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Wednesday, 10 October 2012
Page: 12007

Mr VAN MANEN (Forde) (18:45): Following the contribution from my colleague from Hinkler, it is great to see the government's commitment to improve dental health for Australians. We in the coalition share that commitment and we have made numerous efforts over the last five years to work with the current and former Labor health ministers to improve outcomes for Australians. It was after all the Howard government that supported private health insurance to assist people in meeting the costs of dental care as well as the implementation of the Medicare-funded Chronic Disease Dental Scheme.

As my colleagues have ably touched on already in this debate, we are not going to oppose the bill before us today. However, there are a number of concerns with the government's six-year dental package. One of the key components of this package is providing some 3.4 million children aged two to 17 who are eligible for family tax benefit A with access to subsidised dental care capped at $1,000 per child over two years. In addition, there is funding of $1.3 billion for the public dental system so that around 1.4 million additional dental services can be provided for adults on low incomes including pensioners, concession card holders and those with special needs. There is also the funding of some $225 million of dental capital on a workforce to support expanded services for people living in outer metropolitan, regional, remote and rural areas.

The implementation of the dental reform package which requires the replacement of the Chronic Disease Dental Scheme is our big concern with this package of reforms. It is worthwhile looking at some of the stats for the Chronic Disease Dental Scheme. Approximately 20 million services have been provided to over one million patients under the scheme since 2007. Labor has repeatedly tried to close the scheme for political reasons. Labor has gone to great lengths to undermine the scheme, in all probability because it was established by Tony Abbott when he was health minister and it has been such a success in improving access to treatment and consequently a better life for those who have received that treatment.

First and foremost my concern is for the patients whose treatment will be compromised by the closure of the Chronic Disease Dental Scheme. It is not just the coalition that disagrees with the government's poor planning which will see patients, including children, left to wait between the closure of the Chronic Disease Dental Scheme on 30 November this year and the planned implementation of the new scheme in January 2014, for children, and 1 July 2014, for adults. For example, our friends at GetUp! have facilitated an online petition against the closure of the Chronic Disease Dental Scheme and that has reached some 13½ thousand signatures to date.

In addition, the Australian Dental Association has expressed their concern about the early closure of the Chronic Disease Dental Scheme, with President Shane Fryer observing:

Many of the patients being treated under the CDDS require complex care; some of which includes surgical procedures that need to be completed over a series of months, for example, periodontal treatment. It is unreasonable to expect patients to now be responsible for the cost of procedures they consented to on the understanding their treatment would be covered by Medicare.

Hans Zoellner of the Association for the Promotion of Oral Health also stressed his concern about the closure, paying particular attention to children who will not require services to the value of the new cap and, on the other hand, children who require more expensive procedures who will be significantly affected by the capping under this proposed legislation. The minister and the Greens should explain why these children must suffer for 13 months with incomplete treatment and no certainty of a schedule of services that are to be provided once the government actually delivers on its unfunded promise in 2014.

It is also worth noting that the majority of patients in the Chronic Disease Dental Scheme come from low-income families. Health Care Card holders represent some 80 per cent of the 1.5 million people who have accessed the scheme. On 7.30 last week many Australians will have seen one such case highlighted of a patient who had been accessing the Chronic Disease Dental Scheme. This man, who is in his late 20s, is on a disability pension and suffers epilepsy. He carries clove oil around with him to be used as pain relief while he waits for around 19 teeth to be removed. He joked that for as long as he has had teeth he has had problems with his teeth and had had nine teeth removed at the age of only three. He said he dreamed of the day he would have new teeth, because he wants to go to TAFE, get a job, give up the pension and move on with his life. This is just one example of how debilitating poor dental health can be on an individual and how improved dental health outcomes can and are being achieved under the current scheme.

There are already 650,000 people, or 400,000 adults, according the government, on the public dental waiting list. I have been told that in Queensland there is a five-year waiting list for services in the public sector. The question might be: why is this important? It is important that we get this right because we are not just talking about numbers here, we are talking about the real lives of individual people. We are talking about those people who suffer the broken and painful smiles of the underprivileged, and we need to be mindful of this rather than how a few dollars can be saved at their expense in between dental schemes.

I recently had the chance to meet with one of our constituents following an email he sent to my office with regard to his concerns about the closure of the Chronic Disease Dental Scheme. He writes:

I am writing to urge you and the opposition to take action to improve Australia's dental health care. Dental care, never included in Medicare, is underfunded, and disadvantaged people suffer the most severely. Poor dental health hurts quality of life. Bad teeth cause pain, impair the ability to eat and speak and they erode confidence. And all this can make it harder to gain and keep work.

Research shows that people on low incomes are much more likely to have few or no teeth, and children in poorer areas are more likely to have tooth decay. However, it is not just the disadvantaged who cannot afford treatment. Dentist visits are expensive, and many people struggle to pay for them; or they delay going to the dentist, which can result in worsening oral health.

As a result of this email, I took the opportunity to meet with the constituent. His proposal was that an extension of funding be granted for people already in the Chronic Disease Dental Scheme. The reason that he stressed the importance of this extension was highlighted when I was informed about the process involved in fitting dentures. New dentures need to be monitored and, as the patient's gums heal and the alignment of their gums changes, alterations need to be made to the dentures so that they still fit comfortably in their mouth.

With the closure of the scheme, this particular denture professional explained, there would be at least 12 patients in his particular clinic left in the lurch. Taking into consideration the number of other dentists around my electorate, there could be many more disgruntled patients left with poorly fitting dentures as a result of the closure of this scheme. It was also brought to my attention on the very first day after new referrals were cancelled—and on a daily basis since—that this constituent has been encountering patients who have become distraught when told that they are now required to attend a state government clinic and place their name on a waiting list—which, as I touched on earlier here, he advised is around five years.

He has forwarded me an image to highlight the real issue. It is an image of a patient who has no upper teeth and a small worn-out partial on the upper. Her lower teeth all need removal and replacement with an immediate denture. He stresses that this is just one example of the many thousands of people who will be in the same predicament, struggling with the full impact of compromised oral health. I seek leave to table that photo.

Leave not granted.

Mr VAN MANEN: Well, it is far more important than an electricity bill. We are talking about somebody's health.

According to the report Public dental care and the Teeth Care trial: a history of decay, by Sharon Bond, inability to access dental treatment in a timely manner has significant impact on individual health and wellbeing, including: prolonged pain and suffering; increased damage to teeth and gums; the risk of the spread of infection to other parts of the body, resulting in other acute medical conditions requiring treatment in hospital emergency departments or by general practitioners; dependence on pain medication and the implications of their side effects; poor diet due to inability to eat fresh fruit or vegetables, resulting in other medical conditions, like vitamin deficiencies, digestive problems and obesity; other major health problems, such as cardiovascular disease, stroke, diabetes and low-weight babies; dental induced speech problems; and diminished self-esteem due to physical appearance.

In addition to the closure of the Chronic Disease Dental Scheme, we are also legitimately concerned about the unfunded $2.7 billion cost of these proposed changes. The question still to be answered is: where is this $2.7 billion to come from? And when you consider that this is on top of another $6.5 billion a year announced for Gonski education reforms, that is some $9.2 billion in government spending that Australian taxpayers have yet to be informed as to how it is going to be paid for.

In addition to the unfunded issue, we are also concerned that this is another bill being rushed through parliament without a schedule of services and fees and other essential details. The coalition renews its commitment to work with the government to refine the Medicare Chronic Disease Dental Scheme in the meantime, including reviewing the process for providing certain high-cost items such as bridges and crowns. As I said at the outset, the coalition supports investment in dental health and does not oppose the intent of this bill. However, we do remain concerned and oppose the closure of the Chronic Disease Dental Scheme for any of the many reasons I have outlined tonight.