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Thursday, 22 November 2012
Page: 9620


Senator BUSHBY (TasmaniaDeputy Opposition Whip in the Senate) (21:26): I rise also tonight to speak on the Dental Benefits Amendment Bill 2012. Whilst not entirely opposed to this bill, the coalition has some concerns in relation to the changes to public dental services that this bill will enact. This bill will completely change the way taxpayer funds are directed for public dental programs. We also hold concerns and have done so for a long time in relation to the way that this government has set about introducing its dental agenda. The Gillard Labor government has chosen to link the introduction of its new dental benefits scheme to the closing of the Medicare Chronic Disease Dental Scheme, which, as I am sure history will attest, was one of the most successful public health initiatives that has ever been seen in this country.

The CDDS is a scheme about which I have often spoken in this chamber. My interest in this particular scheme has been sparked not because of its patent level of success, which was demonstrated by the huge uptake rate by primarily concession card holders, who would otherwise have had little or no access to the dental care that it funded, but because of the government's underhanded attempts at closing it through an obvious and shameless witch-hunt of dentists who were practising under the scheme.

Of course, their exploitation of dentists in this regard has had a devastating impact on many individual dentists right across Australia—and I see Senator Di Natale down there in the chamber; he has had many representations from dentists right across the country about how they have been affected by the treatment they received from the Labor government over the last couple of years. But it has also had an impact on the level of confidence that the profession has in publicly funded dental schemes.

The government's blatant abuse of dentists has also led to concern amongst CDDS patients, who were understandably worried that the funding for the dental care that they so desperately needed and which was so necessary to managing their chronic illness was being pulled out from underneath them.

By way of background, the CDDS was a successful Howard government initiative, implemented in 2007, and introduced by the then health minister, now Leader of the Opposition, the Hon. Tony Abbott. This scheme has assisted over one million Australians suffering from oral health complications, resulting from chronic disease, through the provision of up to $4,250 in Medicare benefits for eligible patients. The average amount spent by patients was, in reality, much less than $4,250 but the uptake was higher than anticipated as the scheme was clearly well targeted and uncovered a huge unmet demand for such badly needed dental care treatment. Those who used it included cancer patients and patients suffering from diabetes and coronary disease, amongst other chronic illnesses that impact on oral health.

Over 80 per cent of patients accessing the CDDS—over a million people—were also health care card holders. This makes sense because statistically people with greater means usually use their means to deal with chronic disease dental issues, either through private health or direct payment because they have the means to do so. But this statistic highlights that it is unlikely the vast majority of CDDS patients would have been able to privately fund the treatment that they received under the scheme and would otherwise have had to wait years for treatment under public dental practices, if they could have got it at all.

What we are debating today, the new scheme that the government proposes, does not provide an alternative to fund the needs of these patients. Labor have sought to close down the CDDS as a scheme they reject because it was not theirs, and because it was introduced by a man who they are doing everything humanly possible to vilify, the Hon. Tony Abbott. They have used every spurious trick in the book to do this, including many mistruths about it being used by millionaires, who of course largely have private health care or would, as I have mentioned, otherwise have self-funded their chronic-disease related dental needs, and about widespread rorting by dentists culminating in their demonisation of the dental profession through auditing the crossing of t's and dotting of i's and then seeking repayment of all fees paid for otherwise legitimate dental work that was needed by the patients and was actually delivered by the dentists.

Needless to say, Labor wanted the scheme gone. They could not get the Greens' support so the only alternative they had was to make it as unattractive to dentists as possible and, in the process, also hopefully undermine its public profile. The allegations that Labor make about the scheme simply cannot be supported and the facts on its success stand on their own. As mentioned, the Labor government has linked its cancellation of the CDDS to the introduction of the Dental Benefits Amendment Bill 2012 that we are discussing in this place today. Indeed, the introduction of the scheme in this bill was the carrot that finally attracted the Greens to support ending the CDDS. I am sorry that the Greens senators have now left the chamber.

What are we getting for this wonderful deal that arises out of yet another collaboration of Labor and the Greens? The fact is that the Labor government is redirecting public dental funds that were once available to anyone in Australia who had dental needs occasioned by a chronic disease, largely taken up by those with little alternative to that care, to a completely different demographic of patients through the establishment of the Child Dental Benefits Scheme, the CDBS. Under the CDBS eligible children between the ages of two and 18 years will be able to access basic dental care, capped at an entitlement of $1,000 per child over two years. Not only is this significantly less than the amount available for urgently needed dental care under the CDDS, it also excludes chronic care needs of two- to 18-year-olds and completely excludes funding the urgent dental care needs of adult patients who are suffering under a chronic disease.

It is a significant concern to the coalition that the closure of the CDDS will leave chronic disease sufferers without access to the dental care that they need. Since first getting involved in the issues related to the unfair treatment of dentists by Labor, I have had many constituents contact my office to tell me just how much this dental treatment means to them in terms of managing their chronic illness and consequently improving their quality of life. The work undertaken through the CDDS not only assisted in restoring a patient's physical and dental health, but also in many instances the treatment that CDDS patients received had a significant impact on their mental health and their social outcomes. I have seen before-and-after shots of CDDS patients who, due to chronic disease, had suffered almost unimaginable dental decay. The 'before' photos showed mouths full of broken, chipped and rotting teeth. This obviously would have had a significant impact on each of those individuals' relationships, their ability to engage and interact socially and their ability to obtain employment.

With the closure of the CDDS and dental funding redirected to children's health, such patients will be entirely dependent on the limited resources of state dental services, which notoriously experience demands which exceed capacity. The sudden closure of this scheme will compromise patient care, and this actually matters. The people affected are real people for whom the scheme was making a real difference.

This Labor government has turned its back on the many Australians who have been accessing the vital and necessary dental care under the CDDS and those who could have accessed the scheme if it was continued. Labor claims their CDBS, because it focuses on children and teens, is a measure to target preventative dental care. However, respected submitters to the Standing Committee on Community Affairs inquiry into this bill were critical of the age limit imposed on this scheme.

For example, Associate Professor Hans Zoellner, representing the Association for the Promotion of Oral Health, stated in the organisation's submission:

Of particular concern in dentistry, is that young adults, becoming independent of their parents and commencing adult independent life, have essentially equivalent dental needs to older teenagers. One aspect of the teen-age population, is an increase in the rate that decay develops, so that sudden withdrawal of dental services from young people once they reach the age of 18, will result in a corresponding deterioration in dental health in young adults.

Professor Zoellner's submission also states:

There seems no clear reason why the dental care of any individual should be determined on the basis of age…

And finally:

There is the further practical impact of sending a signal to young people, that once you get over the 'teenage years', that oral health is assured, whereas in fact life-long care is needed, especially as people age and accumulate chronic disease…

As those quotes demonstrate, dental care is required at every stage of life and those needs may increase as one gets older.

The fact that the government has closed the CDDS only serves to demonstrate that they on that side of the chamber have very little understanding of what the CDDS achieved in providing ongoing care and assistance to patients of all ages suffering with chronic disease. Some of the speakers in this place may even know very little at all about the issue, just accepting the government's spin fed to them, along with speaking notes prepared by the department.

Through you, Madam Acting Deputy President, I invite those opposite to actually have a look at the way the Chronic Disease Dental Scheme treatment has transformed the lives of some of the most vulnerable and disadvantaged Australians—people who those on that side of the chamber purport to represent—and how its withdrawal and replacement with a far more limited scheme will remove that opportunity for thousands more vulnerable Australians. The government may have set 30 November as the closure date for the CDDS, but the patients who have accessed the scheme since it started in 2007 will continue to suffer from chronic disease long after that date.

Examples of patients requiring ongoing treatment as a result of having dentures fitted under the CDDS are common. Dentures require frequent adjustment over a long period of time before the process can be deemed as finalised. Given the high number of health care card holders who accessed the CDDS—I repeat, over 80 per cent of people who accessed the CDDS were health care card holders—it will come as no surprise that many denture patients treated under the CDDS will be unable to afford to fund the completion of this process. It seems unfair that these patients received the life-changing news that they would receive ongoing dental treatment to be funded through Medicare, only to have that treatment taken off them as the government have changed course because they did not like the scheme because they did not introduce it and Mr Tony Abbott did.

Stakeholders also expressed concern at the inquiry in relation to the lack of detail for this policy. As yet, no details in relation to the schedule for treatment under Medicare are available. The government has said that this schedule will be provided in a series of regulations and maybe amendments. This only serves to demonstrate that this bill is just another example of the Gillard Labor government implementing major policy on the run. It also serves to highlight the worrying trend that is evident right across the activities of this Labor government of requiring parliament to pass into law bills that do not have the detail included, meaning that parliament has no way of properly understanding the consequences of the decisions that we make in this place at the time that those decisions are being made. This is not the way that a Westminster system of government should be run, and it is counter to the fundamental principles of the accountability of the executive to the legislature.

It is not just adult CDDS patients who will suffer as a result of the closure of this scheme. Children who currently access treatment under the CDDS will also experience diminished access to oral health care as a consequence of Labor's bill. Under the Dental Benefits Amendment Bill, the financial assistance provided will be slashed to a capped amount of $1,000 per eligible child over two years, compared to the CDDS financial limit of $4,250. Additionally, under this bill, eligible children will only be able to access basic dentistry. Associate Professor Hans Zoellner wrote in his submission to the committee that this will significantly impact upon children currently receiving treatment under the CDDS. I think it goes without saying that that is obvious. Professor Zoellner concurs that most children only need basic oral health treatment—so he agrees with that—but there are those who do need advanced dental treatment, and those children will be greatly disadvantaged by current government plans relative to their options under the CDDS.

Some witnesses to the inquiry quoted statistics to suggest that Australian children have poor dental attendance and consequently inadequate preventative service. However, as Associate Professor Zoellner points out in his submission, most Australian children already have access to dental care through state public dental services. It therefore seems illogical to argue that this new scheme will be the panacea to children's oral health issues when in fact, in all likelihood, the public dental system will be placed under increased pressure as a result of the closure of the CDDS. Yet the government remains quite critical of the CDDS and has made all sorts of far-fetched claims, as I have mentioned, in an attempt to win support for their CDBS.

The government has claimed that the CDDS was not targeted, but this is incorrect. The CDDS was a highly targeted scheme aimed at assisting individuals within our society suffering from some of the most cruel health complaints. The government has also claimed that the scheme was accessed by millionaires, but the figures show that over 80 per cent of patients under this scheme were health care card holders. This fact strongly refutes Minister Plibersek's claims that the scheme was providing free dental care for wealthy Australians. However, I think the worst claims made by Labor were during their incessant attempts to shut down this worthy program by accusing the dentists performing work under the scheme of rorting the system.

The coalition has a proven record when it comes to dental care, and we were the first party to establish a publicly funded dental scheme that worked well and provided sound patient outcomes. We do not entirely oppose this bill because, despite our conclusion that it is clearly not the superior option and that it will not deliver the most beneficial outcomes for the amount of taxpayer funds spent, it will still deliver some benefits. But, given that the government is so intent on redirecting public funding towards children's oral health and, with the Greens support, will achieve that change, what we then would like to see is continued support for children requiring complex dental care equivalent to that they could have accessed under the CDDS.

This should be delivered in such a way that there is no treatment gap between the closure of the CDDS and the commencement of the CDBS, and with extended financial assistance in excess of the $1,000 cap, if required. It is always difficult to achieve the balance in relation to public dental schemes, particularly in times of fiscal restraint. Yet it is disappointing that this Gillard Labor government has had to publicly shame dentists and cut funding for adult chronic disease sufferers to push what is, on the facts, clearly an inferior public dental agenda.