I rise to speak on the Dental Benefits Amendment Bill 2021. In the early weeks of lockdown in New South Wales, in Greater Sydney, one of my lockdown binges was a TV series called This Way Up. The lead character spends a couple of days with a missing tooth after it was accidentally knocked out. The consequence of avoiding smiling or laughing or even talking normally was of course very dramatically played out, but the point couldn't be missed: for such a small thing, losing a tooth has a really dramatic effect on you.
The Australian Institute of Health and Welfare, which does really great research and is chaired by my predecessor, the former member for Macquarie Louise Markus, publishes a lot of information about the consequences of poor oral health and poor dental health. I want to go to some of the things that it identifies as being consequences:
Poor oral health—mainly tooth decay, gum disease and tooth loss—may result in a person experiencing pain, discomfort and feelings of embarrassment. They may also choose to avoid eating some foods and taking part in certain activities. Poor oral health is also associated with a range of diseases and conditions, such as heart and lung diseases, stroke, low birthweight and premature births—
And, it goes on:
Tooth loss can affect both oral function and appearance, and therefore negatively impact on quality of life.
It can actually 'reduce the functionality of the mouth, making chewing and swallowing more challenging', and that 'can compromise nutrition'. The Australian Institute of Health and Welfare says:
On average, Australians aged 15 years and over are missing 5.7 teeth. The average number of missing teeth increases with age, from 3.2 for people aged 15-34 years up to 13 for people aged 75 years and over.
What they also say is:
Poor adult oral health is strongly predicted by poor childhood oral health.
We know that since the late seventies the oral health of children has improved, likely with the use of fluoride in water and toothpaste, but 'more recent trends suggest that children's oral health may actually be deteriorating'. The institute says:
Around 1 in 4 (27%) children aged 5-10 years and around 1 in 10 (11%) children aged 6-14 years had at least one tooth with untreated decay.
That's what we know about the facts of adult oral health and how it can be determined, in some ways, by what happens with children, which is why what we're talking about here is so important.
In August 2012, I remember the Gillard Labor government introducing the Dental Health Reform Package to help bridge the gap between the need for treatment and people actually receiving it. I remember it, because I was a candidate at that stage; I'd lost an election, and I was running in the next election. I followed very closely the really positive things that were being done, especially in the area of what could be seen as trying to prevent longer-term problems, and this one was one of those.
I know I was really lucky to be a child that had a mother who made me eat horrible tasting fluoride tablets before fluoride was in the water and regularly took us to the dentist, but over the years I've seen many people who hadn't been so lucky. They talk about the cost and the pain of dealing with the consequences of it—the cost, if they could afford it.
A key part of the Gillard government package was the Child Dental Benefits Schedule, delivering means tested financial support for dental services for kids. So families with children from two to 17 years who received benefits, such as family tax benefit A, the parenting payment, the double orphan pension, a carer payment and other benefits, have been eligible for the child dental benefit, which provides around $1,000 over a two-year period to cover dental services like examinations, routine cleaning, fillings and even root canals. In its first two years of operation this scheme provided more than 9.7 million services, which were mainly delivered through private dentists and essentially bulk-billed to families at no extra cost. So it was a really successful scheme. In fact, the department's own evaluation of it was that it was a successful scheme. It will have changed the oral health of children, potentially for the rest of their lives, by getting them familiar with a dentist and hearing messages about teeth cleaning directly from a dentist, not just relying on a TV ad showing the back of a dentist while he's brushing his teeth. Many of us grew up with this ad as the ad that taught kids about brushing their teeth. But when you get to go to a dentist, you get to look a dentist in the eye, and they get to look you in the eye and talk to you about the best way that you, as a five-year-old or seven-year-old or 10-year-old, should be looking after your teeth.
It is exactly the sort of scheme or program that you'd think would have bipartisan support, especially when you see that today we're supporting an extension of this program to remove the barrier for the under-twos so that children of all ages can access it. But in 2016 the then federal health minister, Sussan Ley, revealed that in her view the scheme had failed to live up to expectations and that funds could be better spent elsewhere. This was after the Abbott government deliberately hid the scheme from parents and made it really hard to even know it existed—no promotion of it—so many who would have benefitted from it didn't know it existed. The Prime Minister announced a review. He decided to abolish the dental scheme and proposed a different, cheaper approach that relied on the states and territories to deliver services through public dental services. I think the kindest way to describe those state schemes back then would be as underresourced and overstretched. There were waiting times for the public dental schemes that ranged from 127 days in metropolitan Perth to 933 days in Tasmania; everywhere else had waiting times in between those. That's what the Liberals set out to do, and Labor opposed it.
I want to point out that at the same time there were also cuts to other dental services. This one was just the latest in a series of what I consider to be unforgivable decisions when it comes to dental care. The dental waiting lists were getting longer because $390 million—$390 million—was cut from adult public dental services across the country. On top of that they axed $225 million from Labor's program to build dental clinics in regional Australia and from nursing homes. That was on top of the $125.6 million that had been cut from the Child Dental Benefits Scheme. I had the good fortune at that time, around April 2016, to meet with Leura dentist Dr Rik Sandstrom, who is still practising there today. I talked to him about the work he'd done as a provider of the Child Dental Benefits Scheme. Two days prior to when I caught up with him he had seen four children as part of the scheme—kids who might otherwise not have been able to get to the dentist. When you're a mum and you've got a bunch of kids, sometimes it's kind of all or nothing. Families missed out on going to the dentist unless it was an absolute emergency. Rik's view then was that the scheme should be expanded to allow even more families who struggle to access it.
It wasn't until December 2016—and by that time I was a member of this place—that the minister announced the scheme would not be scrapped. That was a significant victory for Labor and the people who had supported the scheme. I am really pleased that now we are seeing a modest improvement to the scheme. Since Labor introduced the reform, it has provided extraordinary benefits—$2.3 billion in benefits—and delivered more than 38 million services to over three million Australian children. That means three million kids have avoided the worsening physical and mental health impacts from untreated dental conditions, with massive flow-on benefits for their families and their communities, including the government's bottom line avoiding downstream medical costs. It is a terrific Labor legacy. It is the sort of thing we do so well. It's a great example of what a government can do when it genuinely tries to make Australians' lives better—in this case, Australians in that low- to middle-income bracket who have kids.
The bill today is a welcome reform to the schedule, and Labor is supporting it. It extends the coverage to children from birth to 17 and removes that lower age limit on eligibility. The bill will help deliver a positive initial dental experience for more Australian kids now, at a younger age, and you always hope that puts to rest any of the negative feelings people have about dentists and oral hygienists. I'm under no illusions, though, that there are many adults who would wish to have the same access to basic dental services as these kids will. I support the amendment that we have moved, which really urges the government to do more to address access to dental and other health services, including GPs, especially in areas like mine—outer metropolitan areas. It also takes steps to further address out-of-pocket costs—not just for families with kids but for families, individuals and older people—because there are still huge cost barriers to people accessing the dental treatment that they really need.
I recognise that one of the things that often gets missed in the discussion is that there is a really strong argument that addressing poor oral health has multiple benefits on wellbeing and social connectedness, not to mention the links between oral diseases and cardiovascular disease, stroke, diabetes, cancer and lung conditions, as well as the negative effect on pregnancies. My view is that the lack of access to affordable dental care increases the burden of disease, leading to bigger costs down the line. I would like to see more from this government. However, we are almost back where we were in 2012. We're investing in young people in the belief that it will benefit them, that it will instil good practices and that it will potentially reduce the pressures on the system for adults going forward.
As a result of this change, each year an additional 300,000 children between naught and two will become eligible. In practical terms that means, from next year, it's estimated around 15 per cent of the children in this new eligible age group will get access. You're going to hear this figure a lot in this debate: 45,000 children per year will now be able to, and hopefully will, access the Child Dental Benefits Schedule. That's 45,000 kids with better oral health, and better physical and mental health as a result. It means up to 45,000 families with fewer worries about being able to afford the dental care that they know their kids need and they want their kids to have. Hopefully, it means 45,000 kids with a better relationship and view of dentists, having been exposed to a dentist early in life. And hopefully that benefit flows through and we don't get dentist hesitancy. So I'm very pleased to support the amendment and this bill.
