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House of Assembly - Fifty-Second Parliament, First Session (52-1)
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Parliamentary Committees

SOCIAL DEVELOPMENT COMMITTEE: DENTAL SERVICES FOR OLDER SOUTH AUSTRALIANS

Ms BEDFORD (Florey) (11:33): I move:

That the 31st report of the committee, on Dental Services for Older South Australians, be noted.

In conducting this inquiry the committee agreed to focus on a range of areas, including the current and future dental care needs of older South Australians, factors that impact on their 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.

While a final draft report was prepared by the membership of the Social Development Committee as constituted for the 51st Parliament, it was not able to be adopted before the state election in March this year. I, therefore, thank the former membership of the committee for the effort and energy expended in putting forward this very important report in such a vital area for so many South Australians.

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

In the course of this inquiry the committee received 19 written submissions and heard testimonies from 10 separate groups of witnesses. The committee commenced hearing public evidence on 15 June 2009 and finished hearing evidence on 9 November 2009. A number of submissions expressed concern that the oral health of adult South Australians is, on average, poorer than that of their same age counterparts in comparable countries. Indeed, 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 across Australia thousands of hospital admissions could be avoided each year if early intervention for oral health problems was available. The impact of poor oral health, however, should not simply be measured in economic terms. The broader health and social implications are significant. Poor oral health has been linked to a number of serious health problems including cardiovascular disease and diabetes. The inquiry heard that poor oral health can also have far-reaching effects on a person's social and psychological wellbeing.

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 resident's 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 about the limited availability of professional dental equipment in aged-care facilities. Concerns about the dental workforce's capacity to meet future demands were also raised. Fortunately, some evidence to the committee was more promising. The committee was heartened to hear firsthand about the enormous contribution made by a number of dentists and their staff, who take time out from their very busy private practices to provide oral health care services to aged-care residents.

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. 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 that this is 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; however, changes are still needed.

To that end the committee is pleased that the state government has recently released its seven-year dental health plan, entitled South Australia's Oral Health Plan 2010-17. The plan, aiming at improving access to dental health care for all South Australians, was released on 21 June this year.

The committee is pleased that many of the plan's commitments build on the recommendations of the committee's report. The plan's emphasis is 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, and is entirely consistent with the committee's recommendations.

The committee considers that the implementation of these initiatives and the other recommendations contained in the report should lead to further improvements in dental health care. Such efforts 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 overall wellbeing of older South Australians, particularly those in nursing homes who are unable to access help in their own right.

Mr PEDERICK (Hammond) (11:40): I, too, rise to support the reference and committee report on the inquiry into dental services for older South Australians. I will reflect quickly on the terms of reference of the committee. In the last parliament, I was on this committee, and some very interesting submissions were made to the committee, both written and orally, on the dental health of older South Australians. The terms of reference included looking at:

(a) current and future dental care needs of older South Australians,

(b) factors that impact on the oral health of older South Australians including physical and cognitive impairment and the effect of medications,

(c) the social, economic and health implications of poor oral health on older South Australians and the South Australian economy,

(d) the adequacy of current and proposed State and Commonwealth dental health services, programs and funding for older South Australians,

(e) factors that impede the provision of quality dental health care to older South Australians including dental workforce issues,

(f) possible measures to improve the oral health of older South Australians, and

(g) any other relevant matters.

What interested me in this inquiry was the fact that, as Australians and as South Australians, the more we look after our teeth, and the better dental health we have in our younger years, the more it becomes a problem in our older years. This was a surprise to me and seemed to be totally the wrong way around.

The simple fact is that we are looking after our teeth far more than our parents and our grandparents did. As we get older, especially as people enter aged-care facilities, we find that more people still have their original teeth, or most of them. This is where good dental care is so vital, especially in aged-care facilities.

My father is in low-category care in Resthaven in Murray Bridge, and they do a very good job looking after him. However, there are certainly people there who, sadly, have lost their memory or the function to speak (and this would be reflected in all aged-care facilities across the state), so sometimes the message cannot get out as to what is wrong with the person—for instance, why they are not eating correctly—and especially people who cannot communicate properly cannot get the message through that they have a major dental problem, whether it is gum disease or just a tooth that is hurt or infected.

We heard evidence about some people receiving different levels of care. It was only after some time, when people realised that the problem was actually in their mouth and there was something wrong with their teeth, that the problem for some of these people in aged-care facilities was remedied and they could get on with life in a much more comfortable manner.

In relation to people retaining their teeth, 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 around 50 per cent. The increasing rate of teeth retention, coupled with the ageing population, means that we need to deal with the predicted increase in demand for services from an already overstretched public dental healthcare system.

The committee also noted that there was a lack of availability of professional dental equipment in aged-care facilities. One of the recommendations from the committee was:

...that in the short term, the State Government should provide additional funding to increase the availability of mobile portable dental units and, in the longer term, investigate the feasibility of ensuring all new-build designs for aged care facilities, or those undergoing a major upgrade, integrate a multipurpose health room for use by health professionals, including dentists.

It was interesting to note that the committee heard presentations from several dentists who allocate some of their time to visit aged-care facilities, and it might only be for a couple of days a week or a couple of days a fortnight. I take my hat off to them because, when these people could be making more money elsewhere, they found it part of their professional and, I guess, part of their moral obligation to assist people in these aged-care facilities. I do salute these dentists and their staff who do their work.

Sadly, a lot of this work is done just with people sitting in chairs or sitting up in their beds, and it is very awkward for everyone involved. I know there have been some second-hand dental chairs already going into some facilities, which does make it a lot more convenient for both the dental staff and the patients to get their oral care.

There were also concerns raised about the dental workforce's capacity to meet the future demand as far as staffing is concerned, and there was some evidence to the inquiry that suggested that allied oral health practitioners, such as dental hygienists and dental therapists, are underutilised and could play a greater role in providing preventive oral healthcare services.

For that reason, the committee has recommended that consideration be given to reforming the dental workforce and developing strategies to help attract and retain more dentists and allied healthcare professionals in both the public and private sectors.

One of the overriding themes that emerged from the inquiry is that oral and general health are inextricably linked and should not be separated. I mentioned before how there were people in all sorts of grief in these facilities who could not get their message through as to what was really wrong and that, in the end, affected their health quite significantly.

The committee also heard, however, that oral health has been a largely ignored area of public health policy, so the committee has also recommended that oral health be better integrated into overall health in all aspects of policy development, funding decisions and service delivery.

There were 20 recommendations made by the committee, and I have mentioned some of them in my speech. Recommendation 16 states that the committee recommends that the Minister for Health investigate the feasibility of ensuring all new build designs for aged care facilities, or those facing major upgrades integrate a multipurpose health room for use by health professionals, including dentists.

I think that is something that really needs to be taken up in this state because, as I said before, more of us are retaining our teeth and more of us over time, whether we like it or not, will possibly end up in these facilities. I would like to think that we would get appropriate care when we get there, but everyone in society needs this care.

I note that recommendation No. 20 states that the committee recommends that the Minister for Health, in conjunction with the commonwealth and other key stakeholders, ensure that all aged-care facilities have a designated senior staff position responsible to oversee oral health services in the facility, including the provision of appropriate and ongoing staff training in oral health care. I think that is also a significant recommendation. It may be someone who already has a senior role in health in the facility, someone who is already seeing residents on a regular basis.

As noted by the committee, oral health is linked directly to the health needs of older South Australians and I, for one, am very pleased with the report that the committee has put out. I just hope that the state and federal governments will act and implement these recommendations so that older South Australians have a better time in these residential aged-care facilities and get the appropriate care.

Ms THOMPSON (Reynell) (11:50): I want to congratulate the Social Development Committee on raising this matter. It is one of those problems that have sort of sneaked up on the community in many ways. I note that there are some very difficult issues to be worked through, particularly in relation to the dental workforce.

The relationship of dental health and general health has not been well understood. The fact that dental health has not been part of the Medicare system is in itself a huge problem. The measures introduced by the Howard government in which people could get certificates from their doctor in relation to ongoing general health problems relating to their dental health and then get dental health treatment has actually served to narrow the number of people who can access dental health care using commonwealth funds. It is very sad that the measures to widen the commonwealth dental scheme proposed by the Rudd government were blocked in the Senate by the opposition and by a number of the minor parties as well.

One of the involvements I have had in dental care relates to the excellent work done by Steve Parker and his team at the Noarlunga Health Village, under the community-based Noarlunga Towards a Healthy Community initiative, now Onkaparinga Towards a Healthy Community. As the group that was looking at health issues in industry went around to small businesses, the matter that was most commonly raised was the interruption to the workforce when people had to suddenly take time to attend emergency dental appointments.

The team put together a package of simple dental information, which was taken out into the workforce, about the need for preventive action. It included such basic techniques as: if you insist on having a sticky bun for morning tea please rinse your mouth out afterwards, because that will help decrease the amount of oral decay likely to occur from sugary substances. However, the member for Hammond made the point that those of us who look after our teeth in our early days do present more of a problem in our older days.

When I was growing up in the country I remember that a quite common 21st birthday present for a young woman was to have all her teeth extracted. The view seemed to be not so much that this would not be a problem in the nursing home; it seemed to be that this would make her more marriageable because her husband would not have to pay the expense of dental treatment. What a birthday present!

Ms Bedford: Where was that?

Ms THOMPSON: Cambrai. I am assured that this practice was not confined to Cambrai but that in those far distant days it was quite a common practice. However, we do now have a situation with so many more people in nursing homes and in all sorts of settings in aged care facilities and in the community who are older and who still have their own teeth. I do not think we have to reflect very long to recall how uncomfortable it is to have your teeth cleaned and scaled; how, as you are a bit older, just holding your mouth open for all that time is not easy; and how difficult it is for the therapists, hygienists and dentists undertaking that process.

I commend to members the discussion on page 43 onwards in the report about the issue of the role of dental hygienists, therapists and dentists. In the public sector there is a much greater role for hygienists and therapists than in the private sector. There is a view put forward by some that, indeed, hygienists and therapists who have a bachelor degree can do far more dental care work. The dentists are fairly committed to the fact that this should be under the very close supervision of dentists.

It might surprise members to know that the last time I was involved in stacking a meeting it was at a meeting of the senate of the University of Adelaide at which we, the senate, endorsed the decision of the university council to introduce a bachelor course for dental therapists (I think) into the university and the School of Dentistry. The dentists themselves were not at all keen on this notion. They had a nice little world there, and they did not like all these women coming in and doing some of the things that they have traditionally done, which is why I was able to roll up quite a large number of women in support of hygienists and therapists. It is my experience that we, as a parliament, and leaders in our community need to carefully watch the protective work practices that might happen there, and look carefully at the industrial and health grounds being put forward and maybe look to the public sector as a model.

Another issue that has recently been raised with me about dental treatment—and one which, on checking with the Chair of the Social Development Committee, was not raised with the committee—is the impact of no intervention orders in relation to treatment for dental problems. The case to which I am about to refer was not something that happened in South Australia; it was another state, and it was brought to my attention by a distressed dentist who works in the nursing home area. He had a situation where a patient had 17 abscesses in her mouth, which would have caused tremendous pain. A no intervention order was issued in relation to this woman, and the nursing home and her daughters maintained that that meant no treatment at all, which included no treatment of the abscesses. Death would almost certainly be hastened by not treating the abscesses; it would be a cruel and difficult death.

I discussed this matter with my dentist and asked his opinion. He said that the way he treats this is: if a person had a bed sore on their body, would a no treatment order apply? So far, if anyone has been concerned about that, he has always been able to argue the point on that basis. He was aware of the problem, but he was not aware of any situation where a dentist's advice in South Australia had not been complied with. This might be an area that we have to look at more carefully, in terms of just what the interpretation of a 'no intervention' or 'no treatment' order is in relation to dental care.

The final point I make is to again emphasise the importance of the relationship between dental care and general health, and the fact that a greater effort is needed not only in the older community but among all our citizens. Unfortunately, when the Howard government abolished the commonwealth dental scheme, waiting lists in South Australia blew out to 49 months; they are now down to 18 months, but it has taken us a long time.

In 2002, when the Rann government came to power, the waiting lists for dental treatment in South Australia were 49 months; they are now 18 months. We had hoped to do better, and we have very firm plans to do better. The goal of eliminating dental waiting lists is going to be greatly enhanced in my area by the GP super clinic, which will double the number of dental chairs available at Noarlunga. I do not know what Tony Abbott is going to do about funding the GP super clinics, and this is another area of great concern to me.

Motion carried.

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