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Thursday, 23 August 2012
Page: 6202


Senator BACK (Western AustraliaDeputy Opposition Whip in the Senate) (11:04): I rise to support the Health Insurance (Dental Services) Bill 2012 [No. 2], and I congratulate Senator Bushby for his generosity on behalf of the Australian people to help the Labor government out yet again from a hole that it has dug for itself.

Originally, the legislation for the Medicare Chronic Disease Dental Scheme was introduced by the coalition while in government by none other than the then very successful health minister—and probably last successful health minister we have had in this country—and that was Mr Tony Abbott. But what we have seen, as usual, is an effort by the Labor government to try and dismantle a scheme that was enormously successful, that was cost-effective for the Australian community and, amazingly enough, was not concentrated on bureaucrats and bureaucracy. It was actually concentrated on taxpayers with dental problems. But, needless to say, the efforts made by the Labor government to try and dismantle it—because it was ideologically driven, because it had been introduced by Mr Abbott—have come back to haunt them, and they have been unable to actually dismantle it.

That is why I congratulate Senator Bushby, because in this legislation he genuinely is helping the government out of a problem that they cannot get themselves out of. Needless to say, we see an analogy for this in the asylum seeker debacle that we see today, where the Labor government of today inherited a perfectly good solution to what had been a problem and, led by the now Prime Minister, they dismantled it only to find some years later that they have to go back and reinstitute what was a successful policy position. As others have said, we have a circumstance here where under this Medicare chronic disease dental scheme, initiated by then Health Minister Abbott, we had 17 million services delivered to one million people since 2007. Needless to say, it has been tremendously successful.

Now, I applaud the government for the move to want to audit public expenditure; only I wish that they would audit themselves when they misspend public moneys, such as on pink batts, school halls and failed green schemes. But, nevertheless, like everybody in the chamber knows, it is the role of the parliament to ensure that funds are wisely spent, and to root out—excuse the pun in terms of dentistry!—where there is rorting, where there is corruption and where there is failure.

But where there has not been rorting or corruption, there is not a role for the audit process to vilify dentists, as of course has happened in this circumstance. What has failed is the commonsense approach. What we have seen is the effort of using a sledgehammer to crack a peanut and the failure to ask: did in fact the peanut, or those represented by it, fail in the first place? As Senator Bushby has eloquently said in his contribution to this debate, 'Therein lies the problem.'

I refer to correspondence and communication from a colleague of mine in Fremantle in Western Australia, a very senior member of the dentistry profession, a very, very credible man of great integrity. When I asked him about this he said, 'The disappointment, Chris, was that the government made no attempt to consult with the dental profession on this whole question.' This is not a man given to rorting or to corruption. He simply made the point that as a profession 'we have not interacted with the Medicare system; we did not understand or know the rules of the Medicare system'. He said the disappointment now that this confusion has been created is that some of the very people who have been treated successfully under the scheme introduced by the coalition are now turning their backs on the chronic dental work that they so badly need.

He mentioned cases to me, and I am going to refer to a second and even more distressing case in a minute where a GP referred a patient to the dentist and the dentist failed to write back in time to the GP, the very person who referred the patient. This is a circumstance in which very often people are disadvantaged. Fremantle is an example and there are many other areas around urban and rural and regional Australia where low socio-economic families or individuals, young people living on their own, and Aboriginal people suffer disadvantaged. As my colleague said to me, 'Chris, not only is it difficult to get these people into the dental service to start addressing some of the chronic dental problems they have, the great difficulty is in being able to predict the amount of work required.'

This brings me to the second point: giving some sort of close indication, which you are then bound to, of what the costs of the treatment are going to be before you start the treatment. Any of us who have a clinical background would know—and particularly anyone from the dentistry profession where there is such an underservicing in this country and so many people who have not visited a dentist for a long time—it would be very, very difficult for a dentist to be able to predict what sort of work is required.

Can it be audited? Is there a process in which an independent auditor or scrutineer could go back afterwards and see whether or not they think that dentist has rorted the scheme, has actually instituted treatments that the patient never needed? Of course there is a process, and of course it can happen—it happens every day of the week. It does not need a whopping bureaucracy from Canberra to determine it. My colleague and friend Dr Colgan said, 'Chris, get the system right and then worry about the money. But let us go back to the centrality of who this is all about and what the system is in place for. It is for those people who have fallen through the gaps in the dental treatment process.'

Let me give you an indication of the stupidity of this legislation as it was attempted to be introduced by the Labor government, and the consequences of this audit process. This is an actual case. A medical specialist referred a patient to a dental specialist, a periodontal surgeon. This particular person had a history of a renal transplant, was using immunosuppressive medications and had a very, very severe necrotising ulcerative gingivitis—and if Senator Farrell would like me to repeat that so that he can get it down and understand it, I will do so. In other words, this was an acute emergency—should I refer this to Minister Kim Carr—referred by the doctor. What do you think that dentist did? Heavens above, what they actually did was commence emergency treatment of this patient, a highly acute patient, a renal transplant patient, one who was on immunosuppressive medication, now presented by the doctor because of the urgency of the case.

But this dental specialist regrettably fell foul of the Labor-led audit process. Why? There are two reasons. Firstly, they did not seek in writing the permission of the doctor who had referred the case as an emergency. They failed to write to the doctor in the first place to say, 'I am about to treat this patient—would you like me to?' And, secondly, with this patient in tremendous distress, they failed to give some indication of what the cost might be. So foolishly, one would think, they actually went ahead with the treatment, only to find themselves foul of the system and being vilified—this being a highly-credentialed dental specialist in the city of Perth.

What do you think they did? The practice manager wrote to the authorities outlining the circumstances and asking whether they could review it and meet the payment. That was a letter from the practice manager of the dental specialist. Lo and behold, there was a second letter, on this occasion from the referring doctor, an associate professor, writing to support the application because of the treatment given to this gentleman with necrotising ulcerative gingivitis. Where do you think it all went? It was refused because of the so-called failure of the bureaucratic process, which was doing nothing to help the patient who is surely the most important person in this triangle. So what was the endgame? The person was not paid. The dental specialist then was caused to reduce the account enormously so that they could at least get some of their cost back. This is the actual effect when you go and speak to people rather than trying to adopt a bureaucratic process or procedure.

What it does, Mr Acting Deputy President, as you and I well know, is that it destroys confidence from practitioners back to government back to the bureaucracy. And when that happens, what would be the next reaction by that dental specialist should they have a patient referred to them by that doctor in an emergency circumstance? How willing would they be to actually pick up their instruments, place the patient in their care and start treatment because they have not gone through these Sir Humphrey Appleby-like bureaucratic processes? So in May this year, a couple of days before this private senator's bill was to go through the house without government support, we had Senator Kim Carr, the minister, tabling a statement in the Community Affairs Legislation Committee estimates hearings that the government would issue a retrospective determination to remedy the issues, some of which I have explained here this morning and some of which of course go to Senator Bushby's recommendations in the first place.

In her contribution Senator McKenzie spoke of dental services in rural Australia. I heard Senator McLucas retort to a comment made by Senator Boyce that there was no relationship between this discussion today and rural and regional Australia. Well, let me tell Senator McLucas—through you, Mr Acting Deputy President—it goes straight to dental services in rural and regional Australia. It is hard enough now to get dentists to go to and stay in country towns without having this sort of threat of vilification in a circumstance where they may find themselves in default under the Medicare process. But what about patients under these circumstances? In the absence of a dentist in a country town, not only do we have the ultimate cost of dental services, but very often we have the cost of travel to get to the dentist and, if there is need for treatment over a couple of days, there are the overnight accommodation costs, often not just for the patient but for their carer or the person supporting them. And who are those most at risk in this circumstance, Mr Acting Deputy President? You guessed it: low socioeconomic people, singles very often, and members of our Aboriginal communities. It is vitally important that we have that level of confidence between government, the medical and dental associations and individual practitioners, and this sort of activity does nothing to encourage that level of confidence.

In Senate estimates this year I asked the Director of the Professional Services Review what interaction, if any, he had had with cases referred to him by Medicare in the circumstance of possible corruption or rorting. I will quote the words he said to me in estimates:

As I understand the current stories in the media around dentistry, and I am simply going on what I read in the media, I understand they are more to do with strict auditing processes, auditing of paperwork et cetera. That is not the sort of matter that comes to PSR. But we have found no formal notification from Medicare, although there have been some suggestions in the future there may be cases later this year—

So we have that threat hanging over their heads. The quote goes on:

But we have had no formal indication from Medicare that they are referring a dentist to us for inappropriate practice which goes beyond, as I understand it, the sort of issues that have been in the media lately. As I said, they are more to do with auditing. Inappropriate practice in terms of the actual professional decisions made by a dentist, which would be the type of matter that would be referred to PSR—we have not had any referrals and no formal notification.

I was very much a participant in a Professional Services Review Scheme review last year by a committee which I recall was chaired by Senator Siewert. We looked in great detail at the involvement of the PSR, its relationship with Medicare and its examination of doctors who, it was claimed, may have been rorting the system. So PSR very much is an organisation that would be central to this circumstance, should there be the level of corruption that is claimed. This has unfairly vilified the dental profession and, of course, it has been in many instances the first time that dentists have ever interacted with the Medicare process. How much better would it have been to have spent some education money and to have sat down with the associations to get information out to the dentists to say that these are the circumstances, but that there must be occasions—such as the emergency I spoke about with the necrotising ulcerative gingivitis—where a dentist can go ahead with emergency treatment and be able to fill in the innumerable bits of paper afterwards.

What we have seen from the Labor government, in its attempts to replace the Abbott initiative, has failed. The Commonwealth Dental Health Program introduced in 2008 failed, as it would indeed have to do because it delivered so little that it was scrapped in the 2012 budget. We saw the Teen Dental Plan, which one hoped might have been successful, but regrettably less than a third of children who could have accessed this service have done so. I see children in the public area here today and I can only recommend to them that prevention is always better than cure. Whilst many of us do not like attending the dentist, I do encourage them to get into the habit—which I myself have not done—of making sure that they have regular dental check-ups. Not only is the cost of prevention a lot less to your parents than treatment afterwards, it is also a lot less painful.

I come to the recommendations made by Senator Bushby in his contribution. Not only is his draft legislation spot on the money, but he went as far as to help the Labor government, because they need all the help they can get, with the options that they might take to try and redress the failure they have visited upon the dental profession and the Australian people. The first recommendation is that they should enact amendments, as laid out in schedule 1, which relate to quotations not being provided prior to treatment—and I will not labour that anymore because I have already given a very good example of why those amendments are necessary.

A second option is for the government to waive its right to repayment under the Medicare scheme to try to build confidence again with the dental profession. His third suggestion, if the first two cannot be enacted, is to make act-of-grace payments to redress the inequality that has been visited upon them or alternatively to provide for the inequity to be addressed through the income tax system—although I hope that would not happen, simply because many dentists, as Senator McKenzie has told us, are now facing financial ruin—or to take some other action which might redress it.

I am pleased to speak to this bill. I support it strongly, and I particularly look forward to the support of the Greens through Senator Di Natale, because we are fortunate now to have in Senator Di Natale a medical practitioner who has had a lot of involvement in rural, remote and Indigenous communities and who is well and truly across issues associated with dental health and the need for it to be improved in Australian communities, particularly those in which he has worked. I have heard him speak in this chamber about dental services, and I look forward to his strong support of this legislation to right a wrong, to put dentists back where they have always been—and that is at a level of high confidence in the community.