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Monday, 26 November 2012
Page: 9691


Senator NASH (New South WalesDeputy Leader of The Nationals in the Senate) (13:30): On 29 August 2012 the Labor Party and the Greens announced they had agreed to significant changes to government policy on dental health. The package of measures included an expansion of private dental treatment subsidies for children from January 2014, increased funding for adult public dentistry from July 2014 and the immediate closure of the current Medicare Chronic Disease Dental Scheme. The Dental Benefits Amendment Bill 2012 replaces the current Teen Dental Plan for children aged 12 to 17 with the new Child Dental Benefits Schedule, which would subsidise private dental treatment for children aged two to 17 by up to $1,000 over a two-year period. The national partnership agreement for adult public dental services promises to increase funding to the states and territories for public dentistry for adults by $1.3 billion starting in the 2014-15 financial year. However, the deal negotiated with the Greens also included the immediate closure of the Medicare Chronic Disease Dental Scheme, or CDDS.

The CDDS has provided up to $4,250 in Medicare dental benefits over a two-year period for patients with a chronic medical condition and complex care needs and whose oral health was likely to impact on their general health. 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. The Labor-Greens government's closure of the Medicare Chronic Disease Dental Scheme categorically proves two things. Firstly, the Labor Party has long stopped caring about the most disadvantaged Australians. Secondly, you cannot trust a word the Greens say. The previous coalition government established the scheme because we believed that people with chronic diseases, such as cancer, diabetes and heart conditions, should not be left to languish on public dental waiting lists. There are currently 650,000 Australians, including a quarter of a million children, on public dental waiting lists.

The government is not only closing the scheme for future patients but leaving thousands of current patients in limbo. The decision was announced on 29 August, new admissions to the program were stopped on 7 September and current patients only have until next Friday to complete their treatment. If your teeth are only half-fixed by then, tough luck. You either have to fund the rest of the treatment, which was never in your family budget, or carry on suffering. It is a disgrace.

The CDDS was the creation of one of Australia's best-ever health ministers, Tony Abbott. It is not surprising that it is being axed by one of Australia's worst-ever health ministers, Tanya Plibersek. It seems that is the only reason the program is being shut down. The Labor government cannot stand the fact that it has to administer a successful scheme created by the current Leader of the Opposition. The Minister for Health has repeatedly asserted that the CDDS benefits millionaires. 'Tony Abbott needs to stop standing up for his millionaire mates,' the minister keeps carping. This shows an astonishing level of ignorance. The CDDS is a Medicare scheme. If you are going to deny higher-income earners access to the CDDS, why not also deny them access to GP Medicare rebates, free public hospital treatment or the PBS? In any event 80 per cent of the one million people who have been provided with treatment under the CDDS are on concession cards. By contrast, the government has not produced any evidence of millionaires having claimed CDDS subsidies. Why would those opposite bother? Closing the scheme is not going to hurt them but it will certainly hurt the 800,000 low-income earners who cannot afford $4,200 to have their teeth fixed.

If the government is so worried about the other 20 per cent of claimants who are not on concession cards—very few of whom, I suspect, are millionaires—why would it not try a means test? Why did the government repeatedly decline coalition offers to work with it to reform the scheme? The only possible reason is that it was the Leader of the Opposition's baby. What possible hope is there of delivering decent health policy when the first consideration seems to be jealousy of the Leader of the Opposition?

Let me introduce to the Labor and Greens senators on the other side of this chamber who are supporting this legislation some of the Gillard government's so-called 'millionaires'. Mrs Kathleen Curtis is a 68-year-old widow who lives in Banora Point, on the New South Wales north coast. Mrs Curtis suffers from a rare disease, called Sjogren's Syndrome, which causes her to experience an extremely dry mouth. This disease has affected Mrs Curtis's overall health and wellbeing and she has also suffered other effects of the syndrome. That is why she signed up to the coalition's CDDS. However, after next Friday she does not know where she will find the money to complete her treatment. Mrs Curtis told her local newspaper:

… the government should introduce some help for people with chronic illnesses especially the ones that cause tooth decay.

"That's not an unreasonable request."

It is certainly not an unreasonable request, Mrs Curtis. Your local Labor member of parliament, Justine Elliot, who presumably enjoys top-level private health insurance perhaps, should hang her head in shame.

Dr Glen Hughes is a dentist who runs a private practice in Alstonville and also works in public dentistry at the Aboriginal Medical Service in Casino. Both communities are in the electorate of Page. The oral health of Indigenous Australians is a national disgrace. Dr Hughes is determined to do something about that and he is incredibly passionate about his work supporting the local Indigenous community, and I commend him for the work that he is doing. He takes photos of the teeth of every patient he treats at the Aboriginal Medical Service. When I visited him there, he showed me before and after pictures of patients he treated under the CDDS, and the results were astonishing. This is some of what he had say to me when he heard of the government's decision to abolish the CDDS:

The closure of the CDDS, with no similar replacement, is going to wreak havoc amongst the adult Indigenous population. I currently have 258 clients with EPC referrals that remain untreated and incomplete. The closure of the scheme could potentially remove a funding stream of a million dollars from my clinic alone. I know you're extremely busy and appreciate it may be a done deal with Greens-Labor agreement. However, please protest loudly and long on behalf of the most needy Australians, who will be adversely affected.

To be fair, Dr Hughes did get a hearing from his local Labor member of parliament, Janelle Saffin. Ms Saffin told Dr Hughes that she was sympathetic. I am sure Ms Elliot too would have been sympathetic to the plight of Mrs Curtis if she had known about it. But what use is sympathy for people suffering in those electorates when those members of parliament fly down to Canberra and vote in parliament to make their constituents' plights worse? If those Labor members of parliament had voted for the National-Liberal disallowance motion to stop the closure of the CDDS, Dr Hughes's Aboriginal patients and Mrs Curtis would still be getting the treatment they deserve.

I said earlier that this bill shows that you cannot trust the Greens. This is what the Greens Senator Siewert told the media the first time that Labor tried to close down the CDDS in 2008:

Since it started … the Chronic Disease Dental Scheme has helped thousands of Australians suffering from chronic health problems directly related to dental problems.

The Government says it is essential to close down the chronic disease dental scheme and redirect funds [for] a program that will not be operational for months to come.

… it's ‘wait and see' for sick people in dire need of support.

What happens to the thousands of people who are currently receiving help through this scheme? The Government has been unable to assure us that people currently receiving treatment will receive the same level of dental health care under the CDHP.

…   …   …

This issue is not about programs or money - it is about people with medical need. The Government is trying to force the Parliament to choose between two dental programs that benefit people in need. The Greens are not prepared to make that choice, and leave these people out in the cold.

As late as the 2012 May budget, the Greens were saying:

The reforms we've negotiated for the 2012-13 Budget will mean:

the Chronic Dental Disease Scheme will be saved from Budget cuts, until we can develop a comprehensive national scheme with the Government to replace it;

So what have the Greens apparently negotiated to replace the CDDS with? Children with chronic disease will have their benefits cut from $4,250 to a thousand dollars and adults will have to wait until at least July 2014. Talk about a breach of trust. You would think that the Greens would be embarrassed about their betrayal of needy Australians but they actually seem to be boasting about it. The Greens website now claims full credit for closing down the CDDS that it supported only six months ago. Senator Di Natale said that this achievement, 'shows how power-sharing governments can make a real difference to people's lives when parliamentarians work together constructively'. The Greens achievement, so to speak, is certainly making a real difference to the lives of people like Dr Hughes's Indigenous patients but, unfortunately, colleagues, it is not a good one.

The Greens and Labor argue that it is okay to close the CDDS because the new systems, one for children and one for adults, are better. But the government is ripping a billion dollars out of dental health with the change, so it seems unlikely that it will provide better outcomes. Let us test the theory. The first problem is the timing. The new plans do not begin until 2014, so why are the Greens letting Labor close the CDDS in 2012? The fact that nothing will happen until after the election shows that this is not really a new law but an unfunded $4 billion Labor election promise. The new schemes are no more l-a-w law than Paul Keating's undelivered tax cuts.

The Prime Minister can stand up and say, perhaps, 'There will be a dental scheme under a government I lead,' but nobody is going to believe her. Labor's promised means-tested scheme for children will leave many parents out of pocket. Over 60,000 services have been provided to children under the CDDS. Apart from the fact that children will have to wait for 13 months before they get any treatment at all, the help they will get is capped at a thousand dollars over two years, compared with $4,200 under the CDDS. From the government's own figures, the average cost per person is $1,716. This means that families on the lowest incomes will not be able to afford to have their children's teeth fixed. That is ironic because it is exactly the complaint that Labor is levelling at the CDDS.

The scheme for adults is not really a scheme at all. It is a promise to throw a bucket of money, $1.3 billion, at the states and hope for the best. That is the same strategy that Labor used with the $16 billion school halls program, and is likely to be just as ineffective. Notwithstanding some of those schools being so pleased to see those buildings, the waste and mismanagement we saw through that program were just extraordinary. The new scheme is not set to begin until July 2014.

The Medicare CDDS allowed patients to be treated by their private dentist in the same way that Medicare rebates allow patients to be treated by their private GP. The Labor-Greens plan would see all funds go towards public dentistry. Remember that there are already 650,000 people on public dentistry waiting lists. So what will be the outcome of the government's plan for a massive shift from the private to the public system? Let us go back to the Casino Aboriginal Medical Service and Dr Glen Hughes, who said:

The public sector waiting lists will skyrocket and reducing waiting lists by simply doing more extractions and emergency dentistry is to the detriment of oral health. Unless the private sector is included in sharing the oral health burden, the next two years will be a nightmare for any low-income adult needing dental work.

There is simply no capacity within the public sector to meet demand. In my public clinic I have at least 250 clients who are eligible for care under the CDDS. To meet this demand within the public sector would require the equivalent of five full-time dentists and ancillary staff. I am currently funded by the state government to work only two days per week. It is so difficult to recruit and retain public dentists in rural areas that the current policy focuses on teams of dentists being flown from Sydney to remote locations for 12-week rotations.

Every public dental clinic I know is able to only barely meet emergency demand. The dentists working at those clinics as a general rule have become de-skilled in providing comprehensive care. There is simply no infrastructure, personnel, scope of practice or capacity within the public sector to take on the workload that, up until now, has been provided in the private sector. It won't matter how much money is thrown at the public system, there simply aren't enough dental chairs or dentists to provide the treatment, and without huge structural change at a state level it cannot happen.

Dr Hughes is no partisan scaremonger; he is just intensely passionate about the oral health of disadvantaged Australians, particularly those in the regions. I implore Labor and Greens senators to heed his well-informed views.

I particularly appeal to the Greens. While it is too late now for them to change their view on this, I can only say how disappointed and absolutely appalled people must be out there in the community to see this change of view from the Greens. They actually had it right when they were continuing to support this. They had it right, even when they said 'until something equivalent is in place', until those needs can be met. But they have simply rolled over to do the government's bidding, and that is going to have such an impact on these people. This is a shoddy piece of legislation, leaving so many Australians in the lurch. The time frame is appalling and, again, we see that the government is not able to deliver decent, reasonable policy for Australian people. And this piece of legislation in particular is a detriment to those in regional communities.