NACCHO
National Aboriginal Comuity
Ith Organisation
AborigmConr?lale/hdel~:in Aboriginal hands
… www. naecho.erg.au
NDIS participant experience in rural, regional, and remote
Australia
Submission to the
Joint Standing Committee on
the National Disability
Insurance Scheme
March 2024
ABOUT NACCHO
NACCHO is the national peak body representing 145 Aboriginal Community Controlled Health Organisations (ACCHOs). We also assist a number of other community-controlled organisations.
The first Aboriginal medical service was established at Redfern in 1971 as a response to the urgent need to provide decent, accessible health services for the largely medically uninsured Aboriginal population of Redfern. The mainstream was not working. So it was, that over fifty years ago, Aboriginal people took control and designed and delivered their own model of health care. Similar Aboriginal medical services quickly sprung up around the country. In 1974, a national representative body was formed to represent these Aboriginal medical services at the national level. This has grown into what NACCHO is today. All this predated Medibank in 1975.
NACCHO liaises with its membership, and the eight state/territory affiliates, governments, and other organisations on Aboriginal and Torres Strait Islander health and wellbeing policy and planning issues and advocacy relating to health service delivery, health information, research, public health, health financing and health programs.
ACCHOs range from large multi-functional services employing several medical practitioners and providing a wide range of services, to small services which rely on Aboriginal health practitioners and/or nurses to provide the bulk of primary health care services. Our 145 members provide services from about 550 clinics. Our sector provides over 3.1 million episodes of care per year for over 410,000 people across Australia, which includes about one million episodes of care in very remote regions.
ACCHOs contribute to improving Aboriginal and Torres Strait Islander health and wellbeing through the provision of comprehensive primary health care, and by integrating and coordinating care and services. Many provide home and site visits; medical, public health and health promotion services; allied health; nursing services; assistance with making appointments and transport; help accessing childcare or dealing with the justice system; drug and alcohol services; and help with income support. Our services build ongoing relationships to give continuity of care so that chronic conditions are managed, and preventative health care is targeted. Through local engagement and a proven service delivery model, our clients ‘stick’. Clearly, the cultural safety in which we provide our services is a key factor of our success.
ACCHOs are also closing the employment gap. Collectively, we employ about 7,000 staff – 54 per cent of whom are Aboriginal or Torres Strait Islanders – which makes us the third largest employer of Aboriginal or Torres Strait people in the country.
Enquiries about this submission should be directed to:
NACCHO
Level 5, 2 Constitution Avenue
Canberra City ACT 2601
Telephone: 02 6246 9300 Email: policy@naccho.org.au Website: naccho.org.au
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Recommendations
In line with the National Agreement on Closing the Gap, there must be an ongoing, concerted effort to build the capacity of the community-controlled sector to deliver NDIS services through:
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A long-term, stable block funding agreement (with the Commonwealth and State governments) should be in place to ensure the ACCHO sector can build its capacity to sustainably deliver NDIS services in thin and culturally thin markets.
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ACCHOs and ACCOs being funded to deliver navigation services, including Remote
Community Connector, Evidence, Access, Coordination of Planning Officers and Aboriginal
Disability Liaison Officers, and national coordination of these programs being transferred from the NDIA to NACCHO.
- All Aboriginal and Torres Strait Islander participants receiving as default, funding in their plans for support coordination, including Return to Country.
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Acknowledgements
NACCHO welcomes the opportunity to provide a submission to the Joint Standing Committee on the National Disability Insurance Scheme.
NACCHO supports the submissions to this consultation made by NACCHO Members and Affiliates.
National Agreement on Closing the Gap
At the meeting of National Cabinet in early February 2023, First Ministers agreed to renew their commitment to Closing the Gap by re-signing the National Agreement, first signed in July 2020. The reforms and targets outlined in the National Agreement seek to overcome the inequality experienced by Aboriginal and Torres Strait Islander people, and achieve life outcomes equal to all Australians.
This Government’s first Closing the Gap Implementation Plan commits to achieving Closing the Gap targets through implementation of the Priority Reforms. This represents a shift away from focussing on the Targets, towards the structural changes that the Priority Reforms require, and which are more likely to achieve meaningful outcomes for our people in the long term:
Priority Reform Area 1 – Formal partnerships and shared decision-making This Priority Reform commits to building and strengthening structures that empower Aboriginal and Torres Strait Islander people to share decision-making authority with governments to accelerate policy and place-based progress against Closing the Gap.
Priority Reform Area 2 – Building the community-controlled sector This Priority Reform commits to building Aboriginal and Torres Strait Islander community controlled sectors to deliver services to support Closing the Gap. In recognition that Aboriginal and Torres Strait Islander community-controlled services are better for Aboriginal and Torres Strait Islander people, achieve better results, employ more Aboriginal and Torres Strait Islander people and are often preferred over mainstream services.
Priority Reform Area 3 – Transformation of mainstream institutions This Priority Reform commits to systemic and structural transformation of mainstream government organisations to improve to identify and eliminate racism, embed and practice cultural safety, deliver services in partnership with Aboriginal and Torres Strait Islander people, support truth telling about agencies’ history with Aboriginal and Torres Strait Islander people, and engage fully and transparently with Aboriginal and Torres Strait Islander people when programs are being changed.
Priority Reform 4 – Sharing data and information to support decision making This Priority Reform commits to shared access to location-specific data and information (data sovereignty) to inform local-decision making and support Aboriginal and Torres Strait Islander communities and organisations to support the achievement of the first three Priority Reforms.
Review of Closing the Gap In its first review of the National Agreement on Closing the Gap, the Productivity Commission found that governments are not adequately delivering on their commitments. Despite support for the Priority Reforms and some good practice, progress has been slow, uncoordinated, and piecemeal.
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The Commission noted that to enable better outcomes, the Australian government needs to relinquish some control and acknowledge that Aboriginal and Torres Strait Islander people know what is best for their communities. It needs to share decision making with Aboriginal Community Controlled Organisations (ACCOs), recognise them as critical partners rather than passive funding recipients, and then trust them to design, deliver and measure government services in ways that are culturally safe and meaningful for their communities.
‘Without external perspectives, government organisations will not be able to overcome any blind spots relating to institutional racism, cultural safety and unconscious bias.’1
NACCHO recommends any interventions to improve participant experience with the NDIS align with the National Agreement and its four Priority Reform Areas.
Introduction
NACCHO recommends that in considering the experiences of Aboriginal and Torres Strait Islander participants with the NDIS, the committee first review the discussion and recommendations of the following inquiries:
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Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability2, specifically, Volume 9 – First Nations people with disability3
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The Independent Review into the NDIS: Working together to deliver the NDIS. NDIS Review: Final
Report4
Evidence to date
In July 2022, NACCHO CEO, Pat Turner provided evidence alongside Cassie Atchison, CEO from
Broome Regional Aboriginal Medical Service (BRAMS) and Jenny Bedford, Deputy CEO from
Kimberley Aboriginal Medical Services (KAMS) at the Disability Royal Commissions Hearing 25, The
operation of the NDIS for First Nations people with disability in remote and very remote communities, in Alice Springs. Key points from this evidence were that:
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There is a paucity of useable data on the prevalence of disability and the impact of disability on Aboriginal and Torres Strait Islander people and communities.
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Aboriginal and Torres Strait Islander people do not access the NDIS at a level commensurate with their need (poor service demand).
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There is widespread under-utilisation of NDIS plans by Aboriginal and Torres Strait Islander people which demonstrates poor service supply and the difficulty people have in accessing supports. This is due to:
o Lack of (or no) service providers o Lack of culturally safe service providers
1 Productivity Commission, Review of the National Agreement on Closing the Gap, Study Report, Canberra, 7 Feb 2024 Study Report - Closing the Gap review - Productivity Commission (pc.gov.au). 2 https://disability.royalcommission.gov.au/ 3 https://disability.royalcommission.gov.au/publications/final-report-volume-9-first-nations-people-disability 4 https://www.ndisreview.gov.au/
NACCHO Submission – NDIS participant experience Page 5 of 7
o Difficulty navigating complex systems and coordinating budgets and services, particularly where service coordination is not part of an NDIS plan
- There are not enough community-controlled NDIS providers o ACCHOs/ACCOs in many instances are providing services and support without remuneration to ensure the needs of their communities are met.
o Current processes within the NDIS prohibit the community-controlled sector to deliver services at a standard expected both by themselves and community.
o For ACCHOs wanting to deliver NDIS services, there is a tension between the market model (profit-driven) and the ACCHO model of care. This tension poses a reputational risk for ACCHOs and may compromise the health and wellbeing needs of community if they become distrusting of ACCHOs as a result.
- ACCHOs providing NDIS services are continually challenged and their sustainability compromised by:
o meeting quality and safeguards standards in addition to PHC accreditation standards o completing registration o working to the NDIS price guide - the real costs of delivering services to Aboriginal and Torres Strait Islander people in regional remote and very remote areas needs to be fully assessed. o maintaining IT equipment and systems o accessing a culturally appropriate disability workforce
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The NDIS Ready program made good gains in building interest and capacity across the community controlled sector, but was defunded after just 20 months.
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There are not enough culturally safe mainstream providers o Where no ACCHO or other ACCO exists, mainstream providers must be culturally safe if providing services to Aboriginal and Torres Strait Islander people. There is a need for strong governance and accountability measures where mainstream services are funded by governments to provide culturally competent care.
o Accreditation standards could be used to improve delivery of culturally safe care, to increase the number of staff who have undertaken cultural capability training, and to adopt validation tools led by Aboriginal and Torres Strait Islander people which regularly assess organisational and workforce cultural capability as part of broader institutional assessments.
- ACCHOs are not for profit entities – the market-based, for-profit system undermines the way they operate in their communities
In September 2023 the Disability Royal Commission’s Final Report was released. Volume 9 – First Nations people with disability5 - comprehensively details the experience of First Nations people with disability and documents the unmet potential of the NDIS for First Nations people with disability.
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In October 2023, the Final Report of the Independent Review into the NDIS was released, again highlighting the unique challenges First Nations people experience with the NDIA. In their June 2023 progress paper, Improving access to supports in remote and First Nations communities, the Review stated that,
Communities know best what works for them based on what they need where they live.
The NDIA Review alternative commissioning paper also states:
Evidence from past and ongoing reviews and inquiries continues to show that the current market-based model with individualised funding arrangements persistently fail to meet the needs of both First Nations and remote communities.6
6 Australian Government, NDIS Review, Alternative commissioning for remote and First Nations communities, May 2023
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