opposition. If they had read the releases that went out today and listened to what the Leader of the Opposition said, they would know it has been made clear that the $290 million in our announcement today is only the first instalment. So I would urge all my constituents to make sure that they keep abreast of the additional announcements that Labor will make on our Commonwealth dental program.

Under our plan we are going to use the infrastructure that already exists in states and territories. They will get additional funding but they will be required to meet some new standards of dental care. At the top of that list of those who will benefit from the announcement today will be people with chronic diseases, who will have a high priority—and rightly so—but we will also expect that timely service is provided for preventative and emergency services and that governments will commit to maintaining their current effort.

Under our plan, over three years, up to one million Australians will finally receive much-needed dental treatment. The community at large will understand that only Labor, with national leadership on this issue, will end the blame game that they are so used to hearing from the other side of the House. We will provide the national leadership. We will provide the funding and resources, and request that the states sign up to clear objectives so that we can clear the huge backlog of 650,000 Australians languishing on the public dental waiting lists.

The states will be able to either supplement their existing public services and infrastructure or purchase private sector appointments for the hundreds of thousands of people who are now waiting for some light at the end of the tunnel to get their urgently needed dental conditions treated with some expediency. So it is for those reasons that I reject the government’s limited proposals. I do not begrudge the people that will benefit, but I say to the government again: if 7,000 people out of 650,000 got treatment under the scheme as it was first devised, I do not see that it will do much better into the future. (Time expired)

7:32 pm

Photo of John AndersonJohn Anderson (Gwydir, National Party) Share this | | Hansard source

Mr Speaker, I indicate at the outset that I understand you may give me a little latitude in terms of speaking to the matter in hand before the House. This will be the last time I speak in this place, some 18½ years after I was sworn in and just over 18 years since I gave my maiden speech as the second person to do so in the House of Representatives who never served in the old parliament, following the by-election on Ralph Hunt’s retirement in 1989.

I have had a very privileged run; I have been very fortunate. I had 13 years on the front bench, 9½ of those in cabinet in government, six years as my party’s leader and as Deputy Prime Minister. I can only say to the House that I have deeply appreciated the courtesies, the understandings that have been extended to me in so many ways, even when I have stood for things that not all might have agreed with and when you have those inevitable moments that everyone in public life has when things do not seem to be going so well.

I feel in a way I have already bored you with my remarks, as I exited the scene a little over two years ago when I stepped aside as Deputy PM, so it is kind of you—those of you who are present—to come in again tonight. Now is the time for me, though, to go out to pasture. I am looking forward to it with a sense of real anticipation, even excitement, notwithstanding the great privilege that it has been being here for all these years.

There are a few things I want to reflect on tonight. Perhaps the toughest task I was ever involved in was as one of the first six members of the razor gang set up in 1996; a dreadful process. We spent I think five months of the first 14 in government locked up preparing the first two budgets. It was a very grinding exercise that never seemed to end and yet it was worthwhile. The fruits of those exercises I think are now well established.

I think of some of the other things I was involved in—Agriculture Advancing Australia, with the restoration of farm management deposits. I think they have been immensely valuable to the farm sector through these very difficult times. I think of the Farm Family Restart package, which helped people exit with dignity when there was no other future for them—that was part of Agriculture Advancing Australia. I think too of FarmBiz, which at the time I wondered about, but farmers everywhere have told me that it has helped them lift their professionalism and the way in which they go about their business. I see that reflected in the incredible way that Australia’s livestock farmers have coped with this drought in terms of the management of their pastures and the much more rapid and effective decision-making processes and so forth that they go through, and I draw much satisfaction from it.

I think of AQIS reform. Somebody had a go at me the other day when I mentioned it because of the quarantine issues that the current minister is currently grappling with. The resources we put in to provide the services were not there when we got into government. No service is ever perfect, and you may very well find things that have to be done differently in the future. But compare it to the service we had when we got into government in 1996 and compare it to the old days when the red meat industry was regularly shut down because the government could not provide inspectors—do you remember Mudginberri?—and yet at the same time there were scores of inspectors headquartered in country towns, being billed against meat producers, who were doing nothing but could not be moved on. We reformed all of that. As I speak, I understand the total bill to the red meat industry in today’s dollars would be about $40 million this year for the inspection services provided by AQIS. When the member for Hotham was last the minister for primary industries it was $140 million. That is $100 million odd—a lot more in today’s terms—that does not leave farmers’ hands in the form of taxes paid to Canberra for services that were, to put it mildly, barely adequate.

I think of the regional policy that we pursued so actively for so many years and some of the people who helped me put it together—Stephen Oxley up there, Peter Langhorne and others too numerous to mention who helped us with all of that stuff. From time to time you hear a bit of criticism of regional policy. I just say: there is a case for social justice. Many people in rural and regional Australia felt for many years, understandably, that the contribution they made was underrecognised, that the services they got were out of kilter in proportion to the contribution they made to the wellbeing of the nation and that social disharmony is not the ideal platform for political stability—and political stability is needed if you are to take a nation forward and to engage in the economic reforms that have taken the country forward.

I do not apologise for what we have done in regional Australia. I do not say that everything was right, but I do say that we put back into those country towns banking services, postal services, mobile phone towers when Telstra would not do it and Roads to Recovery. All of those things have been good and worthwhile things to do. I would ask those who would tut-tut in the leafy suburbs about the likes of One Nation to not tut-tut when we go out to grapple with the real problems that some of those people deal with.

AusLink and the National Water Initiative were two big national policies that I was very proud of. I believe that both are world’s best practice—they are both in capable hands now, and I am very pleased about that—but I mention them here tonight for one reason only. I have a very high regard for the best intellects in the Public Service—and I include the head of Treasury, Dr Ken Henry—but I was astounded to read that at the Sydney Institute in the spring of 2005, shortly after I stepped aside as Deputy Prime Minister, Dr Henry spoke of AusLink and water in these terms:

In water, electricity and land transport, we can’t afford anything less than world’s best practice.

He gave the reasons why we in Australia cannot afford less than world’s best practice. He went on to say:

... in each of these areas, ambitious Commonwealth-State programmes are in place to take reform much further:

He listed them in this order: the National Water Initiative, AusLink and the COAG Australian Energy Market Agreement.

I have had the opportunity to say to the head of the Treasury face to face that Treasury loudly protested that, when big policy issues are involved, you need the deep intellect of departments such as Treasury. That is fine—I welcome it—but I made the point to him that I faced open hostility on AusLink: ‘No, you can’t spend any more money.’ But then: ‘That was until we discovered that the ports, Mr Deputy Prime Minister, were not working well enough and that we had to do something about infrastructure.’ Treasury should have been deeply engaging with us rather than obstructing us, as they did. This simple attitude of saying no overlooks the fact that some investments by the Commonwealth produce money—they are not simple outlays or recurrent expenditure.

I would have welcomed Treasury’s engagement. With the National Water Initiative we got a passive, ‘All right, we will let it progress,’ rather than provision of the deep intellectual input that that department now says that it wants to provide and that I know it can provide. I make those comments in the spirit of wanting to be helpful as I pass from this scene. There are deep intellects in the bureaucracy, but they really need to engage in these solid policy issues. They have not always been, and I dare say nothing has changed. I know there are times when they have to say, ‘That’s a political matter,’ or, ‘We disapprove’—we all know that—but there are times when their active engagement would short-cut the route to better policy outcomes. I would encourage that approach from them.

In terms of social policy, I have always had a deep commitment to those things. I simply say, without wanting to in any way do anything other than accord full credit to those who were responsible, that policies like the new schools policy—which replaces the old ‘no new schools’ policy—are tremendously important. It gives parents choice and ensures a far better guardianship for many of the values and beliefs that many of our parents would want emulated and taken forward for the betterment and indeed the maintenance of a stable society. Some might ask why the government did not go for income splitting, but I believe that the way that the family tax benefit now works, whereby if you earn around $53,000 you are as well off or even better off if one parent stays at home, gives parents real choice. I think it is very high quality social policy. I am privileged—there is no other word for it—to have been associated with a government that has moved in those sorts of directions over the last 11½ years.

I think, too, of mutual obligation. As a civilised society we do need to recognise that we will be judged by the way we treat the less fortunate, but part of treating them well is to get them to recognise that a little social obligation is a very good thing. I have been very surprised and delighted at the change in attitude that many parents have told me they have found in their young people when they have been through something like Work for the Dole or Green Corp, for which I give full credit to Tony Abbott. Those sorts of things have been very good.

Let me say that this wonderful country is, in my view, economically—and, I would argue, in many other ways—stronger now than it was in 1996, and that is for the better. On almost every reasonable indicator, we are a massively fortunate nation. Employment—labour market penetration—is now at the highest levels we have ever seen in our society. On longevity, provided only if we take reasonable care of our own health: which society could have looked to the lifespan that we as men and women in this country enjoy? Think of health care. Yes, it can always be improved—we have vigorous debates about it—but we are wealthy enough that we can spend more on health care in this country than the total GDPs of 65 per cent of the nations on earth.

Look at the way in which we can communicate. Look at the transport revolution that has done so much to give us freedoms we could never have dreamt of. Sound aviation policy means that more Australians than ever are flying despite the tragedy of the loss of Ansett a few years ago. These things are all good, but I have come to realise—perhaps I knew it before I started here—that happiness is not a function of material wealth. Happiness is a rare commodity in Australia today. I think most of us in this place would know of people who are happy, who are content with their lot and have a sense of hope; however, happiness is not as common as we might like in this country. I acknowledge that events such as crippling drought leave many people with extraordinary, deep worries that are, understandably, very hard to cope with. However, we now have an epidemic of depression—which is, of course, the opposite of happiness—in the Western world, including in this country.

It amazed me to realise this, as I thought back over it, that many of the happiest people I have known are people who in material terms have not been well off at all. The most outstanding example of all was the Watoto Children’s Choir—a group of 30 or 35 young Africans. I listened to them in the foyer of Parliament House and I met with them. Those kids had nothing. They did not even have their parents, let alone a home, a DVD or an iPod, which many kids think are important. They did not have any of those things, yet the joy as they sang and danced as only the Africans can and the hope as they told me of their aspirations—they wanted to be teachers, doctors and farmers—really struck me. It was a powerful reminder for me that happiness is not a function of our material wellbeing but, rather, of beliefs which shape values and attitudes and determine whether or not we have hope and whether or not we are in effective relationships with others. Those are the things that I think will determine the strength of the nation in the future.

I say to the House that, ultimately, the beliefs of the people will shape our society for better or for worse in the long run. That is of greater material interest to us all, including in government, because we are a function of a society that puts us here and supports us or chooses to withdraw its support. One of the reasons that I believe the government is absolutely right to insist on the better teaching of history is that it will help us to understand the consequences, for good and for bad, of different belief systems or of no belief systems. Whilst I would obviously recognise the need to separate church and state, I do think we need to put our young people in a position where they are better able to make judgements about what they believe and why and what will work for them and our society.

This year, 2007, is in fact the 200th anniversary of the abolition of the slave trade—not slave ownership itself; that took another 30 years to achieve—by the then global superpower, Great Britain. It is sobering to realise that just 200 years ago freedom was only a far-off dream for an estimated, according to the reliable historians—or the ones I would regard as reliable—90 per cent of humanity. Most of humanity was either in slavery or little better off in serfdom—and, of course, in our country, they were in irons.

The story of William Wilberforce and his supporters, as told in Amazing Grace, is a story of transformed lives transforming society. It is an astonishingly powerful story, the outcomes of which were of undeniably great benefit not only to those slaves who gained their freedom but to all of society as well. Our freedoms grew historically as we expanded our understanding of who belonged to the family of human beings. Our freedoms, I note in passing, will contract as we exclude people from the human family.

The ending of the slave trade came about through the first of the great human rights campaigns—perhaps the biggest of them all—and, arguably, the first major modern political campaign. It led directly to a further political campaign: to end the corruption of the electoral system in Great Britain, to enable in 1833 a truly representative parliament to act on the people’s wishes and to actually free the slaves—having ended the trade—whose owners were granted massive compensation. What for? For the loss of their goods and chattels. But we do not think of black people as goods and chattels anymore; we recognise them fully as members of the human family.

It is a very powerful story, yet only 500,000 people have been to see Amazing Grace. I wish every Australian could see it. It gives great and valuable insights into our society—into the condition that we confront as people. And as we confront our endless problems—terrorism, global warming, energy security and the epidemic of depression, as I have mentioned, that sweeps the modern age—we can, I think, learn a lot more from history than we have been doing to date. I am convinced that history shows us that a loss of the beliefs or, worse, a denial of the beliefs that a culture is built on will ultimately lead to the decline and even destruction of that culture.

Dawkins and Hitchins et al would have us believe that the problem is that we have not been secular enough. They would say that we ought to be more secular. As I see it, we gave secularism a great run in the 20th century. We tried atheistic communism and got 60 million dead in Russia and we got the killing fields of Pol Pot—and goodness only knows how many dead in China. We tried atheistic right-wing fascism in Germany and beyond and got the gas chambers and another 60 million dead. Today we are not so arrogant; we are beginning to question again. But I would urge that we learn the lessons of history when we seek out and respond to the truth. When we do not sit on the fence, we in fact will find that truth is available to us. I deeply and sincerely believe that. I think if Wilberforce were here today he would say, ‘Your society is not so different to the one that I have been active in, and the great truth remains,’—challenging us that the central figure in history said to us: ‘There is such a thing as the truth, and I am it and the way to God is through me.’ I put that challenge there. We are free to respond either way, but I say that as a society we should no longer go on ignoring it. We can no longer go on skirting around it, either as individuals or collectively.

Let me finally, but most importantly perhaps of all tonight, say a heartfelt thanks to so many, and I have mentioned some already who are here tonight. I thank all of my friends in the National Party—past and present. I think of Ralph Hunt, whose place I took in this House. I think of Ian Sinclair, who mentored me for so long as I sat over on the cross-benches. I think of my leader Mark Vaile and the other cabinet members from the National Party. I think of our wonderful ladies—Kay Hull, the member for Riverina; De-Anne Kelly, the member for Dawson; Fiona Nash, Senator for New South Wales—and the other members, many of whom are here. I cannot tell you how much I appreciate your friendship and your support. And I say precisely the same to my Liberal colleagues here and to those members opposite, many of whom I have enjoyed a very good relationship with over the years—some of them even when we have disagreed vehemently on policy matters. In their absence, I thank old friends, the Prime Minister, of course, Peter Costello and other cabinet members.

A long way from home, I thank tonight my long-time campaign director, Ruth Strang, who is in the gallery tonight with her husband, John. She has run six of the seven campaigns that I have been through. It makes you realise how short federal terms have been historically. I have been here since 1989 and I have been through seven campaigns if you count the by-election. I thank Margaret Illingworth, whose brother served in this place as a Liberal member for many years, Virginia Armitage, Warwick Knight and so many others from the home front—my extended family. In particular, of course, I thank my beautiful-in-every-way wife—described by one perceptive media writer as ‘indefatigably sunny’. I hope I pronounced that properly; it was something like that. Being from the National Party, I had to look the word up in the dictionary!

My father loathed front, but he would have forgiven me for saying tonight that no man can know greater pride than I do in my four children: Jessica, who cannot be here with us tonight as she is at Sydney university; my son, Nicholas; my second daughter, Georgina; and my youngest daughter, Laura—who are up in the gallery tonight. Thank you all very much.

7:52 pm

Photo of Sharon BirdSharon Bird (Cunningham, Australian Labor Party) Share this | | Hansard source

Can I open by acknowledging the member for Gwydir and wishing him and his family all the best in the future. I acknowledge that his final speech in this House contributed not only to the quality of debate in this House but to the national discourse.

I take the opportunity this evening to speak on the Health Insurance Amendment (Medicare Dental Services) Bill 2007 and to outline why I support the ALP’s position in opposing this bill. The bill amends the Health Insurance Act 1973 in order to provide for the expansion of the government’s Medicare dental program for people with chronic conditions and complex care needs. The bill seeks to make amendments because, as the Minister for Health and Ageing acknowledged in question time today, the government got the original program so wrong that it was seriously insufficient. The government now seeks to amend the bill to correct those failings and in doing so perpetuates the very reasons it failed in the first place.

The amendments proposed in this bill enable a monetary limit on Medicare benefits for dental services to be introduced for eligible patients. The limit of $4,250 over two consecutive calendar years will be set out in a ministerial determination made under section 3C(1) of the Health Insurance Act. The original scheme for people with chronic conditions and complex care needs was established by this government in July 2004, eight years after this same government had axed the Commonwealth dental health scheme—eight years during which this government vehemently denied over and over again that they had any responsibility for the suffering of an increasing number of people who no longer had access to a Commonwealth dental health scheme.

I did wonder what amazing event had occurred at that point in time to change those denials of eight years. What was so significant in July 2004? It did not take very long to realise that it was only a few months before an election. And, no surprise, only now, over three years later, does the minister acknowledge that there are serious problems with the 2004 scheme and seek to amend the act. What is so significant about this timing? We are once again only a few months, perhaps weeks, away from election day.

Because the 2004 version of the scheme has been defined by an extremely low take-up, due to the complexity of the referral system it created and the high copayments, the government announced in the budget this year that it would pour an additional $377 million into the failing program. This government is dragged reluctantly, protesting, to any serious addressing of the dental health problems our communities face. It only ever responds immediately before an election. It comprehensively fails to understand that the rising cost of dental care is a major cost-of-living issue for families and has contributed to a national dental health crisis that has left one in three Australians avoiding dental care simply because of the cost. The reality is that the targeting of the program to only those with chronic conditions and complex care needs has resulted in a very limited uptake of the program to date, with only 7,228 Australians over those three years being able to access help with their dental problems.

The proposed amendment before the House seeks to increase to $4,250 the level of Medicare funded dental treatment able to be accessed over two consecutive calendar years. This may assist in reducing the high copayments, but the retention of limited eligibility to people with chronic conditions and complex care needs will necessarily mean that only a small proportion of the population will be eligible to access this assistance. For the wider community there will be no change to the cost or availability of dental treatment as a result of this bill, and certainly no assistance will be provided to the 650,000 people currently on the public dental waiting list, who sit there because they cannot access this government’s current scheme and so will not be assisted by these proposed amendments at all. That is 650,000 sufferers left waiting yet again.

In its very first year in office this government axed the Commonwealth dental health scheme, which was providing $100 million per year for public dental services. This has directly led to the 650,000 men, women and children who now sit on the waiting list, and is evidenced in the sharp deterioration in dental health standards amongst low-income people and young children. As a member of this House from a New South Wales seat I would also like to identify that within that 650,000 figure are 178,876 people from New South Wales, as at 31 May 2007, and that 45,000 of these are children. This is disgraceful. Any parent who has a child suffering dental pain knows that every day waiting is unacceptable. Indeed, the government’s chronic disease dental program has, over the past three years, only assisted 14 preschoolers and one child under five.

A report produced in 1999 by the University of Adelaide reported that Australian children had the ‘world’s best’—that is their words—teeth during the 1990s. Sadly, this has not been universally sustained. Between 1996 and 1999, five-year-olds experienced a 21.7 per cent increase in deciduous decay. The New South Wales Chief Health Officer’s statistics also show that hospitalisation rates for children under five for the removal or restoration of teeth increased by 91 per cent between 1994-95 and 2005-06. This worrying development was further confirmed by information released in February this year by private health insurer MBF, which showed a 42 per cent increase in children being treated in private hospitals for dental cavities.

Not only have waiting lists become a problem under this government; the average cost of dental treatment has also increased well in excess of inflation, putting it beyond the reach of many low-income people. The Australian Institute of Health and Welfare in its report entitled Australia’s dental generations: the national survey of adult oral health 2004-2006, found that the 30 per cent of Australians reported avoiding dental care due to cost. That is 40 per cent of Australians not going to the dentist when they needed to simply because of the cost. 20.6 per cent said that costs had prevented them from having recommended dental treatment and 18.2 per cent reported that they would have a lot of difficulty paying a $100 dental bill—and to be quite honest, given the current cost and the increase in the cost of dental services, I think they would be doing pretty well to find anything that cost them only $100 to start with. Most of them know that they are up for quite a bit of money and, clearly, from these figures 40 per cent are not even seeking dental advice because they know that they are just not going to be able to afford it, and 20.6 per cent seek the advice and then are not able to follow through on the full service because they cannot afford it. That is an unsustainable and disgraceful situation.

Over the 11 long years that this government has persisted in justification and reluctant, ill-conceived policy activity on dental health, the states and territories have more than doubled their funding to public dental health in an effort to alleviate the pain left by this government’s abandonment of the field in 1996. Time and time again the Howard government has asserted that the states are wholly and solely to blame for the dental health crisis, in complete contradiction of the constitutional allocation of jurisdictions. Indeed, the Prime Minister said today that before the Hawke-Keating government took a role and met their responsibility, dental health service had ‘since time immemorial’—to use the Prime Minister’s own words—been provided by the states. For a Prime Minister who so recently announced that this government has to stop talking about the past and focus on outlining plans for the future, they spend an awful lot of time investigating further and further into the past when asked to debate any particular issue of concern to the community today. On that sort of basis, heaven help the development and rollout of new technologies if this is to be the approach of this government to taking responsibility for any matter.

The public dissatisfaction with the removal of the Commonwealth Dental Health Program has not abated over the intervening long 11 years. Indeed, in my own region I have supported the work of local community activists and would like to particularly acknowledge the work of my colleague the member for Throsby, who has provided extensive support to these local people in advocating in this parliament for the return of a Commonwealth dental scheme over the preceding years. Local groups in our area have united in the Illawarra Dental Health Action Group, and organisations such as the Combined Pensioner and Superannuants Association have maintained their determination to see the return of a scheme that was so critically important for the people they represent and on whose behalf they advocate so strongly. I would like to mention the outstanding leadership offered in this campaign by locals such as Alice Scott, Tom Ward and Edna and Eric Stevenson, but I also acknowledge that they are only able to maintain their efforts because of the support of so many other local people who join with them in the campaign. Such community people, as well as the 650,000 still waiting on public lists, would have no trouble understanding why Labor would oppose such a bill as that before us today. It will do so little to address the public dental waiting lists and nothing to make dental care more affordable and accessible to Australian families and pensioners.

When the budget announcement was made, Labor announced that we would be likely to use this money to invest in a dental care scheme that actually provided real benefit to the ordinary Australians who expect, and indeed deserve, so much better in health policy from a federal government. Today federal Labor took up that expectation and made a significant announcement on dental health. The federal Labor leader, Kevin Rudd, and the shadow minister for health, Nicola Roxon, announced that a Rudd Labor government will re-establish a Commonwealth dental health program and provide funding for up to one million additional dental consultations for Australians needing dental treatment. This commitment pledges up to $290 million to such a Commonwealth dental health program as a first instalment in Labor’s overall commitment to dental health. Under this plan, to be introduced by a Rudd Labor government, up to one million people will finally receive, over the three years, their much-needed dental treatment.

This is in comparison to the Howard government’s chronic disease scheme that has failed to assist 650,000 people who still sit on the waiting list, the scheme that over the three years of its operation has only provided some relief to 7,000 people because of the barriers of its complex eligibility process and referral criteria. Federal Labor is not interested in the cheap-shot blame game that the Howard government has played with this issue. We are just committed to clearing the backlog and relieving the pain and suffering of those people caught in this backlog.

This money and the services it will purchase will supplement existing public services or purchase private sector appointments for these people. Under the Rudd Labor plan, the state and territory governments will be required to meet new standards of dental care as part of their commitment to ensure that this additional Commonwealth funding arrests and reverses our failing dental health standards, particularly amongst the most needy and vulnerable in our communities. State and territory governments will be required to meet the new standards, which include providing priority services to individuals with chronic diseases affected by poor oral health, providing timely service for preventative and emergency services and maintaining their current efforts.

I have absolutely no doubt that the Rudd Labor announcement will be resoundingly applauded and welcomed by local groups in my area who have been fighting on this issue for all the years since this government axed the scheme. I commend the Labor leader and the shadow health minister on understanding the needs of communities like mine and making a real and practical announcement on such an important health issue. This will bring significant relief to so many people in Cunningham. I note that in the contribution of my colleague the member for Throsby she outlined the fact that in our own area there are approximately 7,000 people on the waiting list. The member for Throsby, like me, has regular contact with those people, and we are particularly and pertinently aware of how frustrating it is for them to deal with the pain and suffering and other ongoing physical effects of their poor dental and oral health. I know each and every one of those people will be extremely pleased when we inform them of the announcement of Labor’s commitment today and that they will absolutely understand that we are committed to providing a real, direct service, the sort of service they got up until 1996 and which had been so successfully attacking the long public dental waiting lists. By its axing we have now seen the situation get to the point where 650,000 of these people across our nation are unfortunately unable to get access to the public health service that they need.

8:08 pm

Photo of Judi MoylanJudi Moylan (Pearce, Liberal Party) Share this | | Hansard source

Dental health has certainly been a topic of considerable discussion today. It is a fact that dental health is fundamental to overall health and wellbeing. People who have a chronic illness such as diabetes, cardiovascular disease or cancer are more susceptible to oral health problems. In fact, poor oral health may contribute to heart disease and stroke, according to the American Heart Association. People undergoing treatment for cancer are also at risk of oral health conditions that without treatment pose a very serious additional risk to health.

Poor oral health can affect a person’s ability to eat, swallow and speak. It can result in considerable pain, the possibility of infection and loss of teeth. While the dental health of children—with the exception of some children in the Aboriginal and Torres Strait Islander population—has improved, with a significant reduction in the number of children with tooth decay, there remains a problem in the adult population. In fact, Australia ranks first amongst OECD countries for the oral health of children. Conversely, in the adult population, according to a 2001 study by the Australian Institute of Health and Welfare, there are 19 million untreated decayed teeth—the most prevalent chronic condition affecting health. Australian adults rank third last in oral health status in the OECD.

For some years state governments have failed to maintain the dental health system, and the waiting lists have grown so that there are an estimated 500,000 people now on state government waiting lists. In Western Australia in particular I find this totally unacceptable. It is a wealthy state and there is no reason for the large number of people on waiting lists.

This situation exists despite the federal government having provided a four-year catch-up program in 1994, with the allocation of $278 million over that period. Under the Commonwealth Dental Health Program, 1.5 million services were provided, and the Australian Institute of Health and Welfare carried out an evaluation of the program in 1997. Despite some positive outcomes, including shorter waiting times, fewer extractions and a greater level of satisfaction, there were also some shortcomings of that program, and these included only a small difference in emergency care treatment despite the intention of the scheme to shift the emphasis to general care.

The people eligible for care under the CDHP, Commonwealth concession card holders, were more likely to present for tooth extraction and were more prone to toothache than the general population, and the range of services was restricted, with insufficient incentives for private practitioners to participate in the scheme. Despite the investment of the federal government in the CDHP, by June 2002 the waiting list for people in Western Australia had more than doubled, to 26,000 people, with the waiting time increasing dramatically from eight months in 1997 to 13 months in 2002. I think you would agree that this is a deplorable situation for a wealthy state. Similar figures, I understand, applied in other states.

Following the 2007-08 budget announcement on dental health measures the government, in consultation with stakeholders, has provided greater flexibility for patients to receive complex treatments as required. And the scheme is more generous since the announcement in the budget. The Health Insurance Amendment (Medicare Dental Services) Bill 2007 will improve and increase access to dental treatment under Medicare for people who have a chronic condition and who have complex care needs. New dental items on the Medicare Benefits Schedule will be introduced from 1 November 2007, and this will enable eligible patients to receive Medicare benefits for a broad range of dental services. Up to $4,250 in Medicare dental benefits over two consecutive calendar years will be available to patients. This includes any Medicare safety net benefit payable to the patient. The treatment will be based on clinical needs.

In total, the government has committed $384.6 million over the next four years so that patients can have access to dental treatment in the private sector. This is meant to complement and take the pressure off existing state dental services, not to supplant them. It is, after all, a state government responsibility. There are clear lines of responsibility, and this is one that falls within the state parameters.

To be eligible for the Medicare dental benefit a person will need to be managed by a general practitioner under specific chronic disease management and multidisciplinary care plans. Patients will need to be referred by their general practitioner to a dentist. The Health Insurance Amendment (Medicare Dental Services) Bill 2007 will also enable Medicare benefits to be paid for the supply of dental prostheses, including dentures, which will be of particular benefit to the elderly.

This program complements other government initiatives announced in previous federal budgets designed to increase access to dental treatment. Measures announced in the 2004 budget by the Howard government allowed a patient to be referred to a dentist if they had a dental problem that was exacerbating their chronic condition, whereas now a patient can be referred to a dentist if their oral health is impacting on, or likely to impact on, their general health.

The existing EPC dental items have had low uptake since they were introduced in July 2004. The new items will be more consistent with the way dentists practise and will cover a broader range of services, including dentures. This, combined with a significant increase in Medicare benefits payable, will make the arrangements much more attractive. The new arrangements will also be widely communicated to both GPs and dentists. Considerable investment by the government in a new School of Dentistry and Oral Health at Charles Sturt University, more rural clinic placements and dental scholarships for Indigenous students will ensure the delivery of services into the future.

Quite apart from these new measures, the Commonwealth undertakes a number of other dental health services, including: Medicare benefits for dental services provided to in-patients and patients in public hospitals, including oral surgery, cleft lip and palate and X-rays; Medicare benefits under the cleft palate scheme; subsidised medicines prescribed by dentists under the Pharmaceutical Benefits Scheme; and university training of dentists and dental auxiliaries. Today we heard the Minister for Health and Ageing speak about the number of places that have been made available; I think it was in the order of 356 new training places. Also included are dental services provided through community controlled Aboriginal medical services; dental services on Cocos and Christmas islands; private health insurance rebates; and a full range of dental services to Australian defence personnel and the Army reserves and eligible veterans at no charge. Dental services provided through the Local Dental Officer Scheme are a central part of the arrangements for the provision of health care services for eligible veterans, war widows and dependents.

I think the criticisms of the opposition are totally unfounded. The Commonwealth is more than pulling its weight in delivering dental services to the community, and the shortfall remains under the responsibility of the state governments. The constituents of Pearce are eager for the government, in general, to improve dental services, with the priority toward preventative dental care, and I fully support the work of the Minister for Health and Ageing thus far to address the needs of people in Pearce and the broader community in delivering dental care services.

As always, it is the people in the lower socioeconomic groups, including Aboriginal and Torres Strait Islanders, who struggle to access dental care. Often it is the people with a disability or a chronic illness, the aged and those on fixed incomes who are the most disadvantaged and are likely to have more serious dental health problems. AJ Spencer, in a paper called What options do we have for organising, providing and funding better public care?, through the Australian Health Policy Institute in Sydney, reported that about 10 per cent of the Australian population suffered complete tooth loss. This rose to 16 per cent in the Indigenous population and to almost 25 per cent for health card holders.

One of my constituents wrote to me recently, pleased with the improved resourcing of dental health by the Commonwealth but urging us to do more. This constituent felt that with ‘good economic times and a large budget surplus, we must improve dental services’. As a first step this constituent called for ‘a free course of preventative dental care every two years for low-income Australians’. I am sure that many Australians would support that call, and I am strongly committed to ensuring that all Australians have access to quality, affordable dental care with particular emphasis on preventative care. In the meantime, this bill is a significant step forward, and I give it my wholehearted support.

8:19 pm

Photo of Steve GeorganasSteve Georganas (Hindmarsh, Australian Labor Party) Share this | | Hansard source

I too rise to speak today on the Health Insurance Amendment (Medicare Dental Services) Bill 2007. This legislation will do nothing to help hundreds of thousands of individuals within Australia and hundreds of individuals within the electorate of Hindmarsh who have been waiting for dental treatment for many, many years. The proposed legislation is an extension of an existing program that has not serviced the needs of Australians since its implementation in July 2004. That is why, today, the announcement was made that a Rudd Labor government will fund up to one million additional dental consultations for Australians needing dental treatment by establishing a Commonwealth dental health program.

I congratulate the federal Leader of the Opposition and the shadow health minister, Nicola Roxon, who came to the electorate of Hindmarsh and heard firsthand from a group of elderly constituents in my electorate their stories of how they have been waiting for years to receive dental treatment. As I said, many of these people were elderly pensioners who cannot afford private treatment or a visit to a private dentist. They told Ms Roxon of their concerns about having to wait for up to five years for a pair of dentures, for example, or about having received dentures many, many years ago but now needing new ones because the dentures they had were not fitted properly. I am very pleased that our shadow minister, Nicola Roxon, took their concerns on board. I am pleased that she heard them and listened to them that day in my electorate office and ensured that we came up with a policy that would assist not only the people we met with but also thousands of Australians around this magnificent continent of ours who, for some reason or other, have been waiting for many years. That ‘some reason or other’, we know very well, refers to one of the first acts of the Howard government: the axing of the Commonwealth dental scheme that serviced many, many people. When that axing took place we saw the waiting lists for dental care skyrocket. A couple of years ago, the Rann Labor government in South Australia injected millions of dollars to make the waiting time reduce from four to five years to two years.

The federal Labor leader, Kevin Rudd, today pledged to invest up to $290 million in a Commonwealth dental health program—one of the first programs, as I said, scrapped by the Howard government in 1996. This is the first instalment of Labor’s Commonwealth dental program. The Commonwealth will give the states and territories the funds necessary to play a huge part in reducing our dental waiting lists. This funding will be tied to the states and territories meeting certain standards for dental care, such as providing care to individuals with chronic diseases affected by poor oral health, ensuring the provision of preventative and emergency services and maintaining the current effort.

In contrast, since the introduction of the government’s chronic disease scheme, which targets individuals with chronic disease and complex care needs, there has not been any substantial decrease in the number of individuals on the public dental waiting lists. Over the past three years, the scheme has cost $1.8 million and has assisted only 7,000 people, leaving an estimated 650,000 on waiting lists, with no hope of seeing a dentist in the very near future. The government’s chronic disease scheme is overly complex and forces individuals to partake in an extensive referral system with very high copayments. As I said, there are currently 650,000 Australians on public dental waiting lists. In South Australia, as I said, the Rann Labor government has been working hard to reduce the public dental waiting lists—from 49 months in June 2002 to 25 months in February 2007 and down to 23 months in June this year.

The huge increase in waiting times is a result of the Howard government axing the Commonwealth dental scheme in 1996; it was one of its first acts as the Commonwealth government. The South Australian government has worked hard to address the problem of dental waiting lists. It has put in over $20 million into the state’s dental program, with $12.9 million allocated in the most recent budget. These extra funds aim at reducing the waiting lists by 10 months by 2010. The Health Insurance Amendment (Medicare Dental Services) Bill 2007 will not provide care to the vast majority of those 650,000 Australians who have already waited years for dental treatment. This legislation will increase the funds available in the government’s chronic disease scheme, which is absurd when the program is already failing to meet the needs of thousands of Australians.

Dental care is an issue that I have campaigned on strongly and vigorously since my election in 2004. During this time, I have had dozens of Hindmarsh constituents contact me because they are receiving inadequate dental care or they are on extensive waiting lists, with no hope of seeing a dentist in the very near future. At every forum or street corner meeting that I attend in the electorate, the topic of dental care is raised with me. It is an issue that is raised week in, week out. There are continuous phone calls into my office from people who have been waiting on the list for many years and who have all sorts of dental issues that need immediate attention.

The Hindmarsh electorate is demographically one of the oldest electorates in the country, and many pensioners are in need of dental care and many of them are receiving inadequate care. They live on a small pension and do not have the money to be able to attend a private dentist. Recent research from the Australian Institute of Health and Welfare found that 30 per cent of people deliberately avoid seeking dental treatment as it is too expensive. Many of the individuals who avoid dental treatment are our elderly Australians.

At a recent forum that I held in the electorate on this issue, I was introduced to a gentleman who had taken it upon himself to perform his own dental care. This gentleman was elderly, he was a pensioner and he had been on the list for a number of years. This do-it-yourself dentistry has been gaining traction since the federal government abolished the Commonwealth Dental Health Program in 1996. Elderly pensioners such as Mrs Searle and Mrs Thompson, who are only two of the many people who are in need of dental treatment, are being forced to wait for it even though they suffer from ongoing pain and discomfort. They are both no closer to receiving treatment than they were 12 months ago. Maybe the Prime Minister should think of Mrs Searle and Mrs Thompson and how they cannot afford dental treatment when he claims that working families have never been better off. Mrs Searle and Mrs Thompson will not be helped by the government’s proposed Health Insurance Amendment (Medicare Dental Services) Bill 2007.

A recent study conducted by the Journal of Health in the US found a link between oral health and heart health. The study was able to link gum disease and teeth loss with the occurrence of heart disease. Tooth decay, as we all know, is currently one of Australia’s most prevalent health problems. It is speculated by medical professionals that bacteria in the mouth cause cavities and gum disease. This, in turn, could cause disease to enter the bloodstream, which could potentially cause damage to the body’s key blood vessels and place strain on the heart.

During the early years of an individual’s life, oral disease has a huge impact on an individual’s overall health. We believe that it is important to pick up health problems early so that they do not affect a child’s ability to learn and develop at school. We know that poor health in children not only affects their learning but also is a strong predictor of poor health in adulthood. In Australia, there has been an increase in the number of hospitalisations due to poor dental health. There has been a 42 per cent increase in the number of children being treated in private hospitals due to dental cavities.

These figures are alarming and are reinforced by a report released by the Australia Fair campaign in August this year, which found that 40 per cent of Australians were unable to access dental care when they needed it. The states and territories need the Commonwealth to play its part by contributing to the alleviation of Australia’s dental crisis and not engaging in the blame game, as we have seen again and again in relation to the many issues that are raised in this parliament.

The Howard government has continued to play the blame game with the states on dental health. The Commonwealth continues to try to shift the blame to the states and territories. However, the Commonwealth has the power to take hold of dental services and ensure that adequate dental care is delivered to all Australians. The House of Representatives Standing Committee on Health and Ageing, in its report entitled The blame game: report on the inquiry into health funding, made the following recommendation:

The Australian Government should supplement state and territory funding for public dental services so that reasonable—

and I emphasise ‘reasonable’—

access standards for appropriate services are maintained, particularly for disadvantaged groups.

This recommendation has, in my view, not been taken seriously by the Commonwealth, as 650,000 Australians are still languishing on public dental waiting lists. The responsibility for the training of dental professionals lies entirely with the Commonwealth. The Commonwealth has not planned for ensuring that there is an adequate dental workforce. There are only about 9,000 practising dentists in Australia. These dentists are not distributed evenly or in areas with the highest need. Many of these dentists are in the CBD, business districts, residential suburbs or high-density areas.

This workforce shortage has received a lot of attention in the electorate of Hindmarsh, with thousands of individuals signing a petition to increase the number of dentists available in Australia. The community is angry that there are not sufficient dentists available in the public sector and, as a consequence, they are forced to wait for years to see a dentist, without any hope. Labor understands that there needs to be an investment in the dental health area. That is why we announced today that, as a first step, we will be committing to funding up to one million additional dental consultations for all Australians. As I said, this is the first step in Labor’s Commonwealth Dental Health Program, which will aim to service all Australians, including Australian families.

Poor dental health impacts on the whole health system. Simple dental treatment can often prevent the development of other, more complex health issues. As an individual’s health condition escalates, they are more frequently hospitalised and there is an increased use of prescription drugs and painkillers. This places an increased burden on our health system. Early prevention of medical conditions is preferable to treating complex and often advanced health conditions.

Labor has taken the first steps to addressing Australia’s dental crisis, unlike the government with its Health Insurance Amendment (Medicare Dental Services) Bill 2007, which does not provide the dental care that thousands of Australians need.

8:32 pm

Photo of John MurphyJohn Murphy (Lowe, Australian Labor Party, Shadow Parliamentary Secretary to the Leader of the Opposition) Share this | | Hansard source

I oppose the Health Insurance Amendment (Medicare Dental Services) Bill 2007. I support the contribution to the debate made by the previous speaker, the member for Hindmarsh. The debate on this bill is timely indeed. It comes during a period when Australia is, undoubtedly, in the middle of a calamitous dental care crisis. Despite living in a First World country, it is absolutely appalling that large chunks of our population are living with Third World mouths. So alarming are the statistics that many members would no doubt have to pinch themselves to see whether what they have just read is true. Currently, there are 650,000 people on public dental waiting lists around Australia. In New South Wales alone there are 178,876 people waiting to be treated, including, appallingly, some 45,000 children. These waiting lists are seemingly carved out of stone, and such is the permanence with which the names are etched into them that Australians have been waiting on these motionless lists for an average of 27 months, many of them waiting years upon years for treatment.

That in itself is unacceptable, but there is far more to Australia’s dental care crisis. The Howard government’s dental care credentials only get worse with each published report and survey. The Australian Institute of Health and Welfare recently found that 30 per cent of Australians reported avoiding dental care due to cost. Indeed, 20.6 per cent said cost prevented them from having recommended treatment and 18.2 per cent said they would have difficulty paying a $100 bill, as mentioned by previous speakers.

Those facts are sobering enough, but the Howard government’s inept response to the dental care catastrophe over 11½ long years has ensured that there is a conveyor belt full of other heartbreaking statistics. Most heartbreaking of all are figures from the New South Wales Chief Health Officer stating that, between 1994 and 2005—more than a decade—the hospitalisation rates for children under five seeking to have their teeth removed or restored has increased by 91 per cent. It is not a record to be proud of. The government should be deeply ashamed that Australian kids, who had the world’s best teeth during the mid-nineties, have seen the state of their teeth spiral downwards over the last decade. The Minister for Health and Ageing should ponder those facts very carefully. He should reflect upon the fact that the Howard government has presided over a 91 per cent increase in hospitalisation rates of our children and the fact that waiting lists have grown out of control and adults cannot afford basic dental treatment.

More importantly, the minister should have some humility and accept some responsibility for the fact that Australia is a First World country with many Third World teeth. The response from the minister has truly been inadequate. We have seen the Howard government engaging in yet another round of the blame game, blaming all and sundry for the nation’s ills, without accepting an ounce of responsibility. In his second reading speech, the minister said the measures in this bill ‘will help to further strengthen dental care in Australia’.

Putting aside for one moment the folly of that statement, there appears to have been a sudden revelation amongst members of the Howard government that dental care is a serious problem in Australia. You can be certain that it is. And it is no coincidence that the enlightenment has only come at a time when the government tries to bolster its electoral fortunes in the lead-up to an imminent federal election. The minister’s previous responses have been most illuminating and have given a more accurate reflection into the insight of the Howard government. Prior to its flagging electoral fortunes, the minister was quoted as saying:

The government believes that it has already taken sufficient action in this area.

The minister was also quoted ad nauseam as having said that dental care is a state responsibility. Indeed, the Prime Minister repeated that nonsensical claim today in the House. It is hard to tell whether they are being facetious or whether they are far removed from the reality of the Australian Constitution, as was made plain during question time today. I know that both the minister and the Prime Minister are avid supporters of our constitutional monarchy yet they have seemingly not bothered to take a cursory glance at section 51 of the Constitution, which I will record again in the House today:

The Parliament shall, subject to this Constitution, have power to make laws for the peace, order, and good government of the Commonwealth with respect to:—

       …         …         …

(xxiiia.) The provision of maternity allowances, widows’ pensions, child endowment, unemployment, pharmaceutical, sickness and hospital benefits, medical and dental services ...

On our side of the chamber we live in hope that the Howard government will slowly but surely find the will to pursue a just and orderly dental care policy. Given the circumstances, we hoped that the government might develop effective policy solutions to address some of the areas I mentioned earlier. A just and orderly approach to dental care would recognise that 650,000 Australians need to be taken off waiting lists before they develop chronic health problems. A just and orderly approach to dental care policy would attempt to stem the growing tooth decay epidemic by engaging in a broad based public health campaign highlighting preventative oral health care.

Having spent years pontificating and blame shifting, with an election looming the government now wants to be seen to be doing something. At five minutes to midnight the government has brought to the parliament a bill that seeks to expand a failing Medicare dental program for people with chronic conditions and complex care needs. After all of the minister’s hot wind and bluster about dental services being a state responsibility, it was pleasing to see the government at least talking about dental care—I will give them credit for that. However, the minister is talking about dental care in such a way that we will not see real solutions to any of the major dental care problems in Australia. That is the truth. Money is being allocated to half-hearted and flawed policy initiatives that will see very few people get the care they so desperately need. Under the government’s initiatives in this bill patients will still need to go through the rigmarole of showing that (1) they have a condition with complex care needs; (2) they have a dental problem which significantly adds to the seriousness of their medical condition; and (3) they are receiving care from a general practitioner under a written management plan. All of this just to get a tooth fixed.

What the government is effectively telling Australians on waiting lists is that they must wait until they develop chronic problems before the government will provide assistance. Talk about putting the cart before the horse. The government’s chronic disease management program, to which this bill makes minor changes, has been so poorly designed that very few people have used it since its inception in 2004. I have absolutely no confidence that the bill’s cosmetic changes to threshold amounts and increases in claimable Medicare items will make this program any better. There are a range of other problems besetting the program that this bill does not address, particularly the overly restrictive eligibility criteria. This is not only my view. Professor John Spencer, Professor of Social and Preventive Dentistry at the University of Adelaide, stated in his submission dated 24 August 2007 to the Senate Standing Committee on Community Affairs:

I make this submission in response to an invitation to do so. The views expressed are those of an individual dental academic at The University of Adelaide and are not endorsed by any level of the University of Adelaide.

The Health Insurance Amendment (Medicare Dental Services) Bill 2007 increases access under Medicare to dental treatment for people with chronic conditions and complex care needs. The rationale for this Bill is that people with chronic conditions have poor oral health which can adversely affect their condition or general health. This is an important, albeit very constrained step in improving the oral health and access to dental care among the Australian population. Nonetheless, there are several issues that should be discussed with regard to this Bill and its rationale.

First, many Australians who suffer with poor oral health will not obtain dental services through this Bill. This is despite the observation that “You cannot be healthy without oral health” (US Department of Human Services, 2000). This quote from the US Surgeon General challenges the premise of the Bill ‘that poor oral health is only important in so far as it affects a chronic medical condition or its management’. This premise has been previously captured in the phrase ‘medically necessary dental treatment’. However, the quote from the US Surgeon General acknowledges that oral health per se is important, even without an identifiable increase in the severity or complexity of the management of any medical condition.

Second, classifying those medical conditions which are adversely affected by poor oral health is a difficult task. Poor oral health may quite plausibly affect nearly all medical conditions through pathways involving reduced ability to chew, altered food choice and decreased nutritional value of foods consumed. Alternatively oral symptoms may adversely affect quality of life, reducing coping and self-efficacy. However, there is lack of research in these areas. There is difficulty in ruling a line between medical conditions which are affected or not by poor oral health. At present any decision about what conditions are included will seem quite arbitrary.

Third, the criteria for inclusion of dental services in a GP Management Plan are not defined. Uncertainty about specific medical conditions to be included could lead to either few or many eligible patients receiving dental care. Past experience with much lower rebates was that few eligible patients received dental care. If the new arrangements are more attractive to patients, general medical practitioners and dentists, it is possible that most people under a GP Management Plan and Team Care Arrangements, estimated at approximately 400,000, could desire dental care. At the maximum Medicare benefit for dental services and the level of funding set out in the Financial Impact Statement only some 45,000 people will receive dental care in any year of full funding. How then will the one in eight eligible adults under a GP Management Plan be chosen by their general medical practitioner? Will they be limited to people with particular chronic conditions, specific oral disease or dental treatment needs, financial circumstances, or none of these criteria.

Professor Spencer goes on to conclude:

The Financial Impact Statement for this Bill outlines a total cost of $384.6 million over 4 years. This will present the second highest outlay on dental services by the Australian Government (the highest is the 30 percent private (dental) health insurance rebate). Such an outlay needs to be actively monitored and evaluated. It is likely that ‘fine tuning’ will be required to ensure satisfactory processes lie behind the provision of Medicare Dental Services and the best outcome is achieved for the expenditure.

To inform these judgements, evaluation needs to be conducted at two levels: one among persons receiving Medicare Dental Services, and another at the population level. Among persons receiving Medicare Dental Services profiling of these patients and what services they receive would be an expected routine part of any administrative overview. However, a number of more specific questions might reasonably be asked about the persons receiving Medicare Dental Services:

• the reasons for seeking care

• the social, medical and other relevant characteristics of those who received care

• the oral problems they had

• the impact dental care had on their underlying medical condition and its management, and

• the perceptions of the process from general medical practitioners dentists and persons involved

At the population level it is important to understand the coverage achieved by Medicare Dental Services among those persons with chronic disease and complex needs and those who are under a GP Management Plan and Team Care Arrangement. Such questions can only be answered by planned evaluation activities. The implementation of such evaluation activities early in the program is of high importance if the management of the interface between oral and general health is to be improved in Australia.

Those are the words of Professor John Spencer, from the Department of Social and Preventive Dentistry at the University of Adelaide.

In my electorate I have been campaigning and fighting for better dental care. Just to give you some insight into how chronic it is in my electorate, at one of my mobile offices, at Concord, a few Saturdays ago an elderly gentleman who was on the pension came up to me with a plastic bag with five dentures in it. This is serious stuff. He had received those from the dental hospital. They were all ill-fitting and he could not use them. As he was speaking to me one of his dentures fell on the ground. He had nowhere to go and he was pleading with me to do something to help him.

We all know the importance of maintaining good oral health. Not so long ago I had three crowns fitted and it cost me something like $4,200. My dentist was definite that I had to have them done because, if you do not look after and preserve your teeth, with the pressure that you put on your teeth when you chew and the inevitability of the ageing process, you put the other teeth at risk. Anyone who knows anything about oral hygiene will tell you that you have to do everything possible to look after each and every one of your teeth. The last thing that anyone should be forced to do is take the easy option of pulling out a tooth. Very soon after you take one tooth out, the teeth nearby are under greater stress because they have to work harder. Eventually you lose those teeth and, in the final analysis, you end up with no teeth, and no-one wants that.

I hope that the minister takes that on board and has taken note of the announcement made by the Leader of the Opposition and the shadow minister for health today in relation to taking responsibility for another one million dental consultations. The government is awash with money—the budget surplus is in excess of $17 billion—and dental health is fundamental for all of us. I think it behoves all of us in a bipartisan way to do something to assist those people, particularly the most vulnerable in our community who are existing on pensions or are self-funded retirees with very limited resources. They clearly cannot afford root canal therapy, crowns and dentures without more assistance from the government. I hope that the minister and the government take that into account and this becomes an important issue at the federal election.

8:50 pm

Photo of Roger PriceRoger Price (Chifley, Australian Labor Party) Share this | | Hansard source

I, like my Labor colleagues, am speaking on the Health Insurance Amendment (Medicare Dental Services) Bill 2007 to oppose it. Surely that must be unusual, because it increases some benefits for people who access the government’s dental program. ‘Why is this so?’ you might ask. Our fellow Australians who are suffering from halitosis, gingivitis, ulcerated mouth, abscesses, chronic infection, sinus pain or, more particularly, the inability to chew properly—which leads to malnutrition—will not necessarily be benefited by the government’s dental health provisions. In fact, to get your teeth fixed you have to have a chronic disease and your dental problems need to impact on that chronic disease.

At present we have a waiting list of 650,000 people across the nation. That is a staggering figure: 650,000 people on our dental waiting lists for public dental treatment. Question time was most illuminating. The Minister for Health and Ageing, when he was talking about Labor’s new policy, said that we were stealing $100 million. What are the facts? The facts are that when the Howard government came to office it decided to abolish the existing pensioner dental health program. In its last full year of operation, that program assisted over 600,000 people and was costing $100 million a year. What happened? It got abolished, or it was not re-funded—whichever makes you feel most comfortable. For 11 years, the Commonwealth has been saving that $100 million. You could say that the people of Australia have been robbed not of $100 million, which is what the government accuses the opposition of, but $1.1 billion.

The Prime Minister is always fond of saying that this is all the responsibility of the states—‘It was ever thus, and they’re not doing their job.’ What is the truth? What is the reality? That is what the Prime Minister said in this parliament, but what is the truth; what is the reality? The state and territory governments, after the abolition of a highly successful program which helped our fellow Australians, have doubled the money that they spend. Notwithstanding that doubling of the money, we still have waiting lists of 650,000 people. It is an outrage; it is a scandal.

How many people have been assisted by the Commonwealth’s program? It has complex criteria. To become eligible, you have to be chronically ill, not with teeth problems but with other problems, and your teeth have to impact on that illness. In three years, some 7,200-odd people have benefited from this program. Contrast that to what Labor was doing. In the last full year of the pensioner dental health program, over 600,000 benefited—that was in one year. This current program has benefited 7,000 people over three years. The measures in this bill are not designed to add to or increase the number of people who are going to take it up. It is not as though we are going to go from 7,000 over three years to 70,000 over three years or 700.000 over three years. It is not going to increase, because of the complex eligibility criteria associated with the government’s dental health scheme.

As my colleague the honourable member for Lowe mentioned, we have announced a new program. I am pleased that we have for this reason: whenever I go to pensioner groups in particular the one question I get asked all the time is whether we are going to do something about dental health. Are we going to do something about the disgraceful length of the queue for those waiting for attention for their teeth? I am really pleased to say that, yes, we are. I was always confident that we would, and we are. We are not assisting 7,000 over three years; we are not assisting 70,000 over three years; we are not assisting 700,000 over three years. We are providing, for one million consultations over three years, $290 million. Whichever way you want to play the figures, that is going to impact hugely on people in that queue.

As I said at the beginning of my contribution, if you have halitosis, gingivitis, an ulcerated mouth, sinusitis, chronic infection, pain or more particularly the inability to chew properly and you are eligible for public dental health treatment, this is going to benefit you. You do not have to have a heart problem. You do not have to have high blood pressure. You do not have to have any other chronic disease to benefit from Labor’s initiative—that is, one million consultations over three years.

I am pleased. In my electorate there used to be only one public clinic, the one at Mount Druitt Hospital. It is named after the late May Coupe, who did so much with the ladies auxiliary at that hospital. I have been there and I have seen the empty dental chairs that would be able to be fired up with this initiative. Blacktown Hospital, which I have now inherited, also has a public dental clinic. I must confess I have not trooped around to have a look at it, but I am going to be highly motivated, given what the Prime Minister and the minister for health said today about who is robbing who. I am going to have a look at Blacktown, but I am very confident that there is spare capacity there. The only time that it really ran at capacity was when Labor was in government and we had the pensioner dental health program. It is going to be good news for my electorate.

I suppose the most disappointing thing is that, if you look at any of the statistics about dental health, we are going backwards in Australia. Tooth decay ranks as Australia’s most prevalent health problem. The government is not interested unless you have another associated problem. But tooth decay is our No. 1 public health problem, and this legislation is not going to have an impact on that. Twenty-five per cent of Australia’s adult population has untreated dental decay. How can a government be proud of that? I oppose the government’s bill but I fully support the announcement that Labor made today.

Debate interrupted.