Clare O'Neil (Hotham, Australian Labor Party) Share this | Link to this | Hansard source

I want to again extend thanks to the shadow minister for moving the second reading amendment. In my previous contribution I spoke about the important policy reform that was undertaken by the last government in the area of dental care. We have known for a long time in Australia that dental care has been in many respects the poor cousin of health care not for any kind of moral or sound public policy reasons but really through the different ways it has been managed by governments. In 2012 Labor announced the biggest investment in dental care since Federation. It was an enormous reform that has changed the situation for so many Australians, especially Australian children, who were the big focus of that scheme, and lower income adults, whom all of us in this chamber know are those who have really borne the brunt of what has happened to dental care over successive governments both state and federal.

In my last contribution I was talking a little bit about some of the concerns we hold on this side of the House about the progress of this important issue through this parliament. I am very sad to say that we have seen a pretty destructive pattern from those on the other side of the House. They appear to have come into government with very few ideas of their own and instead have put their energies towards busily unpicking some of the really good things Labor did while in government. I think we heard the beginnings of some quite disturbing rhetoric from the minister when he gave his second reading contribution. He talked about these early concerns that he had with the dental program. He talked about how they would be monitoring this program very carefully. Unfortunately, we have heard this story before from that very same minister. Whether it was promises to make no cuts to health and then immediately attempting to introduce a new tax to make changes and cuts to state funding to health, whether it was school and university funding, all of these things went through this same pattern of behaviour. I want to put the government on notice that with the leadership of the shadow minister we will be very much holding them to account on upholding what has been an important reform that was made by the Rudd and Gillard governments.

Of course, much of the bill pertains to administration of the transfer of arrangements that were made in 2012, and we are very happy to support those detailed elements of the policy, but I say again that we will be watching. It is the same robust protection that we have turned on Medicare and other iconic elements of our system of social protection that we will also be putting onto the dental reforms.

Bob Baldwin (Paterson, Liberal Party, Parliamentary Secretary to the Minister for Industry) Share this | Link to this | Hansard source

I rise today to speak on the Dental Benefits Legislation Amendment Bill 2014. A strange sense of deja vu comes over me as I again have to fix another one of Labor's bungled attempts at finding their elusive surplus. When the Labor government decided to axe the coalition's Medicare Chronic Disease Dental Scheme we lost a great service. That scheme provided over 17 million services to approximately one million patients from 2007 to 2012. It provided $4,250 in dental benefits over two years for eligible patients with a chronic health condition. Then Labor cut the plan and had no backup system until 2014. It put those with chronic dental conditions out into the wilderness with no plan in place—and Labor preaches its concern and regard for the health of our nation! To this I say: rubbish, absolute rubbish.

Labor's alternative was just another program that did nothing but plunge the disadvantaged people into even worse circumstances. Dental care should be a basic right as an Australian citizen. Constituents in my electorate of Paterson, who cannot afford any more cuts in funding, wrote to me in droves as they discovered that a basic service like dental care was taken away from them. Pensioners make up a large percentage of my electorate and they are most likely to have other health issues that can get worse without regular dental check-ups and treatment. Parents with young children were told they would need to wait at least 13 months until they could get their children's growing teeth examined. Working families living in remote rural areas, who do not have immediate access to a public dental hospital, had to incur lost time, travel costs and invariably accommodation costs for what should be a given service to taxpayers. The disabled and the unemployed are already working within tight budgets and tough situations, especially the disabled where every aspect of their health needs to be carefully managed. These disadvantaged people had already endured other cuts by Labor when searching for a surplus—a surplus that was never achieved. The Labor government failed yet again. The Labor government failed to service those most in need—the chronically ill—yet they preach their commitment and their concern to the disadvantaged of this great nation.

The purpose of this bill that we are debating today is to restore sanity to the system. We have an opportunity to help those dentists who were so overwhelmed with patients that they did not have the opportunity to do the paperwork. The Dental Benefits Legislation Amendment Bill of 2014 will waive debts for dentists who, under the former Medicare Chronic Disease Dental Scheme, did nothing more than make minor paperwork errors and who have been waiting for way too long for an adequate resolution. The Chronic Disease Dental Scheme was set up in 2007 and provided access to benefits of up to $4,250 over two calendar years for patients with chronic health conditions. Eighty per cent of people who accessed this scheme were concession card holders. It was the country's biggest investment ever into dental care and in 2012 the former Labor government closed it down. For what purpose? Political gain. Another failure to add to the former Labor government's cap.

The scheme included a technical reporting requirement. Dentists needed to provide treatment plans to GPs along with a quote and a treatment plan to patients prior to commencing treatment. The former Labor government sought to use dentists' technical oversights as a means of discrediting the scheme. They introduced a change that saw dentists who did not meet all of these reporting requirements pursued for repayment of the full amount of the Medicare benefits paid under the scheme although in most cases the dentists had met all other requirements of the scheme and, importantly, had provided much needed services to the patients. It should be all about the patients and their health care.

I understand that some believe this scheme was scrapped due to an abundance of dentists who committed fraud and did not comply with the other legal requirements of the program. This was clearly not the case. The majority of dentists provided services in good faith and treated their patients with the care they needed. They will now be rewarded for their service. It was yet another shameful act that a former Labor government used as a political power play.

The Council of Australian Governments Reform Council has released its latest snapshot on the progress of the Commonwealth against the 2008 National Healthcare Agreement. The Healthcare in Australia report notes six areas of concern. One of them is that more Australians are putting off dental care because it is seen as too expensive. It is a worrying precedent that some Australians are not going to see their dentist, orthodontist or other dental professional because of costs. The report finds that nearly one in five—18.8 per cent—of Australians aged over 15 put off seeing a dentist. The statistics are worse in our poorer communities. Amongst the poorer communities, one in four people put off going to see a dental professional because of the costs. If you go to the doctor, particularly in a disadvantaged area, it is bulk-billed; there is no cost to the patient. But, if you go to a dentist, there is a significant cost, and it is a big deterrent to people.

According to an Australian Bureau of Statistics report, Census of population and housing: socio-economic indexes for areas (SEIFA), my electorate of Paterson has a population of 230,235 people. This report notes that, out of 722,685 doctor visits, 566,357 were bulk-billed. That is over 78 per cent of my residents who need bulk-billing. With that high a percentage for standard GP visits, you can only imagine the number who could not access dental health specialists.

Dental health is critical to maintaining good health. It is especially important when you already have other medical ailments, other health issues, to manage. This is increasingly common when you are in the older segment of our society, when you are elderly. In my electorate of Paterson, senior citizens make up a large part of my community—self-funded retirees and age pensioners. In Paterson I have 36,319 constituents aged 60 and over, who make up 28.4 per cent of the electorate. In Australia the number of constituents aged 60 and over is approximately 4.2 million, which equates to 19.6 per cent. So you can see we are batting above the average in terms of the elderly in my electorate of Paterson. By 2037, nearly 23 per cent of the nation's population will be 65 years old or older, and this equates to more than 6.4 million people by 2037.

As my constituents get older, they encounter more healthcare needs. As the following examples will explain, their dental health can prove interconnected with their existing conditions when it comes to treatment options. I was contacted by a constituent who wanted to complain about the axing of the Labor government's scheme. This person is 66 and was diagnosed with lupus, with secondary Sjogren's syndrome. Despite surgery on her saliva ducts, this lady's glands were producing a minimum amount of saliva. Due to this, her teeth were deteriorating rapidly and she required a lot of dental procedures. Also factor in the cost of the additional trips to Westmead Hospital's Specialist Dental Centre, which involved hotel stays overnight. With her condition consisting of six extra issues caused by the first, she was seeing eight different specialists in all, so her medical bills were high, and, with the Chronic Disease Dental Scheme being closed down, she was concerned about the future of her health. I can fully understand why. She would not be on her own in that respect. My electorate is rural and, in parts, quite remote, so any visit to Sydney is quite a journey, and when you are sick it would be quite exhausting.

Another resident contacted my office. She too was concerned when the scheme was closed down. She was over 60 and being treated for breast cancer. This terrible disease had her enduring surgery, chemotherapy and radiation. In addition to all this, these services were causing problems with her bones and her teeth. Her GP referred her to a dentist under the scheme, but six weeks later the scheme was shut down. So not only does this resident have to endure the biggest battle of her life with breast cancer; she also has to take on dental issues as a second, encore round.

And it is not just seniors who are finding it tough. A resident in my electorate who goes by the name of Angel was seriously injured in a car accident when he was in his early 40s and was affected by the axing of the chronic disease dental plan. In this accident he broke his back in three places and his pelvic plate in five places and completely snapped his right hip joint. He broke his left leg and both his ankles and broke his heel bones off. He also received muscular damage and torn nerve endings. He spent four months in traction and six months in a wheelchair, and once he finally regained the ability to walk he was slapped with a $25,000 bill. So, already, Angel has taken on his fair share of the pain, and that is quite a recovery that he will have to make. Following all this, he has to take heavy medication for the pain and the nerve damage, which has an effect on his teeth. He estimates that his teeth will rot within a couple of years if he does not go to a dentist on a regular basis—which of course he cannot, without the scheme that was in place.

Now my constituent has to choose between going further and further into debt and losing his teeth at the age of 45. And I have to ask: how could the former government have been so cruel to those who needed their help the most? When you are fighting cancer you have to keep up good dental health because of the amount of surgery you will be having. That is why it is quite concerning for a senior citizen, whom I have mentioned before in this place, who is fighting breast cancer. She is having surgeries as a result of chemotherapy and if she does not find the money to fund her dental treatments she cannot continue to fight the cancer. As I asked at the time, when Labor was cancelling the scheme, what kind of a heartless government would cancel such a vital scheme that delivered so much to people outside the major cities? Let me take you back to 2012, when we were first discussing the ridiculous concept of scrapping the scheme. I told you about Margaret Rylands from Forster, who had been living with diabetes for 52 years. Her husband had to have five bypass operations and then they had little money coming in. They also had bad teeth. Now, with no scheme in place, if their teeth get worse or her husband needs another operation, they could be in real trouble.

Let me explain. I know of a young man in Forster who had jaw cancer. He needed to keep good teeth while battling this disease, at it could affect his general health. If he got so much as a gum infection in a tooth, it would flow on to his bones and down to his jaw. Now he has cancer and an infection, and that infection could kill him. In my area of an ever-growing number of retirees, this could be catastrophic. If one of my elderly residents falls down and breaks their hip, they will need surgery. If they have bad teeth, they will now have to find the funds to first fix their teeth before they can even get onto the waitlist for a hip replacement. This means that they will need to find extra help just to get around, and then wait until their dental health is cleared before they can take the steps towards independence again.

As I said earlier, I yet again find myself having to fix another one of Labor's bungled programs. In the past year we have had to deal with many of their shoddy schemes—policies like disastrous home insulation schemes, the failed solar rebate, the implementation of crippling carbon taxes and mining taxes, and the lapse in border protection. All of these were especially felt in my electorate. And of course there were the never-ending issues with digital television, which I raised yesterday. To fix one more mess and assist the overworked, undercredited dental health specialists in my area is important. This bill will address that in part. I commend the bill to the House.

Adam Bandt (Melbourne, Australian Greens) Share this | Link to this | Hansard source

In Australia, you should be able to get dental care on Medicare. Going to the dentist should be like going to the doctor: you can bring out your Medicare card and have treatment, in the same way. The mouth is part of the body, and if you keep your mouth and your teeth healthy you in fact significantly reduce the risk of contracting other, potentially more serious, diseases. But in Australia, when it comes to healthcare funding, we treat the mouth as being separate to the rest of the body. As we have been reminded, yesterday in particular, there were struggles in the initial establishment of Medicare, or a form of universal health care in this country, and it was resisted. But it was ultimately accepted and is now one of the things that people like about Australia.

The cost of going to the dentist, however, is getting to the point where many people are putting off treatment for themselves or for their family members. And we are seeing, increasingly, people presenting to GPs and in some instances to hospitals because of preventable diseases or health issues that have arisen because they did not get their teeth seen to in time. It is not only a health issue; it is also a social justice issue—you are less likely to get that job if you turn up to the interview with fewer teeth. Someone who turns up to a job interview with a full set of teeth, looking good and in good health stands a much better chance.

Prior to the 2010 election, the scheme that we had in this country, the CDDS scheme we are discussing here today as part of this legislation, was a measure that the federal government was taking towards health care and dental care. But by no means was it universal. It did not mean that you could front up to the dentist with your Medicare card and say, 'I need some treatment.' In fact, it only addressed the situation when it had got to that end where no-one wants to get to: the chronic stage. There was no federal government scheme to help people with the cost of going to see the dentist to stop them getting into that situation in the first place. There was no federal government scheme before 2010 that would allow you to do something akin to taking your Medicare card to the dentist to get support.

The 2010 election saw a power-sharing parliament. In 2010, thanks to the people of Melbourne, we were in the position of sitting down and saying to the government: we will support you but we will support you on conditions. One of those conditions was putting a price on pollution and taking world-leading action on global warming. Another of those conditions, in an agreement that I was very pleased to sign, concerned reform of our dental scheme.

During the course of the last parliament, we commissioned some expert analysis from the Oral Health Council to say: if you wanted to start putting dental care into Medicare and making dental care universally available in this country in the same way that other forms of health care are, how would you go about it given that there may be a limited budget to spend? Also, from a straight health perspective, what is the best way to go? That council considered a number of options and reported back to the government and to us. They said very clearly: 'We can give you a few ways to go but here is what we think is best: the best way to improve the dental health of the Australian population is to start with the kids, to start with young people. 'Because if we can create a generation of young people who have no substantial dental health issues and know how to maintain themselves then we are going to, first of all, make a much healthier Australian public but, secondly, we are going to reduce the burden for generations to come on doctors and on hospitals who, at the moment, are seeing those people who are suffering from diseases that they could have prevented if they had only got to the dentist in time.'

So with that in mind, we crafted some legislation and some policies in the last parliament that said let's take Australia on the journey towards getting dental care into Medicare. Let us start making going to the dentist like going to the doctor. We followed the report of the experts, which was to say let's start, first of all, making universal dental care available to children. So we began by saying: if you are eligible for certain family tax benefits, you can now take your kid to the dentist, present your Medicare card and get a certain amount of treatment for free. We made sure in the package that was negotiated that that would not be an excuse for states to pull back on funding. In fact, we made sure there was funding available for states to expand their public health system so that people, including pensioners, who were on healthcare cards now had an expanded public health system to get into.

We were aware, because the experts told us, that this was not something we were going to be able to flick the switch to overnight. There actually were not enough dentists and health professionals in Australia at the time to enable the flicking of the switch to a universal dental healthcare scheme, so there was a proposal to train up some more health professionals to ensure that in time everyone would be able to get access to universal dental health if we proceeded on this plan. Part of that reform involved rolling the existing CDDS into this new scheme. Part of that was because the government insisted that there was not an unlimited amount of money and therefore it had to be found from somewhere and so should be found from this, but part of it was also a policy question. Rather than picking people up when they get to the extreme end, let's make sure there is support available for healthcare card holders, pensioners and those who cannot afford it and let's start making this a universal scheme where you can get access to it no matter how much money you earn and where the mouth starts to be treated as part of the body.

In that respect, I think the government, in moving and speaking to this bill, needs to tone down some of the rhetoric about the reasons for the closure of the CDDS. They may have a view that there was an ideologically mounted attack or it was about some health minister or other not liking a particular scheme, but I can tell you that from our point of view the reform of the scheme was necessary because it was a lot of money going to a few people whereas the Greens believe in the principle of universal health care. We would much rather see money being spent across the board on everyone regardless of income and on improving the dental health of the whole of the Australian population. This should not be an excuse to attack a particular political party by saying that a minister had a particular vendetta. We should be having the debate here about how to spend Australian taxpayers' money to get the best return and to ensure that everyone in this country can go to the dentist no matter how much money they earn.

I cay say that, as someone who represents the electorate with the most public housing of any electorate in the country, there are many people who have just put off going to the dentist because they were not able to afford it. In some states, there have been very good programs run by the state governments for children through schools and through other public health providers. That has given children some access to it; but, for families in public housing, if something went wrong with their kids' teeth, prior to us morphing the CDDS into this new universal scheme there was nowhere for them to go. Parents who did not have a lot of money—and by definition that is what those in public housing are—were just not able to take their kids to the dentist. By 'kids' we are talking about people under 18 as well, not necessarily only those who are in primary school. I something goes wrong, they just could not take them to the dentist. Then that festers, and they are the people who in their 20s find themselves with fewer teeth than others. They are the people who, as they go on into their 30s and 40s find themselves at greater risk of heart disease because they do not have all their teeth in their mouth in good condition.

I am very proud that, working with the other members of the last parliament, we were able to change that so that low-income families in my electorate and right around the country can now take their children to the dentist, present their Medicare card and be able to get some free services. That is a good start, and we need to build on that.

Rather than having an ideological and small-minded partisan debate in this place, we should be having a debate about how we can make dental health care universal and how can we make it so that not only children, especially children of families up to a certain point, but everyone is able to front up to their dentist with their Medicare card just as they do with their doctor. There are plenty of places to find the money for it if we wanted to. We give billions of dollars each year in subsidies to the big banks, we give billions of dollars in subsidies to big miners and fossil fuel companies. If you asked Australians: 'Would you rather the government dollars go towards giving the likes of Gina Rinehart subsidised diesel fuel or would you rather the government use that money to ensure that everyone can go to the dentist when they need it?'—I know what people would say.

That is the debate that we need to have here because we do not have a budget crisis, as we hear from the government. If anything, we have a revenue crisis. We are not raising the revenue that we need to fund the services that Australians expect and that is the debate that we should be having here. People in Australia like Medicare and they want dental care to be part of it. Let us go down that road.

David Gillespie (Lyne, National Party) Share this | Link to this | Hansard source

This bill amends the Health Insurance Act 1973 and the Dental Benefits Act 2008. It allows the operation of the Child Dental Benefits Schedule to be overseen in a similar fashion to the Medicare oversight process. Not only will the professional service review process be able to be applied to the Child Dental Benefits Schedule but also the CEO of Medicare can request documents to substantiate Chronic Disease Dental Scheme billing is appropriate. These are sensible and appropriate measures that ensure compliance with the intent and design of the scheme.

I would just like to make some observations on this scheme and its history and some reflections on the previous government's dental policy and its development. The Child Dental Benefits Schedule commenced in January this year, but it is a leftover policy from the previous government. There has been a dental scheme absence, apart from state-based public dental schemes, since the Chronic Disease Dental Scheme was axed in August and September 2012.

The Chronic Disease Dental Scheme was a great scheme, with a good clinical basis and intent, but, like in any government scheme, there were instances where either patients or dental practitioners were pushing the boundaries to a stage where the envelope was broken. I am very loath to say 'abuse' or 'fraud' but in some cases the intent and the administration of it was not ideal, and the response was not appropriate to the problem. In classic ALP fashion, rather than instituting compliance and oversight, which you would think any sensible administration would bring into play if it had concerns, it appears to me that it gave them the excuse to get rid of a scheme or a coalition achievement that actually had some runs on the board.

There also appeared to be the opportunity to save the previous administration a heap of money, because there was no replacement for about 14 months. They also summarily demanded in retrospect refunds of thousands of dollars from dentists who had supplied services to patients. The justification of that, to me, seems to be a technicality—that the dentist had not filled out part of the paperwork. This also reflects badly on the previous administration because, surely, with most transactions in business you check that the work has been done before you pay the provider. That tells me that they were not checking on the processes that they should have had in place in the first instance.

For many people in my electorate this scheme was a godsend, because there are lots of elderly people, concession card holders and pensioners in the electorate of Lyne who unfortunately, because of the generation they grew up in, had bad dentistry. They also have serious kidney, vascular and heart conditions. The Chronic Disease Dental Scheme in many instances prevented further disease. Even though it was being done late in life for many of these recipients, it was very preventive. If you have kidney disease, gingivitis, rotten teeth or you cannot eat good nutrition because you have no teeth, this was a godsend. Twenty-five per cent of the electorate of Lyne either have a concession card or are in receipt of a pension, so this change had massive ramifications for the electorate. When the axe fell, many were left in limbo. In some cases, they were halfway through their treatment program. Others who had committed to it were left high and dry and struggled on in chronic discomfort or had to commit to multiple extractions and false teeth.

I think the previous administration were so desperate to save money anywhere that they just saw this as an excuse to blame the dentists and give them an account rather than institute what we are doing with this amendment. We are instituting proper oversight of a scheme which is targeted to a different cohort altogether. Paradoxically, the two-year-old to 17-year-old cohort probably have the best teeth in the country. We are also instituting means-testing so that it is applied to people who really need the help.

I am sure the spin doctors were consulted heavily in the development and rollout of this scheme, because it is hard to criticise anything that is targeted at children. Everyone knows that if children have good nutrition, have a toothbrush that is used, have fluoride in their toothpaste and are not fed sweet drinks all the time, most of them should be left with healthy teeth and gums by the age of 17. I hope this really is a dental program and not a spin doctor program that was punched out in the dying days of the previous government.

The coalition government will certainly be monitoring and observing this scheme to make sure it has the outcome that was intended. We still need to address the other problem: with the summary execution of the Chronic Disease Dental Scheme, many genuinely concerned and good practising dentists and dental practices were left with huge bills, in retrospect, months and years after they delivered good service. This is a classic case of using a fig-leaf response to cover up the deficiencies and inadequacies of the previous administration. The old saying 'Throwing out the baby with the bathwater' is applicable here. There were problems with the Chronic Disease Dental Scheme, but, rather than fixing them, they got rid of the whole scheme altogether.

The amendments to section 34 of the Financial Management and Accountability Act, with oversight and the CEO of Medicare able to inquire, and with professional services review processes, will simplify the process of garnering the debts that were levied. It will also give the department the ability to waive the debts. It will not excuse fraud; it will not excuse abuse. Currently, the investigation process whereby money is retrieved is so laborious and long that the amount of funds expended in getting funds back costs as much as the returns. Also, I find that it was an affront to bill retrospectively professional people who were doing a good job for patients with chronic disease.

I commend these amendments to the House. As I have said on so many occasions, when you are in government you have to have good administration. This is a good legislative response to a problem that is now going to be addressed and fixed. I commend the bill and the amendment to the House.

Bob Katter (Kennedy, Independent) Share this | Link to this | Hansard source

I am speaking to the Dental Benefits Legislation Amendment Bill 2014. I think that the government has to be cognisant of the fact that we are a wealthy country—an extremely wealthy country by world standards. The government says that they are broke. There is a wonderful paper out about comparing the deficits of the allegedly terrible ALP government—and I probably would agree that it was a terrible government!—comparing Wayne Swan's deficit with the Menzies last budget and the massive deficit that was registered there. But, of course, they were made to sound like irrelevancies compared to the deficits registered by the Queensland government that I was part of.

It was made mention of with Gough Whitlam yesterday—I might seem like I am wandering off track here but I can assure you that I am not, Mr Acting Deputy Speaker—that there was a vote of no confidence in Gough because he sacrificed economic growth for social reform. It was a very perceptive comment and, in my opinion, very accurate. There will be those who argue that social reform needed to come. Where I am going with this is that there has never been a government in human history that has not accused the outgoing government of making the government broke, 'We've got no money and therefore we can't do these things.' That is just standard operating procedure. After 41 years in parliament I think that every minister probably says it at least once every second day.

Where I am going with this is that here is this great, rich country—one of the richest countries on earth—and it cannot supply dental services to its citizens. My homeland is North Queensland's midwest, the country between Mount Isa and Townsville. I have lived there all my life and four or five generations before me. In that area, the four main towns in the midwest are Cloncurry, Richmond, Julia Creek and Hughenden. There are may be seven, eight or 10,000 people living in those towns. For my entire time as a state member I can never remember us having fewer than three dentists serving that area.

Normally when I have rung up over the last 10 or 15 years, there have been no dentists in the area. A person can go from Julia Creek on a 400- to 600-kilometre round trip to Mount Isa to see a dentist. A person in Hughenden can go to Charters Towers—a 500- or 600-kilometre round trip. Or maybe he has to go on to Townsville. The costs of doing this—and the ability to be able to do this if you have a jo—are so high. That is in a remote area. Let me switch to the outer suburbs of Cairns, to Babinda. A good friend of mine came along to one of our meetings. He had taken out his own tooth on Channel 9 because he had waited for two years in pain. They had said, 'Oh, we had you on the top of the list but we had to put you down again.' This was after two years, he was in continuous pain and he realised that he was never going to get there. So he pulled the tooth out himself with a pair of pliers on Channel 9. Outrageous as that seems, it is a matter of public record; it was done on Channel 9. Similarly in Richmond another person pulled his own teeth out with a pair of pliers. So in this great wealthy nation there are people who go to the most primitive methods of medical treatment. With no painkillers or anything they haul their teeth out with a pair of pliers.

This is a very sad day for Australia. We are wasting the time of the House talking about an audit requirement. Quite frankly, the dentists I have spoken to have said: 'Of course there should be an audit requirement. Surely that does not have to go in legislation.' Any properly operated scheme anywhere does not need legislation to back it up. Just haul them in. Surely there is accounting oversight taking place now.

That is the bill as it stands. I was deeply disappointed when a minister who I considered to be quite a good minister, the now deputy leader of the Labor Party, abolished the Chronic Disease Dental Scheme, which dealt with cases like the one I referred to on the outskirts of Cairns where an elderly person had to take his own tooth out. It came to grips with that sort of problem. The approach that had been used was very good, but that money was taken away and put into some prevention program for children. Yes, all right, there might be value in a prevention program for children, but I would have thought that giving every kid in Australia a toothbrush and the schools a tube of toothpaste and getting them to brush their teeth every morning would be 100 times more effective than putting something on a video screen and having a teacher talk to them. It would go in one ear and out the other. It would be very practical if they actually brush their teeth as part of the school curriculum.

We spoke all of yesterday about the legacy of Gough Whitlam. I most certainly would not be hypocritical enough to say it was an all-good legacy—and I would probably say something short of that. There is the provision of a great fund of money to address the real problems of Australia, such as the health problems. A government has no higher priority than that. There was a wonderful article in The DailyTelegraph that stated that the primary responsibility of government is to protect the people. It should be to protect their people from one of the most terrible pains that can be registered. I have had enormous pain in my life playing rugby league and other such activities—and I dealt a bit out too, I might add. There are some times when the pain of toothache can be really out of this world. Of course the Nazis used it as a torture device to get people to speak because it is one of the worst pains you can possibly have. People in Australia are taking the worst pain you can possibly have and they cannot get in to see a dentist. In my home town of Charters Towers there are two dentists. The last time I attempted to get in there was a three-month wait. If a dentist friend of mine in Townsville had not stayed back an extra hour, I might have been running around with the pliers to pull my own teeth out too.

The government is failing miserably in this area. I do not blame the minister and I do not blame the last minister. They have been given very limited resources. The federal Labor government was blaming the state Liberal governments and prior to that the Liberal federal government was blaming the state Labor governments. I checked this and found really neither were to blame in the sense that over a decade there has been an over 300 per cent increase in federal spending on health in the state of Queensland and also a 300 per cent increase in federal health spending.

In Queensland—and I suspect this may well be all over Australia—the long-serving president of the AMA in the state quoted the figure again and again that 16 years ago there were three hands-on health workers—nurses, doctors—for every backup staff, and now it is reversed. I spoke to 11 doctors that have served for over 15 years and each of them said that, yes, that figure would be about right. So we are carrying one of the most top-heavy—with administration and PR and a whole run of other people—health departments.

We had an example of what they do in Queensland. I am pleased the member for Leichhardt is here because I am sure he would back me up in this. Two of our doctors in Cairns had the temerity to say, 'A suspected Ebola patient came in here and they were just treated like an ordinary patient until somebody said they were an Ebola suspect and raced them off down to what was supposedly an isolation ward but really was just a ward down the end of the corridor effectively.' There was no particular characteristics of that ward that made it an isolation ward. Those doctors were immediately punished. Under the successive Labor governments in Queensland, there was a culture of fear that you were not supposed to speak up.

Heavens, in the Bundaberg hospital there is a man losing his leg from gangrene. This is not a hard thing to pick up. If any of my footballers break a limb, I would go down there to check myself to see there was no redness or swelling because you have got to move very quickly if you are dealing with something like gangrene. In the case in Bundaberg, this bloke visibly had gangrene and only one single nurse had the courage to speak up, which is an absolutely scalding indictment of the other people that worked in hospital who were quite happy to preserve their jobs to watch a man lose his leg. It was claimed in the press that 11 times that sort of incident was repeated in the Bundaberg hospital because everyone was too scared to speak out. The nurse who spoke up, of course, was punished immediately.

That terrible culture that surrounded the 'Doctor Death' incidents at the Bundaberg hospital is still there. It is alive and well and blossoming. Oh, an Ebola patient went into a general ward in hospital and we have got no ability to deal with them, and all of these health workers were exposed. What do we do? What we do is get anyone that opens their mouth. The answer is not: what we do is make sure we introduce protocols to protect our health workers in our hospitals, no. That is not what we did. We immediately moved to shut them up.

It is to do with the health department in Queensland making sure that they have a great PR message to take out there and nothing to do with the health and welfare of the people. You can look no further than the incidents of the so called 'Doctor Death' at the Bundaberg hospital and look no further than the two top nurses that are still stood down at that hospital for doing the right thing. They were punished for doing the right thing, and it is a scathing indictment upon the administration of the health department in Queensland.

Nick Champion (Wakefield, Australian Labor Party) Share this | Link to this | Hansard source

It is a great opportunity to speak on the Dental Benefits Legislation Amendment Bill 2014. This is a relatively uncontroversial bill but we are obviously having an important debate about dental care in our country. As the member for Ballarat said, oral health care is the missing link out of Medicare. I think there is a great deal of truth to that.

Oral health has been left to the states for a long time. What we have seen really out of the states' administration of this area is a system of haves and have-nots. We have seen over the last couple of decades the federal government, by necessity, become increasingly involved in the area of dental care. We can go right back to when I joined the Labor Party. I can remember the Keating government embarking on a program to reduce state waiting lists for public dental care, because those waiting lists had grown so long—not just the time you waited to get seen but the time you waited to actually get the treatment. So, there were often two waiting lists: the waiting list to get an assessment and then the waiting list to get the treatment. And they blew out, particularly in New South Wales at that time. The member for Kennedy talks about people removing their own teeth. Sadly, sometimes people were going to that extreme, taking drastic action themselves, because of these terrible waiting lists.

So there was an endeavour by the Keating government at that time to address this matter, and we saw even the Howard government—no friend to Medicare, no friend to universality or to getting involved in state responsibilities—embark on the CDSS. We know that that was a poorly targeted scheme. It was meant to cost $90 million a year and ended up costing $80 million a month. Now, maybe that is because there is vast demand out there; I do not know. But one of the things we also know about it is that more than 20 per cent of the recipients were not concession card holders, were not pensioners, and more than 20 per cent of the spending was on high-cost restorative services. So, that was the record of the Howard government. They were getting involved in this area, I guess out of necessity, because the states were doing such a poor job. We all know that there were problems in that scheme, and those opposite should not try to run from them.

The previous Labor government, of course, embarked on a $4.1 billion scheme, and that was designed basically to clear waiting lists to create a workforce—and not just a workforce in capital cities but a workforce outside of capital cities—and also focused on children's health. Children's health is particularly important. The member for Ballarat in her speech talked about some terrible statistics—that 20,000 children under the age of 10 are hospitalised each year because of avoidable dental issues and that by the age of 15 six out of every 10 kids have tooth decay. We know that this is not just because they do not have toothbrushes or because of sugary drinks; it is because they do not see a dentist. A dentist is an integral part of oral health care.

The impact of oral disease is particularly important. The Department of Health, on its website—the National Advisory Council on Dental Health—talks about the National Oral Health Plan for 2004 to 2013. It says:

Oral health is fundamental to overall health, wellbeing and quality of life. A healthy mouth enables people to eat, speak and socialise without pain, discomfort or embarrassment. The impact of oral disease on people’s everyday lives is subtle and pervasive, influencing eating, sleep, work and social roles. The prevalence and recurrences of these impacts constitutes a silent epidemic.

It goes on to talk about the international research that indicates associations between chronic oral infections and lung disease, stroke, low birth weight and premature birth. Associations have been made between periodontal disease and diabetes in international literature as well.

So, we know that oral health is vital to the health of the rest of the body. And the statistics that are there scream out for a shift away from the system of haves and have-nots that is endemic in allowing the states to retain responsibility over this area. We know they have not done a good job. They have not done a good job for decades; this is not something that has sprung up overnight. I remember when the Rann government came to power in 2002 one of the things we acted to do was to aim to reduce the waiting list for public dental care, and that is because in electorates like mine I am often shocked—and I do not have great teeth—by just how bad some people's teeth are, and often they are desperate to get treatment. There are a whole lot of impacts, obviously, on their lives. It is very hard to seek work and it is very hard to socially engage if you have got really poor teeth. Obviously it is very painful and affects your overall health.

The statistics are very serious and pretty brutal. In 2010 nearly half of children aged 10 had experienced tooth decay in their permanent teeth. That is out of the Australian Institute of Health and Welfare and the University of Adelaide's Oral health and dental care in Australia: key facts and figures trends 2014. So we know that those statistics are not good. In terms of tooth decay in adults there is the effect of geography as well. The proportion of people with untreated decay varied from 23.5 per cent in major cities to 37.6 per cent in remote and very remote areas. An obvious point that we know about our health system is that the further you are from the GPO, the harder it is to get health treatment generally. We know that prior to the previous government's opening of cancer centres there were some pretty horrendous figures in relation to cancer and degrees of remoteness—the further you were away from the GPO affected your treatment—and it certainly does in dental as well.

There is an income barrier as well. In 2004-06, the proportion of people with untreated decay was higher for those with a household income of less than $12,000 a year and lower where the household income was $100,000 or more. A higher proportion of uninsured people, 31.1 per cent, than insured people, 19.4 per cent, had untreated decay. So there is a gap related to geography and there is a gap related to income.

Mr Briggs interjecting—

You might learn a thing or two, Member for Mayo. I talked about the states before. I talked about their poor record—all of them, Labor and Liberal—in this area. So let us share the blame around. I know the member for Mayo is a centralist in his heart, just like his old boss, John Howard—a great believer in the federal government. We saw that in their ideology in Work Choices—the commitment to a single, central system in this country. It is something that I think is spread in the coalition. We would like to see that.

But back to the statistics about dental. About one in three cardholder adults had untreated decay, 32.9 per cent, compared to less than one in four non-cardholders, 22.9 per cent. Obviously there are big impacts related to geography and income in your ability to access dental care. These are all mapped out in the Australian Institute of Health and Welfare and the University of Adelaide's report. It notes similar things in terms of gum disease, where age has an effect, gender has an effect and geography certainly has an effect. In terms of gum disease, 36.3 per cent of those living in remote areas had gum disease compared to 22.1 per cent living in major cities. In terms of income and gum disease, people on lower household incomes generally were more likely to have gum disease than those on higher incomes, varying from 42.3 per cent for those in households earning less than $12,000 per year to 14.3 per cent for those in households earning $100,000 or more. A lower proportion of the insured, 19.4 per cent, than the uninsured, 27 per cent, had gum disease. Cardholders had higher rates of periodontal disease than non-cardholders—some 33.6 per cent compared to 19.5 per cent, respectively.

These are pretty stark figures. We know that what this government is doing will not help these figures. We know that. We know of their plans in health generally—some $50 billion worth of cuts and the GP tax. It is a tax which cascades from your GP waiting room into the place where you get your blood tests and into the place where you get your scans. And if you have to go back through the process to see your doctor again to get more tests, to get more scans, then the $7 cascades over and over again. We know that those opposite are committed to that GP tax and they are committed to the $50 billion worth of cuts.

We know that one of the things they did in the last budget was also basically to defer a $390 million partnership. There are 400,000 people on dental waiting lists around the country and in some states this funding has helped to cut waiting lists by half. We know that if you let those waiting lists blow out the problems get worse. I have heard other speakers say, 'Why did the previous government start with children?' That is because prevention is better than cure and universality is an important thing. One of the things it does is it lets people see their doctor or their dentist before problems get out of hand, before people have to have more extensive work and before they have to be, God forbid, hospitalised. We talk about some 20,000 children across the country being hospitalised for avoidable dental operations and interactions, you know that prevention is better than cure. It is much cheaper, too—that is the thing. There is a saving in it for the Commonwealth, there is a saving in it for the states and there is a saving in it ultimately for the community.

We know that the delay of the $390 million national partnership programs is going to be a disaster. Griffith University Professor of Dental Research Newell Johnson said:

It's certainly going to make it worse for people who rely on the public system. It's high time we realised that dental health is as important as any other part of the body.

Australian Dental Association President Dr Karin Alexander said waiting lists could double or triple, depending on the delay:

Then the waiting lists are going to grow and you are going to have people sitting there in pain at once again.

It is not good enough for this nation, which is wealthy, which has experience of universal health care in Medicare—a reform that was hard fought for in the Whitlam era. It was hard fought for then; it was hard fought for by the Hawke government, which went down the Medicare path and managed to institute it into our public life, make it untouchable for those opposite—and they will find the GP tax that they are so committed to will be their undoing. But it is not good enough to simply say that dental care should be left out of Medicare, that it should be a haves and have-nots system, that it should be a system where your health is dependent on your income and your ability to pay for a service that is vital for your interaction with the community, for your place as a citizen in this community. And if there is one thing we should learn from this debate it is that these schemes where the Commonwealth is fiddling about, trying to fix up what the states have not the wit, the inclination or the resources to do is an error. We should look at putting dental care in its rightful place in our public health.

Craig Kelly (Hughes, Liberal Party) Share this | Link to this | Hansard source

I am pleased to rise on the Dental Benefits Legislation Amendment Bill 2014. As this is a health related bill, I would like to firstly address my comments to rebut some of the points made by members of the opposition during this debate.

We have heard this common phrase throughout many of the members of the opposition's speeches about 'cuts to health spending'. I am not sure, but I think maybe in their talking points members of the opposition are told: 'Just keep repeating this, time after time after time. Never mind the facts, and then maybe it might become a truth.' I have more faith in members of the Australian public to look at what the actual facts are and determining those facts and seeing if they are being misled.

The facts are that for overall health spending this financial year there is a nine per cent increase—this government is putting $1.3 billion extra into health spending this financial year. Next financial year, on top of that $1.3 billion, there is yet another nine per cent—or $1.4 billion—increase in health spending. And in the financial year after that, the third financial year of this government's budget, there will be yet another nine per cent increase. That is another $1.5 million, on top of all those other increases, that is going to our hospitals from this federal government. So if members of the opposition come in here and think that a nine per cent increase every year for the next three years is not enough, it is up to them to simply say how much more they are going to put in, but most importantly where the money will come from. Where will the money come from if a nine per cent—$1.3 billion to $1.5 billion—increase each year in our health spending by this federal government is not enough? How much more do they want and where will that money come from?

Getting onto the exact provisions of this bill: to explain the details of this bill and the necessity for it, it is necessary to do a review of history to see how we have come to this stage. There is the concept that this government would like to see more money invested in dental care across the nation, but there is simply no such thing as free health care or free dental care. Somebody has to pay for it; the money has to come for it from somewhere. There is no such thing as Magic Pudding economics. At the end of the day the bills have to be paid by someone.

To go back to the origins of this bill we need to go back to 1996, when the previous coalition government were first elected. What they inherited at that time was a budget in deficit and $96 billion worth of accumulated debt—that was their inheritance. But even more importantly, they also inherited a liability to pay interest on that debt of $9.5 billion in the first year. So rather than having $9.5 billion to spend on all the many things that we needed in our society, $9.5 billion worth of taxes had to be raised, taken out of the economy and used to pay the interest bill on the previous government's debt. And what we saw was a successful government; we saw they were successful because they created opportunity. They encouraged entrepreneurs to get out there and take risks, to experiment with their new business ideas and to innovate: that is what created the wealth and prosperity, so the money started to flow into the federal Treasury, which allowed us to slowly pay down the debt; to run a surplus year after year and to slowly wind back that debt.

One of the most important things the previous government did to wind that debt back was to lower company tax rates. It often sounds quite counterintuitive, but by lowering company tax rates the Howard and Costello government actually got more money in the coffers. For example, in the first year of the Howard and Costello government company tax rates were 36 per cent; about 3.3 per cent of GDP was raised in company taxes, something close to about $19 billion. But what the Howard and Costello government did was lower those tax rates; they wound those company tax rates back to 30 per cent. Now for those who do not understand how the economy works they would simply say, 'That will cause revenue to the government to fall', but the exact opposite happened. By lowering those company tax rates, by giving individuals and companies and businesses and small businesses the incentive to go out there and invest because of a lower company tax rate, we saw an expansion of the economy. What we also saw was the percentage of total GDP raised by company taxes increase, and increase substantially, at a lower rate of company tax.

So then we move forward to about 2005 or 2006. By then, after good economic management for close to a decade, we had finally been able to pay back that $96 billion worth of Labor debt. But most importantly, because there was no debt, there was no interest bill that the government had to finance. That freed up money to fund a lot of the social programs that are so desperately needed in our society. One of those social programs put in by the then health minister, now the Prime Minister, was the Chronic Disease Dental Scheme. This is one of the dividends of good economic management: when you have government keeping the budget in surplus and the economy running, the benefits and dividends you get allow you to spend on social programs. That Chronic Disease Dental Scheme, established during the Howard government by the now Prime Minister, provided $4,250 every two years for private dental treatment for people who had a chronic dental disease. Twenty million services were provided to over one million Australians who benefited under that scheme. One million Australians were the recipients of that good economic benefit—that dividend—through the Chronic Disease Dental Scheme. It was the most successful scheme for curing dental disease and dental issues in our nation's history.

But what happened when the Labor government came to power? We saw reckless and wasteful spending, and one of the saddest things of all was that they tried to delegitimise the success of the previous Howard government. They went out and criticised the Chronic Disease Dental Scheme. What they did so they could take it away—because they wanted to cut costs to try to wind their budget back—was go out looking for scapegoats. Remember, one million Australians received benefits under this scheme. So they went out looking for scapegoats and the scapegoats they found were the dentists who had made a mistake filling out their paperwork. That is simply what they had done: they had made a genuine mistake filling out the paperwork. Of course, the previous Labor government came out and said this was rorting. They found a few cases—a handful of cases—out of one million Australians who received treatment under the program, and that is the reason they gave for cutting this scheme off. The true reason was they were too embarrassed to admit this was a successful scheme brought in by the previous health minister, then opposition leader, and current Prime Minister, Tony Abbott.

This is what this bill addresses. It enables those so-called debts that were created—debts the government claims are owed by dentists—to be wiped off. They are not genuine debts; the services were performed. They are simply the result of an error of paperwork. We all know how hard it is to fill out government forms and paperwork. Only the other day I was at a volunteer awards ceremony in southern Sydney with all the volunteers. There were many worthy volunteers in that room. There were rural firefighters; people who volunteer in our hospitals; people who volunteer in our aged-care sector; and people who volunteer with our kids with disabilities. But the overall winner was a group called the 'form-filling helpers'. Their specific volunteer contribution to society is to help citizens fill out government forms.

This is why you cannot simply go back and look at a form in which there has been a slight discrepancy and try to take away the money that was paid to dentists for work they did in good faith—to claw that money back. That is what this bill addresses. It winds back and brings in amendments to make sure those so-called debts, where the work was done in good faith, are repealed. Without delaying the House any further, I commend this bill to the House.

Matt Thistlethwaite (Kingsford Smith, Australian Labor Party, Shadow Parliamentary Secretary for Foreign Affairs) Share this | Link to this | Hansard source

I speak in support of the amendment to the Dental Benefits Legislation Amendment Bill 2014. It is well known that bad oral health can have a negative impact on a person's quality of life. Untreated dental decay, as well as causing pain and infection, can affect nutritional status and growth and cause issues such as sleep disturbance, poor concentration and other behavioural impacts. Addressing oral health in children and young people in particular can significantly improve lifelong oral health, which is a key determinant of health and wellbeing throughout a person's life.

In my electorate of Kingsford Smith, particularly among young children, dental health is a real issue and as such it sparked a local public health initiative to tackle the problem. I am pleased and proud to say that the charity arm of the mighty South Sydney Rabbitohs, Souths Cares, launched an oral health care program on 8 April this year, designed to help spread the message of 'clean well, drink well' and the importance of oral hygiene for young people in South Sydney. Accompanied by graduate students from the University of Sydney, lead member of the Souths Cares team and former first grade rugby league player Rhys Wesser launched the program's first session at La Perouse for children from kindergarten to year 2. Rhys began by reading the children an Indigenous Dreamtime inspired story called The healthy tribe: 'I can help my body stay well'. The book aims to educate children about oral health and general health and it focuses on the oral health message 'eat well, drink well and play well'. The story is about a young boy named Marley who talks about his journey gaining the knowledge to live a happy and healthy life, which is told through stories of the Biripi and Worimi people. These tales were developed so that Aboriginal and non-Aboriginal people could gain the knowledge to improve their health in a culturally appropriate way. I congratulate Souths Cares and all concerned with this organisation for the work they are doing to promote better health care, particularly among young Indigenous students in my community. That is an example of one of the oral healthcare programs that runs in my electorate.

Labor, of course, considers dental health and dental care a vital component of good public health. In this area, it is fair to say, we have put our money where our mouth is. In August 2012, Labor introduced a $4 billion dental program aimed at providing access to government subsidised dental care to millions of children and adults on low incomes or in rural areas. As part of our plan to address increasingly poor oral health among Australians—in particular, low- and middle-income families—the unprecedented six year dental health reform package included $2.7 billion for around 3.4 million Australian children who will be eligible for subsidised dental care; $1.3 billion for around 1.4 million additional services for adults on low incomes, including pensioners, concession card holders and those with special needs, who will have better access to dental care in the public system; and $225 million for dental capital and workforce, which will be provided to support expanded services for people living in outer metropolitan, regional, rural and remote areas.

This bill will create a waiver provision for the Medicare Chronic Disease Dental Scheme and make a number of amendments to the operation of the Child Dental Benefits Schedule. When Labor was in government an audit of the activity of the CDDS detected a high rate of noncompliance with the reporting requirements for dentists. As a result of this audit, activity debts were raised against dentists found to be noncompliant. The last speaker, from the other side, mentioned that it was his belief that this was one of the most successful healthcare programs that had ever been run in Australia. My experience from talking to GPs in our community was that, unfortunately, the CDDS was being rorted by a small number of doctors and dentists. I spoke to a number of GPs in my community who gave examples of people requesting certificates to say they had chronic dental diseases and required dental treatment under the scheme through Medicare when in fact they did not fit that category but had heard from others that there was an opportunity to get free dental health care through this program. That was uncovered in an audit of this program that was run by the previous government. That is why the program was shut down. It was found that taxpayers' valuable dollars were being wasted—admittedly in a small number of cases—and there was no ability to put in place measures and other safeguards to rein in the rorting that was occurring in the scheme. That is why Labor acted to replace that program and make changes to the program. On the whole, I think the targeted program that Labor put in place, particularly to target those people on low to middle incomes and children, has been effective.

This bill also makes amendments to the Dental Benefits Act and the Health Insurance Act to align compliance powers and make those powers applicable to the CDBS. It also amends both acts so that the Professional Services Review scheme can be applied to dental services provided under the CDBS. The CDBS commenced on 1 January 2014 and provides to those aged from two to 17, who meet a means test, access to up to $1,000 in benefits over two calendar years for basic dental treatment. This program is an investment in prevention. We know that the oral health of our children is the best predictor of oral health as adults. We know that children from low-income families and low-socioeconomic areas have inferior dental health to those from more affluent areas. That is why this scheme was targeted and means tested for children who fit those criteria. The CDBS replaces the Medicare Teen Dental Plan and provides more comprehensive coverage through a greater range of services to a larger group of children.

Labor also takes very seriously the issue of inappropriate professional behaviour and supports the application of compliance powers as well as the operation of the Professional Services Review scheme. The dental health reform package that Labor implemented is delivering a better and fairer system of dental care for Australians. It is an accessible and affordable scheme that focuses on prevention to deliver future improvements in Australia's oral health. From its commencement on 1 January 2014 until 1 March 2014, over 84,000 children received dental treatment under the CDBS, including over 26,000 children from outside of major cities. That is proof positive that this scheme is working and delivering its intended benefits without the rorting that we saw under the previous scheme that was put in place by the Howard government. In 2013, over 200,000 public dental patients received treatment because of Labor's program and its funding of the public dental waiting list blitz. It is because of Labor that over 280,000 adults now have better oral health as a result of free or subsidised care under the dental health reform package.

I am proud of Labor's improvements to dental health. I am proud that Labor has increased accessibility to dental health through a targeted scheme to ensure that low-income families in this country get the necessary support to access basic dental healthcare services and, importantly, that children, particularly those from low- to middle-income families and low-socioeconomic areas, have access to those dental schemes. It is a great legacy from the previous Labor government. This bill will tidy up the deficiencies in the Howard government's Chronic Dental Disease Scheme and will ensure that the legacy is removed forever. I commend the bill, with the amendment, to the House.

Debate adjourned.