Ms Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health) Share this | Hansard source

I rise to speak on the Dental Benefits Legislation Amendment Bill 2014 and note that this is the first time this bill has been debated for second reading since the minister's second reading speech on 26 March, which is quite some time ago—well before the budget. The bill amends the Health Insurance Act 1973 and the Dental Benefits Act 2008 to waive debts for dentists under the former Medicare Chronic Disease Dental Scheme, which was closed in 2012. It will also make a number of amendments for the operation of Labor's Child Dental Benefits Schedule to bring the compliance framework of the scheme into greater alignment with Medicare's compliance framework. This bill amends both acts so that the Professional Services Review scheme can be applied to any dental services provided under the Child Dental Benefits Schedule so that suspected cases of inappropriate practice can be investigated.

The bill amends the Dental Benefits Act to enable the chief executive of Medicare and relevant employees of the Department of Human Services to obtain documentation from a dentist to substantiate the payment benefits under the Child Dental Benefits Schedule. Finally, the bill makes a number of machinery amendments to both the Dental Benefits Act and the Child Dental Benefits Schedule. I will say at the outset that Labor will not be opposing this bill but I will have a second reading amendment on the bill as well.

While the contents of this bill are of themselves not too contentious, the remarks of the minister when he introduced it are of great concern to Labor, especially in relation to the concern that he flagged at the end of his second reading speech about the operation of the Child Dental Benefits Schedule. This is a government that, frankly, came to power promising no cuts to health and no new taxes and then, when elected promptly set about smashing public hospital funding and announcing a new tax on visits to the doctor. When a minister has not been up-front before the election about how he planned to rip $50 billion out of public hospitals and slug patients with a tax every time they visit a doctor or attend an appointment for a scan, I think we have some very strong grounds to be deeply concerned when this same minister flags his so-called 'concerns' with another scheme that he supported in opposition.

It is worth discussing here a little of the history of Commonwealth funding for dental schemes, which we are debating here today. The great missing link in public health in Australia has been in dental care. It was left out of Medicare back in 1984 reputedly because of both cost and the politics of having to tackle both doctors and dentists at the same time, which was considered a bridge too far. This is especially so when one recalls that the Liberal Party was then, as it always has been, implacably opposed to Australians having access to decent, affordable health care regardless of income—a battle we are fighting again today over the GP tax. It is good to know your history when it comes to these matters.

Labor has to fight two elections, a double dissolution and a historic joint sitting of parliament to introduce universal health care in Australia with Medibank only to see it promptly torn down by the Liberals after 1975. In 1983 we were elected again on a promise of introducing universal health care and, despite ferocious opposition, again from the Liberals, succeeded in introducing Medicare in 1984. The Liberals promised after every election that they were going to tear it down, and they finally learnt their lesson in 1996, when John Howard promised, if elected, to retain Medicare despite having once called it 'the greatest disaster ever to befall the health system'. It is important to know your history when it comes to these matters. I know some on the opposite side are parroting the same lines, they are staying on message, but this is your history. The history of the Liberal-National Party is to get rid of Medicare, and now you are just trying to do it by stealth.

So Labor has had to fight the Liberals every step of the way to introduce Medicare and to protect it from those who have thought decent health care should only be available to those who can afford it. Throughout that period we have sought to improve and extend Medicare. Previously when we are in government we did have a Commonwealth Dental Scheme, a very important scheme that was actually seeing public waiting lists in dental going down. What was John Howard's first act when he came into this parliament as Prime Minister? He got rid of that scheme and introduced a very limited scheme that then blew out. It was very limited scheme that was never designed to do what it was ending up doing back in 2012. It is important to know your history when it comes to dental health and when it comes to Commonwealth funding for dental health.

The former Labor government was able in 2012 to provide the most significant Commonwealth investment in dental care since Federation. There has never been any logical reason for why health care should stop at our teeth and why Australia should care about every part of the health of a person's body, apart from what is in their mouth. The abolition of the Commonwealth Dental Scheme by John Howard was, frankly, something that saw public dental lists blow out in this country. He was responsible for that.

We know that dental care is, of course, not just about teeth, but poor dental care is a good determinant of poor general health care; that poor dental care is linked to chronic disease; and that if teeth are not properly cared for poor dental care too often leads to much greater health problems. So it was with some pride that as a member of the former Labor government I was involved in the steps we took to advance our universal system of health care to dental care with the announcement of a $4.1 billion Dental Reform Package. As far reaching as this was, it still the not fully extended to dental care the same level of support that Medicare provides for just about every other area of health care. As always, the budget had to be taken into account. We had to ensure that the steps we talk to extend Medicare to dentistry could be afforded and, indeed, justified against the competing demands of so many other worthy areas of health. So we targeted the areas of dental care that were most likely to deliver the greatest return of that investment and was most deserving of funding. In other words, children and low-income earners.

The $4.1 billion Dental Reform Package we announced back in 2012 comprised $2.7 billion for around 3.4 million Australian children who will be eligible for subsidised dental care. Ours was 'Helping kids to grow up smiling'; the government has now changed it to the Child Dental Benefits Scheme. There was $1.3 billion for around 1.4 million additional services for adults on low incomes to have better access to dental care through the public dental system; and $225 million for dental capital and workforce was to be provided to support expanded services for people living in outer metropolitan, regional, rural and remote areas. The centrepiece, of course, was the Child Dental Benefits Schedule, which commenced on 1 January this year—the program that meant that for over 3 million children aged two to 17, going to the dentist now has become like going to see the GP.

We introduced the scheme because of disturbing evidence that the oral health of children has been declining since the mid 1990s. According to the Australian Institute of Health and Welfare, in 2009 the proportion of children who had experienced decay in their baby or deciduous teeth ranged from 42 per cent of five-year-olds to 61 per cent of nine-year-olds. The proportion of children with permanent teeth affected by decay ranged from five per cent for six-year-olds to 58 per cent for 14-year-olds. That is a damning indictment on what was happening in dental for children.

Almost 20,000 kids under the age of 10 are hospitalised each year due to avoidable dental issues. By age 15 six out of 10 kids have tooth decay. So the scheme sought to tackle that by providing a capped benefit of $1,000 per child over a two calendar year period targeted at low- and middle-income families by tying eligibility to those receiving family tax benefit part A or an equivalent Australian government payment—trying to put money where it was most needed: preventative health of children's dental and for low- and middle-income earners. The program is a crucial investment in the long term health of children, because we know that dental health in children is the best predictor of dental health as adults but also a predictor of overall health. In just the first two months of this scheme's operation, more than 84,000 children have received dental treatment under the Child Dental Benefits Scheme, and that includes some 26,000 children outside of major cities. As those figures show, it is a scheme that has been desperately needed, and Labor was very proud to deliver it.

In addition to dental for children, the Dental Reform Package provided extra funding for 1.4 million additional services for adults on low incomes, including pensioners and concession card holders and those with special needs to have better access to dental health care through the public dental system. It also meant more services and more dentists in areas of most need—outside capital cities and large regional centres where, again, we know there are higher rates of poor dental health and chronic illness. Again here the funding was driven by the evidence about who was most in need of government support. According to the Australian Institute of Health and Welfare, while untreated decay and fillings are similar across income ranges, if you earn more than $60,000 a year you have on average seven more teeth than those earning less than $20,000 per year. That is, again, pretty damning statistic and evidence that, sadly, in Australia, while we have a health system that guarantees first-class care for people who have an accident or get cancer or heart disease, the state of a person's teeth are still a very good determinant of income.

Importantly, this package was in addition to the $515 million announced in the 2012-13 budget, which included a blitz on public dental waiting lists. In the 2013 calendar year, over 20,000 public dental patients received treatment because of Labor's funding of the public dental waiting list blitz. It is because of Labor that over 280,000 adults and children have better oral health now resulting from free or subsidised care under our Dental Reform Package. And just as it was only Labor that introduced or defended Medicare, so it is only Labor that would advance Medicare to improve the health of all Australians. And just as this government seeks to tear down Medicare, so it is, we suspect, with Labor's dental health programs. Whereas Labor sought to extend and improve the health services available to all Australians, the Liberals demonstrate that time and time again they see decent health care as something that should only be available to those who can afford to pay. Indeed, in introducing this bill, the Minister for Health told this parliament:

I put on the record some early concerns about the way in which the Child Dental Benefits Schedule was structured … we will continue to monitor that program very carefully because I do have some concerns about the way in which this scheme was designed …

The truly bizarre thing about this is that this scheme, although conceived, announced and funded by a Labor government, actually commenced its operation under the Abbott government in January this year. The Minister for Health, if he had concerns about the scheme's structure or its design, had the opportunity to amend it prior to its commencement in January. But he waited until March to drop his concerns into the back of a speech, making a series of technical amendments to the child dental benefits scheme and amendments to the issues around debts for dentists following the abolition of the Chronic Disease Dental Scheme. He drops it in at the tail end of a speech. So despite not opposing the scheme in opposition and then actually presiding over its introduction—being in government for several months, having the opportunity, having representations from dental associations across the country about the scheme—it seems the minister is already planning to make changes to the Child Dental Benefits Schedule for millions of kids. When a minister who promised no cuts to hospitals and then slashes $50 billion from hospitals says that he has concerns about the child dental health scheme, the warning lights are flashing bright red and the sirens are sounding even louder as to what they are intending to do with this scheme.

This has all the hallmarks of yet another example of the Abbott government laying the groundwork for cuts and destroying universal health care in Australia. They are pulling the same trick that they did with their new GP tax and Australian families should not fall for it. They can see the evidence about this government's commitment to dental health right before their eyes in the budget. Before the election the Prime Minister, as the then opposition leader, declared in January 2013 that there was an aspiration to extend Medicare to cover dentistry. Fitting with this government's dedication to saying one thing to get elected and doing an entirely different thing in government, rather than extending Medicare to dentistry, they instead slashed the commitment of the Commonwealth to fund dental care.

In just its first few months in office we saw the Abbott government reverse the proposed expansion of the Voluntary Dental Graduate Year Program, cutting $40 million. The budget itself saw nothing but cuts to dental programs: $229 million was cut from the dental infrastructure scheme for rural, regional and outer metropolitan areas—the scheme that was designed to provide more dental chairs for public patients across the country, more capacity for clinical training places for dentists across the country; another $15 million was cut from Charles Sturt University's program to establish dental clinics on the New South Wales Central Coast; and $390 million has been cut by putting on hold a program for the states to shorten adult dental waiting lists by delaying the second national partnership agreement with the states, with no guarantee that money will ever be returned into the public dental system down the track.

The first two cuts show the contempt this government has for the people in rural and regional Australia, and, frankly, the complete inability of the National Party to stand up for its constituents against a Liberal health minister determined to slash and burn health, particularly in the regions. Rural and regional Australia only has about half as many dentists per capita as metropolitan areas, and these programs, while not fixing that overnight, would have gone some way towards improving the number of dentists practicing outside our capital cities. Indeed, just this month I attended, with the Assistant Minister for Health, the opening in my electorate of a new student accommodation facility designed to help universities train medical students locally, giving them a taste of living and working in regional Victoria. As the minister then correctly noted, the investment, which came from the former Labor government, ensures more medical students not only live and train in regional Victoria, but those who do have that experience are much more likely to want to practice in those areas when their training is complete. Knowing that, this government still cut those programs to the detriment of people in rural and regional areas who are in desperate need of more dentists and better dental care.

The deferment of the national partnership agreement means hundreds of thousands of people with poor dental health, many of them in constant pain, will continue to wait for treatment. An estimated 400,000 people are on dental waiting lists around the country, and in some states that program has helped to cut waiting lists by up to half. As Griffith University Professor of Dental Research Newell Johnson told the ABC, these cuts will be a disaster for dental health and could double or treble waiting lists. He said:

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

Dr Melanie Hayes, National President of the Dental Hygienists' Association of Australia, correctly nailed this as the Abbott government abandoning 'continued investment in preventive oral health, demonstrating contempt for those Australians who rely on public dental services'.

And already we see these cuts have had an impact on real people. The budget cuts have now placed in doubt the work of the community dental programs operating out of a clinic in Light Square in central Adelaide. The Light Square clinic was set up with government grants, support from the Australian Dental Research Foundation and significant donations from medical companies; it gives free care to a range of people otherwise unable to afford a dentist. It is also an important training ground for final year Adelaide dental students and provides simple restorative work like fillings as well as extractions, cleaning and preventive care. But its funding will wind up at the end of the year, possibly leaving only donations as a funding source. The clinic is working on strategies to see how it can keep going, but it has made it clear the loss of federal government funding means it will be treating many fewer patients with no guarantees of how long the organisation can survive. And that is a pattern that will be repeated right the way across the country for hundreds of thousands of Australians unable to find the money for dental care, many of them waiting years for public clinics to treat them.

So that is the record of this government when it comes to dental health: it is as mean and deceitful as it has been in all other areas of health. It is no surprise then that these bills are not about improving dental health, but are, instead, simply technical bills designed to pick up a number of issues with various dental programs, including some long gone, such as the Chronic Disease Dental Scheme, which Labor closed in 2012. This scheme was poorly targeted and was failing to address the problems in the existing dental scheme such as public dental waiting lists, infrastructure, workforce distribution and of course the appalling state of children's dental health in Australia. The scheme did not deal with those issues and we believe very strongly that the money for the Chronic Disease Dental Scheme would be better targeted at hitting those areas: children's dental health and poor and middle-income Australians who are reliant on public dental schemes. That money was better spent in that area.

The Department of Human Services conducted audits of the Chronic Disease Dental Scheme and found that there was a high rate of noncompliance with the provider-reporting requirements set out in section 10(2) of the determination. Debts were raised against dentists found to be noncompliant through the audit process.

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