House debates

Thursday, 12 August 2021


Dental Benefits Amendment Bill 2021; Second Reading

10:00 am

Photo of Adam BandtAdam Bandt (Melbourne, Australian Greens) Share this | | Hansard source

Getting dental into Medicare for kids is one of the great Greens balance of power achievements. Because we had the Greens in the balance of power in the shared parliament back in 2010, we said that one of the reforms that we need in this country was to get dental into Medicare. It is crazy that dental is not in Medicare. Why is it that if you break your jaw you can get treated on Medicare but if there's a problem with your teeth you can't? We know that so many people around this country have avoided going to the dentist because it is too expensive. Other medical treatments that you can get when you use your Medicare card are in the excellent great Australian Medicare system, but not dental. So, when we were in shared power, when people put the Greens into the balance of power in both houses, we said, 'Let's get dental for kids into Medicare,' and in that parliament we got it. As a result, since this scheme commenced, over three million children in this country have been able to go to the dentist and their parents have been able to pop on the Medicare card at the time of checkout and get dental funded by Medicare.

This isn't just a great health reform; it's actually a social justice issue as well because, if people don't have great teeth, it affects the rest of their life. Think about it. If you have two candidates going for a job sitting in front of you and one of them is without great teeth because they haven't been able to afford to go to the dentist, it affects their job prospects. It doesn't just affect the health of your teeth and your mouth; it affects the rest of your body as well. So many diseases come because people haven't had their teeth looked after. They get problems. They get an infection in the bloodstream and that goes through and affects the rest of their body as well and they end up in hospital. Crazily, if you end up in hospital as a result of a complication that comes from your mouth because you didn't go to the dentist, you can do that hospital visit on the public health system. So wouldn't it make sense to have dental in Medicare from the start to prevent people getting sick as a result of preventable diseases?

For health reasons and for social justice reasons—and for fairness reasons, because it is just too expensive for so many people to go to the dentist and, especially, to take their kids to the dentist—the Greens got dental into Medicare by working with the Independents and Labor in that shared power of parliament, getting a reform that benefited the whole country. But we can't stop there. We've got to get dental into Medicare for everyone. I am very pleased that in this bill what we're doing is extending this scheme that the Greens secured so that young children between the ages of zero and two are now also going to be covered by the Greens scheme. That is terrific. That is really good because, if you start this early, not only are you going to end up with children and adults who have better teeth but, actually, if the economy's your bottom line and the dollar's your bottom line, you are going to relieve a burden on our health system, because there are going to be fewer people with diseases down the line.

It is terrific that the Greens scheme that we secured is now being expanded upon. But what we need to do today, tomorrow and at the next election is get dental into Medicare for everyone so that, just as you use your Medicare card when you go to the doctor, you can use your Medicare card when you go to the dentist. It is affordable to do this not only because we're going to save a lot of money in the long run, because there will be fewer people ending up in hospital, but because it's what happens when you have a country where you make billionaires and big corporations pay their fair share of tax.

If we put a tax on billionaires' obscene wealth, we can get dental into Medicare for everyone. We need to do that because the billionaires and big corporations in this country are making out like bandits. Did you know that during the pandemic, while the rest of us were all locked down and over a million people lost their incomes and many other people had to rely on forms of social security, Australian billionaires increased their wealth by a third, mining billionaires more than doubled their wealth and Australia's billionaires grew their wealth during the pandemic faster than billionaires in any other country? They've been making out like bandits, often thanks to this government giving them millions of dollars in JobKeeper payments that they didn't need. One billionaire, with his corporation, took JobKeeper payments from the government and then went and bought a private jet with the millions that he got thanks to this government's largesse.

No, we need to make the billionaires pay tax. The Greens will put a six per cent tax on billionaires' obscene wealth and make the big corporations that are making superprofits pay a superprofits tax as well. Then we can help fund getting dental into Medicare for the rest of the population. Ask most people: do you think it costs too much to go to the dentist? Yes. Do you think it's great that you can use your Medicare card for kids to go to the dentist? Yes, and thanks to the Greens for securing that. Should we get dental into Medicare for everyone else? Yes, we should. Can we afford it? You bet we can, when we make the billionaires and the big corporations pay their fair share of tax.

As I said, this isn't just a social justice issue. We know that it's people on lower incomes who are the ones who aren't going to the dentist as often as they need to, because they simply can't afford it, but it's not just people on low incomes. It's First Nations people. It's people in regional and rural Australia. It's people who live further from the services that they need and can't afford to pay for the increasing cost of going to the dentist. We know it's a social justice issue to get dental into Medicare for everyone else, but as I said, it's also a health issue. It's going to make our country better off when fewer people end up in hospital from preventable diseases.

The good news is that getting dental into Medicare is actually really close. If there were an election held today then, looking at the current polls, we would be on the verge of turfing out this terrible government. This terrible government of climate deniers and turbocharged inequality would be gone. Why would they be gone? Why would we be on the verge of getting dental into Medicare for everyone? It's because they won the last election by only two seats—828 votes. That's all that the Prime Minister is hanging on to majority government by. We can kick them out with a very small shift in the public vote—the polls suggest that's what's going to happen—and put the Greens back into balance of power in both houses of parliament again. We'll finish the job and get dental into Medicare for everyone else, make the billionaires pay their fair share of tax and make Australia a more equal place where everyone can go to the dentist, slap their Medicare card on the reception desk at the end and pay for it as part of our public health system.

10:09 am

Photo of Terry YoungTerry Young (Longman, Liberal National Party) Share this | | Hansard source

I rise to speak on the Dental Benefits Amendment Bill 2021. When you have young children, there always seem to be 101 things you need to do throughout the day. There are play dates to arrange, books to read, items around the house to put out of reach, meals to prepare, mess to clean and sometimes even keys to fish out of the toilet. There are decisions on which day care, kindergarten, preschool or school they'll attend. It's all part of being a parent. But we do all this for our kids and make the tough decisions because we love them and want what is best for them. As a father of four children and grandfather of five, I can tell you I have been there.

Another important thing to pay attention to early on is your child's dental hygiene—getting them used to brushing their teeth and flossing regularly and booking them in for appointments with the family dentist. When it comes to expenses, I know only too well how steep dentist bills can be, especially if you have more than one child. However, if parents promote and practise good oral hygiene with their children from a young age, this can help prevent more serious dental decay and other health issues as they grow up. Good habits can last a lifetime. Babies can start teething from as young as three months old, with the first tooth generally appearing around six to nine months. By the age of one, a baby will usually have around eight teeth, but this varies, of course, because babies develop at different rates.

A lot of parents like to take them for their first dentist check-up before they turn one or when their teeth start coming through. This is long before a child turns two. This is why I am standing in support of the Dental Benefits Amendment Bill 2021, to remove the lower age eligibility restriction of two years so that all eligible children under 18 can access the Child Dental Benefits Schedule, CDBS. This will mean even parents of teething babies can claim the subsidy. Amongst the sleepless nights and babies struggling with teething, do we really want Australian parents to be worried about a dentist bill on top of that? By passing these amendments, we will lighten the financial burden for parents of young children and allow them to take even teething babies to the dentist for a check-up, advice or some reassurance at little to no cost.

One of my staff members has a one-year-old daughter who she took to the dentist when he first started teething at around six months. She had heard about the Child Dental Benefits Schedule and thought it was strange it didn't apply to kids under the age of two, especially because their teeth start coming through much earlier. The dentist took a look at her daughter's teeth, said they were coming through fine, gave her the usual warning on sugary snacks and soft drinks and sent her away with a substantial bill. These costs will largely be a thing of the past with the passage of this bill.

The removal of this age restriction is based on recommendations from the report of the fourth review of the Dental Benefits Act. The review was undertaken through consultation with a range of stakeholders, including the Australian Dental Association, state and territory dental health services, Services Australia, the federal government's Indigenous health division and academic dental professionals. The review committee included the Commonwealth Chief Medical Officer and representatives from the Australian Dental Association, Consumers Health Forum of Australia and others. Review stakeholders recommend that it is important to establish a positive dental experience at the earliest age. It also found that teaching positive oral hygiene practices at an early age would help curb the negative stigma around dental practitioners and oral hygiene. This perception can be reinforced if a person's initial dental experience requires serious treatment. Researchers found that if parents promote and practise good oral health hygiene with their children from a young age it will help prevent more serious dental decay and other health issues as they grow up.

Tooth decay in children is on the rise in Australia. Children aged five to 10 have an average of 1½ decayed, missing or filled baby teeth. So it's more important than ever to teach a child good oral health habits early on that will stay with them for life. The government's health advice for parents is that they should look after the child's teeth from the moment they start teething. Keeping a child's teeth and gums clean will protect against infection, cavities and pain. In fact, we recommend that parents take their baby to a dentist as soon as their teeth begin to appear. The dentist can then check that their teeth are developing as they should. Decayed baby teeth can damage the permanent teeth underneath and end up costing thousands of dollars to repair when the child gets older. If a child loses a tooth because of decay, it can cause crowding problems when their adult teeth come through later. We encourage parents to take their children for regular dental check-ups within six months of the first tooth appearing. We ask that parents make a visit to their child's dentist a positive experience and not a punishment for something. It also might be beneficial to shop around before your first visit to the dentist, as costs can vary widely between different dentists. It's also important for parents to keep in mind that not all dentists perform services under the Child Dental Benefits Schedule, so check before booking in for treatment.

Getting into good dental hygiene habits early on in life can last a lifetime. This is why it makes sense that the age for children eligible under the Child Dental Benefits Schedule be lowered. The change proposed under this amendment will increase access to prevention and treatment services for younger children. It will expand the number of children eligible for the subsidy by around 300,000 each year. The Child Dental Benefits Schedule has been in place since 2014. Since that time it has provided more than $2.3 billion in benefits and delivered more than 38 million services to more than three million Australian children. The budgeted cost for the amendment is $5.4 million over four years.

Currently services that are covered by the Child Dental Benefits Schedule include examinations, X-rays, cleaning, fissure sealing, fillings, root canals, extractions and partial dentures. Many of these services come with claiming restrictions and can be provided in a public or private setting. What the program doesn't cover is: orthodontic services such as straightening of crooked teeth; cosmetic dental procedures like the restoration or replacement of damaged or missing teeth; or any work that might need to be done in a hospital.

At present only eligible children aged between two and 17 years are entitled to access the subsidy for basic dental services, which can be up to $1,013. The benefit is capped over two consecutive calendar years. It also has a means test which requires receipt of family tax benefit part A or other relevant Australian government payment. The payment of benefits under the schedule is administered by Services Australia. This bill will remove the minimum age of eligibility so that children under two years will be covered under the scheme.

This government will continue to reduce the financial burden on Australian families. In the 2020-21 budget we extended tax cuts for low- and middle-income earners for another year. We also expanded the 32½ per cent tax bracket to include incomes up to $120,000, up from $90,000. We are ensuring more of people's hard-earned money is going into their pockets. By lowering the minimum age of eligibility under the Child Dental Benefits Schedule so children under two years of age will be covered, we are further reducing the financial burden on Australian families. It is another example of the government working with private and public providers to improve the delivery of dental services to Australia's children. I commend the bill to the House.

10:17 am

Photo of Mike FreelanderMike Freelander (Macarthur, Australian Labor Party) Share this | | Hansard source

I rise today to speak on the Dental Benefits Amendment Bill 2021. Before I deliver my speech, I should admit my biases: I am the son of a dentist and the brother of a dentist. Some of the earliest memories I have of my father are sitting at the foot of the dental chair in his surgery while he operated on his patients, drilling teeth and pulling teeth. I look back now—I was very young—and I wonder how some of those patients would have felt having a little two- or three-year-old boy sitting at their feet while their tooth was being pulled out. I have always had a very strong interest in dental care, and I was always interested in what my father was doing.

I also am the proud co-chair of Parliamentary Friends of the Dental Industry, together with the member for Lyne, David Gillespie. I work inside and outside the parliament with this group to make sure that the needs and wants of the dental industry are provided to the wider parliament. My brother Andrew Freelander is an extremely good dentist who specialises in some of the newer dental treatments such as titanium implants, removing the need for dentures in many people. I continue to, through him, have a strong interest in all things dental.

I also remember the arguments that were had—and people don't really remember this—when Gough Whitlam introduced Medibank and then when Bob Hawke introduced Medicare. There was a strong push to have dental treatment included in the Medibank system and later in the Medicare system. In many ways it's very sad that we didn't do that, because there is increasing evidence that good dental care is a very strong promoter of good health care, and the association between poor dental care and chronic illness is well recognised. It's always been my belief that health matters are above politics, and I found my membership of the Parliamentary Friends of the Dental Industry, along with David Gillespie, a very good way to promote the importance of dental and oral health and its association with good wider health care. I've worked as a paediatrician, as you know, for many years and during that time I've come to recognise the importance of good paediatric dental care. One of the great tragedies of Australian health care is that I can actually tell a parent's income by looking in their children's mouth and seeing their dental care. That just should not happen in a developed country like Australia.

The Child Dental Benefits Schedule was introduced in 2008 to provide children between the ages of two and 17 access to financial benefits for dental care. Labor introduced this reform, and it's provided over $2.3 billion in benefits to Australian children. That $2.3 billion would have been multiplied many times in overall health care over the time of that scheme. We know that children who develop good oral hygiene and good dental care in the preschool age group have better overall health. There is some evidence that they also have better overall development than their peers who don't get good dental and oral care. Over three million children have avoided the pain and the physical and mental health impacts from poor dental health care over the time of the scheme. They've also benefited by there being less of a financial burden on their families, so it's been a very, very good scheme.

The amendment bill we're debating today lowers the age of eligibility from two years to zero years. People may well wonder how important that is, because many people believe that children's teeth don't develop until they're six to 12 months old and that their primary teeth aren't all that important because they're replaced by their secondary teeth. But that's not true. Some children are born with teeth. About one in 2,000 children have what are called natal teeth; they're born with a tooth, or sometimes more than one. That can be part of their primary dentition, or it can be a third set of teeth. Being born with natal teeth can often cause problems—for example, with breastfeeding—and very often these teeth need to be removed in infancy. There are also a number of conditions in which teeth development is impacted during the development of the fetus. There's a relatively common condition, called ectodermal dysplasia, where children don't ever develop teeth, and that can cause problems with their jaw development, with their oral health and with their feeding and swallowing. There are conditions that do require dental involvement very early on, even just after birth. Some children have cleft palates or similar abnormalities and have dental abnormalities associated with those, and so they need treatment long before they reach two years of age. So it's actually a very good thing that we're extending the age to from birth onwards. This will be a great relief to parents who have children with some of these conditions, which are often associated with other forms of disability. It will relieve some of the burden on them that they would otherwise bear.

Of course, one of the problems that we have in Australia, particularly in outer metropolitan electorates like mine, is a lack of dentists. We suffer from quite a significant shortage of dentists in Australia, and, in the public dental system, such as at the dental hospital at Westmead or the Sydney Dental Hospital, waiting lists for treatment are measured not in weeks or months but in years.

I am a believer in establishing another dental school in New South Wales. There's only one at Sydney university, which actually has the same number of people enrolled to study dentistry as in the 1940s, so there is a very low number of dentists being trained in Australia. We need to really increase the number of dentists to improve the access to dental care, particularly for disadvantaged people and disadvantaged families. I think an unfair disadvantage is often put on children whose parents can't afford access to dental care, and this scheme is very important in promoting that. Another thing that we should be looking at as a country is training more dentists so people get better access to dental care.

This is very similar, in my electorate, to the shortage of general practitioners. Many people are using our public hospital system because they can't get access to a general practitioner. I've petitioned the health minister on many, many occasions about the changes the government's made to the area-of-need classification for general practitioners which is inhibiting recruitment of general practitioners to work in outer metropolitan areas, like Campbelltown or Macarthur and others around the country. I know Emma McBride, the member for Dobell, has been facing the same problem on the Central Coast—and this is true for many disadvantaged electorates around the country. I've petitioned the health minister about this on numerous occasions. The response has been deafening in its silence, and it's another area where the government appears not to want to provide adequate health care for disadvantaged people.

The lack of dentists is a similar thing. However, this scheme will at least help relieve some of the burden on people who have children with oral and dental problems in the first couple of years of life. We know that, with proper dental care, the lives of these children can be made so much better and so much healthier. Believe it or not, there's a very strong association with good dental care and good cardiac health. Looking after someone's dental health as an infant can have huge impacts on the health system over 50, 60, 70, 80 years, so this is actually a very good thing that we're doing. It also raises the importance, in the public and political eye, of dental care and its importance over a lifetime, not just early on. Bad dental hygiene leads to dental caries or decay in primary teeth, which then causes ongoing problems with jaw development, with eating, with swallowing, with nutrition and with development of the secondary teeth. It can cause a whole range of abnormalities later on in life. It's also very good to get children used to seeing dentists at a very early age and encouraging good dental care and promoting the importance of good dental care. As a paediatrician I see children who don't own a toothbrush. Anything we can do to improve awareness of and engagement with dental care is very important in those kids, and for their kids on an ongoing basis.

This amendment will help Australian families and their children but it will also help, as I've said, education and it will help in getting rid of the stigma carried by people who have poor dental care and poor dental hygiene. I've had people, for example, who've had difficulty getting work because, when they go for a job interview, they have very poor dental care and they feel that inhibits their ability to obtain work. Anything we can do to help that is important.

I've been trying to promote, in this parliament and other places, a program called the first thousand days, which looks at child health from preconception, right through the first two years of life. If we look at the first thousand days, it's a way of providing health care that provides a benefit to that child throughout their lives. The most important time in providing health care and the most important time in promoting health in a child for the rest of their lives is that first thousand days. Part of that is attendance to dental hygiene, and that includes being careful about nutrition and health during pregnancy. We know that there are lots of impacts of poor nutrition on the growth of a baby, and one of those impacts can include poor teeth development, because your teeth develop long before you're born. If we can improve awareness of dental hygiene and dental care in young children, that also includes improving knowledge of the importance of good pregnancy care, for good child health care.

Getting health professionals used to being aware of dental hygiene and dental care is also very important. Many, many people here in Australia aren't aware of the importance of child dental care—this includes many doctors, because they aren't able to refer many children for dental care because of the costs involved. That is another benefit of this policy. It's not infrequent as a paediatrician to have to treat children with dental abscesses and poor oral hygiene because of their lack of access to dentists. That's certainly true in some communities that I've had to deal with over many years.

I think we need to be looking at this as a holistic health policy. I think to have other members in the House talking about this has been very important. I'm glad it has bipartisan support. I do think it's imperative that the government looks further in terms of providing dental care. As I've said, I've always been a supporter of the involvement of dental care in the Medicare system; that's something I would actively support. I realise there are significant costs involved, but dental care is just so important for overall health care that it's something, as a parliament, we should be embracing.

I support this bill. I think it's a really good start to improving child health care and I commend the bill and the amendment to the House.

10:32 am

Photo of Matt KeoghMatt Keogh (Burt, Australian Labor Party, Shadow Minister for Defence Industry) Share this | | Hansard source

[by video link] I start with a confession: I hated brushing my teeth as a child. But my parents made me do it, and I am very thankful to them for that. In fact, they generously spent quite a bit of money on orthodontics for me and my siblings. We also had the benefit of the school based dentist program—not at my school but one of the other local schools—that we were able to access. This was a good thing, and not just for my dental hygiene, because both of my in-laws are in dentistry. My father-in-law is an orthodontist and my mother-in-law is a dental hygienist; and now my wife's uncle is also my dentist, and his wife is a dental hygienist. I think my wife's uncle takes a sinister delight in my visits to see him as my dentist! I'm quite clear that, if my dental hygiene had not been so good, I'm sure I would have been struck off as soon as I started dating Annabelle.

The importance of good oral hygiene and dental health is much more than that. In fact, it is very much overlooked by so many in our community, and often even health experts. The reality is that dental ill health can lead to so many other health conditions that getting this right is of vital importance, and getting it right in the early years makes a critical difference to so many people's overall health outcomes. We have moved ahead in leaps and bounds in this area over the last few decades. I only need to think back to my grandparents, who didn't have their own teeth for most of the time that I knew them. It was quite a scary thing to find teeth in a glass next to their bed or to see them able to take them out; we shouldn't forget that as a demonstration of how much we have moved but, still, how far we have to go. It would be a brave member of this parliament who would ever disagree with something that the member for Macarthur said when it comes to health policy, and certainly, from my point of view, I echo his calls that it would be to the benefit of this entire nation if at some point we can find a way to see dental care covered as part of the Medicare program.

Looking at child dental health, I will admit as a parent that getting my son, now five, to brush his teeth on a regular basis, twice a day, is an uphill battle, but it's one that my wife and I take on because we know the importance of not only ensuring that he has good dental health but also instilling that habit to make sure that he will look after his own dental hygiene as he grows up.

To be fair, I've never met anyone who says to me that they love going to the dentist, and that's not saying anything bad about dentists. But people do tend to be scared of it, and sometimes that fear comes at an early age, or even, more often, they're not really sure because they don't have a regular experience of going to the dentist. They think about how it's a bit scary, it's invasive, it can be noisy, and there are strange things going into your mouth. You're not really sure what's going on, because you can't see what the dentist is doing. And sometimes that dentist likes to ask you a lot of questions when you're in no position to answer them!

But going to the dentist is vital, and practising good dental hygiene is a vital life skill, and teaching children is a vital parenting skill. Parents need to be teaching their children from the get-go, before a baby's teeth have even started coming through. It's never too early to be teaching good oral hygiene to our children, and these are behaviours that, once learnt, will stick with them throughout their lives and lead to them having not just better dental and oral hygiene outcomes but better overall health outcomes. The simple fact is that some parents don't actually know how to look after their kids' teeth, especially when kids are at a young age, and the cost, or at least the perceived cost, of going to a dentist does come across as being quite prohibitive.

The bill before us today expands eligibility for Labor's child dental benefits scheme by removing the lower age limit and opening up the Child Dental Benefits Schedule from two to 17 years of age to all children under 18, which means that kids, from infancy, will be getting access to the best possible oral health care. The thought behind making the scheme available to children from infancy is also to encourage positive dental experiences for both kids and parents—for kids to learn how to look after their teeth properly and for parents to learn how to help. If parents promote proactive and positive oral hygiene habits with their children from a young age, they will help prevent more serious dental decay in the children's baby and adult teeth as they develop. It's vital to instil these good dental hygiene practices in children at an early age to curb the stigma around dental practitioners and oral hygienists. This is only reinforced if a child requires serious treatment or intervention at a young age.

Yes, this bill will cost the taxpayer dollars, but oral health is one of the early indicators of other medical issues. Through early intervention, our national health system will ultimately be making savings by ensuring it can address these dental health issues as early as possible. Nationally, children's oral health really isn't that great. Here in WA, kids under the age of 10 have an average of 1.4 teeth missing, filled or affected by decay. We're talking about baby teeth. Kids between the ages of six and 14, with their permanent teeth, have an average of half a tooth missing, filled or affected by decay. These are teeth that are supposed to last for life. It's simply not good enough. So the changes in this bill will enable parents to get their kids to the dentist as early as needed and encourage a life of good dental health, which also means better overall health for the rest of their lives.

We need to be doing everything that we can to encourage good oral health in Aussie kids from the very beginning, for all those reasons, as well as the very core reason for me—having married into a family of dentists and having an even deeper understanding of the vital importance of good oral and dental hygiene and the overall health outcomes that come from having good oral and dental health and learning and instilling those good habits early. I commend this bill to the House.

10:39 am

Photo of Mark ButlerMark Butler (Hindmarsh, Australian Labor Party, Deputy Manager of Opposition Business in the House of Representatives) Share this | | Hansard source

[by video link] I am very pleased to speak on this bill. I thank the member for Ballarat for having moved an amendment to the second reading on my behalf.

We are, as other speakers from the opposition have indicated, supporting this Dental Benefits Amendment Bill 2021. It's an important extension to a great Labor legacy—a legacy which, over the course of the eight long years of this government, has been threatened repeatedly by a Liberal Party that has never supported this reform fully. And that's of a type with this government, that for years and years and years fought the Labor Party in its introduction of Medibank and then Medicare.

This reform, under the Gillard government and led by the member for Sydney, who was then the health minister, was a great reform, and it's delivering great health outcomes to millions of children and teenagers across Australia. It was a reform that was introduced after solid, evidence based consideration by the Dental Advisory Group that was chaired by the formidable former public servant Mary Murnane. And that came on the back of some very disturbing evidence from the Australian Institute of Health and Welfare—that great institution, the AIHW—which showed that as many as 42 per cent of five-year-olds had decay in their baby teeth, as many as 61 per cent of nine-year-olds had decay in their baby teeth and, in a permanent feature of poor oral health, as many as 58 per cent of 14 year-olds had decay in their adult teeth, something that would continue to dog them for the remainder of their lives.

We know that systemic support for dental care has been patchy across Australia. Medicare does not cover dental services, as is well understood by all members of this House. So really, in order to have a guarantee of access to dental care that you don't pay for out of your pocket, you need private health insurance, which is expensive and which is not financially available to many low-income families in Australia. Public dental schemes, including school dental schemes, have been patchy over the last couple of decades and so a number of recommendations were made to the Gillard government—particularly to the member for Sydney, who was the Minister for Health and Ageing at the time—to establish one of a range of options to ensure that children and teenagers would be set up for good oral health over the course of their lives.

That gave rise to the birth of the Child Dental Benefits Scheme. In August 2012 the Gillard government introduced that reform package to the Australian people. A key part of that package was this benefits scheme, which ensures that children of families who receive one of a range of benefits—particularly FTB, or family tax benefit part A, but also the parenting payment, the double orphan pension, the carer payment or other benefits—do have access to what was a thousand dollars of government funded dental services over a two-year period. That has been indexed recently by the government to $1,013 over the course of two years. That covers a little bit more than one half of all children and teenagers in Australia. One half of children are from families who receive one of those eligible payments and more than 70 per cent of Indigenous children and teenagers in Australia have access to this great scheme. It's a scheme that has shown its worth; it has delivered almost 40 million services over its short life of less than a decade to over three million Australian children and teenagers. That's something of which the Labor Party is enduringly proud, and the member for Sydney should be proud in particular.

It's important to note, though, that although we welcome this bill, the fact that the Child Dental Benefits Scheme remains in place is a great tribute to the efforts of the member for Ballarat and others in the Labor Party who have fought repeated attempts by this government over their eight long years to abolish or to cut the scheme. We know that under Prime Minister Turnbull, when the current Prime Minister was the Treasurer, they intended to cut the scheme entirely. That was fought by the Labor opposition, led by the member for Ballarat, who was the shadow minister for health and ageing at the time. Great credit to her and the Labor team; they fought off that original intention by Prime Minister Turnbull and the current Prime Minister, who was Treasurer at the time, to abolish the scheme.

But they weren't to be deterred entirely, because then they brought before the parliament a proposal to cut by 30 per cent the payments which would be received by children and teenagers under the scheme. So, instead of $1,000 of services available to children and teenagers over the course of the two-year period, it was proposed by the current Prime Minister, who was then Treasurer at the time in 2016, that they would only receive $700. It was a cut that would impact about 20 per cent of the children and teenagers who were receiving such extraordinarily important dental services under this scheme. Again, can I pay tribute to the member for Ballarat for having fought that cut and having defeated it.

Finally, the current Prime Minister, who was then the Treasurer, withdrew that cruel, insidious cut—on the eve of it being defeated, frankly—in the Senate, through a motion of disallowance that would have put the thing to bed anyway. We're glad they've finally seen the light and haven't, for three years at least, tried to abolish or cut this scheme. That is important and, again, just shows how important it is for the Labor Party to keep pushing these schemes, because the Liberal Party have never been comfortable with Medicare, and they've never been comfortable with this scheme, which is providing such great dental health benefits to our children and our teenagers.

To the credit of the current Minister for Health and Aged Care, though, he has undertaken a review of the scheme, and that review has come up with, I think, a very constructive suggestion, which is to lower the eligibility age threshold from two years down to one year of age, recognising that good dental health can start earlier than a second birthday. Those statistics I talked about earlier from the AIHW about the levels of childhood baby tooth decay at five years of age demonstrate that you can never start too early on ensuring that our children have good oral health. The review recommended, as I understand it, that the eligibility age be reduced from two years to one year. The government, after discussing this review recommendation with stakeholders, has taken their view onboard that it would simply be better to remove the lower age threshold altogether, so that babies, provided they meet the eligibility threshold by way of government benefit, would have access to this scheme from birth. We see this as a welcome extension of a great scheme, and we are very happy to support this bill.

10:48 am

Photo of Amanda RishworthAmanda Rishworth (Kingston, Australian Labor Party, Shadow Minister for Early Childhood Education) Share this | | Hansard source

[by video link] I am very pleased to speak on the Dental Benefits Amendment Bill 2021, because this measure and this scheme are very, very important in our healthcare system. I welcome the government's changes to expand the eligibility of Labor's child dental benefits scheme by removing the lower age eligibility limits and opening it up to children between zero and two years of age.

I'm proud that 10 years ago I stood in this parliament and spoke on the bill as Labor's first step in our dental reform package. Since Labor introduced this incredibly important reform, it has provided over $2.3 billion in benefits and delivered more than 38 million services to over three million Australian children. Three million Australian children have potentially avoided the physical and mental health impacts of untreated dental conditions, thanks to this program, with massive flow-on benefits for their families, their communities and the broader Australian society. This is a great Labor legacy. I would like to congratulate the member for Sydney, who was instrumental in ensuring that this be dealt with. It is so critically important. It has made many families' lives easier. I'm pleased to see that the government, despite it's previous attempts to attack this program or water it down, has now, with this modest change, built on Labor's legacy.

I've always been an incredibly vocal champion for having more public funding and more public access to dental care for those who need it. Having good quality care and dental hygiene has a significant impact on the quality of life for so many people. First and foremost, there is the positive impact that good dental hygiene has on people's health and wellbeing. We must ensure that dental care is looked at through a preventive lens—as we should do with health in general. Otherwise, it will put a strain on our dental system. Living with poor dental health can be extremely painful. It can affect speech and sleep, as well as the ability to eat. Having poor dental care and poor teeth and oral health can also have adverse social impacts on a person's mental health, on their confidence and, indirectly, on their social life. I have heard many stories from people in my electorate who suffer embarrassment around their appearance if they are missing teeth or have decaying teeth. It leads them to avoid eating in public or enjoying meals with family and friends, and to be afraid to smile and to show their teeth in photos. This is really sad. I've also had constituent saying they believe they have missed out on job opportunities due to their appearance, with missing and decaying teeth. This is of great concern.

It's important to note that, if people are not able to start good dental treatment in childhood, poor dental health will follow them into adulthood. That's why, for a long time, I've been an advocate for supporting preventive care. We need to ensure that small problems in childhood, when it comes to dental care and oral hygiene, are addressed and do not become bigger problems in adult life.

I've heard many difficult stories from locals in my community in the southern suburbs of Adelaide about the impact that poor dental health can have on their lives or on the lives of their children. I've also heard about the lack of access to broader services relating to teeth and other aspects of the mouth. I was contacted by a mother whose son was dealing with a speech impediment, and his speech pathologist advised that braces would assist in correcting some of these issues. After seeing a dentist to have her son's teeth assessed, she was advised that the wait for braces would be up to two years and come with a gap fee of about $1,000. This mother was shocked at the long wait time they could face to get what could be life-changing dental treatment for her son. She was also shocked by the cost. Most families don't have a spare $1,000 sitting in the bank for situations like this. To have braces put on through the private system could leave parents with out-of-pocket costs of over $5,000—and in some instances double that.

This highlights that access to dental care is really important. When it comes to things like speech and speech development, it has a critical impact on a child's long-term development. It also shows that early access is super important in mitigating what might otherwise be lifelong consequences. I'm pleased to say that my office was able to assist this mother in securing dental treatment for her son sooner than the two year wait time she had been given. But you shouldn't have to come to your member of parliament's office to facilitate this. It should be available and accessible to everyone.

I'm also frequently contacted by constituents who are in desperate need of access to emergency dental care. A number of them are adults, not children, who would have benefited from preventive access to dental care as children. One of my constituents in his 30s contacted me to say he was told it would be a 16-day wait to see a dentist for a very painful toothache. Understandably, he was quite upset about the waiting time for what should have been a simple check, as it was causing him deep pain which was really very debilitating. Another elderly gentleman contacted my office seeking help after partially breaking one of his front teeth. He contacted the SA Dental Service and was told it would be a two-week wait to see a dentist. This man was in a lot of pain and said the rough edge of his broken tooth would rub against his lip, causing it to bleed. Patients should not have to wait for this type of emergency dental service just because they can't afford the large out-of-pocket costs that some dentists charge in the private system.

Another constituent contacted me to seek assistance with the cost of dental care after being charged $60 in out-of-pocket costs to have a dental infection looked at. The man was receiving a disability support pension, and the out-of-pocket cost of $60 was a huge impost on his finances.

What we need to see is action taken. We shouldn't rest on our laurels when it comes to improving dental health in this country. All Australians deserve access to universal, prompt and world-class medical care, and that does need to be dental care as well. I think it is critical, unlike this government that has regularly sought to undermine the principle of universal access to Medicare. This was the government that proposed a $7 co-payment—$7 tax!—to go and see your GP and that is making huge amounts of cuts to the Medicare rebates as we speak in the middle of a pandemic, not giving doctors any notice. They have a bad track record of not only trying to discredit the program that we are debating here today but also constantly attacking our universal healthcare system.

Our universal healthcare system and the children's dental program that we're debating today have been incredibly important Labor achievements, but they have not only been important for those who have benefited but been important for society as a whole. So, while I'm pleased the government is making this improvement to this bill, I'm hoping that we will see an end to this ideological attack on the public healthcare system, on the dental care that is provided to children as well as the national partnerships, which at some point this government also decided to try and cut when it came to dental care. We need to be investing more, not less, ensuring that our Australian citizens are in the best health possible, that we're preventing the worst and they can live happy and healthy lives.

10:58 am

Photo of Tony ZappiaTony Zappia (Makin, Australian Labor Party) Share this | | Hansard source

This legislation, the Dental Benefits Amendment Bill 2021, builds on a Labor initiative, the Child Dental Benefits Schedule, which since its introduction in 2012 has provided $2.3 billion in benefits and has delivered 38 million services to over three million Australian children—services and treatment that benefit children, their families and the public health system more broadly, because early intervention in dental treatment will very likely prevent other future health issues, as other speakers have said time and again in this debate. It's $2.3 billion that has been spent, which, in my view, if we could calculate would also have resulted in much more than that in public health savings as a result of that expenditure being made for dental treatment at an early age. Early dental intervention will also increase the likelihood that good dental care practices are ingrained from childhood and carry through right into teenage years and adulthood.

The legislation, in my view, corrects an anomaly in the Child Dental Benefits Schedule, which provides eligible children aged between two and 17 years access worth up to $1,013 for basic dental services, with benefits capped over two consecutive years. Under the proposed changes, the eligibility commences at birth rather than at two years. That means that around an additional 300,000 children will now be eligible for child dental treatment. On those figures, it is estimated that some 15 per cent, or 45,000 children, will access the scheme. It seems to me to be a commonsense correction. Indeed, I don't quite understand why it didn't start when the scheme was introduced. But nevertheless the correction is being made, and I am sure that it will not only make a difference but will assist so many children and families.

Failure to address dental issues at an early age can lead to more serious dental issues and health complications in adult life. The latest Australian adult Oral Health Tracker, of 2020, indicates that dental care amongst Australians is deteriorating. One in three Australians has untreated tooth decay, an increase from one in four in 2018. In just over two years, the figures have deteriorated that much. Adults reporting toothache rose from 16.2 per cent in 2018 to 20.4 per cent in 2020, again a considerable increase over a two-year period. Fifty-two per cent of people without private insurance and 26 per cent of people with private insurance avoided dentists because of the cost. In actual numbers, that translates to about two million Australians every year avoiding a dentist because of the cost.

Apart from the discomfort to those people who needed the dental treatment, the reality is that avoiding the dental treatment will mean other complications down the track and perhaps much more costly complications. For example, poor oral health is directly associated with chronic diseases including stroke and cardiovascular disease. As others have also said, it can also affect a person's confidence, appearance and general wellbeing. It's a pity we haven't had any costings done of what the cost to society is as a result of people not having dental treatment when it is needed.

Dental care was not included in Australia's universal health scheme, Medicare, at its inception, and, four decades later, dental care is still not covered by Medicare in full. This is a partial covering of it, but it's a very limited covering. As other speakers have pointed out in this debate, it would be in the national interest to have dental care included in Medicare. Just why it was not included from day one is still somewhat of a puzzle to me. I understand that, at the time, there was some objection to it from dental groups throughout the country, but nevertheless it seems to me that, had it been included at the time, we might not be having this debate right now, because it would have been part and parcel of everyday health care. Indeed, I suspect that it might be the case that, had it been included, we would have seen a net saving in public health costs throughout the country.

Dental care is health care, which is why several other countries, including Finland, the UK, Sweden, Italy and Greece, all have a form of universal dental care. Those countries clearly recognise the benefits and importance of it, yet Australia still continues with very limited public dental support. It is often shared, in a complicated way, between the state and federal governments; indeed, it varies from one state to another. The sad reality is that, even for those who are eligible for public dental treatment in this country, sometimes the waiting lists are such that people are waiting months or perhaps even years for that treatment. I can't imagine someone who is in urgent need of dental treatment having to wait months or years for it. It would have to be incredibly uncomfortable. I can recall speaking to people several years ago about that very issue and the impact it was having on their lives as a result of not being able to get the treatment that they needed, because they couldn't afford it and so had to wait and rely on the public services for it. While it's not surprising that people on low incomes are more likely to skip dental treatments, somewhat surprisingly it is often people in the 20- to 40-year age group. I say 'somewhat surprisingly' because I would have thought that those would have been the people who might have been in the workforce. But, again, they are also people with lots of financial burdens hanging over them during that stage of their life. That's perhaps why they are the ones who frequently skip dental treatments.

Even when those people do visit a dentist, the statistics would show that the type of care they choose is often determined by the cost of the treatment, rather than the treatment that they would otherwise want to get or the treatment that the dentist suggests they get. Again, even when treatment is available, sometimes it is not the treatment that they should be getting and, because of costs, they choose the cheaper option. Again, it is always people on lower incomes who are missing out. It's unsatisfactory that most people are ineligible for state or federal funding of dental treatment. We have conditions under which people can access that federal funding or that state funding, but if you don't fit in or you're ineligible then you simply can't get it.

Australia lags well behind comparable countries, such as the UK and Canada, with respect to the population overall getting good dental treatment and getting the treatment and care that they need. My understanding, from one report, is that in 2017-18 about 72,000 hospitalisations for dental conditions may have been prevented had earlier treatment been provided. Again, that just highlights the point that if people are going to hospital because they avoided getting dental treatment that they should have got, what is the cost to society for that hospital treatment—and the hospital stay in some cases? I simply don't know, but I can imagine it would have been much greater than the initial cost of the treatment had they been able to afford it or, indeed, had the public paid for it. It actually makes economic sense to look at a more broadly based public dental service that could be made available here in Australia. Dental services in Australia cost around $10.5 billion in total in 2017-18. Given those figures are now two years old, my understanding is that today's figure would be around $12 billion. Of that, half is paid by individuals and the rest is paid by governments and health funds. It seems to me, in proportion to the health cost throughout the country, that something future governments should consider is having 'Denticare' or something similar to that included in our Medicare system.

The other point I want to make about all this is the point that others have made and which I alluded to earlier on in my comments—that is, people on lower incomes are more likely to be the ones that miss out on dental treatment, because they simply can't afford it. The statistics and facts will confirm that. One of the groups that clearly misses out a lot is Indigenous Australians, who are twice as likely as non-Indigenous Australians to not be able to afford dental costs. We were talking about the Closing the Gap statement in the parliament in recent days. This is a terrific example of where a gap needs to be closed, particularly for Indigenous people across the country and those in rural and remote areas, where not only is it a case of cost but quite often also a case of access to dental practitioners. We need to do a lot better and a lot more.

The last point I want to make is this: as part of dental treatment, we know full well that nutrition and, in particular, the consumption of high-sugar foods and drinks has a direct impact on tooth decay and the like. We haven't done enough to address this issue over the years. If we want to minimise and reduce dental costs, and indeed health costs more broadly, throughout the country, we should look at prevention rather than the care afterwards as our priority, yet we don't do enough of that in this country. There is no question whatsoever—and the research will show this and the statistics will bear it out—that the consumption of the wrong types of foods, in particular of high-sugar foods, in this country is contributing greatly towards the dental costs and the health costs of the nation. We should be doing a lot more to either educate or in some way modify behaviour in this country so that people's health is improved through preventative action rather than through having to treat conditions once they arise.

With those comments—and others have made this point—we support this legislation. It is good legislation. A lot of people are going to benefit from it. I commend the legislation to the House.

11:12 am

Photo of Rebekha SharkieRebekha Sharkie (Mayo, Centre Alliance) Share this | | Hansard source

I rise to speak on the Dental Benefits Amendment Bill 2021. This is an important change to the dental scheme vouchers to include children who are under two years of age on the vouchers. We know that previously this scheme was available for children aged two to 17 years. This is an incredibly important scheme. This scheme ensures that children from low-income families are able to access dental care. I think, importantly, it encourages children to develop a lifelong relationship with a dentist through those treatment visits. It's estimated that each year from 1 January next year an additional 300,000 children aged between zero and two will become eligible for the program. The scheme ensures children can access just over $1,000 in benefits for basic dental services, with benefits capped over two consecutive calendar years.

If you want to determine a person's poverty, you just have to look at their mouth. I think teeth give that indication of a person's financial means and social means more than anything else. I believe we have another cohort of Australians, a very large cohort of Australians, deserving of a similar scheme—that is, aged pensioners. I've been a long supporter of National Seniors Australia's Fix Pension Poverty campaign to provide a universal dental healthcare scheme for older Australians. I've been such a supporter of this proposal that I requested that the Parliamentary Budget Office arrange costings for such a scheme back in February 2019. Back then, that cost was approximately $700 million per year, and those costings were determined on a person being 75 years of age or over and on the full pension.

Teeth in poor condition is not just a cosmetic issue; it affects your ability to communicate, it causes shyness and embarrassment—when teeth are missing from the front, in particular—and it causes difficulty speaking. People don't smile—if you're talking to somebody and they're missing front teeth, in particular—and they often hold their hand over their mouth to speak. They're embarrassed by their teeth. Broken dentures and rotten teeth affect your ability to eat; ulcers and abscesses lead to infection. There is a huge correlation between dental and mouth infections and heart infections.

Addressing dental health is recommendation No. 60 of the Royal Commission into Aged Care Quality and Safety, under the heading 'Establish a Senior Dental Benefits Scheme':

The Australian Government should establish a new Senior Dental Benefits Scheme, commencing no later than 1 January 2023, which will:

a. fund dental services to people who:

i. live in residential aged care, or

ii. live in the community and receive the age pension or qualify for the Commonwealth Seniors Health Card

b. include benefits set at a level that minimises gap payments, and includes additional subsidies for outreach services provided to people who are unable to travel, with weightings for travel in remote areas

c. provide benefits for services limited to treatment required to maintain a functional dentition (as defined by the World Health Organization) with a minimum of 20 teeth, and to maintain and replace dentures.

That's one of the findings of the royal commission, and we should be implementing that now—we really should. There would be a cost benefit to us to do this because mouth and teeth issues are the third most common reason for acute preventable hospital admissions in Australia, so if we had a dental scheme for older Australians we would actually greatly reduce the cost of hospital admissions in Australia. My contribution to debate with respect to this bill won't take long. This is a very good bill and I commend this bill. But I would urge the government to look at the needs of older Australians while we are also ensuring we meet the need of younger Australians to have a dental voucher. To me these are two cohorts of Australians that are equally vulnerable and that could greatly benefit from such a dental voucher scheme. Thank you.

11:17 am

Photo of Fiona PhillipsFiona Phillips (Gilmore, Australian Labor Party) Share this | | Hansard source

[by video link] In debate on the Dental Benefits Amendment Bill 2021, I'm pleased to stand in support of the recommended expansion of Labor's Child Dental Benefits Schedule with the removal of the lower age eligibility limit, thus opening the Child Dental Benefits Scheme to infants aged zero to two years. It was the Gillard Labor government's Dental Health Reform Package, nine years ago this month, that ensured basic dental services be made available through the Commonwealth to every qualifying child aged between two and 17 and, additionally, the child's parent, carer or guardian. The Child Dental Benefits Scheme has provided over $2.3 billion in benefits through more than 38 million services to over three million Australian children. Now, if that doesn't put some bright into white, I'm not sure what will. However, there is more potential here for every Australian child, indeed, from the day they are born. With a review of the Dental Benefits Act in 2019, a recommendation was put forward to lower the current eligibility from age two to one. Wonderfully, however, within that time, with stakeholder feedback, the review advised a strong preference for removing the lower age eligibility restriction altogether. By removing the lower age eligibility, it is estimated an additional 300,000 children will become eligible for the program.

Having dental care for infants and toddlers is crucial. Babies are born with 20 primary, deciduous or baby teeth that usually start to come through their gums by the age of six months. All teeth have usually appeared by the age of two or three years, emphasising that care for children's teeth commences well before their teeth arrive. With the appearance of teeth, instantly decay becomes a possibility. I'm reliably informed that one of the most serious forms of tooth decay occurs in babies when feeding from bottles containing sugary drinks, such as fresh fruit juice, for when left in contact with teeth, sugary drinks of any sort will cause decay because the sugar is converted to acid that dissolves the tooth enamel. Prevention is always better than cure, and this bill will help to deliver a positive initial dental experience for more Australian kids and help to curb the unfortunate negative stigma around dental practitioners and oral hygiene.

Speaking of cures, I would like to share with the House some success stories through my electorate office with constituents who were in dire need of overdue dental care. But I do want to start by acknowledging the work of all our dentists and oral healthcare workers. They do highly important work in these very difficult times and the government needs to support them better. My office has seen case after case of people applying through the adult public dental scheme—applying and reapplying—all because of government's cuts to adult public dental funding. The consequence is less availability of adult public dental services on the New South Wales South Coast. Waiting periods of four months are common, and not for a routine appointment, no, this is for urgent dental work.

In the case of Mr Leonard Matthews, a resident of Sanctuary Point, he had been waiting three years for denture moulds—three years! It is difficult to imagine the distress that caused, because dentures are a very big necessity. Mr Matthews' son, David, said:

A massive shout out to member for Gilmore Fiona Phillips. My 88 year old father hasn't had his teeth fixed in 3 years. Finally after months of pain rang the members office and within a few hours found out why (paperwork lost) this happened and then sent a voucher to see a dentist ASAP. I’m so thankful and impressed with her and staff for being so caring and quick to sort this problem. Some politicians do have a go and care for their community.

Glen Harlum from Sussex Inlet, when seeking his appointment, said 'anywhere would do' between Nowra and Ulladulla. NSW Health contacted him saying he remains on a wait list for access to services and was informed if he experiences any pain that there is a way to get access to urgent dental services. But as he is not in pain at the time, he will have to wait. The list is long. Constituent Mr David Lawton of Bomaderry, age 79, received advice through the Illawarra Shoalhaven local health district that an appointment would be made. This application then expired after four months, with no appointment having been generated. Then, if you could believe it, Mr Lawton was advised he would need to reapply and would have to wait another four months.

The federal government's cuts to adult public dental care are nothing short of appalling, for which the government should be totally ashamed. But it doesn't stop with just dental. The shortage of GPs in my electorate of Gilmore is critical and that is why I fully support this amendment to the motion for second reading moved by the member for Ballarat:

That all words after "That" be omitted with a view to substituting the following words:

"whilst not declining to give the bill a second reading, the House:

(1) notes the bill expands access to public dental services; and

(2) urges the Government to do more to address:

(a) access to dental and other health services, including General Practice, in outer-metropolitan, rural and regional Australia; and

(b) out of pocket costs for all Australians accessing these services"—

The GP shortage in my electorate of Gilmore is at crisis point. I want to point out that our local GPs and health workers provide the most amazing and vital support in our communities. They are the champions there every day at the forefront of primary health care, going above and beyond for people in their care. They deserve to be supported more. But in the bay and basin area on the New South Wales South Coast, we have seen doctors retire with the one remaining doctor at the Sanctuary Point Medical Centre retiring soon and no replacement in sight. The minister says again our area is not a distribution priority area. Apparently, according to the statistics, we have too many GPs. In fact, some of our GP practices have been calling to be made a distribution priority area for workforce shortage for some time. Take, for example, the Worrigee Medical Practice, which had 13 full-time equivalent doctors but now has five. Some practices in the bay and basin area of the Shoalhaven have gone from bulk billing to private billing and have closed practices in order to consolidate. This has resulted in the net loss of GP appointments available to communities and poorer patient outcomes, and it has placed enormous strain on remaining practices.

The system is broken. We now have a two-tier medical system, where those who have lost their GP due to a practice closure, retirement or relocation of GPs cannot afford to pay private-billing fees and have little or no access to a general practitioner. Constituents in the Sanctuary Point area contacted me recently with their very real personal stories about accessing a GP, and these are their words. Nancy said: 'When my GP retired, I was at a loss. Being 94 years old, I need someone local. Not so—it's the same old, same old story. Practices had too many patients on the waiting list. Some practices had their GPs retiring, other practices were changing to women's health or COVID-19 vaccine and testing. I feel very frustrated.' Lorelle said, 'My mother had to wait 10 weeks in hospital to be admitted to a nursing home because her doctor had moved and we couldn't find another doctor willing to visit her in the nursing home.'

Leanne said: 'It makes no sense that, at the very least, the number of doctors who have recently retired have not been replaced. It already took weeks to get an appointment before they retired and now the wait time is longer. This is putting more strain on an already-busy Shoalhaven Hospital emergency department. The area is increasing in population, not declining. The number of GPs allocated does not [inaudible]. Wait for a sudden announcement of an increase in GPs just when they call the election so that they can take the credit and say, "We were listening." We need more GPs now.'

Graham said, 'The need for more doctors is an essential requirement for the bay and basin area of the South Coast as the population is growing fast and is also an ageing population.' Estelle said: 'I hope we can get more doctors here, as it used to be. At the moment, it's like living in a third-world country.' Kristy said: 'Where have all the doctors gone? There is a gap, and the minister seems to be in denial. More and more subdivisions are going ahead, with no infrastructure happening or even planned. I'm sure the numbers don't lie, so where is the minister's head on this?' Alan said: 'When our GP retired it took us two months to find another, and not local to me. Every practice was overloaded with new patients. In most cases I was told that one of the GPs at these practices was retiring soon anyway, or one practice was changing its focus.'

Christine said, 'It takes too long to get an appointment because there are not enough doctors.' Thomas said, 'There are not enough permanent GPs.' Leigh said, 'We desperately need more GPs.' Tanya said: 'My doctor I had for years retired and then I found out Sanctuary Point Medical Centre was shutting down, so I decided to try and find a new good doctor. When I finally seem to find a good doctor, the next time I go they're gone. My whole family has been in the situation where we need to see a doctor. Every time I have tried to get in to any doctor, there's a wait—normally a week—so we try and diagnose ourselves. Most of the time we get better and forget about it. My worry is, if one of my family members falls ill with something serious, we will not have one doctor that can see us straight away or that can get to know our family, like our old family doctor. We need permanent doctors out here, and more of them, as I am hearing from so many locals having the same issue. They're really concerned about the current situation.'

Frederick said: 'I'm in my 70s and have reached that time when I'm likely to need more regular visits to the GP. I was disappointed to hear that the Sanctuary Point Medical Centre had not been successful in replacing those two GPs who had resigned. I have a medical condition which requires ongoing observation, and do not feel that seeing a new doctor every visit is providing the level of service that I would expect. Sanctuary Point is a marvellous place to live and I don't see why it's so hard to attract young GPs to the area. As a younger man I would have been very happy to work here and bring up a young family.'

There are many cases, but one thing that strikes me most is when a local GP comes to me for support after having previously had their application rejected to employ a GP to work solely in nursing homes as part of their aged-care program, supporting our most vulnerable. This program literally supports older, vulnerable residents, ensuring they get the care when it's needed. This means less ambulance attendances, less emergency department attendances, lower demand on nursing home care workers, and better coordination with discharge planning and outpatient services, especially palliative care. We've had the Royal Commission into Aged Care Quality and Safety. Isn't this the type of program and employment of GPs that the government should be supporting? Instead, it knocks back supporting it by rejecting the application to employ a GP.

But it doesn't stop there. I'm at a loss as to why a local GP even needed to come to me about support for an application for a GP to work in a COVID clinic. It is beyond belief that that could actually occur. There is so much that needs to be done to improve regional access to GPs. I'm pleased that Labor is listening and that it supported the new Senate inquiry into addressing regional and rural GP shortages. More than ever, the government needs to start listening, to support our GPs, our health workers and our regional communities.

11:31 am

Photo of Pat ConroyPat Conroy (Shortland, Australian Labor Party, Shadow Minister for International Development and the Pacific) Share this | | Hansard source

I am pleased to make a contribution on the Dental Benefits Amendment Bill 2021. This bill implements a budget measure from last year, the 'guaranteeing Medicare' changes to the Child Dental Benefits Schedule. This bill amends the Dental Benefits Act 2008 to remove the lower eligibility restrictions of two years to allow eligible children from zero years of age to access the Child Dental Benefits Schedule. This is a sensible reform and Labor supports it. I note that it's estimated that each year an extra 300,000 children aged between zero and two will become eligible for the program from 1 January 2022, and that 15 per cent of children in this newly eligible age group with teeth issues will access the scheme. Obviously any dental issues in a child need to be addressed, and the sooner they are dealt with the better.

In speaking on this bill, I want to draw to the attention of the House the Child Dental Benefits Schedule, introduced by the Gillard Labor government in August 2012, which was part of Labor's dental health reform package. The package comprised the $1.3 billion national partnership agreement for public dental services, a $225 million flexible grants program, and $2.7 billion for the CDBS—which replaced the Chronic Disease Dental Scheme and the Medicare Teen Dental Plan. Although these reforms may not have been headline-grabbing at the time, they did constitute a serious and progressive public health policy reform, which has always been the hallmark of Labor governments. Since the Gillard government implemented this reform, it's provided over $2.3 billion in benefits and delivered more that 38 million services to over three million Australians.

Almost invariably when I meet with constituents, health is the issue that is always raised as being of fundamental importance to people. In our great Australian social democracy, access to health care based on need, and not ability to pay for the treatment, is something we are rightly proud of and cherish. I do regularly receive feedback from constituents about dental health and the difficulty in getting treatment for particular conditions, so this bill is a welcome addition to the care provided under CDBS. Labor is supporting the government's bill because it does build on a great Labor health reform and is an extension of Labor's legacy in health policy.

In speaking on the bill on health policy, I want to draw to the attention of the House the overwhelming response I've received to my Medicare petition regarding the government's recent attacks. Government members should be very concerned about the feedback I have received. These are some of the things my constituents have told me. I can't repeat some comments about the Prime Minister, as it certainly would be ruled as unparliamentary, but in their comments my constituents clearly identify how much they care about Medicare: 'Stripping essential medical services to ordinary Australians should not be allowed; otherwise, we will end up like America, where people can't afford medical treatment. Medicare is vitally important to all Australians. It gives a sense of safety to those who cannot afford private health insurance.' I have another one: 'Australia's universal healthcare system is revered by many people around the world who cannot afford life-saving and life-altering health care. The Liberals' attempt to transform this system into a money-making machine is deplorable.' I have another one: 'This government doesn't care about any of us, especially those who are struggling and can't afford doctors' fees.' There is another one: 'Our health is our wealth.' Here is another one: 'Medicare is sacrosanct. Hands off.' Finally, Simone from Redhead makes a point that I've often made in this place: 'If people can't afford to go to their doctor, their health will get worse and it will end up putting a strain on our already overworked hospital system.'

They are just some of the comments from my constituents about their passionate support for Medicare and their commitment to a fair and equitable health policy in this country, which this bill builds on. This bill is an important addition to the dental health reforms that Labor put in place, because they're important health reforms. It is health policy that benefits all Australians. I want to emphasise that this bill, the Dental Benefits Amendment Bill 2021, is welcome reform and is supported by Labor, but the Liberals' and Nationals' ongoing attacks on Medicare are not. And let's not forget that we're in the middle of a global health pandemic and that the government is rushing through changes to Medicare that the AMA has warned will drive up the cost of some surgeries.

Many of our colleagues cannot be here because they are in lockdown at home and, since I came to Canberra last week, the whole of Shortland is now in lockdown. In fact, I heard just 35 minutes ago that the New South Wales Premier has extended the Hunter lockdown by another week. Quite frankly, while I'm no medical expert, I would be very surprised if we exit lockdown anytime soon, given the number of cases. But let there be no mistake where the fault for this lockdown lies. It lies with the Prime Minister and his government.

Australia is an international joke because of our vaccine rollout. But it's no joke for the teacher or the cleaner or the truck driver or the aged-care nurse, all of whom are on the front line, all of whom are essential workers who constantly contact my office because they cannot get an appointment to be vaccinated. In fact, the biggest number of COVID cases in my community is an outbreak of COVID at an aged-care home, the Hawkins Masonic Village at Edgeworth. I heard just today that it has been established that those cases—I think there are 12 residents and at least three staff—were caused because an unvaccinated aged-care worker was there and infected the other people. Every single aged-care worker was supposed to have been vaccinated by Easter. They were at priority 1a in the rollout by this government. Mr Morrison has failed my residents with the rollout. The fact that at least half of all aged-care workers are not vaccinated, are still having to go to work and, if they catch COVID, are then very likely to pass it to our vulnerable residents of aged-care homes lies at the feet of this government and of Mr Morrison in particular. That's the context of this bill, which is all about health.

What rubs salt into the wound of the current lockdown is the fact that my constituents see the Prime Minister and Premier of New South Wales on their televisions every night repeating ad nauseam that the way out of lockdown is through vaccination. My constituents have had their appointments cancelled because the New South Wales government stole our Pfizer vaccines and redirected them to Sydney. My constituents and I are absolutely furious about this. Why were they redirected? It is because the Prime Minister failed to get enough Pfizer into Sydney, and he still continues to fail to get Pfizer into Sydney. The New South Wales government's actions are a disgrace. They should be condemned. They should not be stealing Pfizer vaccine from the Hunter and the Central Coast while we have outbreaks, but they were forced to do this because the Prime Minister failed to provide sufficient vaccine to Sydney.

The Prime Minister said in the House last week that those doses would be sent back, but I'm still receiving multiple reports of people who, having had their appointments cancelled, have not had them rescheduled. One constituent emailed me about his daughter's experiences. He wrote: 'My daughter was booked in at Belmont for the vaccination and was advised that her vaccination had been cancelled and given to high school students in Sydney at a private school. She was told she would receive another appointment. Her original appointment was the day after the vaccine was sent to Sydney. She made contact with the booking service and was told bad luck. The government's decision to give the vaccine to the wealthier Liberal Party seats is a disgrace and un-Australian, and something that should be exposed and not forgotten.' This is just a taste of what I'm seeing in my community in relation to health policy and, in particular, Liberal governments' stealing of vaccines from my region, a region that now has a very significant COVID outbreak. This region had known cases of COVID in the community in the northern Central Coast. It was serviced by a Belmont vaccine hub when the Liberal governments stole our vaccine. That is important context for this bill.

In speaking on the dental benefits bill, it's relevant to provide feedback from an actual dentist. Gwen, from Belmont, has a dental practice and contacted my office yesterday. Her business is suffering incredibly because of the lockdown, as she can only perform emergency procedures and she is not eligible for any state government business assistance. Gwen is also absolutely clear about who is responsible for the lockdown that is so damaging her livelihood—the Prime Minister and the Premier of New South Wales. This is the feedback I am receiving from my constituents daily about lockdown, and that's the context for the debate we're having right now.

One aspect of health policy that is relevant to this bill is the attack on bulk-billing in my community. This bill goes to the affordability of dental care, and obviously that's very important, but the affordability of general health care is also very relevant to this debate. Families in my electorate have been slugged by the increased cost of going to a GP because this government has, ridiculously, reclassified my region as a major metropolitan region akin to Double Bay in Sydney. That means that it has cut the payments that doctors on the Central Coast and in the Hunter receive for bulk-billing, and that has had a direct impact on many surgeries. One surgery told me that they've gone from bulk-billing 80 per cent of their patients to bulk-billing 20 per cent. That is having an enormous impact, and I have families who are literally choosing between putting dinner on the table and going to the doctor. That is unacceptable in Australia. It is unacceptable in Australia in the year 2021 that people are being forced to make that choice.

That is just one of the many examples of this government's attack on health policy and health care in this country. Another is the separate, but related, reclassification of the Hunter and the Central Coast in relation to doctor shortages. We are now treated in the same way as the eastern suburbs of Sydney, that, somehow, we've got a surplus of doctors. That means that GP surgeries in my electorate and nearby don't get incentives—doctors don't get the points they get from serving in places like Dubbo or Tamworth—which means my GP surgeries are finding it incredibly hard to attract GPs. They are literally struggling to staff their GP surgeries. I had the head of the Lake Munmorah surgery contact me about this recently. He is having enormous difficulty finding doctors. So if you get to a doctor under this government, you are paying more than you've ever had to before, and that's if you can find a doctor, because under this government it's incredibly hard to get on the list for an appointment to see a new GP.

This dental health benefits bill really should be seen in the broader context, which is the multiple attacks by this government on health care: the GP shortage, through their reclassification; bulk-billing, through their reduction in the bulk-billing incentive; and the attack on the Medicare Benefits Schedule that the AMA and the Grattan Institute have said will increase out-of-pocket costs for people having surgery.

These are all attacks on the health of my constituents, which is made worse by the current COVID crisis. In the COVID crisis, the government has failed Australians and failed my community. I am so furious with the incompetence of the Morrison government. This government has failed with the national quarantine system, which allowed 27 outbreaks, including the one that started the eastern suburbs cluster. The New South Wales Premier, pandering to the wealthy eastern suburbs, was too weak to lock it down when she had the opportunity. She was egged on by the Prime Minister, who, nine days into the Bondi cluster, congratulated her on not locking down. That COVID outbreak then spread to Western Sydney, the Central Coast and the upper Hunter because there wasn't sufficient vaccine available throughout New South Wales and Australia. Then the New South Wales Premier stole the Central Coast's and the Hunter's Pfizer vaccines because she couldn't get sufficient COVID doses to Western Sydney. So this attack on the health of all my constituents in lockdown is just the latest example of this government's contempt for health policy in this country.

Before I commend this bill to the House, I just want to say that this will likely be my last opportunity to speak in the chamber for some time, as my home region will probably still be in lockdown in the next sitting fortnight. I will be travelling home tomorrow to start the joys of homeschooling and to be part of the lockdown with my community. We will continue to do our welfare calls for my constituents. We've managed to contact over 1,500 households in the last two weeks to check on them. I want to say to my constituents: thank you for following rules; thank you for doing the right thing; thank you for bearing with the incompetence of the Morrison government that's caused you to be in lockdown right now. If my office can assist in any way, whether it's income assistance payments, which this government has resisted, or access to food banks and charities or referrals to mental health services, please contact my office. We are still operating remotely during this difficult period.

I just want to let my constituents to know that I stand with you. This is a really troubling and hard period, but we will get through it. But we are in this present situation because of the appalling incompetence and arrogance of the Prime Minister and the Liberal and National parties. They have failed the people of Australia, who are now suffering the health and economic consequences because of the ineptitude and mendacious behaviour of this government.

11:46 am

Photo of Ged KearneyGed Kearney (Cooper, Australian Labor Party, Shadow Assistant Minister for Health and Ageing) Share this | | Hansard source

[by video link] I'm speaking from the lands of the Wurundjeri people of the Kulin nation, and I pay my respects. I'm very pleased to speak on the Dental Benefits Amendment Bill 2021 and the amendment moved by my colleague the member for Ballarat. Dental care is an incredibly important part of our healthcare system. We support this amendment and this bill, which will eliminate the lower age limit on the eligibility to the Child Dental Benefits Schedule, extending access to the scheme to children from birth to 17 years of age. This is a very welcome reform and one which builds on the legacy of the Gillard Labor government, which first introduced the dental health reform package back in August 2012. The scheme provides means tested financial support for dental services for children. Families with children aged between two and 17 years old who receive benefits such as the family tax benefit part A, the parenting payment, carer payment and other benefits are eligible for over $1,000 worth of dental care over a two-year period, and that will now be extended to children from birth.

Since Labor introduced this reform, it has provided over $2.3 billion in benefits for more than three million children. This support is life-changing for so many people. We know that promoting and practising good oral hygiene with children from a young age is a strong determinant of dental health into adulthood and later life. As a parent, and now a grandparent, I know a little help convincing kids to keep up good dental health care can go a long way. Some kids rail against tooth-brushing time, for example. We use incentives like superhero toothpaste or a musical toothbrush, and we know that they can go some of the way. I know that Frozen Elsa and Ana toothbrushes are a staple in my granddaughter's household and so many households. A non-traumatising trip to the dentist as a child is something that really does stick with them and starts a lifetime of good habits around dental hygiene.

My son Ryan, after a positive trip to the dentist, was fixated on brushing his teeth for a minute—no more and no less—and he had a clock situated in the bathroom, on the sink, timing that tooth-brushing regime. It was hilarious, but it was effective—something he learned from a great trip to a school dentist. In fact, I heard the member for Macarthur earlier today mention that some children are born with teeth. Well, that same son of mine actually was one of those children. He was born with a tooth. It had to be monitored from birth, because, as we heard from the member for Macarthur, it can cause problems. Indeed, he required dental treatment from birth to when his braces were removed around the time he was 17. Thank goodness that was when my role as being responsible for his dental care was almost done. In fact, that whole period of care was what this bill now includes: birth to 17. So I can tell you that the lessons of the dentist stick with people.

We also know that dental health has flow-on effects for many other aspects of both physical and mental health. Poor dental health has been linked to diabetes, heart and lung disease as well as issues with nutrition and the stress and anxiety associated with the loss of teeth or the pain of dental issues. Those three million kids who have accessed dentistry as a result of Labor's reforms not only had the immediate benefits of dental care but will continue to benefit from having avoided these issues, which we don't often think of when we're headed to the dentist but are so closely linked to our oral health. It's important to note that what this scheme really speaks to is equitable access to health care. As I said, this is a scheme targeted to families who are receiving benefits. The kids who have access to this scheme are the kids with the highest likelihood of having dental health issues but the lowest likelihood of being able to afford dental care. As the member for Macarthur said, extraordinarily, he can tell the income of a child's family by examining their teeth. For families this scheme is the difference between choosing to send their kids to a dentist for a check-up and being able to pay the bills. It's a choice no family should have to make, and with this assistance it's one they don't have to make. It is a remarkable scheme. As we know, even the government continues to benefit by having avoided increased downstream medical costs from these health issues mentioned earlier, so I do commend the government on this bill, which will extend children's eligibility. It is predicted that 45,000 kids a year will have access to dental care each year as a result of this amendment; that's something to be commended.

It's terrific that the government have followed Labor's lead and will extend access to dental care to more children. But Australians know that Labor is the party of health care. We're the party of Medicare. Central to our approach to health care is the understanding that all Australians deserve equal access to a high standard of medical care, regardless of income, location or anything else. Throughout the pandemic, that understanding has driven our approach when it comes to the government moving legislation and taking health measures to the Australian people. We've supported these measure that give high standards of care to Australians. But where measures draw up short, whether in the standard of care or how they can be accessed, we highlight where the government policies need to be improved. I've had the privilege of serving as shadow assistant minister for health and ageing for the last 6½ months. It's been a hectic time to be in this portfolio. What I've found in speaking to practitioners, experts and patient alike is that the focus is on the pandemic. It's vital, of course, to focus on the pandemic, but we've seen other health priorities drop off. It's an interesting time to be working in the health space because, while it feels like health care and health research in particular have never had so much focus and so much airtime, some of the key pieces of the healthcare puzzle are being left out of the conversation.

Those of us in Labor believe a vital part of our role through all of this is to make sure those issues stay on the agenda, so I'm pleased to speak on this amendment which draws the House's attention to the issues of access to health care for our regional, rural and remote communities. What we're hearing time and time again from doctors, nurses, allied health professionals and specialists in regional Australia is a passion for providing the highest standard of care for their patients. They believe wholeheartedly that their communities deserve this standard of care and proper, equitable access to it. Unfortunately, this government is allowing them to fall through the cracks. Over the eight years of this coalition government, there's been inadequate funding for regional and rural health, and we've seen a complete absence of any cohesive strategy to increase access to health practitioners and care. This is no small issue. In far too many cases this has been a matter of life or death. There are people in this country who are driving for hours to see a GP or specialist. A study from the Australian Institute of Health and Welfare found 20 per cent of rural Australians—20 per cent—were unable to access a GP. We know that 60 per cent of rural Australians can't access a specialist. There are aged-care facilities in this country that have been unable to find a doctor to attend when a resident is sick because there aren't any in the area. We also know that nursing and midwifery positions aren't getting the funding they need from this government, so we're seeing babies being born on the sides of roads. In 2021 this is still happening, and it's happening under a government whose members come into this House every day and declare that they are the party for regional Australia, that they're governing in the interests of regional Australia. Yet we know that regional Australia is constantly left out and left behind when it comes to health care, all on the Morrison government's watch. It's a disgrace.

Having easy access to a GP doesn't just mean you're able to seek help when you're sick; it means having access to the expertise of all kinds of health experts. We know that regular trips to the GP enable the timely diagnosis of more serious illnesses, often when the patients are presenting for a completely different reason. This timely diagnosis allows for better and more effective treatment, and this, in turn, leads to better health outcomes for the individual and decreased health expenditure in the long run. Ease of access to health care can mean the difference between a chronic disease being detected and treated, or being left undetected and worsening. It very often makes all the difference for a person's quality of life.

So Australians living in rural and regional Australia must be given access. It's absolutely a priority and a must for this government. That means training more GPs and providing the right incentives for them to live in regional Australia. It means properly funding and training more nurses, midwives, nurse practitioners and allied health professionals, and encouraging them to work in every corner of the country. It means having a cohesive health strategy, one that understands the local nurse and GP act as a gateway to accessing more tailored health services—and it's vital that these services are easily accessed by patients.

We've seen rates of testing for various diseases, like cancer and diabetes, drop through the pandemic. I will take this opportunity to encourage anyone listening to keep up their regular testing for these diseases. With these rates dropping, it's vitally important, more than ever, that we increase access across the country to health practitioners and get our ongoing [inaudible] back on track. You can't do it without having a GP and other health professionals to go to, and you certainly can't do that if you can't afford the treatment.

I spoke earlier of the importance of the dental benefit schedule in ensuring more equitable access to health care and how core that is to Labor's approach to policy in this area. Unfortunately, we've seen during the Liberals' time in government that the equitable access to health care that Australians pride themselves on is slowly slipping out of grasp. Out-of-pocket expenses are rising, it's more expensive to go to the GP and it's more expensive to access a specialist. And, with the news in the last little while of the results of the MBS review, we know it's now going to be more expensive to have surgery.

The results of the fee hikes under this government are very simple. They mean it's less and less likely that people will go to the doctor to have an illness treated or to get better. A person's income shouldn't determine whether they're able to access treatment. It's a fundamental right that we as Australians sometimes take for granted, but when it's under threat I know we're incredibly protective of it. I've seen that in my life as a nurse and as a trade unionist. Those of us on this side will fight the government every step of the way when it comes to their undermining and underfunding of our healthcare system. So I urge those opposite to utilise the increased focus we've seen on health care through the pandemic to continue that focus and to sort out these issues. We need to act now to make sure that everyone has access to a local GP and other healthcare professionals—access to specialist services. We need to ensure that no-one is turned away from proper care because they can't afford it. The amendment and this bill are welcome, and we support these changes today, but it would be wonderful to see this goodwill extended further and to see the Morrison government really act to better our healthcare system as a whole.

I'll just take my last couple of minutes to give a big call-out to everybody in the ACT today, who we know are going into lockdown as of 5pm this afternoon. I wish everyone well and to take care—especially my colleagues in the House. I know everybody will do the right thing, I know that people will go and get vaccinated and I know that people will be worried, but I ask them to take care.

11:59 am

Photo of Shayne NeumannShayne Neumann (Blair, Australian Labor Party, Shadow Minister for Veterans' Affairs and Defence Personnel) Share this | | Hansard source

I'm pleased to support this legislation and the amendment in relation to it. It's a surprise that the Dental Benefits Amendment Bill 2021 comes from the coalition government. It builds on what Labor has done when we were last in government and I will refer to that and to the history of this particular legislation as well.

Effectively, the Dental Benefits Amendment Bill 2021 removes the lower eligibility age restriction of two years to allow eligible children from zero years of age to access the Child Dental Benefits Schedule. That will benefit 2,000 or more children in my electorate of Blair in South-East Queensland. That's very important. About 300,000 children across the country will benefit each year. This scheme operates to provide eligible children currently between two and 17 years of age access to over $1,000 in benefits for basic dental services, with benefits capped over two consecutive calendar years. This is a good amendment, and it is a surprise that it comes from a coalition government.

I'm happy to talk about the background to this particular piece of legislation and the amendment that relates to it. When Labor was last in government, back in 2008, we brought in a new teen dental plan which meant that eligible families—usually people on family tax benefit A and those in receipt of Abstudy or youth allowance—could receive an annual preventive dental check for each child between the ages of 12 and 17. That was to help families fix their kids' teeth and to honour an election commitment we made. It comprised oral examinations, cleans, scales and x-rays, which cost about $290 at the time. The statistics showed that at that time that one in three Australians avoided attending a dentist because of its cost. That has continued in large part. The funding that we announced was to provide welcome relief for families who were struggling to meet the cost of a dentist.

This particular plan was very well received at the time and supported by families. When we were last in government, we brought in a new scheme on top of that, which was benefiting about 25,000 children in my electorate around Ipswich and the Somerset region, making it easier to go to a dentist or see a doctor. The program was called Grow Up Smiling, which benefited about 3.4 million Australian children. It provided subsidised child care and additional services for adults on low incomes, including pensioners and concession card holders with special needs who needed better access to the public dental care schemes run by the states, and additional funding of $225 million for dental capital and workforce, to provide expanded services for people living in metropolitan, regional, rural and remote areas. I will get to that aspect as well. This scheme was very well received. I remember the then CEO of the previous West Moreton-Oxley Medicare Local in my region, Vicki Poxon, saying, 'An announcement like this will go directly towards improving the all-round health and wellbeing of our residents, in particular, children and pensioners, who need it the most.' About 20 per cent of the whole West Moreton region into rural parts of Ipswich and beyond were children under 14 years of age at the time. That particular announcement was very well received.

It's really important that we address the issue of dental decay in children. That is not just because of the chronic long-term impact and not just in terms of their employability, their lifestyle and their future health; it is also a real benefit to our expenditure when it comes to Medicare and public hospital funding in the future. If you can provide preventive health care at the beginning of life and continue that with regular check-ups, it has better outcomes for the health of the country and better economic outcomes. Poor dental health has a wide-ranging impact on speech, sleep, eating and employability. It's important to relieve the pressures on public hospitals and the broader health system.

Labor have a proud record in this space and we are very pleased to see the government has picked up on this after a review in relation to it. It has not always been the case. Like many on our side of politics, I would be very happy to see Medicare extended to cover dental services as well. When in office many, many years ago, the current government—the Liberal and National parties—were not supportive of better health outcomes for Australians. They opposed Medibank when Gough Whitlam and Bill Hayden brought it in in the 1970s and when Malcolm Fraser came into power in 1975 as a result of the coup that took place on that occasion. They then dismantled Medibank—we know it as Medicare today—and it took until the election of the Hawke Labor government to bring back Medicare in the form that Australians anticipated and that Labor wanted to bring it in back in 1972-75. It took until the eve of the 1996 federal election before the then Liberal opposition leader, John Howard, said that he would support Medicare.

As the shadow minister said, the coalition in opposition and also in government have never been comfortable with Medicare. When it comes to dental care, their form remains the same. For instance, when Labor was in government in 1972-75, the Whitlam government brought in the Australian School Dental Scheme, which had a really big impact. In 1997 the Australian Institute of Family Studies, having examined the scheme all the way through the Fraser years and looked at what happened under Hawke and Keating, said that that particular scheme had reduced dental waiting times for most disadvantaged people. Before that program 47.5 per cent of people with health dental cards waited up to a month for dental treatment, and 21.1 per cent waited for more than 12 months. So, while that program was operating, 61.5 per cent of people waited for less than a month for dental treatment and only 11.3 per cent waited for more than a year. So it was a rip-roaring success. Malcolm Fraser and his government tried to dismantle it in large part, but it took until the Howard government to completely dismantle the scheme and replace it with nothing. It got to a point in this country where the Sydney Morning Herald had a headline on 26 January 2007 saying, 'Country aching over dental crisis'—a pretty clever headline, if you ask me!—and a headline on 19 March 2007 saying, 'Dental care is failing the needy'.

On the eve of the election, or not that long before, the Howard government decided they'd bring in a new scheme. They didn't means-test it at all and they said it would cost about $90 million. This was a chronic disease dental scheme, and it was not means-tested. Twenty per cent of the funding for that was high-cost restorative care. What happened was there were rorts galore of the system—a program that was going to cost $90 million per year cost $80 million a month, and it meant people in wealthy parts of the country could get access to the scheme in large part to the disadvantage of people in poorer, regional and remote areas and outer metropolitan areas. When Labor came in, we abolished that scheme and we set about doing the kinds of programs I have outlined.

But when the Abbott government came in, what did they do? Pretty well straight away, the Abbott government did weird stuff—things like cutting $15 million from the Charles Sturt University dental health program, funding which was needed to help the much-needed dentists of the future. It did really strange stuff, like cutting $390 million out of funding to reduce waiting lists. It was constantly being attacked by people like Griffith University professor of dental research Newell Johnson, who described funding cuts as 'a disaster' for dental health. The Australian Dental Association president, Dr Karin Alexander, warned delays would cause waiting lists to double or treble.

This government, when they came to power, set about, under the National Commission of Audit, cutting and slashing and burning. This is the party of the co-contribution on Medicare. They made it harder for people to get access to the kind of support they needed and regularly took steps to try and cut funding, whether it was attempts to cut funding for waiting times at public hospitals—they were constantly at war with the states and territories when it came to health and hospital funding. Even when Prime Minister Turnbull was in, we had to block the kinds of cuts they wanted to do—30 per cent of cuts to health funding as well. They just never cease to try and cut funding.

This particular piece of legislation is very, very welcome, but it's only a little bit of what they need to do. The office of the Queensland health minister, Yvette D'Ath, has provided me with some information in relation to the role the Commonwealth government plays across this space. The most recent national partnership agreement represented, by this government, a reduction in Commonwealth dental funding of approximately $8.7 million, or 30 per cent less compared to the previous NPA. The Queensland government has accepted an offer from the Commonwealth government of a 12-month extension of the NPA, until 30 June 2022. However, there is no long-term certainty in relation to funding. So the Queensland government has repeatedly expressed its concern about the reduction in Commonwealth funding and the increased pressure it places on the state public dental system. The impact of this funding reduction on public dental services in Queensland has made it more difficult for Queenslanders to get access to general dental care at public dental clinics. So it's crucial that this government do things like not just this legislation that's before the chamber but other stuff such as maintaining a long-term funding commitment to make sure that people can get access to timely general dental care at public dental clinics and that we have a sustainable system of dental care in this country.

In the three minutes that I have left, I'm going to talk briefly about the fact that my electorate has been grossly disadvantaged by the change in classifications of the distribution priority areas. I wrote to the previous minister, the member for Parkes, and I want to thank him for coming to my electorate and meeting with a local doctor at Walloon. I found him useful and helpful to deal with, and his office was very good to deal with when he was the minister. Unfortunately he couldn't fix the problem. I've written to the new Minister for Regional Health, Dr Gillespie, about the issue, saying that we've got a really big problem in my area and we've got to fix it. We've got changes of classification which mean that doctors can't get access to other doctors for their medical practices, and the healthcare system will be worse. Minister Coulton said to me in correspondence that the Commonwealth government couldn't change the distribution priority area classifications but they'd have a look at it at some stage in the future if the health outcomes were worse. Why do that? Fix it now.

All I'm asking is to make sure that Ipswich, the lower Somerset region, around Karana Downs and Mount Crosby can get access to doctors. I've spoken to multiple medical practices in my area, and they all tell me about the challenges of recruiting doctors with these restrictions in place. Whether it's doctors at Riverlink, in the same shopping centre where my Blair electorate office is located, or doctors at Karana Downs or Walloon or elsewhere—it doesn't matter where I go—when I speak to local doctors, they all say the same thing. This DPA classification system is claimed to be impartial, but it's arbitrary and it's inflicting worse health outcomes in my area. I'm calling on the new minister to do the right thing, to change the classifications. The DPA classification system is having an adverse impact in rural, regional and outer metropolitan areas.

Dr Magdy El Ashrey, a specialist GP and the owner of the Walloon Medical Centre in my electorate, at Queen Street, Walloon, is having trouble getting doctors to come and work in his regional medical practice. He's been there for 20 years. He's served with distinction the residents of rural parts of Ipswich—indeed, into lower Somerset and urban Ipswich as well. He needs help. His is just one of many medical practices in my area which need help. The government should look at this again. I'm urging the new minister to correct this problem, to fix it and make sure this DPA system operates for the benefit of all people in my area.

12:14 pm

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

[by video link] I would like to acknowledge the Kaurna people of the Adelaide Plains and pay my respects to them. It is from the Adelaide Plains in the electorate of Adelaide that I speak today. I wish everyone well and I hope that everyone is safe in the ACT, Victoria, New South Wales and wherever else there are lockdowns. It gives me pleasure to speak on this particular bill, the Dental Benefits Amendment Bill 2021. As my colleagues, the member for Blair and the member for Cooper, and others from outside of politics have previously said, we support this bill. It is a good measure because it expands the eligibility of the Child Dental Benefits Schedule, known as the CDBS, which Labor brought in a number of years ago, and that is a good thing. It will remove that lower age eligibility of the Child Dental Benefits Schedule and open it up to children aged between birth and two years of age—to monitor, to check et cetera to see if there are any issues—which will then build a good foundation for the rest of their lives when it comes to oral hygiene and dental care.

This scheme was an important initiative introduced by the Gillard government in 2012. It provided eligible children aged between two and 17 years access to up to $1,013 in benefits for basic dental services, including examinations, routine cleaning, fillings, monitoring and root canals. The scheme covers children who live in lower- and middle-income households, those who receive family tax benefit part A and other payments from the Commonwealth, and the benefits are capped over two consecutive calendar years. Since its introduction, it has provided over $2.3 billion in benefits—that is, $2.3 billion for children who, in other circumstances, perhaps, would not have had their teeth checked, perhaps would not have had work done on their teeth, which then brings in poor oral hygiene for the rest of their lives. We know how important dental care is.

All of us in our electorates speak to constituents who, on a regular basis, speak to us about not being able to afford to get the dental care that they require. I have been a big advocate in my electorate, from day one, when I was first elected in 2004, calling on the Commonwealth for a national dental health scheme. We heard the member for Blair touch on it earlier. We see constituents on a regular basis, pensioners and people who are on very low incomes, who cannot afford to have their teeth fixed. For the life of me, I can never understand why, if you break an arm, Medicare will cover it, because it is a bone and you need to operate your arm. But if you break a tooth, which is, again, a bone, it is not covered. Yet that broken tooth will lead to poor dental hygiene, will lead to poor diets because you can't eat the correct foods and will then spiral into other negative health outcomes, which will then cost the government even more. I have always been a big advocate. I have pursued it and I have raised with governments over the years that we should have a national dental scheme, especially for lower-income people who perhaps cannot afford to have their teeth fixed.

The changes we are debating today are very welcome and have been praised by many stakeholders. There is clear evidence that supporting and establishing a positive dental experience at a very early age, between one and two, makes sense. If parents are practising oral hygiene with their children at this early stage, it will not only aid in the prevention of more serious dental problems in old age and as children are growing up but it will also give them a sense of how important dental hygiene is and how important it is to have regular check-ups and how important it is to see a dentist on a regular basis. It will also, importantly, help curb the negative stigma around dental practitioners and oral hygiene from an early age. If a child's initial experience with dental care is one which is not positive or one requiring perhaps serious treatment, they could be traumatised for a long time if it is not a positive experience. This is really important: if a child is introduced to dental care from a very early age, not only can they avoid serious and painful treatment but the chances of that child going through life having positive experiences with oral hygiene grow considerably the earlier we start. It's estimated that, thanks to this particular scheme, some three million Australian children have avoided worsening physical and mental health impacts from untreated dental conditions. This has enormous flow-on benefits at both a personal and a social level.

It's estimated that, each year from January 2022, 15 per cent of children in this newly eligible age group will access the dental benefits schedule. That's roughly 45,000 children per year—45,000 kids with better oral health, better physical health and better mental health. That's up to 45,000 families with fewer worries about being able to pay for the dental care their kids need. And that's 45,000 kids with a better relationship, better experience and better view of dentists because they've been exposed to a dentist early in life and have the benefits of that flowing into the rest of their lives. That's why, on this side of the House, Labor supports this bill and commends it to the House.

These changes will also help address the fact fewer children appear to be accessing the scheme compared to initial expectations. According to reports, the Commonwealth initially expected about 80 per cent of eligible children would use the scheme. However, as we heard earlier, according to the Grattan Institute less than half of the children eligible for this scheme appear to be involved, so this figure hasn't changed much in the eight years of this government. It is unclear why the figure is so low. It could be that not many parents are aware that the child dental scheme exists and that their children are eligible for care under the scheme. Whatever the reason, one thing is clear: we must do more in this area. We should work more closely with the states to promote the scheme and to boost that uptake. It may be that people are unaware of it or have no idea they're eligible, so we need better promotion of this scheme. There is no doubt we need to make a greater effort in this important policy area and in the process. We need to get more kids to the dentist to have those dental check-ups and to have the dental work that's required.

Australia performs well, and even better than many countries, on a range of healthcare indicators. However, there are some areas where we do need improvement, and they're clearly needed. Comparing Australia with other OECD countries, especially those with universal or near-universal dental care schemes, shows that Australia lags way behind comparable countries when it comes to dental care. I spoke earlier about a national universal dental care scheme. It's quite clear in the Constitution—under section 54—that dental care is the Commonwealth's responsibility. If you look it up, it's in there. It says 'medical and dental care'. For the life of me, I cannot see why we discriminate between those two areas. If you break an arm, you go to a doctor. They fix it for you and Medicare will pay for it. If you break a tooth, it impacts on what you can eat, on the intake of vitamins et cetera that are required for a healthy body. It has detrimental effects, if you can't chew and swallow, and ends up costing the government more in health care, but we don't cover it. I really think we should look at a scheme that covers people's health care, because it is an important part of health. Most doctors and health experts would agree with me: it's an absolutely important part of health, especially as we get older. Bad dental health relates to heart conditions, diabetes and a range of other things.

We heard the member for Blair speak earlier about the scheme Labor brought in for low-income earners, especially pensioners. I can't remember the exact amount, but they were given just over $1,000 per annum to have dental care done at a private dentist instead of waiting on those very long lists, where you can wait for up to six to 12 months to get a pair of dentures or to have your teeth looked at or even a filling. You can imagine a pensioner, someone over the age of 65, 70, 80, 85 or 90, waiting 12 months for a pair of dentures. Our scheme that we had back then provided just over $1,000 per annum for a person to go, with a referral from their doctor if the need were pressing—and it would have been pressing—to a private dentist. We helped and supported many people in our electorate. We got them to go to their GP. They received a letter of referral saying that it was an emergency that they receive their dentures, and they had dentures done within a period of months. It was a great scheme which helped those people then have good oral hygiene and not cause further problems for their health.

We've seen newspaper reports of people who cannot afford to have dental treatment. Recently I had some dental treatment and it cost thousands of dollars. Now, I was in a position where I could pay for it, but the majority of people cannot pay for such treatment. The majority of people go on those public waiting lists. Their dental problems deteriorate, which then has an ongoing effect on their health. It's wrong. I feel it's very wrong, and at some point we should think long and hard about a means-tested national dental scheme that will cover people so they can get the dental care that they are required to have.

We've seen newspaper reports of people who have done self-dentistry with alcohol and a pair of pliers. That has been reported in the papers. It is so sad to see people who have worked all their lives, have paid their taxes and, because they're on a Commonwealth pension, cannot afford to go and see a dentist and have to go on these long, long dental waiting lists that can take up to 12 months. What do we do for those people? We can't just shrug our shoulders and say, 'Dental is not our responsibility.' It is our responsibility, because it affects health. So I'd urge all of us in this place to think long and hard about a scheme that perhaps the Commonwealth could come up with to ensure that we have a dental scheme similar to that of other OECD countries that have national dental schemes that are working well. As I said, I cannot see why we separate dental from our national health scheme.

This is a bill that will go some way towards helping people to have good dental hygiene. We know that if those foundations are put in place very early there is the likelihood that they will help and assist people to maintain that good hygiene so they will have good dental care over the years. I know that we need to go even further and look at people who are entering old age, where teeth deteriorate in a rapid manner. We need to be able to show some care to those people and help them as well.

I know that, when we talk about health in this place, we have a government which historically has opposed Medicare. After Gough Whitlam had brought in Medicare, the next Liberal coalition government that came in under Fraser abolished it. It took another Labor government to come in and bring in a national health scheme so that we could all have cover from Medicare. I'm know that what I'm saying today may fall on deaf ears, but I'm hoping that under a future Labor government we will look at some sort of scheme that will cover health in a way that also includes dental care. As I explained, we went some way towards doing this when we were last in government, with the scheme that assisted teenagers and their dental hygiene, the Medicare Teen Dental Plan. We also had a plan for pensioners that covered them for around $1,000 a year for emergency dental treatment. When you need dentures and you have no teeth, dentures are an emergency. I'd like to see some of those things come back.

We're supporting this bill. I think it's a good, positive step going forward to ensure younger people build those foundations that are required for better dental hygiene and for better experiences at the dentist, ensuring that it puts in place good oral hygiene for their lives. I commend the bill to the House.

12:29 pm

Photo of Emma McBrideEmma McBride (Dobell, Australian Labor Party, Shadow Assistant Minister for Mental Health) Share this | | Hansard source

[by video link] I join my colleagues in speaking in support of the Dental Benefits Amendment Bill 2021 and the amendment moved by the member for Ballarat. Labor is proud of its record in health care. It was Labor that introduced Medicare, as my colleague the member for Adelaide just mentioned, and it was Labor that introduced the Dental Health Reform package in August 2012. A key part was the child dental benefits scheme, delivering financial support for children between two and 17 so they could access dental care, many for the first time. Families receiving benefits such as family tax benefit part A, parenting payment and carer payment are eligible for the child dental benefit, which provides over $1,000 to families over a two-year period so they can cover routine check-ups, dental cleaning, dental fillings and root canals.

Thanks to this program, we know that over three million children across Australia have avoided the painful side effects of untreated dental conditions, impacts that are both physical and mental. This has had significant flow-on benefits to household budgets and to the government's bottom line because it helps people to avoid downstream medical costs. This is a Labor legacy, and it's a demonstration of what government can achieve when it's focused on the day-to-day lives of all Australians, especially young people.

This bill now extends the coverage of the dental benefits schedule for children from birth to the age of 17, removing the lower age limit on eligibility. As a result of this change, it's estimated a further 300,000 children from nought to two will become eligible for the dental benefits schedule every year. It's well known that good dental care from a young age will mean avoiding serious problems in the future. From 1 January 2022, it's estimated that 15 per cent of children in this age group will become eligible for the program. That's 45,000 Aussie kids with better oral care, better physical health and better mental health. It means up to 45,000 families won't need to worry about being able to pay for the dental care their kids need. Labor supports this bill, which builds on Labor's legacy in health care.

I'd like to turn now to the proposed amendment to this bill and the issue of GP shortages and sustainability in rural and regional areas across Australia, including in my community on the Central Coast of New South Wales, where I join you from today. The lack of doctors in rural and regional Australia is not a new issue. It's a longstanding problem. But it is one that has gone on for far too long. People often say that Australia has universal health care, but we don't. We're increasingly seeing a two-tiered healthcare system in Australia, where access to care is increasingly determined by where you live and how much you earn, and communities outside big cities are finding it harder and harder to see a GP, to get the primary health care that they need close to home. We know from Institute of Health and Welfare reports and others that people living outside big cities often have poorer health, which is made worse by longer waiting times, higher out-of-pocket costs and a shortage of healthcare workers.

As a pharmacist and local MP I know that, if people delay care, their condition will only get worse, and these people will end up in emergency departments, clogging up what is already an overwhelmed hospital system, when a trip to the GP could have helped them sooner and avoided these problems. People in my community on the Central Coast have been battling an acute shortage of GPs for a long time now. Practices are being forced to close their books as GPs move away or retire. They're being overwhelmed by lengthy cancellation lists and they can't get access to more GPs to help ease the pressure. That means some locals have to wait up to three weeks for routine appointments; for some, the wait is even longer.

This is in large part because the government refuses to recognise the northern end of the Central Coast as a priority. It's not a distribution priority area, according to this government. I've been calling on the government to make the coast a DPA for a long time now. Changing our classification would allow local practices to recruit and retain more GPs from a wider pool of doctors, and help people in my community get access to health care more quickly—quality care close to home, which is what every Australian deserves, especially in a global pandemic. Fortunately, Wyoming-Ourimbah, which is part of my community, now has DPA status, as of 1 July. This means practices in this area should be able to access more GPs. The northern end of the Central Coast was completely ignored, and much of it remains non-DPA, despite ongoing calls from patients, from GPs, from our community.

I keep hearing stories from locals about how they're struggling to see a GP, and that's in the middle of a pandemic, when it's more important than ever to talk to your GP, to get trusted advice, to have the reassurance you need, especially when it comes to getting the vaccine. People in my community are desperate to get vaccinated. They want to book an appointment with a GP so they can seek medical advice and they can get the jab. But they can't. In the middle of this global pandemic, in the middle of COVID-19, people shouldn't have to worry about getting access to primary health care. They should be able to book in to see a GP straightaway when they need that care and advice.

There are people like David. David lives in Wyong on the Central Coast, in my home town, but he used to live in the Hawkesbury. He told me that he needs to make an appointment at least a week in advance if he wants to see a doctor on the coast, but that not the case further south. He said: 'I'm better off making the trip down to the Hawkesbury. I can get in within an hour down there.' David and others shouldn't have to drive down to the Hawkesbury, or wherever else they've lived before, to see their former GP to get a doctor's appointment, especially in the middle of lockdown. Locals should have timely access to health care close to home in their own community.

Leonie from Toukley told me a similar story. Her husband tried to get in to see a GP in their local area when he became unwell. Every single practice told him they couldn't take on new patients, and they were forced to send him away. He then had to make a half-hour trip to San Remo, where he could get in to see his old GP, only to be told that he was in the middle of a cardiac event. To make matters worse, he had to take his children with him because his wife, Leonie, an aged-care worker, was working at the time. This just shouldn't have happened. If Leonie's husband had been able to get in to see a GP close to home he would have known what was happening sooner and he could have been taken to hospital for the treatment that he needed urgently. Incidents like this are completely avoidable. They're preventable, but they're still happening and that's all because there aren't enough GPs in our community to keep up with the demand.

Then there's Kristy from Wyee Point, just outside my electorate. Kristy is a young mum who became very concerned when her young son fell ill. She tried to take him to a GP, but she was forced to wait days before she could get an appointment. During this time, her son's condition, sadly, got worse. He had a high temperature, he started vomiting and he was having convulsions. He ended up in ICU in Westmead children's hospital in Sydney with a collapsed lung, a chest strain and 40 millilitres of fluid on his lungs. He was 16 months of age at the time. Thankfully, he's now fully recovered, but this should never have happened. This toddler should have been able to see a GP and get care close to home sooner.

As a young mum, Kristy said it was a frightening experience for her. She said, 'Kids should never end up in ICU for something that should and could have been treated earlier.' She said that she developed such bad anxiety from that experience that every time her kids get sick now she gets anxious. But that's not all. Kristy's two-year-old daughter had an incident of her own. Recently, she started having an asthma attack and went into respiratory distress. Kristy took her to the hospital, where she had to wait four hours to be seen by triage. She said: 'Is she meant to be unconscious before someone can give her medical attention? I had to drive back home and call an ambulance.'

This not only is just not good enough; it's risky. It's unsafe for local people in our community, and it's not just good enough. People in my community are suffering because they can't get timely access to medical care close to home. As I mentioned, local practices are being completely overwhelmed and are being forced to close their books because they don't have enough GPs to take on new patients. I was speaking to a senior GP yesterday who was just exasperated. Two GPs from his practice are moving interstate, and he can't replace them. The several thousand patients that they see currently now no longer have a GP. They can't absorb them within that practice and they have had to let them know that they can't provide them with ongoing care.

This is a long-running issue on the coast, which all local MPs are aware of. That's why I was frustrated to see claims recently that 33 new GP registrars were set to start work in our region this month. It's just simply not true that 33 new GP registrars will start work this month. I've spoken to local health professionals in my area, as a pharmacist myself. These registrars already exist and work on a rotational basis. They're not new GPs for our community. We have a major shortage of GPs on our hands and we need to do something to fix this.

Unfortunately, a shortage of GPs isn't the only problem. Affordability is also a major concern. The cost of seeing a GP is at an all-time high, and practices that until recently bulk-billed have now stopped doing so during the pandemic. Across Australia, the average out-of-pocket cost to see a doctor has increased by 37 per cent over the last eight years. On the north end of the Central Coast, in the community I represent, the average out-of-pocket fee is $33, and that's before you go to the pharmacy and fill the prescription that you need for the medicine for your treatment. That amounts to a 31 per cent increase since this government was elected, and it's a direct result of the government's Medicare freeze. But that's not all. The cost of seeing a specialist is even higher, and waiting times are growing. The average out-of-pocket cost is over $85, up over 50 per cent. This increase is felt by many people in regional communities, especially those who can least afford it.

It's well past time that something was done to fix this critical issue in my community and in other regional communities across Australia. That's why my Labor colleagues and I decided to take action. We pushed for a Senate inquiry to investigate the lack of doctors in regional areas right across Australia, including the Central Coast. That inquiry has now been established, and it will be able to investigate the provision of GPs in outer metropolitan, rural and regional areas; reforms to the DPA classification system; GP training; the Medicare rebate freeze; and the impact of COVID-19 on GP shortages. It will also be able to consider the role of allied health professionals, such as pharmacists, dietitians and physiotherapists, in providing quality health care in outer metropolitan, regional and rural communities so patients can get access to coordinated multidisciplinary care leading to better health outcomes, especially for those living in rural and remote Australia. This inquiry is also taking submissions from locals who have been affected by GP shortages in their communities. This is an opportunity for them to have their voices heard, because clearly the government hasn't been listening so far.

I am optimistic about this inquiry. We need practical solutions to help areas like the Central Coast of New South Wales that I represent so that we can get more GPs in our community. People in my community, as I've said, deserve timely access to quality health care close to home that they can afford, and this is no more important than in the middle of a global pandemic.

This has been going on for far too long not just in my community on the Central Coast of New South Wales but in outer suburbs and regions across Australia. We are at a crisis point. Local GPs have told me that their practices may no longer be viable. A practice recently closed because it wasn't able to recruit or retain a GP. This is something that is happening increasingly in the outer suburbs and regions across all of Australia. We're in the middle of a global pandemic, so access to GPs and health care is more important than ever, especially for the most vulnerable in our communities. For too long we've seen cuts to health care under this government. For too long we've seen rural and regional Australians overlooked. It needs to stop. We need to make access to GPs a priority. Every Australian counts.

12:42 pm

Photo of Sharon ClaydonSharon Claydon (Newcastle, Australian Labor Party) Share this | | Hansard source

It's an honour to be able to follow in this debate my friend and colleague the member for Dobell. She has vast experience in this area as a clinician and a pharmacist and in public health. She has enormous knowledge and insights that are of great use to this parliament in our decision-making. So thank you to the member for Dobell.

I've listened carefully to a number of the contributions this morning. Whilst many of my colleagues before me began speeches with some of the trauma experienced as a child in those trips to the dentist, that's never, fortunately, been an experience for me. Indeed, I think the only thing that really gives me great fear is always trying to remain one step ahead of the consecutive coalition governments that have sought to unpick universal health care in Australia.

It is baffling to many of my constituents that oral health was somehow seen to be completely detached from the entire body health and therefore was never part of the original attempts in Australia, in those early days of getting universal health together, to include it in Medibank, which then transformed into Medicare. Notwithstanding the fact that this bill is a step in the right direction—that's why Labor are going to be supporting the bill, although I will be standing to speak in favour of the amendment—we can never ever take for granted in this country that universal health care is not going to be steadily eroded. Indeed, every coalition government to date has sought to unpick the universality of Medicare. I was elected to this parliament in 2013, and I remember very well the then Prime Minister Tony Abbott's efforts. He implemented the Medicare freeze. He extended that Medicare freeze, and it has been ongoing over the last eight years, making it extremely tough for GPs to make ends meet in terms of the cost of managing practices these days. He also introduced a proposal for the co-payment. At one point it was going to be $7 and then it was going to be $5. We were successful in stopping that from happening. Labor joined with the community at large in their outrage that such a proposal would be brought to the Australian parliament.

The reality is that people are actually making much larger co-payments today, even though that legislation was defeated. By stealth, the government is chipping away and extending those Medicare freezes. People are paying enormous amounts of money to access quality health care in Australia—and that is not okay. The member for Dobell spoke about the lack of access to GPs in her region. This was made much worse by this government today. I'm not talking about the historical matters in terms of ongoing attacks to Medicare; this is happening right now. My electorate of Newcastle was one of 14 areas nationally that were targeted by the Morrison government to remove bulk-billing incentive payments. It was astonishing, in my view, that the Prime Minister started last year, 2020, the year of the massive global pandemic, with a fresh round of cuts to Medicare bulk-billing. The loss of that incentive payment is estimated to have cost Newcastle and the Hunter region some $7 million. Doctors were talking to me about having to make really significant decisions as to whether they could keep their doors open. We lost GPs as a result of that, and GPs' surgeries closed their doors. This was at the same time as our community was trying to deal with a pandemic, which, as you can appreciate, caused enormous pressures for GPs.

Those comments about the ongoing attacks on universal health care by coalition governments go to the amendment moved to this bill. The government has to do much more to address not just dental services but access to other health services. That includes access to general practice, as I have just discussed, in outer metro, regional and rural areas. It is terrific that Labor has been successful in getting a Senate inquiry into those matters. As the member for Dobell and other members have said, out-of-pocket expenses are unaffordable for some Australian families. Very few GPs in the city of Newcastle bulk-bill anymore. It is extremely rare to find a bulk-billing doctor. If you do, I suggest that you hang on to them for dear life because they are few and far between. Those out-of-pocket expenses are now forcing families to make really significant decisions. I've had mothers talk to me about the fact that they're making choices when they have to take several children, perhaps, to the doctor. Mothers are having to do without things in order to ensure that the children are able to have good health care and their medications are paid for. Some are having to make decisions about whether school excursions take place or prescriptions get filled. That is a terrible state of affairs. The history of Medicare is that it was born out of the fact that so many Australians were forced into bankruptcy in order to pay their medical bills, particularly hospital or surgical costs. That's why Labor worked so hard over so many decades to ensure that we would have a top-quality universal healthcare system and it's why Labor will fight tooth and nail every day to protect Medicare. We created Medicare and we will always fight to defend and protect Medicare.

This expansion of Labor's Child Dental Benefits Schedule is a great initiative. It has been long in the making, I would suggest. Opening up the scheme to make children from birth through to two years of age eligible is a good thing. We know that. The outcome of the fourth review of the Dental Benefits Act was tabled here in parliament on 23 July 2019—two years ago. It recommended lowering the eligibility age to one. I am pleased that the government, in this bill, has gone beyond what the review recommended because feedback from all of the stakeholder groups made very clear that we might as well bring the eligibility age to zero, to birth. Stakeholder groups said that that would make better sense and would be a better outcome in terms of equity. I welcome the government's acceptance of that stakeholder feedback in the review by removing the lower eligibility age restriction altogether. There's no need for that restriction anymore. Its removal will enable all children under the age of 18 to access the scheme if they meet the Child Dental Benefits Scheme means test requirements.

I know that all of us on this side of the House think that is a very welcome move. By lowering that eligibility age restriction, it's estimated that an additional 300,000 children aged between zero and two will become eligible for this program each year. This will kick in on 1 January next year, and it is estimated that 15 per cent of children in this newly eligible age group will access the scheme every year. That is a good thing because we know how important oral health is for the health and wellbeing of us all. If children have an introduction to dentists that is not traumatic, that is a good thing. Children having more opportunities to engage with oral hygienists and dentists, whether in their school communities or in private practices, should be applauded. It is socialising children to dentistry and helping them to overcome their fear and trauma.

The pain and distress that comes with any kind of dental issue is so horrible. You only have to cast your mind to the last time you had any kind of dental incident. You would almost do anything to have that tooth pain, abscess or gum disorder—whatever it might be—dealt with as a matter of great urgency. I'm very fortunate that I haven't been in excruciating pain when it comes to my dental work. I have a fabulous dentist who has been religious in seeing to my dental health every six months for many more years than I care to remember. He has instilled in me a very strong sense of the need to have regular oral health checks. I've got to say that the whole new profession of oral hygiene, which I don't recall as a child, where you now get to see a hygienist before you get anywhere near the dentist, is also a great addition.

But these are expensive services to access if you don't have a reasonable income or don't have private health care. I'd have to say that in my part of the world many people are choosing not to take private health care right now. They are not seeing value for their dollars. But they do want strong universal health care in Australia. I will certainly back them on that on every occasion.

I realise that this might be the last time I get to speak in parliament for a period of time—I'm not sure. The city of Newcastle is in lockdown and the ACT is going into lockdown at 5 pm this evening. It's an uncertain time. I want to give a big shout-out to my community in Newcastle. I know that there's a lot of anxiety in the community. There's a lot of really deep frustration and anger that the lockdown hasn't been as effective as we might like it to be. I have pharmacists at Doc's MegaSave Chemist trying desperately, having been approved but still not being able to get across the final hurdle, to be able to give out AstraZeneca vaccines. I've taken this issue up with Minister Hunt to try to get this expedited. Having had all the Pfizer vaccines from our community stolen to send to Sydney last week, which we're now desperately trying to bring back, it seems crazy that we're struggling to even get AstraZeneca out there. It's not good enough and I ask the minister to help.

12:57 pm

Photo of Meryl SwansonMeryl Swanson (Paterson, Australian Labor Party, Shadow Assistant Minister for Defence) Share this | | Hansard source

I'm absolutely delighted to speak on the Dental Benefits Amendment Bill 2021 and the amendment brought forward by the member for Ballarat, Catherine King:

That all words after "That" be omitted with a view to substituting the following words:

"whilst not declining to give the bill a second reading, the House …

(2) urges the Government to do more to address:

(a) access to dental … including General Practice, in outer-metropolitan, rural and regional Australia; and

(b) out of pocket costs for all Australians accessing these services".

I'm going to come to general practice in rural and regional Australia in just a moment, but, before I do that, I want to talk about dental benefits. Many people appreciate the importance of dental care from birth. In fact, it is becoming increasingly known, as this bill legitimately points out, that from the very day you are born oral health is a keystone to longevity and health through life. We know now that heart disease and many chronic illnesses are linked to oral health. The sooner we start little children and babies on the journey to having great oral health and receiving exceptional dentistry, the sooner we will have a healthier population.

What does that mean for Australia broadly? It means that people will be well; they won't receive and need as much care, particularly in their latter years; and it will be less of an impost on the taxpayers of the future. That's a really important point to make. We want people to be well, and we want our health dollars to go as far as they possibly can.

This bill is an extension of the reforms that were brought around by the Gillard government in 2012: the dental health reform package for all Australian people, which saw thousands upon thousands of people be able to receive dentistry, particularly children, through the Child Dental Benefits Schedule, which looked after children between the ages of two and 17. This bill expands it to include children from birth to 17. But, as my colleague the member for Blair pointed out earlier in the chamber, this was happening before the Gillard government as well. The Hawke government brought in really critical reforms, and I remember this quite clearly, because, at my school, Kurri Kurri Public School, we had a dental health clinic. I can remember going to the dentist at school; in fact, I had two very big molar teeth pulled out in that dentist chair at school. It wasn't too traumatic, but, I can tell you now, I still remember it.

How is it that, in what was probably 1980, when I had my teeth pulled out at school, we had exceptional services and dentistry for children in at least some schools across Australia, thanks to the Hawke government? In some ways, I feel as though, in the intervening period between the Hawke and Gillard governments, we went backwards with dentistry, particularly for children and the government's support of that. This bill is well and truly long overdue.

I now want to talk about that critical shortage of health care in regional and rural areas and just take a moment to recognise Dr Chris Boyle from the Raymond Terrace Family Practice. He practises with Dr Sarah Bayley and Dr Damian Welbourne. Between them, they do an amazing job of keeping our community healthy. In recent times, they've been running a COVID respiratory clinic and also now a vaccination hub. They have gone above and beyond the call of their Hippocratic oath to deliver wellness to our community, and we will be, I suspect, for many generations, truly indebted to them for their service. They see patients all day, and then they stand up and vaccinate well into the night. They are really burning the candle at both ends for us. I give a deep and heartfelt thanks to them. Chris said to me, when he vaccinated me for the first time: 'Meryl, there is a critical problem in Australia. We are not training enough GPs. There is not enough incentive to become a GP, and we have a critical shortage of them. The areas of need have contracted, in terms of the government's modelling of this, and we need to do something about it.' Dr Boyle, I hear you, and I want our government to hear you as well.

My electorate is experiencing a critical shortage of doctors and is in desperate need for support recruiting doctors to the area. In October last year, I met with Michelle Hudson and Donna White, who are the hard working practice management team at Shoal Bay and Anna Bay Providence Medical practices. While I'm giving a shout-out to people, I just want to give a shout-out to the practice managers and the receptionists at every doctor's surgery across my electorate and indeed across Australia at the moment. You are truly the front line. You are on the phones receiving thousands of calls from frustrated, frightened people, who desperately want to be vaccinated and who are being told day in and day out, 'Talk to your doctor.' Let me tell you, in areas like mine—Kurri Kurri, Maitland, Raymond Terrace—it's incredibly hard to see a doctor. You don't just waltz in, make an appointment and see your doctor. These appointments are so hard to come by—to just chat to your doctor, let alone to get vaccinated. This is a clarion call to all those who are whimsically saying, 'Talk to your doctor.' It would be great to talk to your doctor, if you could get an appointment, so keep that in mind for all of us in rural and regional Australia. We don't just jump on the blower, make an appointment with the doctor and cruise on in. You can be told, 'I'm sorry, we've got nothing for three weeks.' That is if you can get in at all, if the books haven't closed.

After speaking to Donna and Michelle, I was really, really disturbed. They're facing an enormous problem, like many members of our community, and they're frankly at the end of their tether. Issues affecting every medical practice across the Tomaree Peninsula were at the top of their list of issues that needed to be addressed by this health minister. The single biggest issue they raised was the lack of GPs in areas like ours, like Nelson Bay, which is an incredible place to visit but, very sadly, can't get GPs.

We're faced with a crisis in my community, with this government failing to take action to support overworked GPs who can't attract additional staff to the local area because of the flaws in the government's current model. Where in Australia is it more pertinent to have GPs than in a tourism area with a large retirement population? Every year the bay is inundated with tourists. We love that; it makes our businesses thrive. I know it's not happening during COVID, but in normal situations and normal times we love people coming and enjoying our beautiful waterways, our magnificent beaches, climbing the Tomaree headland, having a great time in nature and in our wonderful community. But, if they can't access medical assistance when they need it, they have a real problem—and that is just one of the issues. Sometimes we have a fivefold increase in our population in Port Stephens and Nelson Bay—'the bay' as we affectionately call it—with people streaming in from all over Australia but particularly from Sydney. But, if someone has a kidney stone or someone has a heart attack or someone lacerates themselves on an oyster shell or someone has some sort of medical episode, it is just incredibly difficult. Staff do an amazing job at the small hospital we have, but it's completely underresourced for what we actually need in these times.

Port Stephens, Maitland and Kurri Kurri continue to experience critical shortages of doctors and are in desperate need of support in recruiting doctors to the area. I held a round table and Mark Coulton, the member for Parkes, who was the then minister for regional health, was great. He turned up, he listened, he was very concerned. He knew what it was like for areas like mine, but he couldn't solve the problem. The government just isn't solving the problem—and it is a massive problem. I just want to point out that we have this shortage of GPs, and we're being told in areas like Kurri Kurri that it's the same as metropolitan Sydney. It isn't. We cannot attract the doctors. There is a huge backlog of people with everything from chronic to acute medical conditions who need to be seen. And that's not touching on specialists; it's even worse if you've been referred to a specialist. You just can't get an appointment.

The Morrison government created this mess and they really need to fix the Modified Monash Model. It is not working in communities like mine. It truly is a mess, and they need to fix it. Some practices are turning away more than 100 patients a day. It's outrageous and it demonstrates the failings of the Modified Monash Model and the Distribution Priority Area model as well. At the moment, in this COVID crisis, there are terrible situations emerging all over my seat of Paterson. We need to step up and help our communities. People are waiting up to seven days to get a COVID pathology test back. They can't go to work. I've got big employers like Tomago Aluminium who are absolutely struggling, and I'm going to talk more about that later today.

We've got a critical issue here. There are two things happening. Firstly, someone who was found to be a close contact went to a pub on 1 August. They weren't contacted until the 10th, so there's clearly a delay in people being told that they are close contacts. Secondly, people go for their test, they do the right thing, and they're being told, 'You won't have your results for five to seven days.' This is grinding the essential services to a halt. People are trying to do the right thing, but the government have to step up and assist. They must assist our local businesses that are just—some of them aren't even hanging on by their fingernails. They're not. They've slipped. They know there is no coming back from this.

We are not being dramatic. The Hunter is the engine room of the New South Wales economy, much like Western Sydney, and it needs help now. The people in the Hunter, they're resilient, they're hard-working, they do the right thing; but, at the moment, they are frustrated, they are frightened for their lives and their livelihoods. We must step into the breach at this moment. I implore this government. We've got to have doctors. We need to have people tested more quickly and get their COVID test results back faster. We have got to get on top of this situation. It would be a heck of a lot easier if we had enough vaccines to do that. The government really needs to step up at this time.

1:10 pm

Photo of Matt ThistlethwaiteMatt Thistlethwaite (Kingsford Smith, Australian Labor Party, Shadow Assistant Minister for the Republic) Share this | | Hansard source

[by video link] Like many of my generation, I have memories growing up of my grandparents, who used to keep their false teeth at night in a jar of water beside the bed. People of that generation often had false teeth because dental care wasn't accessible to working class people. It was seen as a luxury, as quite an expensive health resource that many couldn't access and, as a result, many in that generation went through their lives requiring dentures and other dental assistance just to get by. Thankfully, given what we now know about the importance of dental and gum health and oral health for comorbidities, we've started to improve access to dental health services.

The Dental Benefits Amendment Bill 2021 is an important part of making dental health services available to children from the earliest opportunity so that they have the best chance in life. The bill implements the guaranteed Medicare changes to the Child Dental Benefits Schedule. It was meant to start on 1 July 2021 but it will be pushed back to 1 January 2022. It will remove the lower eligibility age restrictions to allow eligible children from zero years of age access to the Child Dental Benefits Schedule. At the moment, the scheme provides eligible children aged between two and 17 years to up to $1,000 worth of benefits for basic dental services, capped over two consecutive calendar years.

The Child Dental Benefits Schedule has provided over $2.3 billion in benefits and delivered more than 38 million services to over three million Australian children since it commenced in January 2014. It was part of a Labor government initiative introduced by the Gillard government in 2012 as part of the dental health reform package. By removing the current age eligibility restriction altogether, it's estimated that each year an additional 300,000 children will become eligible for the program. That will not only be a cost saving for those individuals in the long run but will also be a cost saving for our nation, because we now know the importance the first thousand days in the development of a child's health and wellbeing as the foundation that will set them up for a better future.

The first thousand days are vitally important to a child's brain development, their bodily development and their immune system. Access to quality health care in those first three years will provide a stronger foundation to ensure that those features of the body develop better and will ensure a better quality of life for children. Access to dental care at an early age not only establishes good oral hygiene and good health practices but also, down the track, is instrumental in avoiding other health ailments related to dental and gum disease, such as respiratory problems, diabetes, cardiovascular disease and infections. The earlier that children get access to dental care, the better their quality of life will be, avoiding the situation of my grandparents—having to put their teeth in a glass every evening when they go to bed. It's a shame that the start date for this particular reform has been delayed by six months. We understand, because of COVID, there are delays occurring in a number of government initiatives at the moment.

COVID is causing anxiety for younger Australians at the moment. On Tuesday, I was fortunate to host a Zoom forum with year 12 students from our community to hear how they're feeling about the current COVID lockdown and whether or not they're getting access to the necessary resources and communication they need to complete their final year of schooling. To those students from local high schools who participated in the forum: I want to thank you for the valuable insights you gave me into the challenges that you're facing in your final months of schooling. I'm grateful, and also extremely impressed by the feedback and resilience and intelligence of senior students in our schools at this difficult time.

Quite simply, HSC students deserve better from the New South Wales government at this point in time. Year 12 is a stressful year, made all the more stressful by the lack of certainty and the lack of information that they're getting from the New South Wales government about the final months of their schooling. They deserve that certainty, rather than policy on the run from the Berejiklian government. There are questions: How do students complete major works that are at school? If they can't return to school until they're vaccinated, when will that take place? Kids who aren't in year 12 but are doing accelerated courses—what do they do in terms of vaccination and sitting the HSC? And, if case numbers continue to rise, will the HSC be delayed or put online? There are so many practical, valid questions that these HSC students deserve answers to but are not getting because the New South Wales government does not have a plan for year 12 students, and that's simply not good enough. I've written to the New South Wales education minister on behalf of HSC students in my community, requesting answers to these important questions. The New South Wales Premier must develop a plan for HSC students for their final studies for the rest of this year.

It's a stressful time, and I want to make sure that all HSC students and, indeed, all school students in our area are looking after their mental health. It's okay if you're feeling stressed, it's okay if you're struggling and it's okay to reach out to your peers, to your parents, to your friendship network and to the many support services that we have in our community that can assist you. And I'd welcome you ringing my office and having a chat to me; we're here to help you as well if you need that help.

Debate adjourned.