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

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

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

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

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

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

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

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

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

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

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

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

Mike Freelander (Macarthur, Australian Labor Party) Share this | Link to this | Hansard source

I'd like to thank the minister for introducing this bill, the Health Insurance Amendment (Prescribed Dental Patients and Other Measures) Bill. I think it is actually a very important one. I note the comments by the member for Kooyong, who understands very well that people with quite significant disability find it difficult to navigate the support systems that have been put in place. The previous government was very good at setting limits, and this bill goes some of the way towards trying to make sure that people who have significant disability can get the care that they need.

I should say at the very outset that I'm the son of a dentist and the brother of a dentist, and I know how important dental care is. I also have worked in my community for almost 40 years as a paediatrician. I now see mostly kids with complex disability, and many of those kids have some of the conditions that we're talking about in this legislation—things like Pierre Robin syndrome, where babies are born with an unslung jaw; cleft palate; and various other abnormalities that make it difficult for them to breathe and to swallow. They require ongoing treatment. It certainly doesn't stop when they turn 22. They often miss out on the ongoing treatment that can improve their speech, their swallowing, their nutrition and their ability to interact with society. In that regard, I think this is a very important bill for them. We also see children with a condition called velocardiofacial syndrome, where children are born with facial abnormalities; palatal abnormalities, including cleft palate; and sometimes other abnormalities such as cardiac disease. Their treatment is lifelong. Their management is lifelong.

We know that dental treatment in particular is very important not just for appearance but also for things like nutrition, social interaction and proper respiratory function. These children often require surgery when they're very young, but they may well require revision as they grow older—well past puberty. Even as quite old adults, these kids—these people need ongoing treatment. I keep on calling them 'kids' because that's how I see them, but of course many of my patients are now adults, and they require ongoing treatment. Access to dental care in Australia, in many ways, quite shamefully, is very poor and very expensive. In the past, people have missed out on treatment because of the costs, and this bill will go part of the way to improving that.

Data published by the Australian Institute of Health and Welfare found that Australians aged 15 or over have on average 11 teeth that are decaying, missing or filled, and well over a third of this group have untreated decay. We sometimes see them in hospital. They present with dental abscesses requiring intravenous antibiotics before they can actually access any dental care. Only half of the people aged 15 and over had visited a dental professional in the 12 months of the survey by the Australian Institute of Health and Welfare. Only 10 per cent of people who saw a dental professional received public dental care. The vast majority of people in Australia have to pay for private dental care.

I agree with the member for Kooyong that many people who have other associated abnormalities should be seen in multidisciplinary clinics and should have access to dental care as part of that . Unfortunately, very few of them do. So, many of them will leave the paediatric age group still requiring ongoing intervention, and, once they turn 22, they have to pay for it privately, and it can be prohibitively expensive. It can affect things like speech. Some people who I've seen as kids feel very embarrassed about their speech, so they withdraw socially. They don't work, they tend to withdraw and they don't interact socially. Getting them access to dental care makes a huge difference to their lives, and this bill is very important in getting them that access.

There's only a very limited safety net for dental care for adults, and this bill will help those with some of the most severe abnormalities, such as cleft lip, cleft palate and velopharyngeal incompetence—that's where they have a hypernasal speech that can be very embarrassing for them, and, over time, they often need reviews for their palatal movement but also for their dental care. The current Deputy Leader of the Opposition, of course, was the Minister for Health and Aged Care in 2016, and she was the one who announced that the then Turnbull government would be abandoning the National Partnership on Adult Public Dental Services and the Child Dental Benefits Schedule, which was really devastating for many of those families—absolutely devastating and shameful, I would say. As a result, Australian children, particularly children with abnormalities, were forced onto longer and longer waiting lists, and that jeopardised their chances of improved dental health for the rest of their lives.

By passing this bill, we'll be delivering on our longstanding contribution to the accessibility of universal health coverage, particularly dental care. This goes part of the way to doing that. This bill amends the Health Insurance Act 1973 to remove age restrictions for patients with eligible cleft and craniofacial conditions. There are a number of conditions, some of which I have already mentioned. They include, for example, children with Down syndrome, who sometimes have palatal abnormalities and dental abnormalities that require ongoing treatment. I'm seeing a little boy with Down syndrome at the moment, who, at age eight, has had every one of his teeth removed because of severe dental caries. Children with Down syndrome often have enamel hypoplasia—that's what he's got—and they require ongoing dental treatment. For this boy, that is not going to stop when he's 22. He's going to need that for the rest of his life.

I do have some connections with the dental community, and I've sometimes had to ring and beg people to see older kids and adults who require dental care in this community. I think my oldest patient with Down syndrome that I see is now 38. So it's a bit old for a paediatrician, but they still like to come and see me, and, indeed, she has ongoing dental problems. We do need to make sure that the most disadvantaged can access this sort of care. This is, again, another sign of the Albanese Labor government and Health Minister Mark Butler moving through the things that should have been done a long time ago. It's part of our commitment to better health care for everyone.

This bill, thankfully, will remove the age restriction and enable access for those with severe abnormalities that are listed on the Medicare Benefits Schedule but who do not currently qualify due to the age restrictions. We also need to remember that occasionally you'll see an adult who has had an untreated submucous cleft palate with dental abnormalities as well, and they will benefit from this scheme. Even though it may seem to be small numbers and quite procedural, I actually think it's a very important bill. I'm really grateful to the health minister for making this commitment. This bill will confer eligibility for Medicare benefits to those who have reached the age of 22 or those who have had their treatment delayed beyond the age of 22, because of the pandemic, for example, or because they couldn't afford to see someone privately. The intent is that, for those who are born with severe craniofacial abnormalities, their family should know that their treatment will be for life. I think that's a really important thing. That will reduce the huge costs and the delay in treatment for many of these kids.

Again, as the member for Kooyong mentioned, it is very important that people with cleft lip and palate and palatal abnormalities get access to the NDIS, because they have ongoing needs for management—not just the surgical needs of repairing the cleft lip and palate, which is often ongoing; they require ongoing speech therapy, and they need ongoing management if they are to stay healthy. This bill is a big win overall for all these children, their families and the believers in accessible, equitable health care in Australia.

Other measures in this bill deal with some unrelated issues, such as developing a system to manage the Register of Approved Placements and to place and remove doctors from it. Currently doctors, to be eligible to access a Medicare benefit, must either hold a fellowship of an Australian medical college or participate in approved workforce or training programs. This is managed by the specific bodies responsible for determining eligibility. This makes it easier for the minister to allow or deny Medicare item numbers for this. It must be noted that, while Services Australia administers the Register of Approved Placements, this is based on notices provided by a specified body and that Services Australia does not have independent assessment capabilities or decision-making abilities. This bill helps in that regard. I think that this bill is supported by all the professional colleges, including the general practice colleges and the regional training organisations, and they're coming to Canberra this week to tell us about this, as they welcome the opportunity provided by this legislation to streamline the very complicated administrative processes associated with some of these schemes. It's imperative that constructive engagement is made between the government and the industries that our work and policies affect, and this is part of that.

This legislation also corrects the inconsistencies between the bill and the Health Insurance (Bonded Medical Program) Rule 2020. I don't know about the member for Kooyong, but I'm frequently being asked by people in the Bonded Medical Program to try and modify their placements. They often signed up to the Bonded Medical Program as very young medical students. Their lifestyles change, they get married, they have children. Sometimes they may have to deal with a major family illness—a parent who is very unwell et cetera. So they find their bonded placements in rural and regional areas difficult to manage. This bill simplifies the conditions around that. I think that is really important. Certainly for some of the people that have seen me about this, it will make it much easier for them to manage their weeks required in training in country and regional areas by splitting them up into weekly segments. They will be able to manage their time between their practice times and their time dealing with their family or other issues in Sydney.

All in all, this is a very important bill. It's not a minor bill. It does make some important differences to workforce training. We certainly know we need to improve our ability to get GPs, in particular, working in rural and regional areas. It also makes a big difference to those who've already signed up to the Bonded Medical Program being able to plan their lifestyle around much easier conditions. When I say 'easier conditions', I mean conditions that are simpler to understand. All in all, I commend this bill to the House. I know that, in the cleft palate community, this is going to make a big difference to many families.

Aaron Violi (Casey, Liberal Party) Share this | Link to this | Hansard source

I rise to speak on the Health Insurance Amendment (Prescribed Dental Patients and Other Measures) Bill 2023, which seeks to amend the Health Insurance Act 1973 with three administrative changes, which are supported by the coalition. Among other measures, the bill will improve access to the Medicare Benefits Schedule for eligible persons requiring treatment for cleft and craniofacial conditions by removing the age restriction, which is currently 22 years of age. Cleft lip or palate conditions affect one in every 800 babies born in Australia. This bill will not significantly alter average patient numbers, but it will nevertheless support improvements to patient treatment plans to ensure support is available for those affected by these conditions.

The coalition supports the intent of this bill to improve access to affordable and life-changing procedures for those Australians impacted by these conditions and to ensure increased access to critical health care through Medicare. However, more can be done for these children, such as timely and affordable speech therapy. I had the pleasure to meet Philippa and Jessica from CleftPAlS Victoria to discuss children born with a cleft palate condition and the significant challenges they and their families have to deal with. Throughout their childhood, there are significant surgeries and ongoing speech therapy. These issues often do not end when they become adults, and I thank Philippa and Jessica for sharing their stories with me and representing their community. They do amazing work. It is heart-wrenching as a parent, when you hear the stories of children born with these challenges. Their parents are doing amazing work to support them, and we need to continue to do all we can to support these families and these children. I commend Philippa and Jessica not only for the amazing work they do supporting their own families but for being the strong advocates they are for the cleft palate families of Australia. The passion they have is clear to see.

Philippa's daughter was born with a complete cleft of the hard and soft palate. Even though Philippa is a speech pathologist by profession, she still needed assistance with her daughter's feeding, hearing difficulties and speech development. I can't imagine what it would be like for a family with no background in speech pathology or health care to navigate this experience. Philippa definitely shared her experience and how tough it was, even with the advantage that she had.

This legislation arose following the findings of the Medicare Benefits Schedule Review Taskforce Final report on the cleft dental services MBS items2020, which suggested that the current age limit of 22 years for eligible persons requiring treatment for cleft and craniofacial conditions be lifted. Age limits for access to the scheme were initially established on the basis that patients with cleft and craniofacial conditions would generally have completed most specialist dental work associated with their condition once their facial growth was complete, on average at 22 years of age. However, there continue to be a small number of patients who are denied treatment on the basis of the age limit in circumstances where the treatment would be clinically beneficial to the patient's condition and general health. For patients who have had their surgeries deferred beyond the age of 22 due to the COVID-19 pandemic, this bill will serve an important purpose in enabling them to access Medicare benefits for the treatment they require.

Research has shown that strong speech skills are essential for a child's social and educational development. Being able to speak clearly is essential for literacy and language development, and underpins a child's ability to make friends at school, deal with bullies and develop self-esteem. This investment is not just helping these young children today but is going to pay dividends for them and their family through their whole life. It's wonderful to see that the bipartisan support for this bill is going to allow it to go through the House.

Parents currently have two options to access speech therapy, and this is why we need to look at speech therapy and supporting parents. They can wait up to two years for a public service or pay thousands of dollars in the private sector. Although there is some assistance available through chronic disease management arrangements, there are only five services per year across all allied health, and up to 90 per cent of children with clefts require treatment for over five years. If the government is serious about strengthening Medicare and improving access to affordable and potentially life-changing or life-saving health care, then it must pursue further urgent action to do so.

The Strengthening Medicare taskforce report released by the government, while clear on the problems facing primary care in Australia, contains no specific actions, no funding and no time lines. Disappointingly, the report has no urgency. There is nothing in this report to address the immediate challenge facing our health system, which is workforce shortages. For months and months we've seen the Prime Minister and the Minister for Health and Aged Care talking about the crisis in health care and the workforce shortages that are putting significant pressure on the system, but we have not seen any tangible plan from this government to address this critical issue. Even today in question time, 10 months into government and six weeks from their second budget, the minister for health was talking about the past, talking about 2014 and looking to blame others.

There is a great saying that I like to live by: if you spend your life looking in the rear vision mirror when you're driving you'll end up crashing, and that's what this government is doing. They are focused on the past and have no plans for the health of Australians.

The opposition has called on the government to immediately provide the time lines and to detail the funding required to ease the pressure on Australia's hardworking doctors and nurses, following the release of this report. Now, aspirations are commendable. But without urgent action to follow, they are not going to assist Australians with their significant cost-of-living pressures, which are continuing to rise: $55 for a script; $60 out of pocket for a GP—all while energy bills are increasing and inflation is skyrocketing. At a time when Australians are struggling with skyrocketing electricity bills, mortgage repayments and grocery bills, we are now seeing the cost of going to the doctor and to specialists skyrocketing too.

On cleft palate and the speech therapy scheme: I urge the minister to review the extension of the speech therapy scheme. This is an investment that will make real impacts on the lives of Australians. We have an amazing opportunity in this House to be the voice of our constituents, and I know that Philippa is very passionate about this issue. In fact, she emailed me today to urge me to speak on this bill and to continue to call on the government to look at speech therapy for those with cleft palates. So I want to finish my remarks with the words of Philippa. I can't think of better words than hers to describe why this government needs to invest in speech therapy. Philippa said:

While extending the speech therapy scheme would not be particularly costly for the Government given the small number of people with clefts in Australia, it would make an enormous difference to the parents who are working so hard to give their children the best chance to reach their potential.

Ged Kearney (Cooper, Australian Labor Party, Assistant Minister for Health and Aged Care) Share this | Link to this | Hansard source

I thank all of the members for their contributions to this debate. The Health Insurance Amendment (Prescribed Dental Patients and Other Measures) Bill 2023 amends the Health Insurance Act 1973 to improve healthcare for all Australians. The amendments will remove age restrictions for accessing cleft and craniofacial services on the Medicare Benefits Schedule, enable Services Australia to automate management of the Register of Approved Placements, and rectify inconsistencies between the act and the Health Insurance (Bonded Medical Program) Rule 2020, and make amendments to enhance the administration of the Bonded Medical Program. Patients with eligible cleft and craniofacial conditions will benefit from the removal of age restrictions, allowing time for their conditions to be appropriately planned and treated.

Under the current legislative arrangements, Medicare eligibility for treatment under the Cleft Lip and Cleft Palate Scheme requires a patient to meet complex and problematic access restrictions, with some patients being denied Medicare reimbursement for treatment based on age alone. Age limits for some patients were previously amended under the Health Insurance Amendment (Professional Services Review and Other Matters) Bill 2002. However, there continues to be a small number of patients who are denied treatment based on age. These changes will provide equity of access to treatment for those patients who suffer from certain cleft and craniofacial conditions relying upon a clinical requirement rather than age.

In addition, the bill provides the facility for Services Australia to develop a system to place a doctor on or remove a doctor from the Register of Approved Placements under section 3GA of the act. Specified bodies, such as the Department of Health and Aged Care and general practice colleges, are responsible for determining if a doctor is eligible to be placed on the Register of Approved Placements. Services Australia places doctors on the Register of Approved Placements based on notifications from a specified body. The specified bodies will notify Services Australia of their decision, and Services Australia will manually place doctors on and remove doctors from the Register of Approved Placements accordingly. The act does not currently allow this to occur via a computer system. This change will reduce the time frames for doctors to start providing Medicare rebated services to their patients at a time of critical workforce shortages in primary care. The bill also corrects inconsistencies between references to 'three years' and 'one year' in part VD of the act, and the definition of how a participant accrues a week of their return-of-service obligation under the Health Insurance (Bonded Medical Program) Rule 2020.

With this bill, the Australian government will make it fair and equitable for young people needing cleft palate and craniofacial procedures, ensuring access to essential health care. It will also make significant administrative improvements to support our health workforce to deliver the care regional and rural communities need. In doing so, the Australian government is strengthening Medicare and putting the health of Australians first.

I thank members for their contributions to the debate on this bill.

Question agreed to.

Bill read a second time.

Message from the Governor-General recommending appropriation announced.

Ordered that this bill be reported to the House without amendment.