Parliamentary Committees

SOCIAL DEVELOPMENT COMMITTEE: DENTAL SERVICES FOR OLDER SOUTH AUSTRALIANS

The Hon. I.K. HUNTER (11:13): I move:

That the report of the committee, on an inquiry into dental services for older South Australians, be noted.

In conducting the inquiry, the committee agreed to focus on a range of areas including current and future dental needs, factors that impact on oral health, the broad implications of poor oral health, the adequacy of current and proposed government programs, and funding and possible measures to improve the oral health of older South Australians. During the course of the inquiry, the committee heard and saw compelling evidence about the poor oral health status of many older people and the significant challenges they face in accessing public dental healthcare services.

Before proceeding much further, I would like to take this opportunity to thank former members of the Social Development Committee for their contribution to this inquiry and the report. Firstly, I thank Mr Adrian Pederick, from the other place. From this chamber, I would like to thank the Hon. Dennis Hood, who I note still remains on the committee, and the Hon. Stephen Wade. Two other former members of the committee, and indeed of parliament, also need to be acknowledged: Ms Lindsay Simmons, who was responsible for initiating this inquiry, and the Hon. Trish White.

While a final draft report was prepared, it was not able to be adopted before the state election in March of this year. On 21 June this year, the newly formed committee of the 52^nd parliament passed a motion that the final draft report be adopted and tabled. I thank the new members for recognising the importance of this report: Ms Frances Bedford, Mr David Pisoni, Mr Alan Sibbons and the Hon. Jing Lee.

Inquiries such as this would not be possible without the cooperation and contribution of the many individuals and organisations that came forward to give evidence. We thank all those who presented evidence to the inquiry, whether through written submissions or by appearing before the committee. Last, but certainly not least, I thank the staff of the Social Development Committee for their contribution to this inquiry and the report.

During the course of the inquiry, the committee received 19 written submissions and heard testimony from 10 separate groups of witnesses. The committee commenced hearing public evidence on 15 June 2009 and finished on 9 November 2009. Evidence presented to the inquiry suggested that the oral health of Australian adults is amongst the worse in comparable countries, ranking in the bottom third for rates of adult dental decay. The total economic cost of poor oral health in older Australians has been estimated to be more than $750 million per year.

The committee heard that thousands of hospital admissions could be avoided each year in Australia if early intervention for oral health problems had been available. The impact of poor oral health, however, should not simply be measured in economic terms. The social and health implications are significant. Poor oral health has been linked to a number of serious health problems, including cardiovascular disease, diabetes, aspiration pneumonia and malnutrition. Disturbingly, the inquiry heard that there may be a reasonable percentage of people dying in aged-care facilities from aspiration pneumonia, in which poor oral health is implicated.

The inquiry also heard that poor oral health can have far-reaching effects on a person's social and psychological wellbeing. It can profoundly affect speech, social interaction and self-esteem. The committee heard examples where some people avoid eating particular foods because of oral health problems and, in more severe cases, shun all social interactions because of embarrassment about their dental appearance.

Some witnesses to the inquiry highlighted the changing nature of oral health among older people. Over the years, there has been an increasing trend for people to retain more of their natural teeth, and for far longer. The committee was told that, during the 1970s, only 10 per cent of people living in residential aged-care facilities had most or all of their teeth. Today, this percentage has risen to about 50 per cent. The increasing rate of teeth retention, coupled with an ageing population, means that there will be a strong demand for dental services into the future. There is little doubt that this demographic change will have major implications for the state's healthcare system.

The inquiry was told that older people living in rural areas are more likely to suffer oral health problems and experience greater difficulty in accessing appropriate dental services. Recruiting staff for rural and remote dental health services is a major problem, with the overwhelming bulk of dentists and allied health practitioners employed in urban locations. Older people living in aged-care facilities often have significant oral health problems.

The inquiry heard that some aged-care facilities have been resistant to implementing oral health programs. Although current aged-care accreditation standards require proper care of residents' oral health, the committee was told repeatedly that, broadly speaking, the oral health of aged-care residents is poorly maintained.

The impact of long public dental waiting lists and inadequate public dental health funding was raised in evidence to the inquiry. There is no doubt that lengthy waiting lists act as a significant deterrent to older people accessing public dental care. The committee heard that the public dental service in South Australia is overstretched and unable to meet current demand. The committee repeatedly heard about the limited availability of professional dental equipment in aged-care facilities. Concerns about the dental workforce's capacity to meet future demand were also raised.

Fortunately, the evidence presented to the inquiry was not all bad. Numerous witnesses spoke about the benefits of some of the current dental programs specifically targeting older people. The committee commends the work of the South Australian Dental Service in leading and developing a range of programs which have been successful in delivering better oral health to older South Australians living in the community and in aged-care facilities.

The committee was also heartened to hear firsthand about the enormous contribution made by a number of dentists and their staff who take time out from their busy practices to provide oral healthcare services to aged-care residents. Nevertheless, the committee recognises that these types of trial programs are typically small scale and fragmented.

The recent announcement by the commonwealth government that aged-care workers will be trained in oral health as part of the Nursing Home Oral and Dental Health Plan was generally well received. The committee considers this an important step forward in improving oral health standards in aged-care homes.

It is certainly apparent that there are a number of positive initiatives in place. Nevertheless, from the evidence presented, it became clear that, if the current approach to oral health for older South Australians remains static, it will not be able to meet future demand. Changes are needed. To that end, the committee was pleased that the state government recently released its seven year dental health plan, entitled 'South Australia's Oral Health Plan 2010-17'. The plan, aimed at improving access to dental health care for all South Australians, was released on 21 June this year.

The committee is also pleased that many of the plan's commitments build on the recommendations of the committee's report. Indeed, the plan's emphasis on health promotion and early intervention, providing dentists with access to portable equipment to enable easier treatment of nursing home residents, and ensuring those who are disadvantaged have access to timely and affordable dental care are entirely consistent with the committee's recommendations.

However, the progress so far needs to be seen as a start, not an end. The committee considers that the implementation of these initiatives, as well as the other recommendations in its report, will lead to further improvements in dental health care.

Finally, the committee recognises that South Australia, like other jurisdictions, faces growing pressures on health funding for a range of reasons, including its ageing population. Nevertheless, it strongly believes that dental services need to be reconfigured in a way that ensures they focus on early detection and intervention. Doing so will help alleviate some of the burden placed on the overall health system by reducing, among other things, the need for surgical intervention and hospital admissions. Most importantly, it will improve the overall wellbeing of older South Australians.

Finally, the committee considers that all Australians have a right to high quality, accessible and affordable dental health care. It considers that delivering services to fulfil this right is a goal to which all levels of government and oral health service providers should aspire. The committee has put forward a total of 20 recommendations covering a range of key areas in support of this important and worthy goal.

Debate adjourned on motion of Hon. T.J. Stephens.