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Wednesday, 19 September 2012
Page: 11193


Mr DUTTON (Dickson) (11:15): On 29 August, Labor and the Greens announced the closure of the Medicare Chronic Disease Dental Scheme. It was proposed for 30 November but had a closure date of 7 September, only a couple of weeks ago. It has been a devastating blow in this country to people with chronic disease who need dental services. This was the only dental scheme for adults that provided treatment under Medicare. A dental benefits schedule for children is due to commence in January 2014. That is the subject of this debate. A national partnership agreement for adult dental services that will provide payments to the states and territories, the government claims, will start in July 2014.

There are a number of points to make in relation to this. The coalition's position, firstly, is that we support further investment in dental care not just for children but also for people who are suffering from chronic diseases. Under the old scheme, they would have been referred immediately to a dentist, to relieve some of that pain and to put them on a more sustainable path. A significant part of our concern in what the government proposes is that there will be a gap of up to 19 months between the closure of this Chronic Disease Dental Scheme on 30 November and when the new scheme for adults starts in July 2014.

The existing scheme has provided up to $4,250 in Medicare dental benefits over a two-year period for eligible patients with a chronic health condition. Patients who presented to a general practitioner required a referral from that GP to a dentist and the work was then performed to the satisfaction of the patient. There has been a significant cost in this program, largely because of the huge underlying demand for dental services in our community. The government has made much of the expense under this program but it is important to remember that over 20 million services have been provided, to over a million patients, over the course of the last five years. That says to all Australians that there is a demand and that demand, in part, has been met. We know that the Labor Party sought to destroy the Chronic Disease Dental Scheme, not because of a lack of demand, considering that 20 million services have been conducted, but simply because they want to discredit and trash a scheme that was set up by Tony Abbott.

The Australian public might ask themselves: 'Who is Tony Abbott and what is Tony Abbott about?' Tony Abbott was the architect of the Chronic Disease Dental Scheme. It provides about $1 billion a year to people in desperate need of dental services. He was the architect of this scheme. He was the person who decided that these 20 million services needed to be provided to over a million Australians, because he wanted to see an end to their suffering of dental conditions. That is why the scheme has been a success. It is for that single reason—that Tony Abbott was the architect of the scheme—not that there is no demand or that the scheme was not justified, that this government has sought to close it down.

Despite the overblown claims by this government, the average claim under the Chronic Disease Dental Scheme, according to the department, was not $4,250 but $1,716. Recent estimates suggest that this figure has fallen even more, down to $1,200 per patient. Eighty per cent of people using the Chronic Disease Dental Scheme have a concession card. The government has tried to paint this as some sort of playground for the rich, for people who can access services under the universal Medicare scheme that we have for conditions relating to the rest of the body. They claim that the Chronic Disease Dental Scheme has been a rip-off because it has applied the same universal scheme as we have operating under Medicare. That shows a fundamental misunderstanding of the targeting of the scheme, given that 80 per cent of the services were not provided to people of significant means; they were provided to people who held a concession card.

This government has an ideological and continuing attack on people they deem to be rich—that is, people with an earning capacity of over $70,000 or $80,000 a year. It determines these people are not worthy of support. Yes, those people have accessed this scheme, but only two in 10 of those who have received services in this scheme have been people other than those who hold a concession card. It would have cost more in the administration of this scheme to exclude that 20 per cent than it did to allow them to receive these services. That, to me, says a lot about what this government is embarking upon. Many of those people would have otherwise been forced to go without treatment or they would have been added to public dental waiting lists that already have 650,000 people on them. Consider that point for a moment.

Eighty per cent of those who accessed support under the Chronic Disease Dental Scheme had a concession card. Had Tony Abbott's scheme not been in place, those people—the 800,000 or so who accessed support under this scheme—would have joined the 650,000 who languish on waiting lists this very day. The government says that there is no need for the Chronic Disease Dental Scheme or that somehow it is the playground of the rich or that somehow it is justified to close this scheme. But it would keep a 19-month gap between now and when people can access a scheme—although it would not be as generous as the Chronic Disease Dental Scheme. Look to the facts, not to the spin, of what this Labor government provides.

It is estimated, on available information, that 16 million services have been provided to patients with concession cards through the Chronic Disease Dental Scheme. Some patients will not be able to complete treatment when the closure is due to occur on 30 November. It may be a cancer patient who is part-way through treatment for their condition—and I will come to a very, very important example in a moment. Consider that this government in its design of this legislation has not even taken into consideration cancer patients or people suffering from chronic disease who may be part-way through treatment. They will suffer under what Labor proposes in its new arrangement and in the closure of the Chronic Disease Dental Scheme. They are patients who cannot afford the full cost of private care and they will not receive treatment for 19 months under what the government is proposing before this House today.

I spoke before of an example, and I want to bring the House's attention to a very, very serious case of a constituent of mine by the name of Mr Wayne Whitehead, who recently contacted me. I think his circumstances deserve recognition in this parliament. This is a man who is suffering and is in significant pain. He will suffer more when the Chronic Disease Dental Scheme closes. This government may be full of good intent but it does not have the capacity to deliver on programs—as we have seen, day after day, over the course of the last five years—and this is just the latest example. Mr Whitehead could well represent thousands of patients around the country in these circumstances. His own circumstances are that he has battled with throat cancer. Due to damage from radiation treatment he is unable to produce saliva or open his jaw normally. He needs frequent dental care and intensive and regular fluoride treatment. Mr Whitehead has been advised that an extraction will require major surgery in a hospital followed by specialised and expensive medical care. The cost of the procedure would be substantial, at about $55,000 for such an extraction and subsequent treatment. Mr Whitehead is on a disability support pension and he says:

… due to my ill health and the cost of daily treatment 3 monthly dental visits for regular check-ups would be prohibitive.

The minister and the Greens in concert need to explain why Mr Whitehead and countless others have to go through the stress and suffering caused by the gap between the closure of the Chronic Disease Dental Scheme and the 2014 delivery of their proposals.

This legislation does not commence until 1 January 2014—bearing in mind that this relates to children. The bill makes very minor amendments to the Dental Benefits Act 2008, only changing the eligibility age of the current Medicare Teen Dental Plan from 12 to 17 years to two to 17 years. It does make other minor terminology changes to provide for a change from the Medicare Teen Dental Plan to the Child Dental Benefits Schedule. The schedule of service fees and details of how the scheme will be funded are still not available. The government is rushing this bill through the parliament without having this detail, even though it does not commence for well over a year—in fact, after the next election.

The minister has acknowledged that services for most children will cost less than the proposed $1,000 cap—at least that is what the government modelling is telling them. Some children will require more services, and there is no provision to ensure they continue to receive adequate treatment, especially in the period before this bill commences. Available data suggests that well over 60,000 services have been provided to children under the Chronic Disease Dental Scheme, and it comes to an end on 30 November. Many children who are sick and suffering from chronic disease will suffer in pain during the 13-month gap before 1 January 2014 when services will be available to them, but at a much lower cap than the $4,250 available to them under the Chronic Disease Dental Scheme. These are children who are in the midst of treatment, who will not be able to have their treatment completed by 30 November. What does the minister or this Prime Minister say to those people, to those families, who have children suffering with severe pain? These are kids who had access under the Chronic Disease Dental Scheme but cannot get access under this scheme. Why are they put in that position?

I bring you back to my earlier point, Mr Deputy Speaker, and that is that the government's intent to close the Chronic Disease Dental Scheme was not about making it easier or making dental services more accessible for children and for adults; it was about making a political point because they want to be able to say at the next election, 'We closed down Tony Abbott's Chronic Disease Dental Scheme, and here we are champions of the new scheme that we have designed in concert with the Greens.' I say that Australians should see through what is completely and utterly a contemptuous act by a government desperate to return themselves to some sort of respectability in the polls.

This decision has not taken into consideration those sick children who have received treatments under the Chronic Disease Dental Scheme—60,000 of them. We are not talking about one or two cases where assistance may be able to be provided. What do people do, what do families do, over the course of the next 13 months? For many of them, if they are in desperate situations, as obviously many of them are, they can only access treatment through what is an already overburdened public system where 650,000 people wait and languish to receive those services.

This Prime Minister and this minister need to explain to the Australian people what happens in those individual cases over the course of the next 13 months where kids are suffering, some of in silence but many of them not. I would say to those families: contact your local Labor member of parliament and contact your local Labor senator and say to those people, 'Why is it that your government is removing much needed assistance for my child? Why is it that this government has decided to close down the Chronic Disease Dental Scheme and not to start anything in its place?'

That is why yesterday, on behalf of Tony Abbott and the coalition, I announced that we would move to disallow the government's procedure in this parliament to close down the Chronic Disease Dental Scheme, so that people can at least get support under that scheme or something similar in the intervening period—which is 13 months if they are children and 19 months if they are adults—until the government's new scheme can commence. That is the very least that this government could provide to people and children who are suffering from dental pain. That is what we need to ask of this government and it is the very least that it can provide to those people.

There are a couple of other points that need to be made as part of this debate. Australia has 5.1 million concession card holders and an additional 2.3 million people without concession cards, on low incomes, who could benefit from coverage, according to the government's own National Advisory Council on Dental Health, under the Chronic Disease Dental Scheme. The government's proposed number of services, even if delivered, as promised, by 2018, will be totally insufficient in meeting the demand that is going to be created under this proposal.

In 2008, Labor proposed the Commonwealth dental program, which it never delivered. The program promised one million services by providing funding to the states and territories, and 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 the number delivered might have been significantly less than that promised.

The number of services to be provided over the full six years under Labor's recent proposal is only 20 per cent of what the Chronic Disease Dental Scheme provided last year alone. The government say that in the design of their scheme, even though in net terms they are training no new dentists, clinicians or technicians, they are going to open the gates to several million more Australians come 1 January 2014, or 1 July 2014, depending on which part of the scheme you are talking about. And they will have people lining up on the doorsteps of dentists around the country, where apparently millions of places are sitting vacant right now! Somehow the government argue that this is a well-designed scheme and somehow, even though they are not going to increase supply between now and 2014, it is okay to have millions of additional services being required from people.

Does anybody hear an alarm bell ringing about the design of this scheme? Has anybody thought back to the pink batts, to computers in schools or to school halls? Do people think that the government possess the capacity to deliver the most basic of design when it comes to programs? I would have thought that the government could have given away free pink batts with some success, but they did not. They burnt houses down and people died as a result of that program. They wasted billions of dollars and there is a huge tail liability in that scheme because they now have to remove the defective pink batts from people's ceilings around the country at a significant cost to taxpayers.

Yet the government say they are going to design a scheme. Again, they are full of good intent, but look at the detail of what they provide. They say that with no new dentists we can bring millions of people into dental surgeries across the country from 1 January. There will be no phased implementation and no increase in the workforce between now and 1 January 2014, and somehow we can provide services to all of those people! There will be no increase in the price that dentists charge, even though they have people lined up out the doors!

Do people seriously believe that this government will get the design right? Think about the school halls program, where they had the same good intent—the same superficially attractive proposal—where they said, 'We will put money into schools.' Nobody would knock that back, but this government spent billions of dollars of taxpayers' money on overpriced school halls that, in the end, did not deliver what this government promised. This government squandered the opportunity to deliver significant infrastructure, because in the process it spent money lining the pockets of people who were greedy and saw a purchaser in distress. Those greedy people saw this government coming, and school halls were built well over price and the benefit was not delivered to the school, the students or to the taxpayer. That is the track record of this government when it comes to those two programs.

Look at what else this government has done. In relation to the provision of solar panels this government completely mucked up the delivery of that program. This is a government that started with billions of dollars in the bank, and it wasted every single dollar. It was not the government's money but taxpayers' money. Not only did it waste that money, it thrust us into unprecedented debt. This government talks about a surplus, and it has talked about a surplus for five years, but this government has delivered the four most significant deficits in our country's history. And it continues to ramp up debt on a daily basis in this country. Yet it asks the Australian public to believe that it can deliver a dental scheme from 1 January 2014.

Let's ask why the government is introducing legislation today, without the detail attached to it, for a scheme that will not start until after the next election. There are only two possible scenarios. The first is that this government has no intention of delivering this scheme, and it wants a policy that is superficially appealing to the Australian public, because, like the coalition, the Australian people want to see more money put into dental services. But the coalition do not want to see money wasted without people getting the services that they rightly deserve.

That is the first scenario: this government has said one thing and they intend to do the opposite after the election. That may well ring a familiar tune with the Australian public, because this Prime Minister said before the last election that there would be no carbon tax under a government she leads but she did the complete opposite when she got into power. So this government should not be taken on their spin but on their track record.

If people want to look at what the government will be like if they are re-elected at the next election, look at what they have been like over the last five years. They have squandered money. They started with good intent in policies but they have not been able to get the design right and not been able to deliver what they promised to the Australian people. That is the first scenario. The second is that they have rushed this in for political purposes but also because they believe they can implement the scheme, perhaps with some significant design feature changes which they will sort out if they get elected at the next election. Either way, people need to be deeply suspicious about what the government is offering up.

What is the position of the coalition? The starting point, as I said in my opening remarks, is that we want to see further investment into dental care. We want to make sure that it is done efficiently and productively. Why? Because we want to make sure that we get the maximum number of services delivered to those most in need. In the end, we are the guardians of taxpayers' money and it is incumbent upon us to make sure that people who deserve the services get the services at the lowest possible cost. That is what we are charged with, and that is what this government has lost sight of.

This government has closed down the Chronic Disease Dental Scheme not to replace it with a scheme that starts from 1 December but to say to the Australian public that, even if you are suffering from a chronic disease, even if you are a concession card holder and you are in the most desperate of circumstances, you will have to wait up to 19 months to receive any assistance at all. The minister will say, 'We've put more money into the public dental waiting list, and somehow we'll work through that list.' Some people at the moment wait five years or more on the public dental waiting list. If they are waiting five years or more, and there are 650,000 people on that list as of today, how can people seriously take this minister at her word? Are people who are receiving treatment today under the Chronic Disease Dental Scheme somehow going to jump the queue of 650,000 people over the next 19 months? This minister has no credibility.

In the end, in wasting money, this government has decreased the capacity of our nation to deliver a more effective health system. When this minister talks about the extra spend in health, what she is saying is that she has employed more health bureaucrats. I think health bureaucrats are well intentioned and I think many of them do a wonderful job. This government, having spent all the money and plunged into debt, has now arrived at a crossroad, where the choice is to continue to spend money on recurrent bureaucratic positions or to reapply and redirect some of that money to front-line services. This government has a decision to make, and future governments will have a decision to make, about whether to continue to bloat the health bureaucracy in this country or to apply that money to the doctors, nurses, dentists and allied health professionals across the country who are trying to make a difference in people's lives.

The idea of an infrastructure or a bureaucracy is to deliver services efficiently to the people they serve, and in our case that is the Australian public. Over the last five years, where have the government spent money in health? They have spent it on the creation of 12 new bureaucracies. They have not spent it in front-line areas. They have not spent it on providing advances and opportunities to our researchers and to people who are delivering amazing interventions on a daily basis. This government have taken a deliberate decision to divert money away from the Chronic Disease Dental Scheme and to put it into their ever-growing bureaucracy.

The Australian people understand that. They understand that because it is what Labor did at a state level. It is what Labor did in New South Wales and Queensland in particular. They bloated their bureaucracies to a point where the recurrent spend became unmanageable. And what happened? People could not get into emergency departments. People waited hours and hours with sick children in emergency departments. Older Australians, concession card holders, pensioners, and self-funded retirees on small, fixed incomes saw services drop off in public hospitals because Labor decided to increase the number of bureaucrats in the system and take money away from doctors, nurses and core services.

After the next election, if the coalition is elected, we will make a deliberate strategy to return support to front-line services, to doctors, to nurses, to those people who are seeing patients and those people who are making a tangible difference in people's lives. That is what the health portfolio is about. It is not about making yourself feel good because you have new buildings, new motor vehicles and new infrastructure which requires billions of dollars more each year to feed.

The government should be about providing support to people who are sick. They have taken their eye off the ball, and there is no more egregious example than the area of dental health. People received millions of services under a system that was designed by Tony Abbott, a system which made an intervention into people's lives and changed their futures. That is what the Chronic Disease Dental Scheme was about. If the government sought to close it down and implement their own scheme immediately after the closure then people might understand. But to leave a 19-month gap during which people cannot access adequate dental services, and particularly where people are already suffering from a chronic disease, is a cruel blow by this government. It underscores the point that we make—that the government, when it comes to health, have taken their eye off the ball. They have adopted the state Labor strategy of spending money not on doctors and nurses but on bureaucrats, and that is why this country has been plunged into billions of dollars of debt.

The government should say here and now, in this place, to the Australian people what will happen over the next 19 months, when this void will appear in people's lives, when treatments that are partly carried out will not be finished. What happens to those people? I ask the following speakers from the Labor Party, who would have been receiving the same correspondence that I have from around the country from people who are suffering from chronic disease and who are petrified at the closure of the scheme: what do you say to those people? How could you look those people in the eye and say that you provide no services to them, not because you have intent to implement a better scheme but because you want to close it down for your own raw political purposes? I think the Australian people will make their judgement at the time of the next election, and so they should. It will be a damning judgement on a government that has failed in so many areas, this just being the latest. (Time expired)