Jan McLucas (Queensland, Australian Labor Party, Parliamentary Secretary to the Minister for Health and Ageing) Share this | Link to this | Hansard source

I move:

That these bills be now read a second time.

I seek leave to have the second reading speeches incorporated in Hansard.

Leave granted.

The speeches read as follows—

DENTAL BENEFITS BILL 2008

The Dental Benefits Bill will allow the Government to deliver on a key part of its election commitment to improve dental health for working families and address Australia’s dental crisis.

The Medicare Teen Dental Plan is the first part of the Rudd Government’s plan for improving dental services in Australia. The second part is a new Commonwealth Dental Health Program, through which the Commonwealth will provide additional funding to the states and territories to reduce public dental waiting lists.

In the recent Budget, the Government announced funding of $780 million over five years for these two new dental programs. We are providing $490 million over five years for the Medicare Teen Dental Plan, and $290 million over three years for the Commonwealth Dental Health Program.

These significant commitments will help ease Australia’s dental crisis, end the blame game, and start addressing the parlous state of Australia’s dental health – the dire state of which should be laid at the feet of the Howard Government: they closed the Labor Government’s previous Commonwealth Dental Health Program and refused point blank to work with the states on addressing this growing problem for a decade.

Before discussing in greater detail the policies which the Rudd Government is implementing, I want to outline the magnitude of the problem which we have inherited from the previous government.

Latest estimates are that there are about 650,000 Australians languishing on public dental waiting lists. Thirty per cent of Australians are reported to have avoided dental care due to the cost of services.

50,000 people end up in hospital each year with preventable dental conditions, putting more pressure on our hospitals.

These problems with accessing affordable dental care have contributed to the dismal and deteriorating state of Australians’ dental health. Tooth decay is Australia’s most prevalent health problem, with gum disease ranking as the fifth highest. Over a quarter of the Australian adult population have untreated dental decay – untreated because they are not accessing the dental care they require.

What is most troubling is that poor dental health is starting with our kids. It then becomes entrenched as our kids transition as teenagers to adulthood.

For example, between 1996 and 1999, five year olds experienced a 21.7 per cent increase in deciduous decay. Children in lower socio-economic groups experience tooth decay at twice the rate of children in higher socio-economic groups. In New South Wales between 1994 and 2004, there was a 91 per cent increase in hospitalisation rates for children under five for the removal or restoration of teeth – that is, the hospitalisation rate nearly doubled.

This poor dental health deteriorates even further through teenage years. According to dental health experts, there is a four-fold increase in dental decay between 12 and 21 years of age. Almost half of all teenagers have some signs of gum disease. According to the OECD, the rapid deterioration in dental health occurring in teenage years leads to the dental health of Australian adults ranking second worst in the OECD. This comes after a history of very good ratings in the past.

This alarming state of affairs is even worse among the poorest, most needy Australians. Concession card holders, such as pensioners, have lost on average 3.5 more teeth than non-concession card holders. The children of concession card holders have over 50 per cent more decayed teeth than those of non-concession card holders.

Above all, when we talk about statistics and waiting lists, preventable hospitalisations and decay rates, we must always remember we are talking about people. We are talking about Australians who sometimes have such severe dental problems that it affects not only their health, but their work and personal lives. We are talking about pensioners who may not be able to eat food comfortably or easily. We are talking about teenagers whose confidence to go out in the world to study and work is badly affected. We are talking about everyday Australians who will not visit friends, who cannot apply for a job or cannot get a job, simply because they cannot get the dental treatment that they need.

It is clear from these terrible facts that Australian working families need action on dental health. But rather than addressing these problems, the Howard Government spent much of the past decade cynically playing the blame game.

Rather than taking any responsibility, the previous government passed the buck. They shifted blame. They repeated the all too familiar mantra that it was the states’ fault. For the past decade, the previous Commonwealth Government did nothing to address the dental crisis in Australia. They did nothing but say that dental health wasn’t their responsibility and blame the states.

But it was the Howard Government that helped create some of these problems in the first place. One of their first acts of government was to scrap Labor’s Commonwealth Dental Health Program in 1996. They ripped $100 million a year from Australia’s public dental system – and this led to the explosion in public dental waiting lists which we see today: 650,000 people waiting, sometimes for years, for treatment.

Then, belatedly, the Howard Government introduced a dental scheme whose referral processes and eligibility criteria were so complex and restrictive that few people could access it.

I acknowledge that, for those able to navigate their way through the complicated referral process and the red tape, the program offered some help. But many people missed out – often the most needy people in our community.

For example, over four years of the previous government’s scheme, right up to 30 April 2008, in the whole of the Northern Territory, no services at all have been provided to children and young adults aged up to 24 years old.

We know that the Northern Territory has some of the poorest, most marginalised people in our Indigenous communities. We know that they have some of the worst dental health problems in Australia. But how many of these young people did the previous Government’s scheme help? No-one at all – zero. Across all age groups in the Northern Territory the picture is similarly poor – only 28 people accessing treatment over nearly four years.

In South Australia, over four years, no services at all have been provided to children up to the age of 14. Again, zero.

This means that, during the entire term of the Howard Government, no child born and raised in South Australia or the Northern Territory got any assistance at all from their failed dental scheme.

In Tasmania, over four years, only eight people up to the age of 24 have received services. That’s only two young people a year on average.

And the picture is similarly poor in the larger states.

Only 52 people in Queensland under the age of 20 accessed the previous government’s program over four years. On average, that’s only about one young person a month over four years across the whole of Queensland.

Only 94 people in the whole of Victoria under the age of 20 have received services in nearly four years. On average, that’s only about two young people a month over four years across the whole of Victoria.

These figures are nothing to be proud of. They show clearly that the previous Government’s dental scheme has failed.

In total, over almost four years to 30 April 2008, the Howard Government’s failed scheme will have spent less than $50 million (currently only $42.8 million). This compares to $780 million of investment in the Rudd Government’s new dental programs over five years.

Moreover, even the limited support provided by the Howard Government’s failed scheme was poorly targeted. We recognise that some people here and there received assistance under the failed scheme. But the problem is that it was not a targeted program. It did not help those most in need.

The poorest people with the worst dental health did not get access to the previous Government’s failed scheme. If you were simply poor and had bad dental health because of your poverty, you could not get treatment under the program. However, if you were wealthy and had a chronic disease with complex care needs, you could get access to the program. A millionaire could get access to their program – once they got through the red tape. A pensioner with an excruciating toothache got no assistance at all.

The failings of the Howard Government’s approach are manifest. They have failed pensioners. They have failed the poorest, most needy people in our community with the worst dental health. They have failed our kids and teenagers – failed to help them maintain their teeth and prevent much worse problems later on in life.

In implementing its dental commitments, the Rudd Government is helping to fix these problems. We are not going to let the Howard Government’s failed scheme continue, while the dental health problems of millions of needy Australians go unaddressed. That is why the Government is re-directing funds from this under-utilised scheme to support better targeted dental programs, such as the Medicare Teen Dental Plan and the Commonwealth Dental Health Program.

We have made a decision, as governments need to, that we should be helping the most needy people in our community first, in the most effective way possible.

We have made a decision that providing up to one million dental consultations and treatments under the Commonwealth Dental Health Program, and enabling more than one million teenagers every year to access preventative checks under the Medicare Teen Dental Plan, is a good investment for our money.

We will work with states and territories and the dental profession to expand the provision of dental care, with a focus on treatment for those in greatest need, and preventative care for eligible teenagers.

Both of our programs are squarely targeted at people who are most in need of help, many of whom couldn’t afford dental care without this assistance.

Commonwealth Dental Health Program

Under the Commonwealth Dental Health Program, the Rudd Government will be providing an additional $290 million over three years to improve access to public dental services, working co-operatively with the states and territories.

This marks a stark change from the last decade of the Howard Government criticising the states for not doing enough on dental health.

We do agree that states and territories should be encouraged to do more – but instead of just passing the buck, the Rudd Government is going to do its bit to help the states to do better.

Discussions with the states and territories about the implementation arrangements for the Commonwealth Dental Health Program are well advanced. As Health Minister, I am keen to end the blame game and to work with the states and territories to fix Australia’s dental care system, and the health system in general. We have already made a good start through COAG discussions over the last few months.

Commencing in July this year, the Commonwealth Dental Health Program will assist the states and territories to reduce waiting times by funding up to one million additional dental consultations and treatments over the next three years.

The states and territories are well placed to ensure that this extra funding will have maximum impact. Often public dental services are the only services available to treat people with the most severe dental conditions, especially in rural and remote areas. These public dental services target the most needy people in the community, and the additional $290 million in funding will ensure that these vulnerable and needy people will be assisted.

We will be putting strict conditions on states and territories to ensure the Commonwealth’s funding goes where it is needed most. We will be requiring the states to target people with chronic disease as a priority, such as patients with cancer, cardiac patients and people with HIV/AIDS. Another priority will be people with increased oral health needs, including pre-school children and Indigenous Australians.

States and territories will also be required to at least maintain their existing efforts in dental health, and report consistently on expenditure, the number of services being provided, and the number of people on public dental waiting lists.

This means that pensioners will get more help. It means that concession card holders will get more help. It will assist the poorest members of our community, and people with the poorest dental health. It will also give priority to indigenous people, and pre-school children – groups that the Howard Government’s program so spectacularly failed.

In Government we have to make choices. And, instead of persisting with a failed dental scheme, we are choosing to provide up to a million more dental consultations and treatments for the most needy Australians.

Medicare Teen Dental Plan

The Medicare Teen Dental Plan will also commence in July 2008, subject to the passage of these Bills.

Under the Medicare Teen Dental Plan, the Government will provide up to $150 per eligible person towards an annual preventative check for teenagers aged 12-17 years in families receiving Family Tax Benefit Part A. Teenagers in the same age group receiving Youth Allowance or Abstudy will also be eligible for the program.

About 1.1 million teenagers will be eligible for the Medicare Teen Dental Plan each year.

The program will assist families to help keep their teenagers’ teeth in good health, and encourage young adults to continue to look after their teeth once they become independent and move out of home. This is an investment in preventative care.

Adolescence is a time when many young people strive for independence from their families, and move outside the parental structures which have supported their health. It is precisely at this stage in life that many young people’s dental health declines. As I noted earlier, there is a four-fold increase in dental decay between 12 and 21 years of age. Dental experts also tell us that the highest levels of reported tooth ache are in 18 to 21 year olds.

We need to stem the dramatic decline in dental health that occurs among our children in adolescence. We need to avoid the terrible health consequences this leads to in later life – which requires more expensive treatment, as well as entailing personal and social costs.

We have said on many occasions that preventative health is a key priority of the Rudd Government. The health system needs to be refocused so that it keeps people well and prevents disease. The $490 million investment that the Rudd Government is making in the Medicare Teen Dental Plan demonstrates our determination to make this priority a reality.

Under the Medicare Teen Dental Plan, we are going to encourage teenagers to care for their teeth properly – to get annual check-ups, so that any problems that might arise do not get worse further down the track. Providing preventative checks to teenagers is an effective way to maintain good oral health and reduce the need for expensive treatment in the future.

The Medicare Teen Dental Plan will operate as part of the broad Medicare arrangements, through a new Dental Benefits Schedule (DBS). The DBS will be administered by Medicare Australia and will operate in a similar manner to the existing Medicare arrangements. However, unlike the Medicare Benefits Schedule, the DBS will be targeted to specific age groups and working families receiving Family Tax Benefit Part A.

The annual preventative dental check will include an oral examination and, where clinically required, x-rays, scale and clean, and other preventative services. These include fluoride application, oral hygiene instruction, provision of dietary advice, and fissure sealing.

Eligible families and teenagers will be automatically sent a voucher by Medicare Australia once the program commences. Once the voucher is received, the teenager can receive a preventative check from his or her dentist. Teenagers or their parents will be able to claim a rebate back from a Medicare Office, or their dentist may decide to bulk bill the dental check. Up to $150 towards the cost of the service can be reimbursed through Medicare Australia.

Eligible teenagers will be able to use their voucher to receive a preventative dental check either from a private or public sector dentist. The dental check may be performed by a dental therapist or dental hygienist on behalf of a dentist, under appropriate supervision.

The Dental Benefits Bill establishes a legislative framework for the payment of dental benefits under a new Dental Benefits Schedule.

Summing-up

In summary, the Rudd Government is delivering on its election commitments and making a $780 million investment in Australia’s dental health through the Medicare Teen Dental Plan and the Commonwealth Dental Health Program.

This marks the end of the blame game that, thanks to the previous Government, has afflicted dental health for more than a decade.

It marks the end of the buck passing and blame shifting that has prevented the poorest, most needy people accessing the dental care they need.

It demonstrates that the Rudd Government can take the tough decisions to close down ill-targeted programs which have demonstrably failed, and replace them with targeted programs that help Australians most in need, such as pensioners and concession card holders.

It also demonstrates our commitment to investing in preventive health, ensuring our kids preserve their dental health today, rather than only treating their dental problems tomorrow.

The programs demonstrate the Rudd Government’s determination to address the immediate pressures on Australia’s dental health system, the 650,000 people on public dental waiting lists who are the Howard Government’s sad legacy.

And they also demonstrate the Rudd Government’s commitment to building for Australia’s future, by encouraging our teenagers to develop good dental habits and preserve their dental health for the long term.

Together, these programs will attack the sorry state of dental health in Australia. They will address Australia’s dental crisis by delivering up to one million more consultations and treatments through the public dental health system. And, by enabling more than a million teenagers to take better care of their teeth, they will support better dental health into the future.

DENTAL BENEFITS (CONSEQUENTIAL AMENDMENTS) BILL 2008

The Dental Benefits (Consequential Amendments) Bill makes amendments to a number of other Acts, including the Medicare Australia Act 1973, the Age Discrimination Act 2004 and legislation relating to the Family Tax Benefit Part A, Youth Allowance and Abstudy programs.

These amendments are necessary for the effective operation of the Teen Dental Plan.

The amendments will ensure that the Medicare Teen Dental Plan does not breach the Age Discrimination Act, and ensure that the investigative powers of Medicare Australia may be exercised in relation to offences contained in the Dental Benefits Bill.

The amendments will also allow the exchange of information between Centrelink and Medicare Australia so that vouchers can be distributed to eligible families and teenagers.

Richard Colbeck (Tasmania, Liberal Party, Shadow Parliamentary Secretary for Health) Share this | Link to this | Hansard source

The Senate is considering the Dental Benefits Bill 2008 and the Dental Benefits (Consequential Amendments) Bill 2008. As has been indicated in the other place by my colleague the shadow minister for health, Mr Hockey, the coalition is supporting these bills. It has long been known that dental health and general health are closely linked. Historically, public health efforts to combat tooth decay have had significant beneficial effects on general health. We are fortunate in this country to have had, for many years and in the majority of the larger population areas, enlightened local governments who have supported the provision of fluoride in our public water reticulation systems. Fluoride as an essential agent for oral health is largely unchallenged in this day and age. But it was not so many years ago that there was a strong debate in the community about its effectiveness and desirability in water supplies. The first three major cities to have fluoride in their water supplies in 1964 were Hobart, Canberra and Townsville. My home state of Tasmania had a royal commission into the question in 1968, chaired by the distinguished judge, Sir Peter Crisp, and I am proud that many of his findings paved the way for large-scale fluoridation of urban water supplies in Australia.

It has been mentioned in debate in the House of Representatives that a staggering figure of 50,000 Australians are hospitalised each year with preventable dental disease, and this is in a country where we pride ourselves on having a very good record on dental health. I was proud to be part of a government which, recognising the strong link between oral and general health, last year established Medicare dental. The uptake in the first two months of operation of Medicare dental—November and December 2007—was 16,000 services. In January this year, according to statistics provided by Medicare, 20,443 services were administered. In February the figure was 40,497 services and in March it was 94,617. Therefore, from July 2007 to March this year, Medicare dental provided something like 172,000 services. In estimates, evidence was given that the total number of services to date was more in the vicinity of 300,000 plus.

It is therefore clear not only that there is a serious need for Medicare dental but also that the take-up rate by Australians with complex oral health problems is increasing. And yet, for an inexplicable reason, the Rudd government is moving to dismantle Medicare dental. I foreshadow that I will be moving a motion to disallow changes to the relevant regulations which abolish Medicare dental. There is absolutely no logic in abolishing a public health initiative for which there is a demonstrated and growing need, and the coalition will do what we can to prevent that from occurring. The reason Medicare dental was so successful was that it allowed dental patients to get access to necessary care—something they could not get previously because of the consistent neglect of local dental services perpetrated by state governments.

We will not oppose the legislation currently before the Senate, but I foreshadow that I will be moving an amendment to provide for a review of the Teen Dental Plan established by the Dental Benefits Bill 2008 after 12 months and periodic reviews at three-year intervals. The amendment will require that the minister appoint a review panel that will comprise the Commonwealth Chief Medical Officer, a nominee of the Australian Dental Association, a nominee of the Consumers Health Forum of Australia—a body which is currently represented on the Medical Services Advisory Committee—and two other persons appointed by the minister, at least one of whom must be a qualified dentist or medical practitioner. We think that this is an entirely reasonable review mechanism and it mirrors similar provisions in other legislation. I hope that it receives support in the committee stage.

The reason that we are proposing such an amendment is that we are very concerned that the Teen Dental Plan is destined for either failure or a significant cost blow-out. The Teen Dental Plan duplicates systems already in place in the states which have been allowed by the states to run down. Some, I concede, are much worse than others. Waiting lists for dental care in the states are very long. One estimate is that there are about 700,000 Australians waiting for dental care, and that is of course an alarming figure. The bill provides that up to $150 worth of vouchers will be available to 12- to 17-year-olds receiving family tax benefit part A, youth allowance or Abstudy, for the purposes of a preventative dental check, plus a scale and clean.

The ALP, when it announced this plan, costed a check-up, scale and clean and X-ray at $240. The scheme provides no funds for subsequent treatment if a problem is detected. People will have to either go into the state dental clinics or seek private dental consultation. It is a bit like giving someone a shiny new car but then not providing the funds for the petrol. This is a scheme that has clearly not been thought through. If a dentist finds something which needs further attention, what does he or she do: refer a patient to join the end of a long queue for attention in the state dental clinics or offer to do the work themselves, for a fee? The problem is exacerbated when one notes that fewer than 10 per cent of dentists practising in Australia are in the public system.

Under the coalition’s Medicare dental, patients who were assessed by their GPs as having complex dental conditions could have a primary care plan. From this care plan they could be referred to a private dentist and receive up to $4,250 worth of treatment over two years—rather better than what the current government is proposing. Of course, with the government’s decision to raise the Medicare levy surcharge threshold, many people with private dental insurance through their private health scheme will be inclined to abandon their cover, again putting more pressure on the public system.

What the Minister for Health and Ageing really needs to do is to go back to cabinet and admit that they should rethink some of the decisions that they have made in this portfolio and take advice from the various health professionals who actually know what the problem is, rather than stick to their old-fashioned policy. Australian health policy has largely been bipartisan. The current minister is doing her level best not only to jettison that approach but also to return to an overburdened public system which simply does not have sufficient funds to provide the necessary care. As I said, we will not be opposing the bills.

Bob Brown (Tasmania, Australian Greens) Share this | Link to this | Hansard source

We too will be supporting the Dental Benefits Bill 2008 and the Dental Benefits (Consequential Amendments) Bill 2008 for the obvious benefits they bring to Australian dental health care, which is very badly in need of a complete refurbishment. The Greens policy—and we went to the election on this—is for a national ‘denticare’ plan, paralleling Medicare and funded from the $2 billion to $3 billion which governments inject into the private health system at the moment. This would give all Australians access to a good dental healthcare system. While it would require a very careful strategy because of the enormity of this program, it is the required direction to go in for a nation which believes that everybody should have proper dental health care.

The spokesman for the opposition, Senator Colbeck, has just quoted the figure of 50,000 to 60,000 people a year who end up in hospital because they do not get basic dental health care. It is an astonishing figure for one of the wealthiest countries on the face of the planet. It is very difficult to understand how it can be that we have a country where there are 600,000 to 700,000 people on waiting lists. The majority of them are poor people, including people from the ranks of the one million-plus pensioners in this country who simply cannot afford to go to private dental health care, where, if you need a root canal treatment, in 2008 you will need more than $1,000 in your pocket, and that is beyond pensioners. When pensioners do get into the public health system, they do get to the front of the queue if they are faced with an infected tooth. They do not have the option of such therapy. The alternative is the extraction of the tooth—and that is the alternative they are left with. We should not have a dental health care system that denies citizens their right to the same dental health options that another citizen would have for major treatment like that. But that is the situation that pertains in Australia.

I well remember that in 1996 one of the first acts of the Howard government was to abolish assistance to pensioners to get dental health care. It was a terrible thing to do. It has left many people, who should not have suffered, with a great deal of suffering, and not a few of those will be amongst the 60,000 people a year who are now, according to the opposition itself, ending up in hospitals because they did not get proper health care.

The Greens believe there is a lot further to go in providing across-the-board basic dental health care to all Australians. We will be pursuing not just the concept but also the reality of a ‘denticare’ system in Australia. Of course, the measure we have before us today covers a much needed area, which is dental care for teenagers to ensure that all Australian teenagers have access to check-ups and to treatment following the check-ups. But of course it should be extended to all Australians. This is what we all should be doing. All of us in this place know that dental care prevents much more serious illnesses that ultimately end up with very expensive fix-ups in the public health care system.

We will be supporting this legislation, but we want the government to go a lot further with the dental health care system in this country. It has the opportunity to do that and we would ask the government—and I ask the minister—to look at the prospect for the introduction of a ‘denticare’ system in this country. It was Labor that introduced Medicare and it is Labor that should now be looking at extending that to the dental health care system. There is only an artificial barrier between the two things. They are both part of the essential delivery of health care—and basic health care at that—to 23 million Australians. Surely that is a goal we should be achieving. I should also mention that the Greens will be supporting the amendment moved by Senator Colbeck.

Lyn Allison (Victoria, Australian Democrats) Share this | Link to this | Hansard source

The Democrats also support the Dental Benefits Bill 2008 and the Dental Benefits (Consequential Amendments) Bill 2008. The legislation provides the framework to allow for the payment of dental benefits in accordance with the Labor Party’s promise during the last election campaign for a preventive dental plan for teens. The legislation also provides for the provision of other dental benefits through the establishment of a dental benefits schedule. Unfortunately it does this at the expense of the program that was established by the previous government for dental services for people with chronic illness. I do not think we have had a reasonable explanation from the government so far as to why that program is to be cut and why this should take its place. However, the teen dental program was widely promoted by the Labor Party during the election campaign as part of the solution to Australia’s dental problems, along with the reinstatement of a Commonwealth dental scheme similar to the one that the Howard government was very quick to get rid of back in 1997.

While we welcome the federal government’s increased role in the provision of dental care, it is difficult to see how these measures will deal with the most serious problems that exist when it comes to oral health. That is because a scheme that offers parents $150 in a rebate on a dental check-up for their teenage children will only cover half the cost of the average check-up, according to the government’s own estimates. Without funding for further appointments to treat established disease, oral examinations, a scale and clean and X-rays are going to do very little. A scale and clean contributes very little to disease prevention and X-rays can identify signs of decay and treatment needs but of course neither of those procedures will stop problems from occurring or fix any existing problems that are identified.

It is encouraging that the minister’s second reading speech included fluoride application, oral hygiene instruction, provision of dietary advice and fissure sealing as part of the check-up. But, at the end of the day, what is the point of X-rays identifying early decay if you cannot afford the fillings and follow-up sessions. There is good value in targeting teenagers because it is, after all, at the beginning of the teenage years that the last baby teeth are lost and young people get their new permanent teeth. These teeth are particularly vulnerable to decay due to the immature tooth enamel and so it is timely that teenagers are able to access dental care. But the Australian Dental Association has pointed out that teens already have relatively good dental care available to them through state and territory school programs, while Australians in their early twenties have shown a significant susceptibility to dental decay. Many young Australians in their early twenties are not privately insured, no longer have parental support and have incomes that are not high so they struggle to access the extent of care that they require.

The Democrats have on a number of occasions called for targeted assistance to provide basic dental care to young people at risk of oral disease. High levels of youth unemployment and youth poverty mean that many people go without dental treatment and experience unnecessary dental decay and long-term dental problems. The Australian Dental Association wants to see the government expand the group of people who are eligible for these vouchers to include people up to the age of 25. Of course, under the current arrangements, that would mean more people facing out-of-pocket costs for check-ups, with no follow-up or treatment.

Under the proposed Teen Dental Plan, eligible teenagers will be issued with a voucher, which will then entitle them to receive a preventive check from a private or public sector dentist. The dentist will then have similar billing options to those that are available to GPs: they will be able to bulk-bill, and the teenager and their family will have no out-of-pocket costs; or, the dentist will be able to bill the teenager and then the teenager will be able to ask Medicare to issue a cheque in the name of the dentist. The teenager will then have to get the cheque to the dentist and pay any outstanding amounts over and above the $150, which is the maximum the cheque can be made for; or, the teenager will have to pay the dental bill and get their rebate back from Medicare.

Putting aside the reality that many dentists will be put off by the administrative red tape, this approach ignores the reality that over the last decade we have seen an ever-increasing shortage of dentists. Not only is it difficult to attract dentists to work in the overstretched public dental health services, but many people struggle to find a private dentist to see them without having to wait several months for an appointment. Experts looking at the growing gap between demand and capacity to provide dental services estimate that we need 1,500 more oral health professionals just to maintain current levels of access.

The distribution of dentists in regional and remote areas remains significantly less than in metropolitan areas. Major cities have 57.6 dentists per 100,000 of population, inner regional areas have 34.5 dentists, outer regional areas have 27.7, and in remote areas it is just 18.1 dentists per 100,000 people. It is encouraging that the dental plan proposes to allow funding for dental services to be delivered by oral health professionals such as dental therapists and dental hygienists. Increasing the number and the range of clinical services that can be undertaken by oral health professionals—instead of just dentists—should be expanded, but this, too, will not solve all of the workforce issues. We need a comprehensive dental workforce review and more Commonwealth supported places in dental schools.

The Democrats would also like to see the government introduce a dental intern program. Unlike other health professions, dental graduates are able to practise without supervision as soon as they graduate, and we argue that dental graduates should undertake a period of supervised practice before obtaining registration. These training places would be primarily in public dental programs and private practices in rural and remote areas. Such a scheme could provide dental graduates with valuable practical experience and would address some of the gaps in public dental service provision. We think that implementing a clinical placement year for overseas-trained dentists is also worthy of consideration.

The major shortage of dental specialists also needs to be addressed. Unlike medicine, there are few salaried specialty training positions. For the poor, the socially disadvantaged, the critically ill, or geographically distant there are very few—and in some cases, no—specialist services such as those provided by paediatric dentists, orthodontists, periodontists and oral surgeons. Salaried, specialty trained positions, with a requirement of two years of return-of-service in the public sector, is an idea that would ensure access for the truly needy. I think we also need to improve the salaries and conditions of dentists working in the public sector. While dentists are in short supply and are free to set their own fees, it is very hard to see why private dentists with full lists will take on new patients and bulk-bill them under this Teen Dental Plan.

That means that families will face high out-of-pocket costs, costs that will not be reimbursable by private health insurance and which will not count towards the Medicare safety net. If any of the families of teenagers who do make use of the $150 voucher can afford the extra $150 they will probably face for a dental check-up are then told that the young person needs treatment, they can always go onto the waiting list for the public dental services if they cannot afford private dental care. But given that there are half a million Australians already on those lists, waiting an average of 27 months, they will probably have to wait for quite a while for that treatment.

It is true that the Rudd government has provided $290 million over three years to the states and territories to clear public dental waiting list backlogs, but with 650,000 estimated to be on those lists this money will not go very far, particularly as the government wants the states and territories to specifically target those with chronic disease, Indigenous people and preschool children—all groups worthy of additional resources. Given that the Rudd government has funded its dental proposals by scrapping the previous government’s scheme that provided subsidised dentistry to those with chronic illness, it is likely that public dental services will continue to be stretched by those with chronic illness who cannot afford private dental care.

Aboriginal and Torres Strait Islander people have more decay and gum disease than non-Indigenous Australians, and this starts at a very young age. There are many reasons for this poor dental health, such as poor dental care, lack of access to fluoride, greater exposure to risk factors such as smoking and poor diet, as well as higher rates of other health problems such as heart disease, diabetes, stroke et cetera, and changing lifestyle patterns. This is not to mention poor living conditions, social exclusion, poverty and unemployment, which contribute to poor health and poor oral health. Significant and sustained efforts are required to reduce these factors. We need to train Aboriginal health workers in oral health, focusing on oral health promotion. We need additional vocational and higher education places set aside for Indigenous and Torres Strait Islander people to study oral health, and we need more outreach services for remote Indigenous communities.

The dental health of preschoolers and toddlers also needs attention. There are reports that the average child starts school with three to four teeth decayed, missing or needing fillings. Some children have extensive decay, which requires hospital treatment under general anaesthetic. Access to education and information about nutrition and caring for the teeth of babies and small children can prevent much of this decay occurring. Integrating information about the importance of preventing dental disease into the care provided by maternal and child health nurses and training them in identifying the early signs of dental disease would go some way to improving the oral health of very young children.

Dealing with the oral health needs of the chronically ill, Indigenous Australians and preschoolers requires substantial investment, and unfortunately the additional funding the Labor government is handing over to the state and territory governments to prop up already floundering systems is barely more than was provided back in 1996—without any greater accountability than we have seen previously, I must say. So we may end up seeing the states and territories simply using the additional funding from the Commonwealth as a way to reduce their own funding contributions to dental health. It will be essential that the federal government holds the states and territories to their obligations when it comes to dental health. We need more investment.

Dental health should not be seen as separate from someone’s overall health—the concept that your mouth is different from the rest of your body is pretty ludicrous. There is a complex interplay between dental disease and general health, and each impacts on the other, so we need a comprehensive response to addressing oral health needs. The legislation we will deal with today addresses some coverage for teenagers and there is also some money to support the states in dental care, but it is by no means a comprehensive or long-term strategy.

Helen Polley (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

I rise in the Senate today to speak in support of the Dental Benefits Bill 2008 and the Dental Benefits (Consequential Amendments) Bill 2008. We Tasmanians know only too well that there is a shortage of dentists around the country, particularly in rural and regional areas. In my home town of Launceston we are facing the rapidly declining availability of dentists due to retirement—including my own dentist, who I keep encouraging to continue. The Rudd Labor government understands that seeing a dentist is simply out of the budget for many Australian working families, and that is why the Prime Minister, Mr Kevin Rudd, and Ms Nicola Roxon, Minister for Health and Ageing, announced the Teen Dental Plan as a key election commitment.

We understand that good oral health is not simply the absence of oral disease but a state of wellbeing in which an individual can eat, speak and socialise without discomfort or embarrassment. Poor oral health has a range of consequences, including pain, difficulty in eating certain foods, impaired speech, loss of self-esteem, restriction of social and community participation, and the impeding of the ability to gain employment. Generally a person’s overall quality of life is affected.

Poor oral health is also associated with an increased risk of cardiac problems, pre-term and/or low-birth-weight infants and poor diabetic control. The statistics are shocking: some 50,000 Australian people end up in hospital each year with preventable dental conditions, 25.5 per cent of the Australian adult population have untreated dental decay, and 17.4 per cent of the Australian population aged 15 and above were unable to eat certain foods because of problems with their teeth during the last 12 months. It is hard to believe that this is happening in our country. A 2007 Australian Institute of Health and Welfare report concluded:

Thirty per cent of Australians reported avoiding dental care due to cost, 20.6% said that cost had prevented them from having recommended dental treatment and 18.2% reported that they would have a lot of difficulty paying a $100 dental bill.

This is simply not good enough.

Rather than taking any responsibility, the previous coalition government passed the buck. They shifted blame. They blamed the states. They simply did not care. As usual, as I said, they passed the buck, with their arrogance. The proof was there that they were completely out of touch with the Australian community. It was in fact the Howard government that helped create some of these problems in the first place. For over a decade the Howard government did absolutely nothing about ensuring that the future needs of the dental profession would be met by our universities. As many of those sitting opposite me would remember, one of the first acts of their government was to scrap the previous Labor government’s Commonwealth Dental Health Program, ripping $100 million a year from the public dental system. This led to the explosion in public dental waiting lists that we see today.

The former health minister, Mr Abbott, claimed that the dental care in this country was ‘in crisis’ but did nothing about it. Mr Hockey said in the other place just last night that the coalition ‘understands the burden of dental disease in our society’. If this was truly the case, why was the Labor government left to deal with some 650,000 Australians on public waiting lists? The former Howard government’s dental policy was a failed scheme and very poorly targeted. Under their policy, if you had a chronic medical condition, certain heart disease, diabetes or malignancies of the head or neck, you had poor oral health or a dental condition which was exacerbating a chronic and complex disease, and you were being treated under a multidisciplinary care plan, then, and only then, were you eligible for assistance with your dental care.

The impact of the Howard government’s neglect is a very real problem facing too many Australians today. Narrow eligibility is one reason why only 7,000 people had received assistance from the program over the last three years. In my home state of Tasmania, over a period of four years, only eight people up to the age of 24 had received the chronic disease dental service—only eight. That is an average of two people a year. This is simply not good enough; Australians deserve better. This policy of theirs was another example of how out of touch they became after 12 long years in government.

I am very proud to say that the Rudd Labor government is committed to stopping the blame game. Our Prime Minister, Mr Rudd, has assured the Australian people that the buck will stop with him, and he means it. He has hit the ground running. During the 2007 election, Labor promised to provide funding to establish two new dental programs: a Commonwealth dental health scheme and the Teen Dental Plan. The Rudd Labor government’s Teen Dental Plan, I am pleased to say, will assist one million Australian teenagers between the ages of 12 and 17 with their dental costs. The Rudd Labor government understands that Australian working families are already under financial pressure due to mortgages, childcare costs, grocery prices, petrol prices and the inflationary pressures that we have inherited from the former Liberal coalition government. They are being forced to make stark choices between dental treatment and other day-to-day necessities. The Teen Dental Plan proposes that eligible teenagers would be issued with vouchers by Medicare Australia which would entitle them to receive a preventative check from a private or public sector dentist, refundable by Medicare. While many primary schoolchildren receive school dental services, these services are not as widely available to teenagers. By targeting teenagers, the scheme will not only ease cost pressures but also encourage young adults to continue to look after their teeth once they become independent and move out of home.

The Rudd Labor government are truly committed to delivering better health outcomes for Australians through our health and hospital system. We have said on many occasions that preventative health is a key priority of the Rudd government. The health system needs to be refocused so that it keeps people well and prevents disease. The multi-million dollar investment that the Rudd Labor government are making in the Teen Dental Plan demonstrates our determination to make this priority a reality. I am pleased, as I said, that the Rudd Labor government is acting on this issue.

Everyone recognises that having healthy teeth is important to a teenager’s self-confidence, especially at a time when many are out seeking their first job. This government understands the issues that are affecting Australian working families, and affordable dental care is one of them. We have identified the problems and are now taking action to fix them. I am proud to be part of a government that is fixing this real, day-to-day issue that is affecting Australian families. I commend the bill to the Senate.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

I thank those senators who have contributed to the debate, particularly those on our side, who have supported the dental benefit scheme and seen through the election commitment to now. I appreciate their contribution to the debate on the Dental Benefits Bill 2008 and related bill. I also, of course, thank the opposition for their support, although I think it is to be qualified with an amendment some time later. I would also like to say, in summing up the debate, that these bills will allow the government to deliver on a key part of its election commitment to improve dental health for working families and address Australia’s dental crisis.

The government has committed something in the order of $780 million over five years for two new dental programs, which have been mentioned in the second reading contributions: the Medicare Teen Dental Plan and the Commonwealth Dental Health Program. Both of these programs are aimed at people who are in the most need of help, many of whom could not afford dental care without these two programs providing that assistance. In addition, the Commonwealth will work with the states and territories and the dental profession particularly to expand the provision of dental care. But the focus is on those in greatest need and the preventative care for eligible teenagers. At those early years it is important to provide that assistance.

These significant commitments will help ease Australia’s dental crisis—because we do have a dental crisis in Australia. It is about trying to end the blame game and start addressing the serious problems in oral health that the Howard government ignored for more than a decade. There are 650,000 people who would attest to the fact that the Howard government ignored their dental issues and allowed the public dental waiting lists to be left to grow to that order.

The passage of these bills will enable the Medicare Teen Dental Plan to commence next month. The government is providing $490 million over five years for the Medicare Teen Dental Plan, and the Commonwealth will provide up to $150 per eligible person towards an annual preventative check for teenagers aged 12 to 17 years in families receiving family tax benefit part A.

I did have the opportunity of listening to the second reading contribution of Senator Allison and those matters that she went to in terms of the administrative complexity. Really, when you look at what this is doing, it is providing the $150 to those families receiving the family tax benefit part A for those teenagers. The way of accessing that will be through one of the agencies within my portfolio. We will work very hard to ensure that, administratively, both the dental profession and the teenagers who will benefit receive a good outcome—and not, like under the Howard years, an outcome of being left to languish on a waiting list.

Teenagers in the same age group receiving youth allowance or Abstudy will also be eligible for the program. There are in the order of 1.1 million teenagers who will be eligible for the Medicare Teen Dental Plan each year. The Medicare Teen Dental Plan will operate as part of the broad Medicare arrangements through a new dental benefits schedule. That will contribute to ensuring that we can deal with it administratively. I can point Senator Allison to these words and say that we will work very  hard to ensure that that dental benefits schedule through the Medicare arrangements will ensure that the burden is where it should be placed—that is, to alleviate the burden rather than create one.

Under the Commonwealth Dental Health Program the Rudd government will be providing an additional $293 million over three years to improve access to public dental services, working in cooperation with the states and territories. I would like to take the opportunity to underscore that remark: it is about working in cooperation with the states and territories. It is about ending the blame game. It is about ensuring that we can work cooperatively to find real solutions to help people who are in need. It does mark a stark change from the last decade of the Howard government, which spent much of its time, when you talked about state and federal relations, criticising the states for not doing enough on dental health.

Commencing in July this year, the Commonwealth Dental Health Program will assist states and territories to reduce waiting times by funding up to one million additional dental consultations and treatments over the next three years. This means that pensioners and concession card holders will get more help. It will assist the poorest members of our community and the people with the poorest dental health, but it will provide priorities as well. Those priorities will also go to Indigenous peoples and preschool children, groups that the Howard government failed to adequately care for and address appropriately.

In summing up, I want to take the opportunity of thanking senators for their contribution to the debate on these bills. These two bills are an important milestone. They represent a new path for the future for those 650,000 people who are on waiting lists. They provide a greater opportunity for the states and territories to work with the Commonwealth. They also ensure that those people who are in need who are on waiting lists will be provided with assistance.

This reminds us of what the Liberals thought about all of this. They have never been able to accurately answer the question of why they ripped out something in the order of $100 million a year from the former Commonwealth Dental Health Program and ignored dental health as an issue for more than a decade—other than blaming states or creating a notion that they were in fact active in this area. Of course, they were active in this area. They were active in creating the waiting list of 650,000.

The Rudd government are working hard to address this waiting list through our $290 million investment in the Commonwealth Dental Health Program, but that program is not alone. We recognise that it has to work in tandem with the $490 million investment in our kids’ teeth through the Medicare Teen Dental Plan.

Unfortunately, we also understand that the opposition have foreshadowed an amendment to the bill. We will deal with that during the committee stage at some length. I will only highlight at this point that, when you look at the issues that are created by amending for such a review as the opposition have outlined, perhaps it really does highlight how they have ignored dental issues over the past 11 years.

When you look at how these programs are implemented, you see that programs such as the Medicare Teen Dental Program are implemented through Medicare. The wealth of information will flow back through to the Department of Health and Ageing. It will provide Health and Ageing, through Medicare, through my portfolio area, with the ability to ensure that the outcomes are being delivered on the ground. It will ensure that there is continual information flow between Health and Ageing, Medicare and, of course, the dental outcomes for teenagers, but also for the experience of the dental professionals. This is an area where there is close cooperation between Medicare and the Department of Health and Ageing to ensure that the outcomes do in fact realise real benefits for teenagers, that they provide better health and dental outcomes for teenagers and that they ensure for those people in receipt of the benefit that it does go to where it is needed. Medicare has a long history of working with Health and Ageing and, more particularly, the dental professionals in ensuring that all of these matters are dealt with adequately.

It is an unnecessary amendment. In fact, I think it is probably a fig leaf to explain why the opposition are now clearly supporting what is a good initiative, which they recognise as an initiative that is well overdue, one that they did not recognise needed to be done but that Labor clearly has now. So I think the foreshadowed amendment provides nothing short of a fig leaf to ensure that they can now support positive measures in this area.

We understand that the opposition is planning to disallow the closure of the former government’s failed chronic disease dental scheme. We acknowledge that some people did get some help out of that scheme—that is clear—if, of course, they could navigate the complex referral process and red tape that abounded in it. But many people, often the most needy in the community, missed out. They did not get the assistance that they needed. I could play Senator Abetz’s game, which is: guess the figure? Guess who? For example, over four years to 30 April 2008, in the whole of the Northern Territory, we could ask: was it one, two or three, or were no services at all provided to children and young adults aged up to 24? It was the latter. No services were provided. In South Australia over the same four years, again, how many services were provided—one, two, three or none? Again, it was none. No services at all—zero—were provided to children up to the age of 14. In total, over four years to 30 April 2008, the Howard government’s failed scheme will have spent less than $50 million, compared to the $780 million that the Rudd government is investing in dental health.

It is nonsensical to disallow the motion—the closure of the failed chronic disease program needs to be put to bed—and, in doing that, the opposition miss a great opportunity to clearly support two new initiatives in this area. Of course, they have a little time to reconsider that position, and I encourage them to take that opportunity. I encourage them to reconsider it. The Liberal Party have an opportunity. They showed today that they were not responsible economic managers. They do have an opportunity to salvage some of that.

Debate interrupted.