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Thursday, 20 September 2012
Page: 11408


Mr LAMING (Bowman) (12:32): In the final hours of this debate, it is fairly obvious that there is not going to be a reconciliation between the two sides of politics. As an opposition we have made it exceptionally clear now that there is a significant service gap for Australians who are trying to get dental care with the implementation of the government's plan to start funding dental care in 2013-14, leaving a 15- to 19-month gap in between. What you are seeing if you are witnessing or listening to this debate today is the age-old divide between Labor and the coalition. There is the current Labor government with its almost unshakeable faith in the public provision of services, and the coalition with its belief in a blended model—the belief that, by working a private and public health system together, we can have the best of both worlds.

The government's approach simply collapses when it comes to dental care, and it is probably because there are no dentists, doctors or medical specialists on that side. I do not think there is even anyone who has worked in the dental profession on the other side—but I am happy to be corrected. The problem with such a paucity of real experience in the dental sector is that you are then utterly reliant on advisers and bureaucrats to send up recommendations about how to save money, rather than actually knowing what happens in dental care as a service. The government does not understand how this sector works. Australia is a 95 per cent private dental system, and that means our public dental system, run by state governments as an mostly in dental hospitals, is extremely constrained in its supply of dentists. So the pure injection of some money by the other side does not fix the problem.

There are three typologies of people who need dental care. There are the young, who often need surveillance and early and quick intervention for usually small cavities; there are older people who have chronic disease and dental problems that can be either aggravated by or a part of it; and then there are extremely sick people for whom dental disease is extremely severe and who can really only be fully cared for as a hospital in-patient. So we have the young, the everyday adult disease and the severely sick.

What you need to understand is where this government is going. Saying, 'Here's a little bit more cash for state dental hospitals,' is to fundamentally misunderstand how those hospitals work. If anyone from this government had ever walked into a dental hospital, they would understand that a bit more money going into a system that does not have enough dentists does not achieve a great deal. It is quite correct—whether the waiting lists in state hospitals for dental care have been three-quarters of a million or half a million, the reality is that in those hospitals they are mostly dental students under supervision, getting final dental training before they go and work in the private sector. They are predominantly learning, working slowly and carefully under supervision. That is not the way to reduce a waiting list of half a million people. In a private dental system, the way to decrease the waiting list is to empower GPs and dentists in the private sector to fix the problem.

The very architects of Medicare do not understand the power of the system that they designed. But the evidence is there in front of them. Tony Abbott's chronic disease dental scheme, in addition to helping the sickest in the community—giving them the dental care they never could get from state dental hospitals—actually reduced those waiting lists. In New South Wales, the wait for a public dental appointment through their dental hospitals has decreased by 40 per cent, because for the first time people can go to their GP and say, 'Look, as part of my chronic disease and the linked dental ailments, send me off to a private dentist and let me get the job done.'

This morning we saw one of the most disappointing displays by a health minister that I have seen in a decade. It was the current health minister first of all choosing in this debate to traduce dentists and imply that they were dishonest, unreliable and rorting the system; and then, in a fit of rage, suggesting that asthma is not a chronic disease. When the list of chronic diseases for which dental care is eligible was read out by the shadow parliamentary secretary for health, she scoffed at him and said, 'Asthma—you call that a chronic disease?' On the very day that this parliament is promoting a bipartisan event on 'When you can't breathe, not much else matters' and the importance of understanding lung disease, Australia's Minister for Health and Ageing was scoffing at asthmatics, suggesting that asthma is not a serious disease and does not deserve its place as a chronic disease. You would not have found her predecessor saying something so ill considered, nor the health minister before that, nor the one before that—all ministers I knew personally. But this narky, nasty aspect of the health minister's personality is very undesirable and very unsuited to the job.

For 10 years now we have been hearing the accusation from this government that we ripped a billion dollars out of the health system. But in one fell swoop, with this new policy, this government—because they need to try to get a surplus by July next year—are ripping a billion dollars out of Medicare. So they are guilty of exactly what they have been accusing us of for the last decade.

This health minister's argument against the Medicare Chronic Dental Disease Scheme set up by Tony Abbott has been that dentists abuse the system. But any public official can, potentially, abuse a system. That is why we have an audit process—to identify them and get them to pay the money back. That is how the law works. That is why we have an audit team in Medicare Australia. They should be allowed to do that job to get back any money falsely claimed. Dentists agree, the coalition agrees and the government agrees.

How disappointing it was today to hear the health minister—not a backbencher reading from notes carefully prepared by a staffer but the health minister—read out a list of all the violations committed by dentists under the chronic disease scheme. On average, only one out of every 1,500 cases led to a complaint which was investigated. Are you telling me that the character of dentists is not as good as that of doctors or nurses, that they are fundamentally different and more dishonest people, that they cannot be trusted with the dental health of Australians? That is patently ridiculous.

Medicare Australia's audit system should be respected and supported. Instead, this government chose—for political reasons—to let this wound fester, to let the program roll on, to not modify, correct or improve it. They did so simply because they wanted to be able to attack the opposition. Given every opportunity to tailor and refine that program, they passed them all up. There was every opportunity to save $330 million a year on this program by more appropriately targeting it as it became more popular. All of these opportunities were passed up just to make a political point.

I think it is worthwhile—because it is quite complex shifting from one chronic disease dental program to the government's alternative—to follow the path of some different patient types. I will talk about sick kids with a chronic disease, about well kids coming from families which are wealthy or which have a concession card, and then about adults—adults with a chronic disease and adults who do not. Up until 9 September, if you were a sick child with dental problems, you would be covered through a GP and a private dentist. Now the sickest children in Australia are being told, 'Complete your treatment by 30 November or pay for it out of your own pocket.' These are young people with complex conditions, often unable to reliably get to a dentist. They may be disabled or have mobility problems. They may be mental health patients with anxiety disorders. For every possible permutation of health condition, you cannot be sure that all the needed treatment can be completed within this very short time frame. But the government will not budge by one day. This is dental treatment which just has to be done—there are no two ways about it.

This idea that you could simply turn up at a state funded dental hospital is bunkum. It is bunkum because state dental hospitals are there to train dentists. If they can reduce waiting lists a bit, that is well and good. But in effect they are there as a service—to train the dental profession. This is a government which has not trained more dental therapists. Dental therapy graduates have fallen by six per cent under this government. I concede there are more hygienists, but it is oral health graduates, technicians and therapists we need—they can treat the majority of disease in the young. The government's decision to cut young, sick Australians off from the current chronic disease program simply shifts them across to state dental hospitals. But the only people who can get treated in a state dental hospital are people whose dental disease is literally dripping out of their mouth. The most urgent cases get pushed up the list to get treated at the dental hospitals. Everyone else simply sits on a waiting list and never gets to the top.

In South Australia, the waiting list is 18 months to two years. In Queensland, it is two to 3½ years. Realistically, no-one with dental disease and a hope of having it cured would sit for that long on a waiting list. It is not a waiting list; it as a list you simply sit on until you go and get it done privately or you pass away. The people who get treated in dental hospitals are primarily the urgent cases—where they have an abscess or something requiring immediate treatment. That is predominantly what gets done in these hospitals.

The government's proposition—that, as of next year, they will start investing in these hospitals—is inadequate. The $212 million per year which has been committed is, when spread around the eight jurisdictions, only a negligible increase in what is already being spent. The Northern Territory and the ACT spend the most per capita. Then we have Queensland and South Australia. The lowest spending per capita is in Victoria and New South Wales. Even with all of the investment which has been promised by this government—we know of course that it is unfunded and simply adding to the debt and that, even as we have this debate, they do not know where this money will come from—the money provided to Victoria and New South Wales does not even get those states to the current level of South Australian or Queensland spending per capita. So if people in New South Wales want to know how they will be treated under this government's program, they should try to get an appointment in Queensland or South Australia—a two-year wait. That is what you will have after the government's program is implemented.

If you live in Queensland and South Australia and this additional money is added, the per capita spend will still be less than it is in the Northern Territory or the ACT. So go out right now and make a phone call to Darwin and see how long it takes to get your chronic disease treated in Darwin's publicly funded system—over 12 months. We can use the states which already spend more to see exactly what the situation will be like, after you add the federal top-up, in the more poorly funded states. The problem with adding money to state dental services is that you never remove the waiting list—you can only ever hope to treat the most urgent cases on the waiting list.

The fundamental flaw in what this government is doing arises from their failure to understand how dentistry works in this country. The program for the young consumes $2.5 billion in treating children under the age of 18 through a cut-price dental program of up to $1,000; many of those children need far more. Try treating an Aboriginal child with a large hole who needs a stainless steel crown; you cannot even do that for a thousand dollars. The Child Dental Benefits Schedule proposed by this government explicitly excludes crowns, bridges and root canal work. We are getting this cut-price dental arrangement that actually does not serve the children who need it most. What is the point of having a universal dental scheme when you say to Aboriginal children with severe caries, 'Sorry, Julia Gillard bans a crown and a bridge—

The DEPUTY SPEAKER ( Ms AE Burke ): The member will refer to individuals by their appropriate title.

Mr LAMING: 'The Prime Minister bans that personally, so all you can have is an extraction. We'll just pull the tooth, because that is all that this government's plan will allow us to do.'

As I have said before, the fundamental flaw is that, predominantly, teen dental disease can be managed by therapists; it can be managed by oral health graduates. Don't tie up the dental profession in public health. They are the most highly trained specialists in the area. They should be dealing with complex and chronic disease. This is a government that has not activated the oral health routes yet, and therapist numbers are falling. That $2.5 billion spend, which has a capped amount of $1,000, is at risk of overspends and rorts; our chronic disease program was rorted by a very, very small number of people. So, in effect, the government's protestations about the former program will be the same ones that will vex the new program. There are DVA dental officials and advisers who can verify which chronic disease patients need further care and which do not. The government has the opportunity to continue the care for the people who need it most but it is electing not to.

This is a simple situation where it has been decided that the political pain of this federal government to find a surplus will trump the dental pain of our nation. Those opposite are more worried about their political future than about the dental future of Australians. This government is insistent on injecting more money into public dental systems which are not overly efficient and, at the same time, it is hobbling the 95 per cent of private dentists in this country who hold the key to reducing waiting lists. By doing what it is doing today, you will see more people going to their GP and being refused dental care, more GPs giving out antibiotics and trying to buy time, and more expenses to Medicare. All of those half a million people will be turning up to public hospitals and emergency waiting rooms seeking antibiotics and quick solutions. That was the old way and that is what Labor are bringing us back to. They should swallow some pride, understand how the dental sector works, agree to continue the Chronic Disease Dental Program and look after Australians' dental care.