Chapter 1Introduction
Conduct of the inquiry
1.1On 8 March 2023, the Senate resolved that the Select Committee into the Provision of and Access to Dental Services in Australia be established (thecommittee). The committee was tasked with inquiring into:
(a)the experience of children and adults in accessing and affording dental and related services;
(b)the adequacy and availability of public dental services in Australia, including in outer-metropolitan, rural, regional and remote areas;
(c)the interaction between Commonwealth, state and territory government legislation, strategies and programs in meeting community need for dental services;
(d)the provision of dental services under Medicare, including the Child Dental Benefits Schedule;
(e)the social and economic impact of improved dental healthcare;
(f)the impact of the COVID-19 pandemic and cost-of-living crisis on access to dental and related services;
(g)pathways to improve oral health outcomes in Australia, including a path to universal access to dental services;
(h)the adequacy of data collection, including access to dental care and oral health outcomes;
(i)workforce and training matters relevant to the provision of dental services;
(j)international best practice for, and consideration of the economic benefit of, access to dental services;
(k)any related matters.
1.2The committee presented an interim report on 20 June 2023. Since tabling the interim report, the committee has published further submissions, and held fourpublic hearings—Perth, Launceston, Brisbane and Canberra. A total of 168submissions were published along with a number of articles, responses to questions on notice, and other documents.
1.3A list of submissions and additional information is provided at Appendix 1. A list of witnesses is provided at Appendix 2.
1.4On 15 August 2023, the committee had the privilege of conducting two very informative site visits—to Casuarina Prison and St Pats Oral Health Clinic, both in Perth, Western Australia. Reports on these site visits—including acknowledgements—are included at Appendix 3 and Appendix 4 of this report.
Notes on terminology
1.5While the terms of reference for the inquiry referred to 'dental care' and 'dental services', the inquiry has considered the health of the whole mouth, along with the teeth. The term 'oral health care' encompasses a wider range of activity related to the health of the mouth and is used regularly in this report.
Acknowledgements
1.6The committee thanks all of the individuals and organisations who gave evidence as part of the inquiry, including people who generously shared their personal stories.
1.7The committee also wishes to thank the Parliamentary Budget Office for preparing costings, and the Social Policy Research Team and Statistics and Mapping Section in the Parliamentary Library, for providing further research and mapping services to assist the committee. Extracts from this research are included as appendices to this report.
Correction of evidence
1.8On 13 September 2023, the Grattan Institute notified the committee that its submission to the inquiry contained an error on page 4, in Table 1.1, row 1. Specifically, the submission states that government expenditure per person on dental services fell between 2017–18 and 2020–21. This is incorrect; it should state that dental expenditure was 'flat' in that period. The Grattan Institute provided a corrected copy of its submission, which was uploaded to the committee's website on 15 September 2023.
1.9This error was also included in the committee's interim report, where the table was reproduced on page 49. The committee thanks the Grattan Institute for correcting its submission.
Structure of the report
1.10The committee's final report has six chapters. This chapter includes notes on the conduct of the inquiry, acknowledgements and corrections, and an outline of the structure of the report.
1.11Chapter 2—A system in decay—highlights inequality in the current oral health system in Australia; discusses the impact of the COVID-19 pandemic on the system, and the oral health of Australians; considers the adequacy of national oral health data, and ideas for improvement; compares the Australian system with those of other countries, including Canada, the United Kingdom, Germany and Denmark; and looks at barriers to reform in Australia.
1.12Chapter 3—Putting the mouth back into the body—looks at evidence challenging the long-held separation of oral and dental health from general health; considers the need to move from reactive approaches to prevention and maintenance; and looks at options for better integrating oral health with general health services and assessments.
1.13Chapter 4—Filling the gaps: improving access for priority groups. This chapter examines suggestions for addressing unmet need for priority groups who are socially, geographically, and/or economically disadvantaged:
Aboriginal and Torres Strait Islander people;
people living in rural and remote locations;
disabled people;
older people, including those in institutional care settings; and
prisoners.
1.14Chapter 5—Workforce and training—focuses on the adequacy of the current dental and oral health care workforce, and outlines gaps. It considers previous and existing programs and initiatives for boosting the workforce and increasing capacity in priority areas, including rural and remote locations, special needs dentistry and public practice.
1.15Chapter 6—Drilling down: pathways to universal access. This chapter presents a comparison of proposed models for reform, considering potential costs and benefits. It concludes with the committee's views and recommendations.
1.16The report also includes a number of appendices:
Appendix 1—Submissions and additional information
Appendix 2—Public hearings and witnesses
Appendix 3—St Pats Dental Clinic visit (Fremantle, Western Australia)
Appendix 4—Casuarina Prison visit (Casuarina, Western Australia)
Appendix 5—Summary of public dental arrangements for selected countries
Appendix 6—Parliamentary Budget Office Costings