Home - Claire Moore - Labor Senator for Queensland

BILLS: Dental Benefits Legislation Amendment Bill 2014

Senator MOORE (Queensland) (13:11): I am not going to take long in this discussion on the Dental Benefits Legislation Amendment Bill 2014, but I want to speak again on this issue around dental services. Mr Acting Deputy President Bernardi, you would remember that in this place we had considerable debate on the issues around the dental services determination bill in 2007. We also had considerable debate-and it is all on record-on concerns about the full understanding of the responsibilities of dentists involved in that program and claims that there was a lack of understanding and a lack of knowledge of the compliance requirements that were brought into place, because this was the first time that there was such a clear use of the government system for dentists. I remember making statements here about the professional needs of organisations to understand their requirements, particularly when government money was involved, and the responsibilities for people in the profession, the dental profession, and also the government departments to work through appropriately their responsibilities. I also talked about the special link that was available in that legislation, which has now passed, between the referral processes of doctors through to the dental profession to make the link that was in that legislation to ensure that the processes under the dental responsibilities met the special needs of people and that there was a genuine understanding of the need for the dental work to fulfil the requirements of the plan, as we then knew.

On our side of the chamber, we celebrated the first steps towards allowing MBS coverage for dental processes. We celebrated the availability of this scheme, because up until then there had been real concerns in the community about how they could access dental services. There was so much evidence, across the board, on dental health; evidence that was pointed out most clearly, from my point of view, in the Senate Community Affairs References Committee Inquiry into Poverty where we were looking at the whole range of issues which had impact on the community. Consistently, when we had private meetings and when we had public meetings in the community, the issues around dental health came up so strongly.

That led to a range of consultations, negotiations and the development of policy on our side but also from the government, who did listen to the concerns about appropriate dental health and the impact of dental health on people's wellbeing at all ages. Indeed, the issues that were raised through that process of consultation did not limit the needs around dental health to one particular group. It talked about the particular processes for young people, which was then picked up by the Labor scheme that came later about adolescent dental health. It looked at the particular needs of developing dental processes so that people would have timely intervention early in their lives so that they would not have the horrors of exacerbated decay and also malfunction in dental processes, which lead to inordinate pain and inconvenience, which are lifelong.

Another particular group of people that came to see us were age pensioners and people who had had no ability in their own youth to have that intervention, and who, as they grew older, were suffering quite seriously from poor dental hygiene and poor dental health.

There was a welcoming but then, when there was an audit of the scheme at the time, we found that the simple process of making the scheme operate, the compliance issues, were not effectively being fulfilled. When the Department of Human Services did their audit-and I think Senator McLucas mentioned this-there was a high rate of noncompliance with provider reporting requirements which were clearly set out in the act. I know that there is a range of opinion but, if you reflect on what I said in this chamber at the time when we were looking at the changes in the dental scheme, I seriously believe that there is a personal responsibility for professional people and organisations to understand the rules and to work within them. Nonetheless, it was put forward by the then government that there was concern, there was a lack of knowledge and there could well have been an 'inadvertent' misuse of the program. People were unaware of their responsibilities and therefore were paid considerable money by the government for providing services under the legislation and then were found out, in effect, to have had an overpayment.

The bill before us talks about the importance of having a clearly understood waiver so that, when the overpayments are identified, there is the opportunity to put it to the people involved. There was great lobbying and advocating by the Australian Dental Association, as well as by individual dentists who visited most parliamentarians in this place to put forward their cases. There was an agreement that there would be a procedure put in place where many debts would be waived, but there were a distinct number of dental operators who did have overpayments identified and then appropriate repayment plans were put in place.

One of the issues that has come out through this bill, which is for all intents and purposes a bit of a housekeeping bill, was to change the way that the waivers and repayments would operate from what is a standard government procedure, which is the Financial Management and Accountability Act 1997-which we all know is essential reading for everybody. Nonetheless, that piece of legislation spells out how overpayments are identified and how repayments to the government are done. Minister Dutton has actually seen that and believes that this is complex and may cause undue stress and delay and therefore they are placing the procedures within the health department to ensure that that will happen. We have no intrinsic opposition to that. I think it is important to see that we look at the history of where it came from and the delegations that now operate within the health act.

I certainly hope that the amount of work that will be done developing this legislation will ensure that professionals in all areas, particularly the dental profession, will have a greater awareness of their requirements of access to Medicare payments, and will have established a stronger communication link so that there is the ability for people to check out what they are required to do before they enter into a contract-and it is a contract.

This is a contract between professionals and the government to ensure that they appropriately receive Medicare payments. My hope is that, from the problems we have had in the past, the identification has been that, perhaps, communication was not as strong as it should have been. Also there is the clear link and understanding that you just do not get Medicare benefits because you do a service. There are individual responsibilities around the type of service you are providing and what you are required to do. In the previous scheme, that real link between appropriate referrals and the types of services covered by the act did seem to be of some concern around the lack of clarity.

The other element leading on directly from putting responsibility back into the Department of Health is the extension of the professional services review to cover dental practitioners who are involved in providing these services. It is one of those things that is self-evident. The professional services review that now operates in the medical profession allows professional consideration of the behaviour and practices of anyone within the services and, under those professional bodies, allows them the ability to check out if there are any allegations of malpractice or misuse of Commonwealth money. We know that it operates in all medical areas now if people are receiving Medicare payments. There have been some considerations around that.

The community affairs committee had an inquiry into this area about 18 months ago, actually stimulated to an extent by lobbying around Senator Abetz with concerns about the way the PSR, the Professional Services Review, operated. The core principle that came out of that discussion, which was vindicated and reinforced by the inquiry, was that there must be appropriate review. Should there be allegations of any malpractice or change of behaviour, there should be a process where that is able to be considered. This bill, amongst other things, actually ensures that activation of the professional services review, with dentists providing services under the MBS covered by the PSR, and that it is appropriate that that would be covered by this scheme.

In terms of our past experience and the investigations that we have had through the development of the wider dental scheme, we totally support the two elements of, firstly, ensuring that the waiver responsibility is back with the department so that they understand the profession and are able to work with it and, secondly, the PSR. I am not going to take the time of the chamber by talking about the importance that Labor places on an appropriate dental scheme across our country. We have made that commitment on the basis that, if you are looking at the health and wellbeing of Australians, it is absolutely critical that we acknowledge that there are needs around oral hygiene and oral health. We have a highly skilled and well-trained dental profession in our nation. In fact, it is highly regarded around the world for the training we provide. We are able, then, to ensure that we can best link the needs of the community across our whole country, not just in large capital cities, but across the whole nation, with effective and responsive services. In this area, it is absolutely essential that we look at making sure that the workforce is located where the need occurs. I see Senator O'Sullivan across the chamber and I am sure he can confirm that, when visiting regional areas in Queensland, one of the key issues that is raised all the time is access to dental services.

I will put on the record a visit I made to the central western area. I went to several significant regional towns with fully set up dental chairs and a history of having had dental professionals-dental professionals with immediate links to the local schools, the local aged-care sector and the local community. Because of workforce shortages and a reluctance of people to serve in regional areas, those chairs-that equipment, those practices-had been abandoned. As a result, people have to travel long distances to get the basic dental services we all expect, as a right, to be able to access in our own suburbs and towns.

We support this bill. There are a whole range of other housekeeping matters in the bill, but I will not refer to those.

Senator Ryan: Of course you won't!

Senator MOORE: No, I will not. I have put the issues that are of principal concern to me. If Senator Ryan were to check the record of debates on this subject, he would find that I have contributed to most of them-and the issues of credibility and professional integrity have always been central to the contributions I have made.