Carol Brown (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

I rise to make a brief contribution to the Dental Benefits Amendment Bill 2012. This bill will implement the federal Labor government's dental health reform package. The oral health of Australian children has been declining since the mid-1990s. By the age of 15, six out of every 10 children will have experienced tooth decay. That is why the Labor government are taking action to implement our dental health reform package.

This is a six-year package that will invest over $4 billion. It includes $2.7 billion for around 3.4 million Australian children who will be eligible for funded dental care; $1.3 billion for around 1.4 million additional services for adults on low incomes—including pensioners, concession cardholders and those with special needs—who will have better access to dental health care in the public system; and $225 million for dental services in terms of capital and workforce for people living in areas of need, such as outer metropolitan, regional, rural and remote areas.

For those 3.4 million Australian children, going to the dentist will be just like seeing a GP. In my home state of Tasmania—and, as Senator Polley has just reminded me, her home state, and also Senator Colbeck's home state—around 74,000 children from 40,000 families will benefit from this new dental reform package. Eligible Australian families who receive family tax benefit part A will be entitled to $1,000 per child every two years over the life of the package. This $1,000 can be used for basic care on procedures such as check-ups, cleaning, scaling, fluoride treatments and fillings. Investment in our children's teeth is so vital. It is an investment for the future and it will significantly benefit them late in life.

Recent studies have outlined that children in lower socioeconomic areas experience 1½ times more tooth decay and cavities than those in wealthier areas, and members of low-income households have more than twice as much untreated tooth decay as those in high-income households. Almost 20,000 children under the age of 10 are hospitalised each year due to avoidable dental issues, and 45 per cent of 12-year-olds have decay in their permanent teeth. In 2007, just under half—46 per cent—of six-year-olds attending school dental services had a history of decay in baby teeth. Finally, people earning more than $60,000 per year have, on average, seven more teeth than those earning less than $20,000.

The statistics are damning. I could go on, but these statistics highlight why the Gillard Labor government have taken action to implement our new dental health plan. These figures are simply not acceptable. For many years, Medicare and public hospitals have given Australians access to free Medicare whilst millions have missed out on adequate dental care. So I am extremely proud that it is the Gillard Labor government that is tackling this issue head on and investing in dental reform and putting forward a package to improve the oral health of Australian children.

But we are not stopping there. As I have mentioned earlier, the dental reform package also includes a $1.3 billion investment in additional services for adults on low incomes. This will cover 1.4 million services for pensioners and concession card holders as well as those with special needs and enable them to access dental health services in the public system. We will also provide $225 million for funding in dental infrastructure and the workforce in outer-metropolitan, rural and regional areas, which will assist more Australians regardless of where they live to gain access to high-quality dental care.

Our $4 billion dental health reform package comes on top of the $515 million announced in the 2012-13 federal budget. This budget measure will see 400,000 people benefit from a blitz on the public dental waiting list. Of this budget commitment, $345.9 million will be set aside for treating patients on waiting lists over the next three years, including Indigenous Australians. This blitz on public dental waiting lists will help treat people with emergency procedures and those with preventative needs.

We will also increase the Voluntary Dental Graduate Year Program from 50 to 100 placements per year by 2016 at a cost of $35.7 million over three years. This will help increase the capacity of our dental workforce by delivering more dentists who can provide support and care for Australians. This funding will be used to provide practice experience and professional development opportunities, including in those areas that are underserviced, to dental graduates. The Gillard Labor government will direct $45.2 million over four years to introduce an oral health therapist graduate year program. This will give placement opportunities with a focus on public dental services to 50 new graduates each year from 2014.

Services in regional areas will be strengthened by a new $77.7 million grants program to encourage and help dentists to relocate to regional, rural and remote areas. There are grants of between $15,000 and $120,000 to relocate, depending on where the dentist moves to, and grants of $250,000 to help with the purchase and fit-out of new dental facilities. This program will play a vital role in attracting dentists to regional and rural areas, where we know it is harder to access dentists and dental services.

In closing my short contribution here tonight I want to say that the evidence was quite clear: the oral health of our children was suffering; it was vitally important that we acted. That is exactly what the Gillard Labor government has done. This bill and other measures we have implemented are designed to improve the oral health of Australians, particularly our children, and I am proud to be part of the Gillard Labor government that is taking action to address the dental needs of our country. I commend the bill to the chamber.

John Williams (NSW, National Party) Share this | Link to this | Hansard source

I rise to contribute to this debate on the Dental Benefits Amendment Bill 2012. The coalition supports good investment in dental health. Last December, the Australian Institute of Health and Welfare released a report card on Australia's dental health. In 2010, approximately one-fifth of the population did not have their own teeth, and many others over the age of 65 who did have natural teeth also wore dentures.

I want to take you to the Chronic Disease Dental Scheme—the very scheme introduced by the then health minister Tony Abbott. The scheme was an outstanding success, providing 20 million services to over one million patients since 2007. I recall when this government tried to throw that scheme out. Thankfully, we had the numbers in the Senate to keep it in place. People with chronic health conditions were referred by their doctors to a dentist, who devised a program. An eligible person could access over $4,000 in Medicare benefits over two years. It is a scheme that has worked, but Labor and the Greens will close the scheme on 30 November. In fact, no new services have been provided since 7 September in this scheme.

I want to refer to a letter I received from a young mum from a small town in northern New South Wales near where I live. She says she took her son to a doctor on 12 September only to be told the scheme had been cut off five days earlier. Her son is 20 years old. He is an insulin dependent diabetic and his dental health is poor. He was devastated to find out this program was cut. His mother, a registered nurse, said:

It is amazing how the government wants to raise the health of the nation, particularly for people with chronic disease, as it is such a burden to the people themselves and the health system. Yet they cut something as important as this. Being a registered nurse I know first hand how valuable this scheme was to people.

She is correct.

Here is another story. A man with chronic health issues and on oxygen came to my office to express his disappointment with the scheme closing. What does he do now? Does he go to the back of the queue in the public system?

I must applaud Armidale dentist Dr Chris Cole, who arranged a petition against the closure of the scheme. He has pointed out the follies of throwing these people onto the public health system. In some of the more remote areas, people may need to travel for hours to get to a hospital. They could be sitting there waiting their turn but then someone with a serious dental issue comes in, is treated ahead of them, and then the dentist runs out of time. So off they go on the long trip home and wait for the next call. This is what we face in rural and regional areas of our nation.

The Chronic Disease Dental Scheme is closing, not because it did not work, but because it was established by the man who, hopefully, will be the Prime Minister after the next election. And the greedy Labor government, who could not balance the books of a school fete, then went after those dentists who made a mistake with their paperwork. It was amazing. When the dentists filled in the paperwork to claim this money back off the government for carrying out this work, all sorts of obstacles were placed in front of them, to the tune of millions of dollars, throughout the nation. These dentists were treated like criminals—this from a government that has wasted billions upon billions of dollars. When shadow health minister Peter Dutton attempted to have the closure of this scheme blocked in the other place, naturally the member for New England, Tony Windsor, stuck with the government. That is not surprising when you read his agreement with the government, which states he must consult with them before voting.

Regional Australia is the whipping boy again. In 2009, figures revealed that there were just 24 dentists per 100,000 people in remote and very remote areas, compared with a massive 62 dentists per 100,000 people in major cities. Fewer services are provided in regional areas compared with the cities. Private dental services are provided at the rate of 601 per 1,000 people in cities, compared to just 397 per 1,000 people in remote and very remote areas.

I started in this job back in July 2008. Not long after that we received an increase in our electoral allowance of $4,800. I believe that dental assistance and dental services are most important. I am not a doctor, but people tell me that if you do not have good dental health, then you do not have good health—full stop. I started the Williams Regional Dentistry Scholarship, in conjunction with the National Rural Health Alliance. I sponsor a first-year dental student to the tune of $4,800 a year and I have guaranteed to do that while ever I am in this job.

Olivia Jom of Albury was the first recipient of my scholarship; Jessica Powell of Tamworth was the second; and Alayne White of Cowra is the current scholarship winner. She is doing her first year in dental science at Charles Sturt University in Orange. I have put my money where my mouth is—and I am very proud of that—to help these regional students who wish to become dentists through the costs of their first year at university. We hope that they will return to regional areas.

In 2000 the coalition government introduced the RAMUS Scheme, the Rural Australia Medical Undergraduate Scholarship Scheme, where people from regional areas could receive a $10,000-a-year scholarship to study medicine. We know that those most likely to return to regional areas are those who have grown up in regional areas. Thankfully, at last, we have seen an increase in numbers where more than 1,400 medical students have completed their medical degree under RAMUS. We also need the same in dentistry.

We come to the Labor-Greens scheme, an unfunded $4.1 billion dental program that will not commence until 2014. This means-tested entitlement for children aged between two and 17 will commence 13 months after the closure of a scheme that was working for the benefit of some of these children. It will provide a $1,000 capped benefit over two years for eligible children. What about those children who require more treatment, taking them over the $1,000 cap? What about those children who were part-way through treatment under the Chronic Disease Dental Scheme before the government so cruelly pulled the plug?

Perhaps Minister Plibersek and her Greens colleagues can explain to those children why they must suffer for 12 months. And it gets worse. The scheme for adults will not commence until July 2014. There are already 650,000 people—400,000 adults, according to the government—on public dental waiting lists, but the minister says Labor's plan will provide only 1.4 million additional services over six years. We have 650,000 people on a list, including 400,000 adults, and, as I said, the minister says that Labor's plan will provide only 1.4 million additional services over six years. It will not cope.

We all remember that, in 2008, Labor proposed a Commonwealth Dental Health Program and promised one million services by providing funding to the states and territories. It was revealed in Senate estimates that the Commonwealth did not assess the capacity of the public dental workforce to provide the projected services and that the number delivered may have been significantly less than that promised.

The coalition does not oppose this legislation but places on record its disappointment with the government's handling of the dental needs of Australians.

David Bushby (Tasmania, Liberal Party) Share this | Link to this | Hansard source

I rise also tonight to speak on the Dental Benefits Amendment Bill 2012. Whilst not entirely opposed to this bill, the coalition has some concerns in relation to the changes to public dental services that this bill will enact. This bill will completely change the way taxpayer funds are directed for public dental programs. We also hold concerns and have done so for a long time in relation to the way that this government has set about introducing its dental agenda. The Gillard Labor government has chosen to link the introduction of its new dental benefits scheme to the closing of the Medicare Chronic Disease Dental Scheme, which, as I am sure history will attest, was one of the most successful public health initiatives that has ever been seen in this country.

The CDDS is a scheme about which I have often spoken in this chamber. My interest in this particular scheme has been sparked not because of its patent level of success, which was demonstrated by the huge uptake rate by primarily concession card holders, who would otherwise have had little or no access to the dental care that it funded, but because of the government's underhanded attempts at closing it through an obvious and shameless witch-hunt of dentists who were practising under the scheme.

Of course, their exploitation of dentists in this regard has had a devastating impact on many individual dentists right across Australia—and I see Senator Di Natale down there in the chamber; he has had many representations from dentists right across the country about how they have been affected by the treatment they received from the Labor government over the last couple of years. But it has also had an impact on the level of confidence that the profession has in publicly funded dental schemes.

The government's blatant abuse of dentists has also led to concern amongst CDDS patients, who were understandably worried that the funding for the dental care that they so desperately needed and which was so necessary to managing their chronic illness was being pulled out from underneath them.

By way of background, the CDDS was a successful Howard government initiative, implemented in 2007, and introduced by the then health minister, now Leader of the Opposition, the Hon. Tony Abbott. This scheme has assisted over one million Australians suffering from oral health complications, resulting from chronic disease, through the provision of up to $4,250 in Medicare benefits for eligible patients. The average amount spent by patients was, in reality, much less than $4,250 but the uptake was higher than anticipated as the scheme was clearly well targeted and uncovered a huge unmet demand for such badly needed dental care treatment. Those who used it included cancer patients and patients suffering from diabetes and coronary disease, amongst other chronic illnesses that impact on oral health.

Over 80 per cent of patients accessing the CDDS—over a million people—were also health care card holders. This makes sense because statistically people with greater means usually use their means to deal with chronic disease dental issues, either through private health or direct payment because they have the means to do so. But this statistic highlights that it is unlikely the vast majority of CDDS patients would have been able to privately fund the treatment that they received under the scheme and would otherwise have had to wait years for treatment under public dental practices, if they could have got it at all.

What we are debating today, the new scheme that the government proposes, does not provide an alternative to fund the needs of these patients. Labor have sought to close down the CDDS as a scheme they reject because it was not theirs, and because it was introduced by a man who they are doing everything humanly possible to vilify, the Hon. Tony Abbott. They have used every spurious trick in the book to do this, including many mistruths about it being used by millionaires, who of course largely have private health care or would, as I have mentioned, otherwise have self-funded their chronic-disease related dental needs, and about widespread rorting by dentists culminating in their demonisation of the dental profession through auditing the crossing of t's and dotting of i's and then seeking repayment of all fees paid for otherwise legitimate dental work that was needed by the patients and was actually delivered by the dentists.

Needless to say, Labor wanted the scheme gone. They could not get the Greens' support so the only alternative they had was to make it as unattractive to dentists as possible and, in the process, also hopefully undermine its public profile. The allegations that Labor make about the scheme simply cannot be supported and the facts on its success stand on their own. As mentioned, the Labor government has linked its cancellation of the CDDS to the introduction of the Dental Benefits Amendment Bill 2012 that we are discussing in this place today. Indeed, the introduction of the scheme in this bill was the carrot that finally attracted the Greens to support ending the CDDS. I am sorry that the Greens senators have now left the chamber.

What are we getting for this wonderful deal that arises out of yet another collaboration of Labor and the Greens? The fact is that the Labor government is redirecting public dental funds that were once available to anyone in Australia who had dental needs occasioned by a chronic disease, largely taken up by those with little alternative to that care, to a completely different demographic of patients through the establishment of the Child Dental Benefits Scheme, the CDBS. Under the CDBS eligible children between the ages of two and 18 years will be able to access basic dental care, capped at an entitlement of $1,000 per child over two years. Not only is this significantly less than the amount available for urgently needed dental care under the CDDS, it also excludes chronic care needs of two- to 18-year-olds and completely excludes funding the urgent dental care needs of adult patients who are suffering under a chronic disease.

It is a significant concern to the coalition that the closure of the CDDS will leave chronic disease sufferers without access to the dental care that they need. Since first getting involved in the issues related to the unfair treatment of dentists by Labor, I have had many constituents contact my office to tell me just how much this dental treatment means to them in terms of managing their chronic illness and consequently improving their quality of life. The work undertaken through the CDDS not only assisted in restoring a patient's physical and dental health, but also in many instances the treatment that CDDS patients received had a significant impact on their mental health and their social outcomes. I have seen before-and-after shots of CDDS patients who, due to chronic disease, had suffered almost unimaginable dental decay. The 'before' photos showed mouths full of broken, chipped and rotting teeth. This obviously would have had a significant impact on each of those individuals' relationships, their ability to engage and interact socially and their ability to obtain employment.

With the closure of the CDDS and dental funding redirected to children's health, such patients will be entirely dependent on the limited resources of state dental services, which notoriously experience demands which exceed capacity. The sudden closure of this scheme will compromise patient care, and this actually matters. The people affected are real people for whom the scheme was making a real difference.

This Labor government has turned its back on the many Australians who have been accessing the vital and necessary dental care under the CDDS and those who could have accessed the scheme if it was continued. Labor claims their CDBS, because it focuses on children and teens, is a measure to target preventative dental care. However, respected submitters to the Standing Committee on Community Affairs inquiry into this bill were critical of the age limit imposed on this scheme.

For example, Associate Professor Hans Zoellner, representing the Association for the Promotion of Oral Health, stated in the organisation's submission:

Of particular concern in dentistry, is that young adults, becoming independent of their parents and commencing adult independent life, have essentially equivalent dental needs to older teenagers. One aspect of the teen-age population, is an increase in the rate that decay develops, so that sudden withdrawal of dental services from young people once they reach the age of 18, will result in a corresponding deterioration in dental health in young adults.

Professor Zoellner's submission also states:

There seems no clear reason why the dental care of any individual should be determined on the basis of age…

And finally:

There is the further practical impact of sending a signal to young people, that once you get over the 'teenage years', that oral health is assured, whereas in fact life-long care is needed, especially as people age and accumulate chronic disease…

As those quotes demonstrate, dental care is required at every stage of life and those needs may increase as one gets older.

The fact that the government has closed the CDDS only serves to demonstrate that they on that side of the chamber have very little understanding of what the CDDS achieved in providing ongoing care and assistance to patients of all ages suffering with chronic disease. Some of the speakers in this place may even know very little at all about the issue, just accepting the government's spin fed to them, along with speaking notes prepared by the department.

Through you, Madam Acting Deputy President, I invite those opposite to actually have a look at the way the Chronic Disease Dental Scheme treatment has transformed the lives of some of the most vulnerable and disadvantaged Australians—people who those on that side of the chamber purport to represent—and how its withdrawal and replacement with a far more limited scheme will remove that opportunity for thousands more vulnerable Australians. The government may have set 30 November as the closure date for the CDDS, but the patients who have accessed the scheme since it started in 2007 will continue to suffer from chronic disease long after that date.

Examples of patients requiring ongoing treatment as a result of having dentures fitted under the CDDS are common. Dentures require frequent adjustment over a long period of time before the process can be deemed as finalised. Given the high number of health care card holders who accessed the CDDS—I repeat, over 80 per cent of people who accessed the CDDS were health care card holders—it will come as no surprise that many denture patients treated under the CDDS will be unable to afford to fund the completion of this process. It seems unfair that these patients received the life-changing news that they would receive ongoing dental treatment to be funded through Medicare, only to have that treatment taken off them as the government have changed course because they did not like the scheme because they did not introduce it and Mr Tony Abbott did.

Stakeholders also expressed concern at the inquiry in relation to the lack of detail for this policy. As yet, no details in relation to the schedule for treatment under Medicare are available. The government has said that this schedule will be provided in a series of regulations and maybe amendments. This only serves to demonstrate that this bill is just another example of the Gillard Labor government implementing major policy on the run. It also serves to highlight the worrying trend that is evident right across the activities of this Labor government of requiring parliament to pass into law bills that do not have the detail included, meaning that parliament has no way of properly understanding the consequences of the decisions that we make in this place at the time that those decisions are being made. This is not the way that a Westminster system of government should be run, and it is counter to the fundamental principles of the accountability of the executive to the legislature.

It is not just adult CDDS patients who will suffer as a result of the closure of this scheme. Children who currently access treatment under the CDDS will also experience diminished access to oral health care as a consequence of Labor's bill. Under the Dental Benefits Amendment Bill, the financial assistance provided will be slashed to a capped amount of $1,000 per eligible child over two years, compared to the CDDS financial limit of $4,250. Additionally, under this bill, eligible children will only be able to access basic dentistry. Associate Professor Hans Zoellner wrote in his submission to the committee that this will significantly impact upon children currently receiving treatment under the CDDS. I think it goes without saying that that is obvious. Professor Zoellner concurs that most children only need basic oral health treatment—so he agrees with that—but there are those who do need advanced dental treatment, and those children will be greatly disadvantaged by current government plans relative to their options under the CDDS.

Some witnesses to the inquiry quoted statistics to suggest that Australian children have poor dental attendance and consequently inadequate preventative service. However, as Associate Professor Zoellner points out in his submission, most Australian children already have access to dental care through state public dental services. It therefore seems illogical to argue that this new scheme will be the panacea to children's oral health issues when in fact, in all likelihood, the public dental system will be placed under increased pressure as a result of the closure of the CDDS. Yet the government remains quite critical of the CDDS and has made all sorts of far-fetched claims, as I have mentioned, in an attempt to win support for their CDBS.

The government has claimed that the CDDS was not targeted, but this is incorrect. The CDDS was a highly targeted scheme aimed at assisting individuals within our society suffering from some of the most cruel health complaints. The government has also claimed that the scheme was accessed by millionaires, but the figures show that over 80 per cent of patients under this scheme were health care card holders. This fact strongly refutes Minister Plibersek's claims that the scheme was providing free dental care for wealthy Australians. However, I think the worst claims made by Labor were during their incessant attempts to shut down this worthy program by accusing the dentists performing work under the scheme of rorting the system.

The coalition has a proven record when it comes to dental care, and we were the first party to establish a publicly funded dental scheme that worked well and provided sound patient outcomes. We do not entirely oppose this bill because, despite our conclusion that it is clearly not the superior option and that it will not deliver the most beneficial outcomes for the amount of taxpayer funds spent, it will still deliver some benefits. But, given that the government is so intent on redirecting public funding towards children's oral health and, with the Greens support, will achieve that change, what we then would like to see is continued support for children requiring complex dental care equivalent to that they could have accessed under the CDDS.

This should be delivered in such a way that there is no treatment gap between the closure of the CDDS and the commencement of the CDBS, and with extended financial assistance in excess of the $1,000 cap, if required. It is always difficult to achieve the balance in relation to public dental schemes, particularly in times of fiscal restraint. Yet it is disappointing that this Gillard Labor government has had to publicly shame dentists and cut funding for adult chronic disease sufferers to push what is, on the facts, clearly an inferior public dental agenda.

Dean Smith (WA, Liberal Party) Share this | Link to this | Hansard source

I rise also to speak on the government's Dental Benefits Amendment Bill 2012. This is an important piece of legislation that aims to tackle some serious problems in relation to dental health. Unfortunately, the way the government has gone about it means that what is being delivered is perhaps not as effective as it might otherwise be. In all the blaze of publicity this government has sought to give to its new scheme, it has been pretty well silent about the fact that it is closing the Chronic Disease Dental Scheme for all patients on 1 December 2012. It is not uncommon for a government to close one scheme and replace it with another. However, the problem in this instance is that the new scheme the government is establishing does not commence until 2014. This will leave some 650,000 people on the public dental waiting lists—those most in need of dental treatment and who were relying on the CDDS to help pay for their dental treatments—without any assistance in the meantime.

The Howard government's Chronic Disease Dental Scheme, which was introduced by the now Leader of the Opposition when he was health minister, is being abolished by this government, and there is nothing to replace it until 2014. Patients who relied on the old scheme are just expected to fend for themselves. The CDDS has been accessed by around one million patients since its inception in 2007. Its costs have not blown out. It has been, for the most part, a well-run, well-managed scheme. Certainly, there were a few isolated problems, but can anyone opposite name a government scheme for which there is not? Yet the government has decided to scrap it, citing massive cost blow-outs—which there were not; the costs were coming down—and rorting, when there was one case out of 1,500. Why? It is because it suits the government's political needs, rather than the community's policy needs.

You have to ask yourself why the government is not replacing the CDDS immediately and why it is waiting until 2014. The answer of course is that the Gillard government is engaged in a series of desperate acts, scrapping and slashing, desperately trying to conjure up a budget surplus for Wayne Swan. This government, unfortunately, cares more about the political imperative of getting a surplus, however thin and however shoddily constructed, than about the dental health care needs of Australians and their families.

I served on the Senate Community Affairs Legislation Committee that examined this bill and we heard from several stakeholders that they are concerned about the way the government has gone about this. I and other coalition senators share these concerns. I point to two sets of comments made by the Australian Dental Association. The first comment, not surprisingly, points to the importance of investing in child oral health from both a health perspective and a financial perspective. The Australian Dental Association said:

Investment in the oral health of children is a sound and sensible investment as it may result in a long-term monetary saving for government and the community by minimizing future deterioration in dental health. There is a substantial body of evidence indicating that early intervention and preventive treatments provided early in life are a proven and well-established method to prevent poor dental health in later life.

I think we would all concur with those sentiments. The Australian Dental Association's other comment focused on its concern that the closure of the CDDS was being pursued in a time frame that was premature. It claimed that many patients will miss out on essential treatment as a result of the 30 November 2012 cut-off. The Australian Dental Association told the inquiry:

A 12-week period, to complete treatment, will mean that patients under the CDDS will not be able to finalise their treatment plans. Treatment of the chronically ill, for which this Scheme was designed, is often complex, requiring an extended period of time. Complex treatments are often staged to allow adequate healing.

…   …   …

The ADA calls on the Australian Government to recognise that it is critical that arrangements are put in place to allow for treatment services to be completed even if this requires introducing a transition process for existing patients on a case by case basis.

That is important evidence because it was made by what we would all regard as the experts in dental health in our community, the Australian Dental Association.

When it comes to adults, Labor's replacement scheme will not commence until 1 July 2014. That is 19 months after the CDDS closes, which is bad enough. But what concerns me greatly is the situation for children. Over 60,000 services have been provided to children through the CDDS. When it closes on 30 November, there will be a 13-month gap for the children currently receiving treatment. These are children in the middle of treatment who will not be able to have their treatment completed by the 30 November deadline. The families of these children cannot afford the full cost of private treatment. There will potentially be serious health, economic and social ramifications for these people as a result of the government's shoddy policy approach.

The government has been unable to say why it thinks these children should suffer for 13 months. They may well suffer for longer than that, of course, because the government has thus far been unable to say anything about the schedule for treatment under Medicare. The government says that issue will be dealt with by a series of amendments to this legislation at a later time. The Gillard government wants us to take it on faith. That is certainly not fair to legislators and it is certainly not fair to the mums and dads of children with important and critical dental health needs.

Frankly, it is a bit rich of this government to expect the public to take it on trust. The people of Australia do not trust this government. They do not trust it for good reason. The list of broken promises grows longer each week. The record of administrative incompetence and policy on the run is a sorry one. How can anyone in this place have any faith whatsoever that this government will ultimately deliver an effective scheme? How can we be expected to believe the government will be able to pay for it? The absence of detail is emblematic of this government's approach: making policy on the run, getting the media release out there and smiling nicely for the cameras, all the while hoping to God no-one starts asking questions about the detail.

If this government had not wasted millions of dollars on pink batts, NBN cost blow-outs and its utterly discredited policies on illegal immigration, it would not now be in the position of having to scrap this scheme and leave dental patients in desperate need of assistance to fend for themselves. The coalition support investment in dental health and it has been a tenet of our policy for a long, long time. The coalition are concerned about the many patients currently receiving treatment under the CDDS and who will be forced to forgo that treatment during this gap period.

What does the closure of this scheme really mean? It means that the means-tested family tax benefit part A or other specified payments entitlement for children aged two to 17 years will not commence until 14 January—13 months after some children lose access to the existing scheme. This proposal is supposedly to provide a $1,000 capped benefit over two years to eligible children, with the government claiming some 3.4 million children will be eligible. Again, the unfunded cost of this is expected to be $2.7 billion. The proposal for adults will not commence until 1 July 2014—19 months after the current scheme closes. Funding will apparently be provided to state governments for public dental services and services will no longer be available for adults through private dentists under Medicare. The unfunded cost of this is expected to be $1.3 billion.

A key element of the package includes a $225 million flexible grants program for dental infrastructure, which will not commence until 2014. The invitation to apply for funding under that grants program will not commence until 2014. This is a critical point that deserves some further examination. As I travel around the great southern region of Western Australia, the needs of regional and rural Australians and their oral health needs are an issue that is constantly raised with me. It is interesting to reflect on the work of a National Rural Health Alliance and the work that it has done in regard to dental care in rural and remote Australia. It has said that there were 57.6 practising dentists per 100,000 population in major cities compared to 28.5 in outer regional and 19.8 in remote Australia; and 33.7 per cent of regional and remote dentists are busier than they would prefer compared to 17 per cent in major cities. They also said that around 73 per cent of all regional-remote dentists are 40 years or over compared to 60 per cent in major cities. Conversely, only 27 per cent of dentists working in regional or remote areas are under 40 years of age compared with around 40 per cent in major cities. It is quite clear from this evidence and the evidence of other coalition senators that dental health needs are important but that this government has been lazy in providing a suitable policy response.

My concern is for the children in the middle of treatment at the moment who will not be able to have their treatment completed. Families have nowhere to turn, and there has been no consideration whatsoever of the impact this will have on those children. The government and the Australian Greens need to explain why these children must suffer for 13 months with incomplete treatment and absolutely no certainty whatsoever on the provision of the schedule of services that are going to be provided. This, of course, is on the proviso that the government can actually deliver on its unfunded promise in 2014.

The coalition supports investment in dental care and does not oppose the intent of the bill, but it has legitimate and necessary concerns about the children who will lose access to that treatment. The coalition is concerned about the children who will not be able to complete their treatment. We have concerns about the unfunded $2.7 billion cost of the measure and we have concerns about the yet to be seen schedule of services, fees and other essential details that are not yet available on this bill.

The oral health needs of Australians young and old deserve better than the lazy policy making demonstrated by this particular legislative proposal.

Sue Boyce (Queensland, Liberal Party) Share this | Link to this | Hansard source

I rise to speak on the Dental Benefits Amendment Bill 2012. It is interesting to look at the area of dental health in Australia. It is certainly an issue that has bedevilled governments over many years. The first real move to do something other than blame the states for not having enough funding to do anything about it was made by the then Minister for Health and Ageing Mr Tony Abbott when he established the Chronic Disease Dental Scheme.

Unfortunately, this government is now trying to dress up something which has been a failure in order to continue programs that assist people with dental problems as though it is a good thing. The first move in this area was to try to blacken the reputation of many dentists by attacking the Chronic Disease Dental Scheme, which had been extremely successful. Eighty per cent of those using the scheme were people who held concession cards. The initial attempt by this government to blacken the reputations of dentists who had made administrative errors in claiming the rebates for the Chronic Disease Dental Scheme, and to liken the scheme to some sort of dental treatment for millionaires, was complete nonsense and absolute rubbish, and it completely disparaged the work that was done by the Auditor-General and others to make the point that this was not the case. The government could not even inquire of Australia's dental prosthetists as to how their work came into the Chronic Disease Dental Scheme, or educate them about it. The then minister, Minister Roxon, claimed that the government had done everything in its power to tell all those involved in the dental industry about the Chronic Disease Dental Scheme and how it worked, and according to her it was due to the stupidity and/or greed of those in the dental industry that it was not working.

The problem then was that the Australian Dental Prosthetists Association came out and made the valid point that no-one had ever undertaken any education or training with their membership around the Chronic Disease Dental Scheme. Given that over 800 of the 1,100 dental prosthetists in Australia had provided services under the Chronic Disease Dental Scheme, it would seem reasonable that they might have been consulted and that Minister Roxon would have noticed and not claimed to have offered training to the entire dental industry when there was this very large component of it that had received no advice or information whatsoever from this government.

The Australian Institute of Health and Welfare, which is in my view a fantastic organisation that produces very valuable material, has done numerous studies into various aspects of oral health in Australia. One, which the AIHW fortuitously brought out on October 25 this year, looks at chronic conditions and oral health, which is exactly the area that Mr Abbott's scheme—the first scheme to look at dental health conditions—addressed. This report found that the impact of oral conditions on people with a chronic condition, including those with asthma, cancer, heart disease, diabetes, arthritis, stroke, kidney disease, high blood pressure and depression, were more than twice that of people who did not have chronic disease. It showed that people with chronic disease experienced, at more than twice the rate of the average person: toothache; discomfort with the appearance of their teeth, mouth or dentures; avoidance of some foods due to problems with teeth, mouth or dentures; broken or chipped natural teeth; and pain in the face, jaw or temple or in front of the ear or in the ear due to teeth problems. The worst-affected people in terms of their oral health were those who had experienced strokes.

Again, people with chronic disease had far worse impairment as a result of oral problems, particularly in the loss of teeth. They had a much higher average number of missing teeth and they had inadequate dentition—that being fewer than 21 teeth—so that they were unable to avail themselves of a proper diet. It is a serious issue which needs to be properly addressed.

Debate interrupted.