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Monday, 16 June 2008
Page: 4898


Mr BALDWIN (7:03 PM) —Today I rise to speak to the Dental Benefits Bill 2008 and the Dental Benefits (Consequential Amendments) Bill 2008. I look at this program that is being put forward by the government and I see disappointment. I see disappointment because it was the Prime Minister who, during the election campaign, said, ‘The buck stops with me,’ and ‘It’s time to end the blame game.’ What we have seen introduced with this bill is a change in program priorities. What we see with the introduction of this bill is a reduction in benefit to the individual and provided to the state governments. The money that is being provided to the state governments under the Commonwealth Dental Health Program, some $290 million, is going to be consumed in the consolidated revenue of health. The state governments in the public system have only 10 per cent of dentists. And in the public system already, they cannot keep up with the work.

One of the interesting statistics provided to me by the Association for the Promotion of Oral Health is a table that shows what state expenditure is on dental health. I will quote New South Wales: it has a dental expenditure of $138 million and a population of 6.828 million, so the per capita spend is $20.21. The previous speaker talked much about his disappointment and the fact that more needed to be done. What the coalition has said all the way along is that the state governments are not delivering on their responsibilities. In fact, it is so dire that people have complained long and hard. In a release from the Australian Dental Association, Dr John E Matthews, the federal president, claims that this program being proposed by the government is too little for too few. He said:

For far too long, the States and Territories of Australia have failed to meet their obligations to ensure proper delivery of dental care to poor and disadvantaged Australians. This Government had the opportunity to rectify some of the specific deficiencies that existed by introducing some coordinated plans that are able to be built upon or modified to meet future needs …

He goes on to say:

Instead it has provided the State/Territory Health Services with additional funding [less than provided more than 10 years ago] to prop up schemes that have not delivered to date. It’s a Band-Aid solution at best.

I will continue to quote him when he says:

The ADA had advised Government that the previous Commonwealth Dental Health Plan was deficient in that it failed to seek accountability from the States as to their contributions to the provision of dental health. Despite the ADA’s calls for the creation of an improved CDHP seeking such accountability from the States as a prerequisite for funding, such calls for responsible Government have been ignored.

Again, in per capita expenditure, New South Wales ranks the lowest. Its expenditure is nearly half of what is spent by the Northern Territory government per capita, which spends $39.99 per person. In Tasmania, it is $34.36, in Queensland it is $33.97, and the list goes on until we get to New South Wales at $20.21 per person. This is an absolute disgrace. It is what we echoed as a government: that the state governments were denying adequate dental health to our constituents. They were ignoring the need and, as we have heard in the quotes from those two gentlemen, the reduction in funding has had a dire effect.

But we did listen to people. We listened to people and we introduced a plan that spread the spend over the 90 per cent of dentists not in the Public Service. We provided funding on a Medicare rebate scheme for dental services. That Medicare rebate was provided after a GP had referred an individual with chronic dental care requirements to a dentist. That was capped at $4,250 over two years. It was a massive improvement. It was $4,250 over two years for one person with chronic dental issues.

What we are seeing is a replication of programs under this government’s Teen Dental Plan. It is $150, provided you meet the means test requirements for the Teen Dental Plan. The New South Wales government provides the school dental plan, which picks up most of the teen dental issues. So what we are seeing here is a replication of expenditure for no direct benefit for those who are chronically suffering with dental conditions.

If you talk to someone who has such infected teeth in their mouth that they are just stumps protruding through their gums, who cannot eat, who cannot afford to get their dentures fixed and who has gone on a waiting list to wait forever, you will see that it is not a pleasant sight at all. That is why the coalition’s program was so strong. It was so strong that in the nearly five months that it was operational it provided 311,943 services. This government has sought to slash that program. It has sought to slash a program that was directly funding the individual with dentists in the private scheme through a Medicare rebate. Now individuals will go back on to the underfunded state government waiting lists.

It will be an interesting turn of events to hear colleagues on the government side talking up a program that has already let the people down. State governments, as you have heard in the addresses from the Australian Dental Association, have responsibility for dental health. This program, the same as the Howard government’s program, was to have provided additional support. But when I look at those funding figures, which are absolutely atrocious as a spend for the individual, I am embarrassed to be coming from New South Wales when it is providing the least amount of per capita support. I think that it is absolutely fraught with danger. I also note that the 311,943 services that I quoted is a figure that was provided at Senate estimates by Ms Gay Santiago, the Acting Assistant Secretary of the Primary Care Financing Branch of the Department of Health and Ageing.

The reality is that this government will go out on the front foot and say: ‘This is a wonderful funding program. We have provided to the state governments additional funds to address the dental problem.’ There are a couple of key concerns with this. There are not enough dentists in Australia, just as there are not enough doctors. There needs to be more provision, more training and more education. All governments of all persuasions can do more about that. But there is nothing being set aside to attract more dentists into the public health system. The provision of this $290 million will do very little to attract people into the system.

Going back to the Teen Dental Plan, a $150 voucher might sound wonderful because somebody can turn up and have a dental check-up, but what if they need an X-ray? What if they need an extraction? What if they need root canal therapy? What if they need a crown? There is no support for that. There are many young people who have chronic dental issues through poor diet and health, failure to look after their teeth, and breaking their teeth and failing to get them repaired, so they have infections in their gums that affect their diets and their lifestyle. These people will now be put onto the waiting list whereas, if it were a chronic condition, they would be able to seek a reference from their GP to the private provider of dental services and have that problem remedied.

I just do not think that this program has been well thought out. What we saw during the election campaign was nothing more than something to grab a headline. Now, by hell or high water, the Rudd government is determined to deliver its program regardless of the consequences to our constituents. I have spoken to many of my constituents who have accessed the Howard government dental plan and been able to get their teeth fixed, get their jaws fixed or have their teeth repaired and finally eat an apple. Something that many of us take for granted is being able to bite into an apple. If your teeth are in such bad condition that you have stumps, if your false teeth are broken or if you otherwise have an inability to eat, you cannot eat basic foods like apples. I think that is atrocious. Associate Professor Hans Zoellner, from the Association for the Promotion of Oral Health, said:

The states can’t provide more service without more public dentists, and the CDHP doesn’t even replace the now axed dental Medicare scheme for people with chronic diseases of $340M (2007-8 Budget papers), so it can’t possibly achieve even more in the public system with less.

And:

Since some states spend about half per capita than others on dentistry, wouldn’t it be more sensible for the Federal government to insist under-funding states increase dental spending to a minimum level, rather than encourage them to just maintain existing funding? - This smacks of a Federal Labor Government going easy on Labor State governments.

It is not about ending the blame game. It is about holding states accountable for their responsibilities. Whilst it is tremendous to be able to provide additional funds for programs, regardless of whether they are from the federal government or the states, I think the taxpayers demand that federal governments hold state governments to account on the way they spend their money and the way they appropriate it into various sectors. As we have seen in New South Wales, at $20.21 per person, they have not spent much on dental health. The bill is flawed, and it is flawed for a number of reasons. It will not address the situation of 30 per cent of Australians having reported avoiding dental care due to the cost of services. It will not address the 650,000 people currently on public dental waiting lists. It will not address the 50,000 people who are admitted to hospital each year with preventable dental conditions, putting further pressure on public hospitals. It is no good just pumping money into a state government that has no intention at all of addressing the need for more dentists and no intention at all of spending more per capita of its individual budget.

In conclusion, I am very disappointed with this bill. I would have thought that, after the years of sitting and listening to members of the Labor Party, more would have been done—that is, more than just handing cheques to state governments, more on personal intervention in dental work and more on direct outcomes. As I said, 311,934 services have been provided. In any man’s or any woman’s language—provided they can speak, with their teeth, of course—that is a significant contribution. How do they expect people to be able to pay for X-rays, at $25 to $48? A scaling and cleaning can cost $51 to $116. Root canal work can cost from $222 to $598. Crowns cost on average $1,100, and prices range from $787 to $1,600. These are unaffordable for many people, but they were affordable under the coalition dental plan with a reference from a GP. The Labor Party will go forward and sell their policy to the people. When we come to the next election and there are still a lot of people who have been denied access to dental services because the state governments have not spent, have not planned and have not provided the benefits they need, they will be held accountable. I would like to see the coalition continue with their policy to provide funding directly through Medicare for the provision of such services, as we did as a responsible Howard government.