1. Home
  2. Hansard & Papers
  3. Legislative Assembly
  4. 25 February 2004
Contact Print this page Reduce font size Increase font size

Regional Dental Services

Printing Tips | Print selected text | Full Day Hansard Transcript         « Prior Item | Item 25 of 41 | Next Item »

About this Item
Subjects -  Dentistry; Rural Conditions; Education; Students; Aborigines: New South Wales; Health
Speakers - Torbay Mr Richard; Burton Ms Cherie; Draper Mr Peter; Cansdell Mr Steve; Acting-Speaker (Ms Marie Andrews)
Business - Matter of Public Importance


    REGIONAL DENTAL SERVICES
Page: 6595


    Matter of Public Importance

    Mr RICHARD TORBAY (Northern Tablelands) [4.24 p.m.]: I am delighted to have the opportunity to raise this matter of public importance today. Dental services across New South Wales, particularly in regional, rural and remote parts of New South Wales, remain a significant issue, one that has been the subject of a number of private members' statements prior to today. Nonetheless, it is important that we continue to strive to improve the situation. When I raised this issue in the House some time ago I commented that regional New South Wales faced a severe shortage of dental health facilities and practising dentists. Regional dentists are unable to attract replacement dentists or recruit support staff despite seeking candidates across the country.

    One of the problems is that the number of dentists graduating in New South Wales has significantly declined in recent years, a trend that is reflected throughout Australia. The statistics make interesting reading. In 1974 there were 115 dentistry graduates from the University of Sydney and in 1979 the figure was 135. But in 1999 only 35 students graduated, in 2000 only 27, in 2001 only 29, and there was a slight increase to 44 in 2002. The figures demonstrate a significant reduction and that can only spell bad news for people of this State. But, as I said, the reduction will particularly impact on those in regional, rural and remote areas. I am pleased to see a number of country members in the Chamber and I hope that they will contribute to the debate.

    In the 1970s there was a ratio of one dentist per 4,500 to 5,000 people. Presently there are only 3,200 dentists practising in New South Wales and the ratio is currently one dentist per 8,000 people. More than a third of the current dentists graduated prior to 1975, and only 14.5 per cent of the State's dentists practise in regional New South Wales. This State, like the rest of the country, has an ageing population of dental practitioners and the number of qualified dentists to replace them is grossly inadequate. The industry has raised the issue with me on numerous occasions. It has told me that a dentistry course takes five years and even if we begin to provide incentives to attract more people into the field there will still be a significant shortfall in the short term. It will take a number of years before the problem can be solved.

    There have been many complaints about the incentive schemes put forward by the Government. I have discussed the matter with the New South Wales Minister for Health on a number of occasions, as I did with his predecessor. The State's attempts to encourage more dentists to regional areas have certainly been welcomed but they have had limited success. The overall shortage of graduates is one problem. Another is that newly graduated dentists have strong preferences to establish practices in more affluent areas of metropolitan cities. More women are graduating in dentistry, from 14 in 1999 to 18 in 2002. But the women dentists that I have spoken to have told me that they face a problem in taking up positions in regional and rural areas because suitable employment opportunities for their spouses or partners may be limited.

    Another important factor is that the majority of overseas students who train as dentists return to their countries of origin to practice. In a few regional areas there are currently adequate numbers of dentists but the problem is the sustainability of the numbers for the long-term provision of dental health services. Other areas have almost no dental services. Honourable members in rural and regional New South Wales know about the challenges in their electorates, which have almost no dental health services. Many people have to travel long distances and wait long delays for treatment.

    A national scheme was established in the dying days of the Keating Government on a dollar-for-dollar basis to address the issue of significant waiting lists for dental treatment in the country. It was a trial and, according to the figures, it was very successful. It had an enormous impact on waiting lists for public dental treatment. I was pleased to see that during a recent visit to New England the Federal Leader of the Opposition put dental health services back on the political agenda. A Federal election will be held later this year and the Hon. John Anderson made a commitment to re-establishing the Commonwealth scheme in part, and matching State funding, if the Coalition is re-elected. Without attempting to be partisan, I hope the Federal Government revisits that issue. It would be good to see the Government and the Opposition in the lead-up to the Federal election commenting about the contributions that they will make to reduce the time dental patients must wait for public treatment.

    I get tired of speaking to people who deserve to be treated but who are experiencing these delays. It is disappointing and disturbing for me, not only as a local member but also as someone who is supposed to help people, to see the frustration of people looking for basic dental services. In many cases patients are told that public dental services can deal only with the most urgent cases. A constituent of mine was told that getting an appointment for treatment for a toothache might take months. That is unacceptable and we can do better. Honourable members should look at the joint State-Federal dental proposal, and at the positive impact it had on waiting lists and the way in which extensive funding was freed up and put into the front line for public dental services. It was a successful model and I urge the Federal and State governments and oppositions to put these dental services strategies in place. They were successful and they will be again.

    I know the higher education aspect of this issue is important. We must make higher education more accessible. We must ensure that incentives are available for people who want to enter the very important career of dentistry. University places in the relevant faculties should not be limited. Rural and regional New South Wales is struggling to attract experts in these fields, but university places are limited. It does not make sense that people want to enter these noble professions but the cost of undertaking the necessary training is so exorbitant that it is impossible for them to provide those services to the State and to regional and rural New South Wales. The move to user-pays or privatised education is frightening. It is eroding the concept of public education at every level, both State and Federal. We have seen the impact on TAFE fees and in other tertiary education institutions as a result of the Nelson reforms. We must support industries and services and educate people who want the opportunity to make a contribution other than on the basis of the size of their bank balance. If that occurs, we will be the losers.

    Miss CHERIE BURTON (Kogarah—Parliamentary Secretary) [4.34 p.m.], in reply. When the Howard Government withdrew from the Commonwealth Dental Scheme [CDS] in 1996 it shamelessly abandoned its responsibility to thousands of people. The Federal Government clearly has a responsibility for oral health. This obligation is enshrined in no less than the Australian Constitution. In 1946 the Australian public voted at a referendum to grant power to the Commonwealth to provide a wider range of health and social security benefits in the post-war period. The outcome was section 51 of the Australian Constitution, which reads:

    The Parliament shall—subject to this Constitution—have power to make laws for the peace, order, and good government of the Commonwealth with respect to:... the provision of maternity allowances, widows' pensions, child endowment, unemployment, pharmaceutical, sickness and hospital benefits, medical and dental services (but not so as to authorise any form of civil conscription), benefits to students and family allowances.

    Good oral health is a fundamental aspect of life-long wellbeing. It is not just about having good-looking teeth. Poor dental health can affect a person's overall health. Serious dental problems can be linked to other health issues including the inability to eat fresh fruit and vegetables, which in turn reduces vitamin and mineral intake, digestive problems, periodontal infections that have been associated with premature labour, and problems in managing blood sugar levels in diabetics. Obviously, poorly maintained or damaged teeth can also have a hugely detrimental affect on self-esteem. As we all know, serious dental problems can mean serious pain.

    The importance of dental health was recognised when these constitutional changes were made in the middle of the last century. In 1997 the Commonwealth Government, despite the longstanding contribution it had made to the provision of dental services across the country, walked away from the CDS. The honourable member for Heathcote and the honourable member for Fairfield organised a campaign on behalf of workers in the dental industry who were being subjected to violent outbursts by seriously ill people who could not get dental treatment. The honourable member for Heathcote was referred to as the "Pacman" of the Parliament. However, those protests fell on deaf ears.

    By walking away from the CDS, the Howard Government walked away from thousands of needy Australians. The CDS was introduced in 1994 to reduce the geographic and financial barriers that prevented people in most need from receiving timely and appropriate dental care. In its last full year of operation—1995-96—the CDS contributed $37.8 million to dental care in New South Wales. John Howard announced in August 1996 that the Commonwealth Government would withdraw from the program and the following financial year New South Wales received just $18.6 million. The impact of this disgraceful decision was immediate and devastating. In the last fully funded year of the CDS—1995-96—the New South Wales Government provided dental services to 444,000 adults. By 1997-98, with dental health care decimated by the withdrawal of Commonwealth funds, that number dropped to just 172,000. Effectively two-thirds of those requiring treatment¯more importantly, two-thirds of those eligible¯were abandoned by the Howard Government.

    The New South Wales Government did not walk away. It stepped into the void left by the Howard Government because it had no choice. A significant portion of the community was in real need, and some were in real pain. Over the past three years this Government has rebuilt dental care in this State. In 2000 the Government announced funding increases totalling $33 million over the next three years. In 2002 a further enhancement was announced, taking the total health budget to $97 million per year. As graphic as the withdrawal of Commonwealth funds was in 1997, so too the lifeline thrown to dental health by this Government had a profound impact.

    I am advised that in the six-month period from 1 July to 31 December 2003 we provided 27,430 denture services, 20,924 vouchers were issued under the Oral Health Fee for Service Scheme, and 140,383 adults received oral health treatment. We have instigated a raft of strategies to make public dental care in New South Wales more effective and sustainable. We established the Priority Oral Health Program, which helps people in urgent need gain access to emergency oral health care within 24 hours. We also established the Oral Health Fee for Service Scheme, which enables patients to obtain treatment from their private dentist, paid for with a voucher. To date almost 1,100 registered private dentists have agreed to participate in the scheme. We are recruiting additional specialists as part of a broader strategy to increase access to public dentistry.

    This is no easy task. As with many other health professionals, a serious work force shortage continues to compromise our recruitment efforts. We have brought new life to rural dental health by establishing three rural and regional oral health centres. These centres—at Queanbeyan, Grafton-Coffs Harbour and Dubbo—provide additional specialist services. As well as providing care, these centres also operate as a hub for providing ongoing training and professional education for dentists in the public sector. The benefits of these rural-based centres are manyfold. They provide better access for people in rural areas to oral health care, including more specialised services; they provide additional services through the Fee for Service Scheme; they give rural dental health professionals in both the public and private sectors the opportunity to maintain and extend their skills; they support the recruitment and retention of rural dental professionals; and they provide a rural base for student and postgraduate teaching, and public health research.

    We have also created a particular focus on Aboriginal dental health. To help provide a comprehensive approach to delivering and funding services, an Aboriginal Oral Health Advisory Committee has been established with representatives from Aboriginal medical services, and the oral health and Aboriginal health branches of NSW Health. We fund 10 Aboriginal medical services to provide oral health services. These medical services either provide oral health care themselves by employing dental health professionals and establishing dental facilities on site, or issue vouchers to enable patients to see a private dentist. We have also made an additional grant to Corrections Health to support oral health care for Aboriginal people in custody.

    Despite the ground we have recovered since the abolishment of the Commonwealth Dental Scheme, this Government maintains that the Commonwealth Government has a clear responsibility to participate in dental health. We believe that this is not just an option for the Commonwealth, it is an obligation. The Federal Opposition, under Mark Latham's leadership, has clearly indicated that it will live up to this expectation when it assumes government. Federal Labor has committed to investing up to $300 million over four years, culminating in a $120 million a year program under its Australian Dental Care Plan. Working with State and Territory governments, the Australian Dental Care Plan would provide up to 1,300,000 additional dental procedures across the country. This would substantially decrease the number of people currently waiting for a dental procedure. Under Labor's plan, concession cardholders could receive free check-ups when they need them, and also timely and appropriate subsidised dental treatments, restorations and dentures.

    Labor's plan will also assess the dental health of every person admitted to residential care and put in place an action plan to provide ongoing care; target programs for indigenous communities that recognise specific problems such as water fluoridation and a high incidence of diabetes; and provide public education and awareness programs to help prevent dental problems, as well as improve data collection to help plan even better services. That is the kind of Commonwealth Government response needed to dental health. That is the kind of plan that this Government could work with. The re-establishment of a Commonwealth dental plan has received endorsement from no less than the Australian Medical Association [AMA]. The AMA calls on the Howard Government to match the commitment from Federal Labor. The Federal Government should participate more in supporting the State Government's approach to dental health. [Time expired.]

    Mr PETER DRAPER (Tamworth) [4.44 p.m.]: Along with my colleague the honourable member for Northern Tablelands I recently attended the Vision New England Summit in Armidale convened by the Federal member for New England, Tony Windsor. One of the key points brought forward at that summit was a recognition that dental services in regional New South Wales are under extreme pressure, and that low-income individuals and families are facing inadequate access to services. The New South Wales branch of the Australian Dental Association [ADA] contributed to the debate at that summit, and it made some interesting observations that deserve serious consideration. When commenting on the 2002 NSW Health Work Force Planning Project, the New South Wales branch noted that the 2010 projection of dentist numbers revealed a clear and alarming shortfall based on current and projected enrolments.

    What needs to be carefully considered is that the difference between the number of registered dentists and those actually practising in the profession of dentistry is already almost 1,000. The ratio of dentists to patients across the State is now one to 8,000, a figure that has doubled since the 1970s. Only 45 dentists graduated from the University of Sydney last year, compared with 135 in 1979. These are alarming statistics, but it is increasingly obvious that there simply are not enough dentists to meet an ever-increasing demand. The New South Wales branch of the ADA clearly supports the need to increase the number of dentists in the work force. It feels that this could be achieved by increasing the number of dental graduates and improving educational opportunities for overseas trained dentists, as well as identifying registered dentists who are not practising and supporting them in re-entry programs. The New South Wales branch also identified the need to look at the role of dental hygienists and how they can be better utilised to improve services to the public.

    The ADA has indicated that it would support the restructuring of hygienists' conditions of practice to include treatment in nursing homes, hospital settings, hospices and rural settings without the direct supervision of a registered dentist. This would depend on treatment being performed as per the supervising dentist's prescription. Such a move would free up dentist resources in treating those who require long-term, intensive, preventative treatment regimes. The New South Wales branch indicated support for the employment of hygienists in the private sector and the ability of those oral health care team members to provide services in residential homes.

    The ADA also indicated its support for any proposal to provide scholarships to students from rural areas to undertake study in dentistry. The projected shortage of dentists does not take into account the distribution of practising dentists. There is a view that there are a number of underemployed city practitioners, whilst very few country practitioners would be underemployed. The costs involved in undertaking a dental degree are a strong disincentive to rural people, and scholarships would encourage such people to undertake higher study. The ADA believes that the contracting of scholarship holders to return to country areas for a period of time, as occurs in the defence forces, should also be encouraged.

    The ADA also supports scholarships to indigenous Australians to undertake dental study at any level, as it recognises that the cultural differences between Aboriginal Australians and other Australians may cause problems in the delivery of dental care. The use of indigenous Australians to deliver services should help reduce these differences. If we are to improve future prospects for dentistry in New South Wales, an informed, co-ordinated national policy on the oral health services work force is needed, and there is a strong need for a State-based work force group to support this process.

    Vocational training is another area that needs to be focused upon. The lack of career opportunities within the public sector appears to be a barrier to retention, and vocational training would provide additional motivation for existing employees. Given the problems associated with recruitment and retention to private dental practice in high-demand areas, such as rural areas, the Australian Dental Association is of the opinion that vocational training would expose new graduates to both the public and private sectors for mutual gain. We need to attract and retain dentists to the public system. The association points out that whilst remuneration in the public sector is undoubtedly lower than that in the private sector, the benefits of salaried employment are not well reported or marketed. Educational opportunities, annual leave, superannuation contributions and additional benefits could be better promoted to make the role a more attractive proposition.

    The association believes that it would be prudent for NSW Health to investigate the rates of remuneration and incentive structures offered by dental clinics operated by health funds. The ADA notes that the discussion groups identified the lack of career pathways as limiting recruitment and retention to the public sector. Dental students identified the need for structured and mentored clinical education. All Australians should have access to modern, comprehensive oral health care. I urge members to take the time to look at the association's policy framework. It offers a vision and suggests solutions to what may become one of the most important issues facing our health system. All levels of Australian government and community groups should work together towards this goal.

    Mr STEVE CANSDELL (Clarence) [4.49 p.m.], by leave: Dental care is an extremely important issue to many constituents in the Clarence electorate and, indeed, across country and coastal New South Wales. I commend the honourable member for Northern Tablelands for raising this matter in the House today. Timely access to dental treatment must be a high priority for any government. However, in New South Wales we have a scheme that is shrouded in secrecy and extensive waiting lists of people who have been waiting years for treatment.

    This reminds me of an issue I raised in the Parliament in June concerning an elderly lady from Yamba whose gums were shrinking and who was taking up to three packets of Panadol a day to relieve the pain. She had to wait over 12 months before she finally received treatment. Also, a middle-aged lady from Wooli was in extreme pain for 12 months before she had any relief. Trying to establish facts and figures on the scheme is nearly impossible, so much so that last week the shadow health Minister was forced to put a series of questions on notice to the Minister for Health in relation to the waiting list for public dental care. I challenge Labor to come clean on the figures so that the public can see the full extent of the poor state of the scheme it administers.

    While the Carr Labor Government fritters away $90 million a year on consultants, more than $3 million a year on monitoring its performance in the media and $36 million running ministerial offices, it allows people in our communities to suffer in pain for years. Under the Australian Health Care Agreement, New South Wales is responsible for public dental services for the community. New South Wales is required to fund public dental services and to report on how many of these services it provides. But given the disgraceful situation Labor has allowed to develop, it is little wonder it is reluctant to publicly disclose the figures. The waiting list could be addressed readily were the Government to direct adequate funding for such services for which it has acknowledged responsibility.

    In 1996 the time limit of the Commonwealth Dental Health program, which was designed to help reduce waiting lists for State and Territory funded public dental services, ceased. This was a one-off grant of $300 million by Prime Minister Keating in the dying stages of his parliamentary term. That grant was fulfilled under the Howard Government and it ceased in 1996. In keeping with this sphere of responsibility in the health care system, the Australian Government also provides Medicare funding for a number of dental procedures for private patients receiving services in private and public hospitals, subsidised drugs that may be prescribed for oral health under the Pharmaceutical Benefits Scheme, funding for the university training of dentists and other dental service providers, and funding for the dental care of war veterans and full-time and part-time members of the Australian defence forces.

    It is a shame that the people who are suffering are mainly low-income earners, many of whom are unemployed, and pensioners who do not have the capacity to pay for dental procedures to be undertaken by private dentists. Their only alternative is to travel several hundred kilometres from outlying areas to Sydney. I am also told that there is still, after 12 months, no public oral surgeon based in Grafton, Lismore or Coffs Harbour. Anyone requiring oral surgery, unless it is an extreme emergency, would have to seek the services of a private dentist who is experienced enough to undertake the dental work required. I believe it is about time Labor got its priorities right. People matter more than spin.

    Mr RICHARD TORBAY (Northern Tablelands) [4.53 p.m.], in reply: I take this opportunity to thank all members who have contributed to this debate, namely the Parliamentary Secretary—the honourable member for Kogarah—the honourable member for Tamworth and the honourable member for Clarence. All those members made very important points in this debate. The Parliamentary Secretary put forward a number of points particularly in relation to the Commonwealth's withdrawal of the dental scheme back in 1992. There is no doubt that that was bad news for dental services in New South Wales. That was obvious from the figures that I quoted in relation to what happened to waiting lists. The Parliamentary Secretary is a hardworking, intelligent person—

    Mr Andrew Fraser: Who told you that!

    Mr RICHARD TORBAY: The honourable member for Coffs Harbour almost applauds, but it is against standing orders in this place and I remind him of that. This is not just about bashing the Commonwealth dental services—and I hope that the second part of the Federal Government's contribution is an acknowledgement that its withdrawal of services was bad news for dental health—but it is appropriate that we look constructively at solutions. That will require the Commonwealth Government and the State Government to co-operate. It will require incentives for higher education, as the honourable member for Tamworth so properly put forward in this debate. We have to help educate, and give incentives to allow opportunities to educate, more dentists. That is going to help in getting those opportunities out to regional and remote areas. The Commonwealth has a contribution to make. Yes, the withdrawal of services occurred, but there is a Federal election coming up. The Federal Leader of the Opposition has commented on this issue and I hope that the Prime Minister on behalf of the Government will do the same. That would be good news for the people of New South Wales and Australia.

    The honourable member for Clarence also made a number of very important points in the debate, particularly in relation to the individual representations we receive as local members in our local areas. As has the honourable member for Clarence, I have a number of stories to relate. I remember a constituent from Uralla who indicated to me in a letter that he had not eaten meat for three years because he could not chew it with his dentures. When I saw him I can confirm that he was dead right. We managed to get some dentures for him through political representations, though sadly that ensured him only a reasonable quality of life. We are not asking for much in this matter. I understand that a local butcher, having read of this man's plight in the newspaper, displayed goodwill by sending him a big cryovac of Scotch fillet. I thought it was pretty good for the people in the Northern Tablelands electorate to get behind that particular process.

    The number of dentists graduating is declining, and that is the trend. The opportunity to educate people to practise as dentists is being made more difficult. The cost of higher education is increasing, yet the waiting list grows. These services are simply basic services that we should be providing to the community, particularly our senior citizens and those who need to access these sorts of basic services. I urge all members from all sides, at both levels of government, to be constructive about this process because it is an issue that affects every single one of us in all electorates in every part of this State and country.

    Discussion concluded.

    Madam ACTING-SPEAKER (Ms Marie Andrews): Order! It being before 5.15 p.m., with the consent of the House, I propose to proceed to the taking of private member's statements.



Last modified 31/03/2009 15:40:59   :   Update this page