NACCHO Submission: March 2013
House Standing Committee on Health and Ageing – Inquiry into Adult Dental Services in Australia
NACCHO thanks the House of Representatives Standing Committee on Health and Ageing, chaired by Ms Jill Hall MP, for the opportunity to make a submission into the Inquiry into Adult Dental Services in Australia and to inform the development of the National Partnership Agreement (NPA) for adult public dental services.
This submission is intended to provide a succinct comment to the House Standing Committee on Health and Ageing – inquiry into Adult Dental Services in Australia, providing detail on NACCHO’s policy position on Oral Health. It argues for the inclusion of dental checks, basic dental treatment, emergency treatment and oral hygiene/prevention as part of the core primary health care services to be provided by all Aboriginal Community Controlled Health Services (ACCHSs) as the preferred provider.
NACCHO asserts that in order to improve the overall health and well-being of Aboriginal and Torres Strait Islander individuals, and thus the community, oral health must be improved and to achieve this all ACCHSs must be funded to provide oral primary health care services.
Since the announcement of the Dental Health Reform Package, also on 29 August 2012, we have been attempting to identify where Aboriginal and Torres Strait Islander people are prioritised in the new policy or in the transition arrangements. From reviewing papers released to date, the new reform package proposes to target disadvantage children and adults on the public waiting list through National Partnership Agreements to be negotiated with the States and Territories, but there is currently no information on specific measures to ensure access for Aboriginal and Torres Strait Islander people. i
More worrying is the gap in time between the closure of the CDDS (8 September 2012 for new patients and 30 November 2012 for all treatments) and the proposed 2014 start date for the new reform package. Transition arrangements accessible for Aboriginal and Torres Strait Islander people as described to us, include continued access the existing Medicare Teen Dental Scheme and a component of the $345 million yet to be finalised arrangement with the States and Territories to address adult waiting lists for 2012-2013. We wish to ensure that the transition arrangements have targets to meet the needs of Aboriginal and Torres Strait Islander people.
The National Oral Health Plan: 2004-2013 clearly prioritises access to dental care for specific groups at risk, one of these being Aboriginal and Torres Strait Islander people.
Some evidence of this prioritisation slowly taking traction was seen recently in the Productivity Commission’s 2012 Indigenous Expenditure Report; where $28.6 million was expended by all levels of government in 2010 – 2011 for dental services for Aboriginal and Torres Strait Islanders, which was a very welcome start.
NACCHO re-endorses the recommendations in Australia’s National Oral Health Plan 2004-2013 endorsed by AHMAC in July 2004.
PRINCIPLES INFORMING the new National Partnership Agreement
The following principles should underpin process and outcome of the National Partnership Agreement on adult dental health services:
A holistic approach;
Health sector responsibility;
Community control of primary health care services;
Promoting good health;
Building the capacity of health services and communities; and
Accountability for health outcomes.
NACCHO recommends that the NPA for adult public dental services:
1. Provide culturally appropriate oral health services to all Aboriginal and Torres Strait Islander people;
2. Increase the oral health workforce available to improve the oral health of Aboriginal and Torres Strait Islander people;
3. Increase oral health promotion activity with the aim of improving health outcomes for Aboriginal and Torres Strait Islander people;
4. Improve the collection, quality and dissemination of oral health information about Aboriginal and Torres Strait Islander people; and
5. Foster the integration of oral health within health systems and services, particularly with respect to primary health care and Aboriginal and Torres Strait Islander people.
In addition, NACCHO asserts that:
1) Oral Health is a priority health issue for Aboriginal peoples.
2) Oral health is a core part of the holistic health that Aboriginal Community Controlled Health Services aim to provide.
3) Aboriginal Community Controlled Health Services should provide primary oral health care services including emergency and preventative oral health care and oral health promotion.
4) Australia’s National Partnership Agreement to come into effect June 2014 should be fully funded and implemented, in particular in relation to measures for Aboriginal and Torres Strait Islander Peoples in particular.
5) The Patient-assisted Transport Scheme (PATS) must be extended to dental patients.
6) Dental services should be subsidised to all needy Aboriginal and Torres Strait Islander patients to reduce or eliminate cost as a barrier to accessing services..
7) Aboriginal and Torres Strait Islanders in correctional facilities should have access to culturally appropriate oral health programs.
8) All oral health workers must receive cultural awareness training either as part of their initial training or through on-going professional development. This will increase the level of culturally accessible oral health services.
9) There should be support for more Aboriginal and Torres Strait Islander individuals to be trained in all the oral health profession: dentists, dental hygienists, dental therapists, etc.
10) The Australian Dental Council (ADC) should include performance indicators for training schools for recruitment and retention of Aboriginal and Torres Strait Islander trainees and have a target of 2.4% of each profession being Aboriginal and/or Torres Strait Islander individuals.
11) Oral health should be included in the core training of all health workers including Aboriginal Health Workers.
12) Fluoridation of drinking water supplies is an effective strategy to reduce oral health problems.
13) Culturally appropriate Oral Health promotion materials need to be developed, tested for impact, and widely disseminated if effective.
14) Improved and regular collection of data on Aboriginal oral health status and use of services is needed to allow monitoring of the impact of interventions and assessment of achievement of oral health goals and targets.
15) Work with all Australian governments to develop oral health service provision at all its member health services.
16) Work with stakeholders to develop cultural awareness training for all oral health workers.
17) Campaign in support of fluoridation of city, town and community water supplies.
18) Improve the level of useful Aboriginal oral health data initially by influencing the capacity for the sector to collect national data collection in those Aboriginal Community Controlled Services with an existing oral health service – e.g Periodontal and dental caries status,oral hygiene knowledge and periodontal links with Diabetes
19) Support research to collect information on the areas of individual oral health behaviours, knowledge and barriers in regards to oral health including the availability and affordability of oral hygiene items.
NACCHO calls upon the Federal Government, in collaboration with state and territory governments and NACCHO, to:
20) Fully fund and implement the 2014 National Partnership Agreement
21) Set and monitor goals and time specific targets in relation to meeting a range of oral health outcomes such as caries rates, periodontal disease rates and tooth extraction rates.
22) Formally recognise oral health as a key part of Aboriginal holistic health care to be provided by ACCHSs.
23) Allocate resources specifically for oral health services for Aboriginal peoples.
24) Increase oral health promotion activities in ACCHSs. This would require both increased financing for the development and testing of suitable materials, service provision and training of the AHW workforce.
25) Provide subsidised tooth brushes, tooth paste and floss to all remote communities in the first place and extend this as necessary to other communities where data collection indicates there is an access issue for these items.
NACCHO calls upon state and territory governments to:
26) Fluoridate all town, city and Aboriginal community water supplies that do not naturally contain a level of fluoride sufficient to prevent dental caries and immediately fluoridisation where this has ceased