ADAVB PRE-BUDGET SUBMISSION

Transcription

1 EXECUTIVE SUMMARY ADAVB PRE-BUDGET SUBMISSION November 2012 The Australian Dental Association Victorian Branch (ADAVB) is the peak body for the dental profession in Victoria, and represents over 90% of registered dentists, working in both public and private sectors. Our mission is to promote the art, science and ethics of dentistry, and the oral health of ALL Victorians. ADAVB is pleased to present this short submission aimed at helping the Victorian Government to target delivery of more effective dental care in the Victorian community. This submission focuses on six areas of need in the Victorian community: 1. Underserved populations in Victoria ADAVB advocates for funding for new models of dental care to be implemented in underserved populations within Victoria. 2. Oral care for residents in nursing homes ADAVB continues to advocate for improved oral care for residents of nursing homes. 3. State Government hospital funding ADAVB maintains that dental services within hospitals are essential services that have been overlooked for an extended period of time. 4. Public Dental Care in Footscray ADAVB urges the State Government to fund the $9 million rebuild plan for the public dental clinics in Footscray. 5. Gaps in federal dental funding reforms Funding under the recently announced federal dental schemes will not reach the levels provided under the Chronic Disease Dental Scheme (CDDS) in any year until The ADAVB urges the State Government to consider how this gap can be addressed to ensure that needy Victorians have adequate access to dental care. 6. Access to General Anaesthesia Insufficient funding is allocated to dental care under general anaesthesia (GA) and this is affecting some of the most needy patients in the Victorian community. ADAVB requests that the State Government press the Commonwealth Government and health funds on fees payable to hospitals and day clinics offering dental treatment under GA. 1

2 1. Underserved populations in Victoria ADAVB advocates for funding for new models of dental care to be implemented in underserved populations within Victoria. In late 2011, the Royal Flying Doctor Service Victorian Section (RFDS Vic), Australian Dental Association Victorian Branch (ADAVB) and Dental Health Services Victoria (DHSV) formed a partnership to develop an innovative Mobile Dental Care (MDC) program in the northern Mallee region of Victoria. This region was chosen as the initial program location for the following reasons: Higher than the State average hospitalisations for dental conditions. In , rates of admission per 1,000 persons were 5.41 in the northern Mallee PCP. The state average was 2.91 Very low socio-economic conditions. According to 2006 Census data, Robinvale Statistical Local Area (SLA) is the 7th most disadvantaged out of all 204 SLAs in Victoria Significant access issues, mainly due to the population being too small to warrant establishment of a permanent full-time public clinic, and many eligible patients not being able to travel to clinics in Mildura or Swan Hill The MDC program has three components: screening and treatment referral, prevention awareness and education. Volunteer dentists are placed in local clinics to increase the capacity to treat people from the local and surrounding districts. A mobile dental care truck funded by the Victorian Department of Health is fitted with dental equipment and visits surrounding communities. There are a number of underserved rural and regional areas across Victoria which would benefit from the implementation of a similar program. ADAVB sees great potential for this innovative model of dental care to be expanded into areas in Victoria in which the population is too small to warrant a permanent full time public dental clinic. 2. Oral care for residents in nursing homes For the last four years ADAVB has highlighted in its pre-budget submission the need to improve oral care for residents of nursing homes. Last year the Health Minister, the Hon. David Davis MP, attended a forum dealing with this topic which was hosted by the Branch, and agreed on the need to help the elderly with their oral care. ADAVB continues to advocate for improved oral care for residents of nursing homes. There are about 45,000 elderly residents living in about 850 residential aged care facilities (nursing homes) in Victoria. Improvements in oral health over the past 50 years has seen a substantial increase in the proportion of dentate people in this sub-population, resulting in more than 50% of residents having natural teeth (on average 14 teeth present). Co-morbidity, polypharmacy, physical and cognitive impairment inherent in this group substantially increases their risk of dental disease. There are also known links between oral and systemic diseases, including atherosclerosis, stroke and aspiration pneumonia. ADAVB offers two suggestions for improving oral care for residents in nursing homes. 2

3 1. Dedicated treatment rooms in Residential Aged Care Facilities Nursing homes are settings in which dental equipment could be installed for use by visiting dentists. Equipment that is fully functional but no longer required by public and private dental practices (due to renovations or equipment upgrades etc.) could be serviced and installed in dedicated treatment rooms within nursing homes. This would allow for basic dental services to be available to residents on site and would ensure that the residents oral health needs are addressed on a regular basis. It would mean that residents are less likely to be required to leave the nursing home in order to access oral health care. We offer the following funding proposal: There are about 850 residential aged care facilities in Victoria. This funding proposal assumes that the program is piloted in a small percentage of these facilities, say 50 (with a view to extending the program to the majority of aged care facilities). It also assumes that there will be a limited number of full sets of used equipment available at any one time. 1 Service of disused equipment from public and private dental practices = $2,500 X 50 2 Basic treatment room fit out (equipment assumed donated or purchased for a small fee) = $20,000 X 50 3 Recurrent funding for screening and treatment provided by private practitioners based on DVA schedule (fee-for-service basis) to treat approximately 2,500 patients annually TOTAL COSTS = $125,000 = $1m = $1.88m* = $3.005m *(approximate treatment cost for dentate resident of $750 per course of care, based on examination, periodontal treatment [scale and clean], preventive treatment and average 1.3 extractions and 1.8 restorations (based on current research of treatment needs 1 ) and administrative costs. The implementation of such a program would mean that equipment to provide dental services would be a permanent fixture in aged care homes in Victoria. Once the equipment is obtained and installed, maintenance costs and practitioner salary would be the ongoing costs. There are also a number of dentists who are retired or working less in paid employment that would be interested in participating as volunteers within aged care homes with dedicated dental treatment rooms. The use of volunteers would reduce costs for the program however the success of this would, of course, depend on numbers of volunteers recruited. 2. Visiting Oral Health Practitioners in Residential Aged Care Facilities In the context of the current oversupply of dentists, we offer the suggestion that dental hygienists and oral health therapists could assist dentists in the care of the aged, and that arrangements similar to those operating in South Australia would help to address the oral health needs of this group. This would see dentists examining residents of RACFs and assigning simpler oral health maintenance tasks to dental hygienists, and/or oral health 1 Hopcraft, MS. (2010) Improving access to dental services in residential aged care facilities in Victoria PHD Thesis The University of Melbourne 3

4 therapists (without the dentist needing to be present), while providing more complex care themselves or referring the patients to specialists as required. Funding proposal offered: 1 Portable dental equipment ($45,000 x 5 units) = $225,000 2 Recurrent funding for screening and treatment provided by private practitioners (dentists, dental hygienists, oral health therapists) based on DVA schedule (fee-for-service basis) to treat approximately 1,500 patients annually TOTAL COSTS = $1.125m* = $1.35m *(approximate treatment cost for dentate resident of $750 per course of care, based on examination, periodontal treatment (scale and clean), preventive treatment and average 1.3 extractions and 1.8 restorations (based on current research of treatment needs 2 ) and administrative costs. This scheme could be gradually expanded with additional portable units. Recurrent funding could be increased if there is demand from practitioners to participate in the scheme and capital funding for extra portable equipment. 3. State Government hospital funding ADAVB is concerned that Victorian hospitals are struggling to operate on limited State Government funding. ADAVB appreciates that reduced federal hospital funding overall will mean greater pressure on the State to support services. However, ADAVB maintains that dental services within hospitals are essential services that have been overlooked for an extended period of time. General practitioner dentists and other dental practitioners in public dental clinics depend on hospital dental units to treat many of their complex care patients. No funding support is provided for these services to ensure that the dental units remain economically viable, and equipped with appropriate clinical facilities. For example, the State Government provides no direct base funding to the Royal Children s Hospital (RCH) outpatient dental clinic by the Victorian Ambulatory Classification System (VACS) formula, making it impossible to meet community health care needs and plan workforce requirements. Severe funding restrictions limit current outpatient service delivery and the RCH unit cannot maintain or develop the future hospital dental workforce to meet the needs of sick children in Victoria, including some with complex care needs such as cleft lip and palate. The capital dental unit equipment (9 chairs and supporting services) funded by the State Government in the new RCH is significantly underutilised (booking only 5 clinics daily) at present due to severe funding restrictions, which limits nursing support staff. In addition, St.Vincent s Hospital has been without a Dental clinic since Both inpatients and outpatients of the Hospital have been forced to seek urgent dental care outside the hospital. St.Vincent s Hospital urgently needs funding to establish a new Dental Clinic within the hospital that will care for patients with complex medical conditions that cannot be managed outside a hospital environment. 2 ibid 4

5 4. Public Dental Care in Footscray The Western Region Health Centre delivers dental services from two clinics in Footscray with 11 chairs shared across the Geelong Rd and Paisley St sites. A 2009 Health Department report described facilities at the clinics as among the worst in the state. The clinics have been in terrible condition since and plans for the redevelopment of the clinics have been repeatedly overlooked in the budget. The Footscray children s clinic treats 400 children a month and continues to be at risk of closing due to a number of risks to health and safety including extremely old dental equipment and inadequate air conditioning. The adult clinic provides emergency and general dental care to some of the community s most vulnerable, including refugees, mentally ill and homeless people, who would not be able to access treatment elsewhere. We urge the State Government to fund the $9 million rebuild plan proposed as an option by the Ministerial Taskforce established to investigate options for redevelopment of the Footscray clinics. This will ensure that patients in the region have access to effective dental care in a clinic free of risks to health and safety. 5. Gaps in federal dental funding reforms Whilst ADAVB is pleased to see the announcement of Federal dental reform measures, the funding under the new schemes will not reach the levels provided under the Chronic Disease Dental Scheme (CDDS) in any year until 2018, despite waiting lists and service gaps still being a problem under the CDDS. Federal dental funding in 2012/13 and 2013/14 will be very low compared with previous years. There is a gap of approximately $614m in dental funding between 2011/12 and 2012/13 with this trend continuing into 2013/14 (prior to the introduction of the Child Dental Benefit Scheme). We urge the State Government to consider how this gap can be addressed to ensure that needy Victorians have adequate access to dental care. 6. Access to General Anaesthesia ADAVB is aware that an inability for dental patients to access suitable care is continuing due to insufficient funding being allocated to dental care under general anaesthesia (GA). Patients who require treatment under GA may include: Patients with certain physical, mental, or medically compromising conditions The uncooperative, fearful, anxious, physically resistant or uncommunicative patient with substantial dental needs and no expectation that the behaviour will soon improve Patients that have extensive orofacial and/or dental trauma Patients with immediate comprehensive dental needs who otherwise would not receive comprehensive dental care Patients requiring dental care for whom the use of GA may protect the developing psyche and/or reduce medical risks Patients requiring significant maxillofacial surgical procedures Patients with dental restorative or surgical needs for whom local anaesthesia is ineffective because of acute infection, anatomic variations, or allergy 5

6 Patients who require treatment not possible under local anaesthesia settings, for example, the removal of impacted wisdom teeth Dentists needing to provide patients with treatment under GA continue to have difficulty in booking theatre facilities at a number of private hospitals and day clinics because the financial benefits for those organisations controlled by health funds are greater for a number of other procedures. The consequences of a lack of access to GA facilities include: An increase in dental disease: patients that need treatment under GA are not able to do so An increase in extractions. With limited access to operating theatres, dentists cannot provide dental treatment in a timely manner and deliver restorations and preventative care An increase in dental fears and phobias: vulnerable patients, including young children, are being traumatised by treatment in the dental chair. ADAVB is conducting a campaign to raise awareness of the issue amongst health funds, DPCs and hospitals within Victoria. However, ADAVB maintains that this issue needs to be raised at the federal level as there is an urgent need to find a way for dental patients to have readier access to procedures under GA. ADAVB again requests that the State Government press the Commonwealth Government and health funds on fees payable to hospitals and day clinics offering dental treatment under GA. More specifically, ADAVB strongly urges the State Government to request the Federal Minister for Health and Ageing, the Hon. Tanya Plibersek MP to instruct her department to examine the way health funds influence the scheduling of GA operations. ENQUIRIES Mr Garry Pearson Chief Executive Officer, ADAVB Inc. Ph: [email protected] 6