With Labor recently securing a majority government in the House of Representatives, it is an interesting time to reflect on the approach the Australian Dental Association (ADA) has taken from pre-budget submission, to post-budget opinion, through to its pre-and post-federal election stance.

Pre-budget submission

The ADA’s pre-budget submission was released in January 2022. The background information highlighted groups identified as most in need in the National Oral Health Plan 2015-24, these including:

• Those who are socially disadvantaged or on now incomes
• First Nations Australians
• Those living in regional and remote areas
• Those with additional and specialised health care needs

Regarding older Australians the submission stated that oral health has been neglected for many years as a result of decreased accessibility and poor affordability, and referred to long waiting lists for public dental services. It cited:

• The Aged Care Quality Standards Recommendation Point 19 from the Royal Commission into Aged Care Quality and Safety, stating that Aged Care Quality Standards are reviewed urgently with a commitment to best practice oral health care being an amendment by 31st December 2022
• The Better Access to Health Care Recommendation Point 60, to establish a seniors dental benefits scheme by 1 January 2023
• The Aged Care Workforce Recommendation Point 79, for a review of certificate courses in aged care to include oral health as a core competency for aged care facility staff

The proposed budget for Aged Care Oral Health was $1.3 Billion per year for a Senior Dental Benefits Scheme for those who receive the aged care pension, and $13.9 million per year for registered dental practitioners to become integral members of aged care teams.

Regarding rural and remote Australians, the submission stated that smoking, drinking, reduced access to fluoridated water, social determinants of health, health literacy are compounded by a shortage of a skilled dental workforce. These factors combined lead to poorer oral health outcomes than in metropolitan areas. Recommendations included:

• Direct improvements to patient-centred oral health services such as increased funding to teledentistry ($2.1 million p.a), support for the development of the Indigenous oral health workforce ($5 million over 5 years for 100 students), and better utilisation of the Child Dental Benefits Scheme ($1 Million media campaign)
• Those for dental and oral health practitioners and specialists for equipment in rural communities, public access to tertiary dental specialist outreach services, CPD courses in regional areas, career incentives for long-term employment of dental practitioners in regional, rural and remote locations, and private health fund benefits for teledentistry
• For dental and oral health students and new graduates, continuing to target an allocation of students from First Nations and regional backgrounds, including dentistry in the “bonded” HECS Reimbursement Scheme, training of students and allowances for transport, accommodation and living expenses for students on rural health placements ($1 million over 5 years)

A national public waiting list for dental services was also proposed at a cost of $89.58 million p.a., as were health promotion initiatives including front-of-pack labelling on all packed food and drink products containing added sugars and the continuation of subsidising TGA-approved smoking cessation products.

Post-budget opinion

The ADA considered that the March 2022 federal budget placed no importance on the nation’s oral health.

ADA CEO Damian Mitsch said “This is a very disappointing outcome when we know that thousands of people have to wait years to get a dental appointment in the public system.

“Also, there are large numbers of Australians including those in residential aged care, those on Level 4 Homecare Packages, those from socially and economically challenged backgrounds and Indigenous and Torres Strait Islander populations for whom dental care is unaffordable.

“The ADA has put to successive governments and to the Royal Commission into Aged Care Quality and Safety our plan to fix the inequity in oral care between those who can afford their own dental care and those who have to wait years in the public system.

“If the government adopted the Seniors Dental Benefits Schedule, it would mean funding dental care for older Australians as well as some fundamental systems finally being put into place to ensure better dental care for residential and home care residents,” said Damian Mitsch.

While National Partnership Agreements were once again extended in the Budget to ensure public dental services for another year or two, the ADA saw this as a Band-Aid measure for a broken system.

Pre-federal election

In the lead up to the federal election, ADA President Dr Mark Hutton requested that members lobby the major political parties to ensure that dentistry was a critical part of the election conversation.

Issues raised in the lead up to the election were:

• The Child Dental Benefits Schedule, which was only being used by 38% of eligible families
• Establishing a Dental Benefits Scheme that provides older Australians with a capped entitlement to subsidised oral health services to address immediate needs
• Ensuring all over 75s, Aboriginal and Torres Strait Islanders over 55 and residents of aged care facilities get a mandatory and reportable oral health assessment
• Overhauling the Aged Care Quality Standards so providers must meet oral care standards, as urged by the Aged Care Commission
• Implementation of core oral health study units in the Cert III Aged Care Courses to ensure staff are equipped to meet oral hygiene needs of residents

During the week leading up to the federal election, the ADA congratulated the Greens for including oral health on their shortlist of issues should they have held the balance of power following the election. The ADA noted the Greens costing of adopting dental into Medicare as $77bn over a decade, starting with a spend of $7.5bn from July 2023 and a further $7.5bn the following financial year.

ADA Deputy CEO Eithne Irving stated “With so many pressures on the public purse, no government has ever prioritised this. Yet the knock-on effect of untreated oral health issues to other parts of the health system including urgent dental problems presenting at emergency departments is huge.

“For example around ten in every 1000 children hospitalised is due to a dental condition. The hidden cost to Medicare from patients seeking care from their GP likewise, has been estimated to be up to $300 million per year.

“The ADA’s plan to start smaller within residential aged care and incrementally fix the broken oral healthcare system there is far more acceptable and will save money in the health system in the long term but more importantly, improve the health and well-being of one of our most vulnerable populations.”

Post-federal election

Following the May 2022 federal election, ADA President Dr Mark Hutton congratulated the Labor government and stated that he was looking forward to its new Cabinet delivering on the undertaking to work with the ADA.

The ADA revealed that in a letter before polling day, Labor promised that it would work with the ADA to improve training for aged care workers, ensuring that an oral health component was included.

Dr Hutton said, “Labor has said it understands the importance of oral health to elderly Australians and acknowledges the relevant recommendation of the Aged Care Royal Commission’s Final Report.

“Further, they wrote to us saying that an Albanese Labor Government would engage with relevant stakeholders, including the ADA, to address issues with aged care vocational and university education programs, the Aged Care Quality Standards and other regulations relating to oral health needs in residential aged care.

“This is great news and will go a long way to fixing some of the biggest issues facing the 190,000 residents of aged care facilities around Australia, many whose oral health issues are not being met as often as they should be, or not at all.”

Dr Hutton added: “Within the next few weeks, the ADA will be contacting all relevant members of parliament to ask for their support in pushing for these and other advocacy issues which will improve the oral health of older Australians – primarily to back a Seniors Dental Benefits Schedule to fund dental care delivered by private and public dental services to older Australians who need it most.”