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Transcript of press conference: Sydney Dental Hospital: 29 August 2012: Dental reform package

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Minister for Health


DENTAL REFORM PACKAGE Sydney Dental Hospital 29 August 2012

E & O excepted

TANYA PLIBERSEK: Good morning ladies and gentlemen. It's a great pleasure to be here today with Senator Richard Di Natale from the Australian Greens Party, and a number of representatives of the Sydney Area Health Service, and indeed the dental hospital. I would like to thank them for inviting us to make our announcement here today.

Since 1998 I've been talking in the Australian Parliament about the importance of doing something better for the dental care of Australians. We know that many low income Australians miss out and a number of those missing out are kids.

For many decades the dental health of children was improving, but since the 1990s we've seen a slowing, and indeed, even a reversal of that improvement. So today, I'm very proud to announce a $4.1 billion dental health package to care for the teeth of our kids and for low income Australians.

Today we'll be announcing that $2.7 billion will go into an entitlement based program for young Australians from the ages of two until they turn 18. That entitlement will be for dental treatment of up to $1000 over two years.

So kids will be able to get the check ups they need, they'll be able to get fillings and sealing of fissures, fluoride treatment - all of the basics. They'll be able to use that entitlement in a place like this, in the public dental system, or they'll be able to take that entitlement with them to their local dentist. So, it can be used in the public or the private system.

That entitlement comes with substantial extra investment in the teeth of low income adults also. We've got a $2.7 billion entitlement scheme for children and a $1.3 billion investment in the public dental systems in the states and territories to treat the five million Australians - low income Australians who are eligible for treatment in the public system.

This builds on the half billion dollar announcement from the previous Budget - $515.3 million in the previous Budget, and will mean that many more low income Australians will be able to get not just crisis treatment, not just when their teeth are falling out or their gums

are abscessing, but actually moving back to a period where the public dental schemes will be able to do prevention and early intervention work with low income adults.

By taking responsibility for the dental health of children up to the age of 18 who are in families that are eligible for Family Tax Benefit Part A, we free up massive resources in the public dental systems in the states and territories.

On top of that, we'll put $1.3 billion on the table for the treatment of low income Australians. That will be contingent however, on the states and territories continuing to invest as they have been, at least to the level that they have been, in public dental in their states and territories.

I should mention that the Family Tax Benefit Part A cut-off is a generous cut-off for treatment. It means about 3.4 million Australian children will be eligible for this entitlement system. It means that a family with say, two parents, two kids can be earning up to $112,000 a year and still be eligible for this entitlement system.

I want to mention that along with this extra investment in an entitlement system for kids and an extra investment for adults through the public dental system, there'll also be $225 million to build extra infrastructure, to invest in the workforce that we need.

We know that there are a lot of parts of the country where even if you've got money in your pocket, you can't see a dentist because there isn't a dental chair nearby or there isn't a dental workforce available to treat you.

So, on top of the entitlement system for kids, on top of the extra investment in services in public dental schemes around the country, there'll also be an extra investment in dental workforce and dental infrastructure.

As I said, this comes on top of the half billion dollar investment - $515.3 million in the last Federal Budget. That's got $345 million to tackle the 400,000 people on waiting lists around Australia, but extra money also for workforce and infrastructure measures.

This package also comes with the closure of the Chronic Disease Dental Scheme. The Chronic Disease Dental Scheme is a scheme thought up by Tony Abbott in the last dying days of the Howard Government. It's been one of the most widely misused schemes ever designed in our public health system.

This is a scheme that Tony Abbott as Health Minister said would cost $90 million a year. It's costing about $80 million a month now and there has been massive over servicing and reports or rorting in this scheme. There have been dentists charging millions of dollars, in some cases doing work that is completely unnecessary and in some cases charging for work that hasn't even been done.

It is an extremely poorly designed scheme and I am very pleased to be seeing the back of it.

The children's entitlement will also replace the Medicare Teen Dental scheme because it's the same group of people and what we're providing is a broader entitlement.

The way it will work is the Chronic Disease Dental Scheme will close. There'll be a period where we spend the half billion dollars from the last Budget and then we'll move into the children's entitlement scheme from 1 January 2014, and the extra investment in adult services through the public dental schemes from July 2014.

I'm very proud of this new investment. This is something that I have been working for for my whole career in the Parliament. I first spoke about the need for a better dental system in 1998 and I can't say how thrilled I am to be here today able to announce a better dental scheme.

We will have a generation of kids for whom going to the dentist is as easy as going to the doctor. We know that the oral health of children has not been improving in the way that it should in a country and with the rich resources that Australia has and we need to turn that around.

We need to make sure that we are getting to the kids who are not getting to the dentist now as a priority, because we know that if you've got good oral health as a child the likelihood that you'll have good oral health as an adult substantially increases.

This is an investment today that will bear rewards in 10 years time, in 20 years time, in 30 years time as this generation of kids - the first generation of kids for whom it will be as easy to go to the dentist as to go to the doctor - when they grow up, they will have improved oral health.

Essentially, parents will be able to go to the dentist, take their Medicare card with them and see a dentist as easily as they would see their GP.

It's something that I'm very proud of. I want to thank Senator Di Natale for his cooperation and hand over to him to make some added comments.

RICHARD DI NATALE: Thanks Minister.

Firstly, I'd like to pay tribute to the work of the Minister. I think it's fair to say that the Minister has had an ambition to improve this area, as have I. She has worked very, very hard on this issue. Together we've embarked on negotiations around the design of this new scheme.

And I'm really pleased to say that I think we've got a great outcome today, Minister, and I want to thank you for all of your hard work and for the good faith in which the negotiations that we had was undertaken.

I think this is one of the biggest reforms to the dental health system we've ever seen. It's one of the most significant reforms to the health sector since the introduction of Medicare. It's a huge reform and such an important reform because for a very, very wealthy country we have very poor oral health.

And one of the reasons we have such poor oral health is that for most people they simply can't afford to go to the dentist. One in three people say we can't afford it. Today a

report in the paper, if you're on Newstart, 50 per cent of people - almost half of them report not being able to go to the dentist because they simply can't afford it.

Well, this package will change that.

It's important because poor oral health leads to a range of other complications. It leads to things like infections, malnutrition, it impacts on people's general health and wellbeing, it has a huge impact on the health system. So, we've got a situation where one in 10 visits to a GP is because people can't afford to see a dentist.

I was in general practice for a number of years before I started this new job in the Senate. One of the most frustrating things that would happen as a GP is somebody would come into your practice, they'd have a bad infection - an abscess of some sort - all you could do was give somebody some antibiotics, maybe some painkillers, send them on their way knowing that they really needed to see a dentist but probably wouldn't because they couldn't afford it.

It's got a huge impact on people's social health and wellbeing as well. If you're looking for, for example, a new job or trying to get a leg up in the rental market and you've got very poor oral health, your teeth are missing, you're automatically behind the eight ball.

So, it's a huge issue. It needs to be fixed and the Greens have been committed to fixing it.

After the 2010 election when the people of Melbourne put Adam Bandt into the Lower House, we struck an agreement to support the Labor Government and that agreement had two key tenants. The first one was action on climate change and we've now delivered a price on pollution and a clean energy package.

And the second one was to improve the oral health of the nation. We, together with the Minister, set up an advisory council. The package that you see today reflects the recommendations from that advisory council.

So as we've said, three and a half million kids now will be able to get access to Medicare-funded dentistry. They can go to the dentist just like they go to the doctor.

We've got people who are pensioners, people on Newstart, other concession card holders who can now go to their local public dental service and get access to treatment rather than languishing on a waiting list for months and years, and sometimes giving up because they know they won't get treatment.

We've got a situation where we've got a huge investment in regional Australia. So, through the grant package that the Minister has already described, we're going to see more infrastructure, more chairs, more dentists, more oral health therapists right around the country.

So it's a hugely important reform and from the perspective of the Greens, it was important that whatever we did today could be scaled up, could be built upon. So that Medicare entitlement gives us the capacity to move to other age groups so that over time

everyone in Australia can have a situation where going to the dentist is just like going to the doctor.

We made this decision many years ago to somehow treat the mouth as separate from the rest of the body. It was a bad mistake and it's the reason that we have such poor oral health in this country today.

I'll just finish by saying that this is a demonstration of what can be achieved when people from all sides of politics work together in good faith cooperatively with a shared ambition. We had a shared ambition to improve the oral health of the nation. We had an agreement with the Labor Party, we had a Minister who was very keen to see this reform through. The Government's honoured its commitment to the Greens.

It's a great day for the health of Australians right across the country and like the minister, I'm very, very proud to be here today to be able to announce this package.

Thank you.

TANYA PLIBERSEK: Have we got any questions.

QUESTION: Minister, can you just clarify how easy it is for families to access the $1000? [Indistinct].

TANYA PLIBERSEK: So, from January 2014 a family will be able to go to their dentist and take their Medicare card. If the dentist is bulk-billing they won't pay any fee at all. Or they'll be able to use it in a public dental facility if they wish to.

And the entitlement is up to $1000, so that will well and truly cover check-ups, cleaning, scaling, fluoride treatment, fissures - any of that sort of basic dental work.

QUESTION: So, it will be automatic on their Medicare card?


QUESTION: Will this solve the waiting list problem?

TANYA PLIBERSEK: Well, we've put $345 million in the last Budget to take care of the around 400,000 people that are currently on public dental waiting lists. So, that work is already underway.

By taking care of the waiting lists, we can reset the way that public dental systems work so that they're not just working with the most desperate people who've got teeth falling out of their mouths and abscesses. They'll be able to go back to do a filling instead of an extraction. They'll have capacity to do check-ups and call people in regularly for check-ups and basic dental work.

So, I believe that this is an incredibly important investment for those people who are eligible for treatment in the public dental system. In fact, a lot of people are eligible for

treatment in the public dental system but they never get it because the public dental system is dealing with the crisis end of needs.

By taking care of the waiting lists and putting $1.3 billion extra on the table, we make the public dental system stronger and more able to deal with people earlier and when they've got problems, and even include prevention and early intervention in their work regularly.

QUESTION: So, what was wrong with the two existing schemes? You say that that was costing the Government loads of money. What is this new scheme going to do to replace the old two schemes?

TANYA PLIBERSEK: So, the Medicare Teen Dental Scheme will stay until the new child entitlement starts. The new child entitlement includes all of the young people who are eligible for the Medicare Teen Dental scheme but it gives them, not just a check-up, it gives them basic dental work as well.

They'll be able to get a filling, they'll be able to get the basic treatments - not orthodontics, not that very expensive end of the work but pretty much everything that you need for basic dental care. So, it expands on the Medicare Teen Dental program.

What's wrong with the Chronic Disease Dental Scheme? How long have you got? This is a scheme that was supposed to cost $90 million a year that is now costing $80 million a month. And we still have whole vast parts of the country where you cannot get basic dental treatment.

It means that if you're a millionaire - it's not means tested. If you're a millionaire you can have $4250 worth of work done at the taxpayer's expense, but if you're a kid with bad teeth in a remote community you don't get a cent.

It's a scheme that - because it's not means tested and it's not targeted in what it can cover, has been open to massive abuse. We've had some dentists charging the taxpayer millions of dollars or hundreds of thousands of dollars for work that hasn't been done or has been done in a substandard way - dentures that don't fit, unnecessary replacement of fillings, cosmetic work - high-end cosmetic work.

These are things that the taxpayer should not ever have been paying for and I'm so pleased that this poorly designed scheme will make way for something that targets the people who need the most help and gives them the range of treatments that is necessary for them to have good oral health in the future.

By having an approach that targets children, we're going to have generations of better oral health in this country. But we have balanced that investment in prevention for kids with extra investment for the public dental system for people who need treatment in the short-term.

So, I think this package is a good package because it's got an investment in the future, but also an acknowledgement of the needs of the community today.

QUESTION: What about people who are on the Chronic Disease waiting list at present? How will they then be treated then [indistinct] if their work was more than $1000 now that's not going to be covered? Where are they left?

TANYA PLIBERSEK: So, there's no waiting list for the Chronic Disease Dental Scheme. That's not how it operates. People will have - the scheme will close to new entrants on 8 September. People will have 12 weeks to conclude a course of treatment and - so, the scheme will close completely on 30 November.

People who are on low incomes who are using the Chronic Disease Dental Scheme are eligible for treatment in the public system. If they're a health care card holder, seniors' card holder, pensioner, disability support pensioner - the reason they haven't been able to get that treatment in the public system is because there has been under-investment for many, many years in the public system.

So, the half billion dollars that we put in the last Budget and the $1.3 billion that we will put in from 2014 will massively boost the ability of the public system to treat people who have been technically eligible for treatment, but have just never got to the top of the list. That's…

QUESTION: Will their entitlements then be less though under this new scheme? Will they be entitled to less [indistinct]?

TANYA PLIBERSEK: The public dental system for adults doesn't have that kind of capping arrangement. The Chronic Disease Dental Scheme amount has been one of the problems with the scheme because high-end cosmetic work has been covered.

QUESTION: [Indistinct] billion dollars. Where are you finding that money from? Is [indistinct] this Budget or is it from the coming Budgets? Where is it all coming from?

TANYA PLIBERSEK: We have a very good record of finding savings in budgets. We found over $30 billion of savings in the last Budget and we will have to find savings to pay for this scheme just as we have had to find savings to pay for all of our investments. But Australia has a strong economy. By international standards employment growth is strong, economic growth is strong, inflation is low, our economy is strong.

The reason we work so hard to have a strong economy is so that we can also have a fair society.

We've found those savings in previous budgets - over $30 billion in the last budget, over $100 billion in previous budgets. We've found those savings so that we can also invest in the things that matter to Labor governments: increases in the aged pension, increases in education, increases in support for disability.

All of these things are priorities for us so yes, we will have to find savings but one of the reasons that we have a strong economy and one of the reasons we worked so hard on those savings is so we can invest in Labor priorities.

QUESTION: Will they all come out of your portfolio?

TANYA PLIBERSEK: We'll work out that across government and it will all be accounted for in the mid-year economic forecast.

QUESTION: Minister, do you expect the Coalition to resist the closing down of the Chronic Disease Dental Scheme and have you been able to secure the support of the cross-benchers in supporting this package?

TANYA PLIBERSEK: I expect Tony Abbott will say no to this as he says no to everything. This is something that he would claim is a, you know, a record of his when he was in government. It is one of the worst designed pieces of public policy I have ever seen in my life, in terms of…

QUESTION: Will you need legislation to repeal it?

TANYA PLIBERSEK: It doesn't need legislation. We will - but when we seek to repeal it administratively it is subject to a disallowance motion in the Parliament and of course I will - I have the support of the Greens and I'll be continuing my discussions with the other cross-benchers.

QUESTION: So will people on low incomes with chronic dental problems, will they be worse off under this new scheme?

TANYA PLIBERSEK: No. The whole of the Australian community will be better off under this scheme because we'll have a system that includes prevention and treatment for kids. Generations of kids will be better off under this, and for people who have been eligible for treatment in the public system but have never got it because the money just hasn't been there, this is a total of almost $2 billion extra invested in the public system.

It does, of course, rely on the states and territories being prepared to at least maintain their effort so I'm going to have to have some pretty tough conversations with some of those state health ministers that have been cutting their health budgets. But this very substantially increases the capacity of the public dental system to not just deal with crisis, as they've been doing, but to get right in and help the five million Australians that are actually eligible for treatment in the public system.

QUESTION: Would you describe it as a crisis at the moment?

TANYA PLIBERSEK: I think the waiting lists are too long and I think the fact that we've actually seen a reversal in decades of progress when it comes to improvement in oral health of our children is something that we should be concerned about, yes.

QUESTION: Senator Di Natale is talking about the - it's a question for you Minister, sorry. He's talking about the potential to scale up the scheme. What's the sort of time frame for a full-scale scheme for adults?

TANYA PLIBERSEK: Do you know what? I thought we could just enjoy today. [Laughs]

QUESTION: I was looking ahead.

TANYA PLIBERSEK: This is a bedrock scheme. It is something that can be built on over time but, as you can see from today's announcement, these are massive investments and so I'm just going to enjoy the fact that in a very tough budget climate we've found $4.1 billion on top of the half billion dollars in the previous Budget. So $4.6 billion to invest in the oral health of our nation, I'm just going to enjoy that achievement for today.

QUESTION: With respect, you haven't actually found the $4.1 billion yet, have you? Or you can't tell us where it's coming from?

TANYA PLIBERSEK: Well, all of the details of the Budget are made clear in the mid-year economic and fiscal outlook and this will all be accounted for then. I can tell you, our commitment to be in surplus is absolutely rock solid.

QUESTION: And the closure of the Chronic Dental Disease program has already been built into forward estimates, hasn't it? [Indistinct].

TANYA PLIBERSEK: Indeed. This is new money that we will have to find because the Chronic Disease Dental Scheme has been slated for closure for some time and consequently provision has not been made for it.

QUESTION: How are you going to find the extra dentists?

TANYA PLIBERSEK: The reason that this scheme builds on a half billion dollar investment in the previous Budget and ramps up to 2014, the reason that the major part of the work doesn't start till 2014 is because we understand that there are actually capacity constraints in the system now.

There are some parts of the country where you can't find a dental chair. There are some parts of the country where you can find a dental chair but you can't find a dentist to work there. We need to address those issues and we've built time into the rollout of this scheme for that very reason.

QUESTION: Minister, if it's about fairness then why not keep the CDDS going until the new scheme starts? Won't there be a lag next year when the current funding is pulled away but the new provisions don't come into place for another 12 months?

TANYA PLIBERSEK: We've put half a billion dollars into the last Budget so that we can meet the need until this scheme ramps up and can I tell you why I don't want to keep the CDDS open? Because it's a hopeless scheme.

Some people have got treatment that they've needed from the CDDS but it has been so massively - so massively used for over-servicing and, in some cases, outright rorting, that I can't wait to see it closed.

QUESTION: Aren't those cases quite a small proportion of the overall though? Aren't you inflating the…

TANYA PLIBERSEK: We've had 1000 complaints about it so far. Do you call 1000 complaints a small problem? I think it's a substantial problem.

QUESTION: In terms of overall services, it's low in terms of all of that.

TANYA PLIBERSEK: Well, I would say that it's a scheme that has proved to be poorly targeted, un-means-tested, unsustainable and poorly designed from the very start.

QUESTION: Can you give us an update on what's happening with the auditing to those doctors who've been - sorry, the investigation into the auditing of those doctors who've run foul of that scheme?

TANYA PLIBERSEK: Well, there are two categories of people that have run foul of the scheme. There are some people who have deliberately misused the scheme, rorted it, and there are others who have delivered services in good faith but not managed to keep up with a quite complex paperwork arrangement. This goes back to the very poor design of the scheme from the beginning.

As we close the Chronic Disease Dental Scheme it does give us the opportunity of being a little bit more flexible with those dentists that in good faith have delivered services of proper quality but have not got their paperwork right.

It does not, however, excuse the many people who have overcharged, charged for work not delivered, delivered dentures that don't fit, done - you know, claimed for phantom patients that they've never seen. None of that behaviour is excusable and they will be pursued by Kim Carr, the Minister for Human Services, and his department.

With the closure of the scheme, however, some of those who have operated in good faith we will be able to take a slightly more flexible approach with.

QUESTION: Senator Di Natale, the Greens had previously supported strongly the Chronic Diseases Scheme. This could be a back down on that issue, also, in a sense, a back down on the carbon floor price yesterday.

Is this a signal that the Greens are being a bit more pragmatic?

RICHARD DI NATALE: Oh, we've always been pragmatic but there are some things on which you can't compromise and I suspect that's what you're alluding to, to the issue of refugees and asylum-seekers.

But on the issue of the Chronic Disease Scheme we've always said very clearly we don't support closing that scheme until something more substantial and more significant replaces it.

I think the Minister and I have perhaps slightly different views on the Chronic Disease Scheme. We acknowledge there are certainly some issues with that scheme. It is inequitable and there is an issue around the proportion of services that are delivered that are particularly expensive treatments, at the cost of basic preventative care.

We absolutely acknowledge that but we've always said until we come up with a scheme that deals with people who need urgent treatment through the public system and unless we get a significant Medicare-based model so that we do ensure that we bring dental care and medical care more closely into line with each other because there's no diff… there's no logic

for why we somehow treat the mouth through one set of arrangements and the rest of the body through another set of arrangements.

So, for us, core principles were: maintaining a Medicare-style scheme, we've got that through the Medicare scheme for kids; ensuring that there's an investment in the public dental system, we've got that through the significant investment in public dental clinics; ensuring that regional and rural Australia are - don't miss out and so there's a significant investment there; and ensuring that what we've got is scalable, that we can increase it over time through that entitlement-based system, through the Medicare model and we can do that by bringing in other age groups over time.

So I think this is a huge win. I think what we've got now is many, many more millions of Australians that will now be able to access dental care and an investment in young kids. And, as the Minister has already stated, there's a really alarming decline in the oral health of young children in this country and the situation we face is only going to get worse if we don't act now and this package deals with that issue.

QUESTION: What sort of time frame are you looking at for the scaling up and how would you pay for it?

RICHARD DI NATALE: I think, like the Minister, today is a day to celebrate the fact that people right across the country are now going to be able to get access to dental care in a way that they previously haven't been able to. The cost is not going to be a barrier any more for many, many people.

We'll be making announcements in the lead-up to the election. We do want to see this scheme scaled up. We have a set of revenue measures that we believe could pay for that. We'll be announcing those, they'll be costed, in the lead-up to the next election but today we've laid the foundations for Denticare. We've built a platform that we can build on over time.

QUESTION: What do you say to those people who will now miss out who were - have cancer or HIV or hepatitis and have medications that cause them to have specific dental problems, have an income that means they're not supported under these new arrangements. What do you say to them? What do they do?

RICHARD DI NATALE: I think the issue here is equity so if you're a concession card holder and you have a chronic disease, you'll now not languish on a public waiting list in a way that you would have otherwise done. And we've also got to acknowledge, one of the key advantages of the public system is that it's not a capped entitlement. So if you need more than the $4000 worth of treatment you'll get it through the public system. The Chronic Disease Scheme was capped and so people were already missing out through that cap.

And there's also, I think, an important equity measure. There are people who have very, very poor oral health who urgently need dentures, who need extractions because they have chronic abscesses and so on, chronic pain, and it's really important we prioritise those people as well and that's what this measure does.

TANYA PLIBERSEK: I think we're all done. Thanks, everyone.


TANYA PLIBERSEK: Can I just thank the staff of the Sydney Dental Hospital for having us here today? It's very good of you and it's - I just want to thank you for the work that you do as well.