NACCHO Aboriginal #MentalHealth and #SuicidePrevention : @ozprodcom issues paper on #MentalHealth in Australia is now available. It asks a range of questions which they seek information and feedback on. Submissions or comments are due by Friday 5 April.

 ” Many Australians experience difficulties with their mental health. Mental illness is the single largest contributor to years lived in ill-health and is the third largest contributor (after cancer and cardiovascular conditions) to a reduction in the total years of healthy life for Australians (AIHW 2016).

Almost half of all Australian adults have met the diagnostic criteria for an anxiety, mood or substance use disorder at some point in their lives, and around 20% will meet the criteria in a given year (ABS 2008). This is similar to the average experience of developed countries (OECD 2012, 2014).”

Download the PC issues paper HERE mental-health-issues

See Productivity Commission Website for More info 

“Clearly Australia’s mental health system is failing Aboriginal people, with Aboriginal communities devastated by high rates of suicide and poorer mental health outcomes. Poor mental health in Aboriginal communities often stems from historic dispossession, racism and a poor sense of connection to self and community. 

It is compounded by people’s lack of access to meaningful and ongoing education and employment. Drug and alcohol related conditions are also commonly identified in persons with poor mental health.

NACCHO Chairperson, Matthew Cooke 2015 Read in full Here 

Read over 200 Aboriginal Mental Health Suicide Prevention articles published by NACCHO over the past 7 years 

Despite a plethora of past reviews and inquiries into mental health in Australia, and positive reforms in services and their delivery, many people are still not getting the support they need to maintain good mental health or recover from episodes of mental ill‑health. Mental health in Australia is characterised by:

  • more than 3 100 deaths from suicide in 2017, an average of almost 9 deaths per day, and a suicide rate for Indigenous Australians that is much higher than for other Australians (ABS 2018)
  • for those living with a mental illness, lower average life expectancy than the general population with significant comorbidity issues — most early deaths of psychiatric patients are due to physical health conditions
  • gaps in services and supports for particular demographic groups, such as youth, elderly people in aged care facilities, Indigenous Australians, individuals from culturally diverse backgrounds, and carers of people with a mental illness
  • a lack of continuity in care across services and for those with episodic conditions who may need services and supports on an irregular or non-continuous basis
  • a variety of programs and supports that have been successfully trialled or undertaken for small populations but have been discontinued or proved difficult to scale up for broader benefits
  • significant stigma and discrimination around mental ill-health, particularly compared with physical illness.

The Productivity Commission has been asked to undertake an inquiry into the role of mental health in supporting social and economic participation, and enhancing productivity and economic growth (these terms are defined, for the purpose of this inquiry, in box 1).

By examining mental health from a participation and contribution perspective, this inquiry will essentially be asking how people can be enabled to reach their potential in life, have purpose and meaning, and contribute to the lives of others. That is good for individuals and for the whole community.


In 2014-15, four million Australians reported having experienced a common mental disorder.

Mental health is a key driver of economic participation and productivity in Australia, and hence has the potential to impact incomes and living standards and social engagement and connectedness. Improved population mental health could also help to reduce costs to the economy over the long term.

Australian governments devote significant resources to promoting the best possible mental health and wellbeing outcomes. This includes the delivery of acute, recovery and rehabilitation health services, trauma informed care, preventative and early intervention programs, funding non-government organisations and privately delivered services, and providing income support, education, employment, housing and justice. It is important that policy settings are sustainable, efficient and effective in achieving their goals.

Employers, not-for-profit organisations and carers also play key roles in the mental health of Australians. Many businesses are developing initiatives to support and maintain positive mental health outcomes for their employees as well as helping employees with mental illhealth continue to participate in, or return to, work.

Scope of the inquiry

The Commission should consider the role of mental health in supporting economic participation, enhancing productivity and economic growth. It should make recommendations, as necessary, to improve population mental health, so as to realise economic and social participation and productivity benefits over the long term.

Without limiting related matters on which the Commission may report, the Commission should:

  • examine the effect of supporting mental health on economic and social participation, productivity and the Australian economy;
  • examine how sectors beyond health, including education, employment, social services, housing and justice, can contribute to improving mental health and economic participation and productivity;
  • examine the effectiveness of current programs and Initiatives across all jurisdictions to improve mental health, suicide prevention and participation, including by governments, employers and professional groups;
  • assess whether the current investment in mental health is delivering value for money and the best outcomes for individuals, their families, society and the economy;
  • draw on domestic and international policies and experience, where appropriate; and
  • develop a framework to measure and report the outcomes of mental health policies and investment on participation, productivity and economic growth over the long term.

The Commission should have regard to recent and current reviews, including the 2014 Review of National Mental Health Programmes and Services undertaken by the National Mental Health Commission and the Commission’s reviews into disability services and the National Disability Insurance Scheme.

The Issues Paper
The Commission has released this issues paper to assist individuals and organisations to participate in the inquiry. It contains and outlines:

  • the scope of the inquiry
  • matters about which we are seeking comment and information
  • how to share your views on the terms of reference and the matters raised.

Participants should not feel that they are restricted to comment only on matters raised in the issues paper. We want to receive information and comment on any issues that participants consider relevant to the inquiry’s terms of reference.

Key inquiry dates

Receipt of terms of reference 23 November 2018
Initial consultations November 2018 to April 2019
Initial submissions due 5 April 2019
Release of draft report Timing to be advised
Post draft report public hearings Timing to be advised
Submissions on the draft report due Timing to be advised
Consultations on the draft report November 2019 to February 2020
Final report to Government 23 May 2020

Submissions and brief comments can be lodged

Online (preferred):
By post: Mental Health Inquiry
Productivity Commission
GPO Box 1428, Canberra City, ACT 2601


Inquiry matters: Tracey Horsfall Ph: 02 6240 3261
Freecall number: Ph: 1800 020 083

Subscribe for inquiry updates

To receive emails updating you on the inquiry consultations and releases, subscribe to the inquiry at:


 Definition of key terms
Mental health is a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.

Mental illness or mental disorder is a health problem that significantly affects how a person feels, thinks, behaves and interacts with other people. It is diagnosed according to standardised criteria.

Mental health problem refers to some combination of diminished cognitive, emotional, behavioural and social abilities, but not to the extent of meeting the criteria for a mental illness/disorder.

Mental ill-health refers to diminished mental health from either a mental illness/disorder or a mental health problem.

Social and economic participation refers to a range of ways in which people contribute to and have the resources, opportunities and capability to learn, work, engage with and have a voice in the community. Social participation can include social engagement, participation in decision making, volunteering, and working with community organisations. Economic participation can include paid employment (including self-employment), training and education.

Productivity measures how much people produce from a given amount of effort and resources. The greater their productivity, the higher their incomes and living standards will tend to be.

Economic growth is an increase in the total value of goods and services produced in an economy. This can be achieved, for example, by raising workforce participation and/or productivity.

Sources: AIHW (2018b); DOHA (2013); Gordon et al. (2015); PC (2013, 2016, 2017c); SCRGSP (2018); WHO (2001).

An improvement in an individual’s mental health can provide flow-on benefits in terms of increased social and economic participation, engagement and connectedness, and productivity in employment (figure 1).

This can in turn enhance the wellbeing of the wider community, including through more rewarding relationships for family and friends; a lower burden on informal carers; a greater contribution to society through volunteering and working in community groups; increased output for the community from a more productive workforce; and an associated expansion in national income and living standards. These raise the capacity of the community to invest in interventions to improve mental health, thereby completing a positive reinforcing loop.

The inquiry’s terms of reference (provided at the front of this paper) were developed by the Australian Government in consultation with State and Territory Governments. The terms of reference ask the Commission to make recommendations to improve population mental health so as to realise higher social and economic participation and contribution benefits over the long term.

Assessing the consequences of mental ill-health

The costs of mental ill-health for both individuals and the wider community will be assessed, as well as how these costs could be reduced through changes to the way governments and others deliver programs and supports to facilitate good mental health.

The Commission will consider the types of costs summarised in figure 4. These will be assessed through a combination of qualitative and quantitative analysis, drawing on available data and cost estimates, and consultations with inquiry participants and topic experts. We welcome the views of inquiry participants on other costs that we should take into account.


NACCHO Aboriginal Health :  The Indigenous Marathon Project @IndigMaraProjct annual search for 12 young Indigenous Australians who are passionate about making a difference : February and March the national Try-Out Tour, visiting remote communities and big cities

“2019 is IMP’s 10th year and its impact has been massive. Running a marathon is hard, doing it in just six months with no running experience demonstrates the incredible strength and resilience of our Indigenous people. It’s an amazing experience – don’t miss it.”

Founded in 2010 by world marathon champion Rob de Castella, IMP is a core program of the Indigenous Marathon Foundation – a health promotion charity that addresses chronic disease in remote communities. IMP now has 86 graduates across Australia, each who have gone on to make their mark on the world

Download the the IMP poster to promote imp a3poster 12-18 (1)

Applications can be made at:

Do you have what it takes to cross the finish line of the world’s biggest marathon?

The Indigenous Marathon Project (IMP) has begun its annual search for 12 young Indigenous Australians who are passionate about making a difference.

Each year, IMP selects, educates and trains a squad of inspirational Indigenous men and women to compete in the world’s biggest marathon – the New York City Marathon.

Open to all Indigenous Australians aged 18 to 30, IMP is not looking for the fastest runner. Instead, those who are passionate about becoming positive role models in their communities, who want to drive change and promote healthy lifestyles, are encouraged to apply.

IMP isn’t a sports program; it’s a social change program that uses running as a vehicle to promote the benefits of active and healthy lifestyles, while celebrating Indigenous resilience and achievement.

IMP Head Coach and 2014 graduate of the program, Adrian Dodson-Shaw, said that IMP’s reach was growing every year.

“It’s great to see the number of applications increase year after year, as IMP grows bigger and bigger and more people understand what the project is about,” Mr Dodson-Shaw said. “This isn’t about completing a marathon – it’s about changing your life.”

Mr Dodson-Shaw will set off around Australia in February and March on the national Try-Out Tour, visiting remote communities and big cities, testing the endurance of applicants with a trial run and an interview.

The successful 2019 squad will have to complete four national camps in the lead-up to the NYC Marathon, as well as taking part in the project’s education component, which will see them graduate with a Certificate IV in Sport and Recreation.

Applications can be made at:



NACCHO Aboriginal Male Health News : Minister @KenWyattMP will provide $1 million over 2 years to @BushTVMedia @ErnieDingo1 to deliver its Camping On Country program, to address health and wellbeing challenges in a culturally safe and meaningful way.

Ernie Dingo believes light moments are important even when talking about serious topics. In one candid exchange with a man who insisted doctors were unnecessary, Dingo shared the story of his decision to allow a doctor to examine his prostate.

“I told the men that I thought ‘Ah well, who is going to know?’ and they had a good laugh,” he said.

Dingo remains vigilant about his health. A dad of six, including three-year-old twin boys, he said being a father and grandfather made him want to encourage men to take care of themselves.

“We have to be around for our kids, and their kids,” 

Actor Ernie Dingo has created a confronting, humorous and bracingly honest reality series about Indigenous men that has captured the attention of federal Indigenous Health Minister Ken Wyatt.

Dingo, a Yamitji man from the Murchison region of Western Australia, became a household name in Australia as the presenter of lifestyle program The Great Outdoors between 1993 and 2009. But his retreat from public life coincided with a struggle against depression that he said made him want to help other Indigenous men.

From The Australian See in full Part 2 below 

Ernie Dingo’s campfire chats a dose of reality TV

 ” I’ve been in film & tv for 40 years that’s long enough! Its time for me to go bush & work with my Countrymen.

No point in having influence if you can’t use it to make the world a better place for our mob!


A new health initiative that places culture and traditional knowledge systems at the centre of its program aims to improve the health of Aboriginal and Torres Strait Islander men and ensure they have a strong voice in health and wellbeing services in their own communities.

The Federal Government will provide $1 million over two years to Bush TV Enterprises to deliver its Camping On Country program, to address health and wellbeing challenges in a culturally safe and meaningful way.

Speaking at the launch on the Beedawong Meeting Place in WA’s Kings Park: (From left) Murchison Elder Alan Egan; Ernie Dingo; Ken Wyatt; Kununurra Elder Ted Carlton.

Respect for culture has a fundamental role in improving the health of our men, who currently have a life expectancy of 70 years, more than 10 years shorter than their non-Indigenous counterparts.

Camping On Country is based on the premise that working with local men as the experts in their own health and community is critical in Closing the Gap in health equality.

We need every Aboriginal and Torres Strait Islander man to take responsibility for their health and to be proud of themselves and their heritage — proud of the oldest continuous culture on Earth, and the traditions that kept us healthy for the past 65,000 years.

Each camp will focus on specific topics including:

  • Alcohol and drug dependency
  • Smoking, diet and exercise
  •  Mental health and suicide

A traditional healer and an Aboriginal male health worker are assigned to each camp to conduct health checks and provide one-on-one support to men, which includes supporting men through drug or alcohol withdrawals.

Traditional yarning circles are used to discuss health and wellbeing issues as well as concerns about employment, money, housing and personal relationships.

Well-known actor, television presenter and Yamatji man Ernie Dingo developed the Camping On Country program with his BushTV partner Tom Hearn, visiting 11 communities and conducting small camps with groups of men at four sites across remote Australia in 2018.

The plan is to conduct 10 camps a year, with the initial focus on communities in need in Central Australia, the Kimberley, Arnhem Land, the Gulf of Carpentaria and the APY Lands.

The program puts culture and language at the centre of daily activities and also uses the expertise and knowledge of local men’s groups, traditional owners and local Aboriginal organisations.

A video message stick will be produced during each camp and made available to all levels of government associated with Aboriginal and Torres Strait Islander health.

The message stick information will also be used by health providers to develop holistic, culturally appropriate programs with men and their communities.

The $1 million funding will also support Bush TV Enterprises to partner with a university and Primary Health Alliances to conduct research to track improvements in remote men’s health and enhance health and wellbeing services.

Bush TV Enterprises is an Aboriginal-owned community agency specialising in grassroots advocacy and producing and distributing Aboriginal and Torres Strait Islander stories.

Our Government has committed approximately $10 billion to improve Aboriginal and Torres Strait Islander health over the next decade, working together to build strong families and communities.

Part 2 From The Australian  

Ernie Dingo’s campfire chats a dose of reality TV

Dingo, a Yamitji man from the Murchison region of Western Australia, became a household name in Australia as the presenter of lifestyle program The Great Outdoors between 1993 and 2009. But his retreat from public life coincided with a struggle against depression that he said made him want to help other indigenous men.

The 62-year-old has partnered with documentary-maker Tom Hearn to make four short films from fireside yarns with indigenous men in some of Australia’s most remote towns and communities.Mr Wyatt believes the program, called Camping on Country, has the potential to change lives. He has commissioned 20 more camps around Australia over the next two years at a cost of $1 million.

“We talk about everything,” Dingo told The Australian. “You want to see the way the men sing and talk once they feel safe.”

Camping On Country could ultimately drive health policy, as Dingo listens to men talk about alcohol and drug dependency, smoking, diet, exercise, mental health and suicide. Mr Wyatt will announce his support for the camps today and hopes that they can help close the health gap between indigenous and non-indigenous men. Aboriginal men die an average 10 years earlier than other Australian men, and generally their rates of cancer, heart disease and mental illness are higher.

An Aboriginal male health worker will be at each camp providing health checks and support, including to anyone experiencing drug or alcohol withdrawals. Dingo and Hearn will make a short film of each camp through production company Bush TV. The federal funding of $1 million covers an independent assessment of the overall program, ­including whether it makes a difference to the health of men who take part.

NACCHO Aboriginal Health and #findyour30 #getactive #lovesport #sport2030 @senbmckenzie launches #MoveitAUS a $28.9m grants program to achieve a goal of reducing inactivity amongst our population by 15% over the next 12 years :applications close 18 February 2019

 ” The Move It AUS – Participation Grant Program provides support to help organisations get Australians moving and to support the aspiration to make Australia the world’s most active and healthy nation.

If successful, applicants will receive grants up to $1 million to implement community-based activities that align to the outcomes of Sport 2030. ” 

How to apply for funding HERE

Photo above : Check out the very active Deadly Choices mob 

Or view HERE

“The nation’s first-ever sports plan – Sport 2030 – sets a goal to ensure Australia is the world’s most active, healthy nation and the Sports Participation Grants Program is part of our ongoing commitment to achieving this goal,

Our goal is to get more Australians more active more often.

We have set the aspiration, put out a call to action and are supporting this with a significant investment to unlock ideas and passion through our partners and communities.

We know that through increased participation, we have a larger pool from which the new elite athletes of the future will come from.

We want Australians to heed advice from the health experts – adults should “Move It’ 30 minutes a day and children 60 minutes a day.”

Minister for Sport Senator Bridget McKenzie has today 7 January 2019 launched a $28.9m grants program which will enable sport and physical activity providers to get Australia’s population moving. 

The government Move It AUS – Participation Grants Program, to be managed by Sport Australia, aims to help Australians reach the goal set in the government’s Sport 2030 report to reduce inactivity amongst the population by 15% over the next twelve years.

The four year program is part of the 2018-19 government Budget investment of over $230 million in a range of physical activity initiatives.

  • Get inactive people moving in their local community
  • Build awareness and understanding of the importance of physical activity across all stages of life
  • Improve the system of sport and physical activity by targeting populations at risk of inactivity, across all life stages
  • Delivering ongoing impact through the development of sector capability (Stream 2 only)

What types of programs are we looking for?

Programs that:

  • Activates available research (through delivery) which results in the development of positive physical activity experience for one or more of the targeted population groups.
  • Engages Australians that are currently inactive to increase physical activity levels in local communities. This includes women and girls, early years (age 3-7) – focus on the development of Physical Literacy, youth (ages 13-17), people from rural and remote communities, people with disability, people from culturally and linguistically diverse communities, Aboriginal and Torres Strait Islander people, low-medium income households or low socio economic status (SES).
  • Employs behaviour change principles and practices in their implementation and delivery.
  • Addresses common barriers to participation (cost, time, access, delivery method) and employs common drivers (eg: product design, market insights, communication, workforce and delivery method)
  • Activates the “Move it AUS” campaign within target population groups.
  • Directly addresses priority initiatives in Sport 2030.

The Department of Health’s Physical Activity and Sedentary Behaviour Guidelines advise adults aged 18-64 should accumulate 2.5 to 5 hours of moderate intensity physical activity or 1.25 to 2.5 hours of vigorous activity each week. Children should accumulate at least 60 minutes of moderate to vigorous physical activity a day.

National, State and Local Government sports organisations and physical activity providers are encouraged to apply for the grants, with key targets including inactive communities, increasing activity for women and girls and addressing the barriers related to participation in rural, remote and low socio-economic locations.

The Sports Participation Grants Program follow the launch of the Better Ageing Grants, aimed at Australians over 65, and the Community Sporting Infrastructure Grants, all aimed at helping Australians ‘Move It’ for life – and have the opportunity and facilities to ensure that happens.

Applications for the Sports Participation Grants Program open on Monday 7th January 2019 and close on the 18th of February 2019. Guidelines and details on the application process will be available on Monday 7th January at


NACCHO Aboriginal Health and #PHNs : David Coombs from @NuraGili : Primary Health Networks’ impact on Aboriginal Community Controlled Health Services


” The Abbott government’s creation of Primary Health Networks in 2015 has substantially affected the way that primary healthcare funding is administered at the Commonwealth level.

Primary Health Networks control a significant amount of Indigenous‐specific health funding, which Aboriginal Community Controlled Health Services have historically relied upon.

These Indigenous sector organisations have been delivering holistic and culturally appropriate healthcare to Aboriginal and Torres Strait Islander people for decades. They are run by and for Aboriginal Communities themselves, enacting Indigenous self‐determination at a local level.

The Primary Health Networks promote contestable funding and competitive service markets, destabilising the Indigenous health funding environment.

This new funding model does not account for the distinguishing feature of Aboriginal Community Controlled Health Services: self‐determination. Additionally, Primary Health Networks possess limited knowledge of Indigenous health contexts and have been resistant to engagement with Aboriginal organisations. All of this limits Indigenous self‐determination and threatens Indigenous health.

David Coombs, Nura Gili Indigenous Programs Unit, University of New South Wales, Sydney. Originally published Online HERE 

DOWNLOAD the 10 Page PDF version coombs-2018-australian_journal_of_public_administration

David Coombs from presenting at the 2018 Symposium: Aboriginal Medical Services in a challenging policy environment

”  Primary Health Networks are being encouraged to consider the skills of the National Aboriginal Controlled Community Health Organisation ( NACCHO ) and Aboriginal Community Controlled Health (ACCHO’s ) groups to assist delivering innovative health programs to Close the Gap in health outcomes.

Broadening the range of member organisations involved in the Primary Health Networks, and ensuring an appropriate range of skills on their boards, would help ensure the specific needs of the diverse groups in our community are considered when commissioning health services.”

The Minister for Indigenous Health, Ken Wyatt AM, MP NACCHO Post 2017


In responding to the question: ‘what has happened to the project of Indigenous self‐determination?’ this paper examines self‐determination in practice with a particular focus on the operations of grassroots Indigenous Community organisations. Reflecting on evidence gathered from interviews with CEOs and senior managers from Aboriginal Community Controlled Health Services (ACCHSs), it considers the nature of power sharing and relations between Aboriginal Communities1 and the Australian state.

Now that the First Nations of this land have once again called on governments to give them a voice in their own affairs, it seems apposite to enquire into the current state of Indigenous self‐determination.

To appreciate the sentiment and motivations behind the Uluru Statement’s heartfelt plea for substantive institutional change, we must look closely at existing institutions. By understanding what is wrong with contemporary structures we will be more able to understand why change is needed.

This paper focuses on one important government funding framework which relies on a purchaser/provider model: the Primary Health Network (PHN). This recent policy initiative exemplifies the way that governments have excluded Indigenous Community organisations and representatives from the decision‐making processes that affect Indigenous peoples. In Indigenous health policy, the project of self‐determination appears to have been abandoned.

When Gough Whitlam adopted self‐determination as policy in 1972 his government encouraged Aboriginal people to form corporations for collective action. This new approach to State‐Indigenous relations allowed for the creation of an ‘Indigenous sector’, of which ACCHSs are a quintessential part.

The continuing Indigenous sector is the most important vestige of the self‐determination policy (Rowse, 2002). However, Primary Health Networks disempower and delegitimise Indigenous sector organisations and undermine self‐determination in the core area of health. This paper commences by outlining the Primary Health Network’s background and modus operandi.

Subsequent sections are organised around three prominent themes from the interview data: relationships, knowledge, and resources. Based on interview responses and previous scholarship the paper concludes that government should pursue a more relational mode of engagement with Aboriginal organisations, where power is more equally shared, investment is maintained over the longer‐term, and trust is fostered.


This analysis is part of a larger research project based on a series of 25 interviews conducted at 20 ACCHSs across New South Wales, including the peak body, the Aboriginal Health and Medical Research Council.2 Informant voices have been de‐identified and are drawn from seven of these interviews (made up of three Indigenous and four non‐Indigenous interviewees) all from separate locations.

The interviews were conducted in 2017 and 2018 across urban, inner‐regional and outer‐regional3 areas of NSW as classified by the Australian Bureau of Statistics. In accordance with a decolonising methodology, following Hart (2010) and Sherwood et al. (2015), Tuhiwai‐Smith (1999), this article lets representatives from Aboriginal community‐controlled organisations speak for themselves.

This methodology is grounded in an ethical commitment to partnering with Indigenous communities in research. Indigenous voices have been consistently excluded from debates about Indigenous issues (Hart, 2010, 5) and non‐Indigenous researchers have often put their own careers ahead of the wellbeing of the Indigenous peoples they study (Simonds & Christopher, 2013, 2185).

Decolonising methodologies are a response to this silencing and they prioritise Indigenous perspectives because of it. This Indigenous‐centred methodology led me to privilege voices from the Indigenous sector.


The Abbott government established the Primary Health Network in 2015. This came in response to a review of the PHN’s precursor, Medicare Locals, which was an initiative of the Gillard Labor government.

The Liberal‐National government ordered the review upon taking power in 2013. The then Health Minister, Peter Dutton, stated that one of the review’s goals was ‘reducing waste and spending on administration and bureaucracy’ (Dutton, 2013).

This was consistent with Tony Abbott’s comments during the 2013 election campaign, where he called for a review ‘to try to ensure that we maintain the actual health services that are being provided by Medicare Locals while minimising the bureaucracy associated with them’ (Abbott quoted in RMIT and ABC 2016).

Abbott’s and Dutton’s message was that Medicare Locals were bureaucratic and wasteful. This echoed the Coalition election campaign’s emphasis on small government and fiscal austerity. In practice, though, PHNs are almost entirely bureaucratic and are only involved in direct service provision as a last resort. Moreover, the cost of winding up Medical Locals has been estimated to be as high as $200 million (Thompson, 2015).

There are now 31 PHNs across Australia, whereas there were 61 Medicare Locals. However, almost all of the PHNs are either consortia of former Medicare Locals or have a former Medicare local as lead partner (Thompson, 2015). Primary Health Networks function as ‘third party payers’ (Wade, Smith, Peck, & Freeman, 2006, 3) in the primary healthcare system, offering funding and support to primary healthcare providers.

Initially, PHNs were tasked with assessing primary healthcare needs and identifying service gaps (DoH 2015a, 3). More recently they have moved into a commissioning phase, which involves ‘co‐designing’ and purchasing additional services (including Indigenous‐specific services) to fill identified service gaps (DoH and PwC 2016, 4).

Purchasing has been by open competitive tender processes and contracting (Henderson et al., 2018, 80), but to date it is unclear whether service co‐design has occurred and with whom. Even though legally PHNs are independent companies, in a practical sense they are closely aligned with government.

They rely on government funding, and work towards government priorities. One of the PHN priority areas is Aboriginal and Torres Strait Islander health (DoH 2015b), a domain in which the ACCHS sector has unequalled expertise, experience and Indigenous cultural knowledge.


See list of all NACCHO Members

The ACCHS sector, often referred to as the Aboriginal Medical Services or AMSs, delivers high‐quality, comprehensive, and culturally‐informed healthcare, and is run for and by Aboriginal and Torres Strait Islander communities (Campbell, Hunt, Scrimgeour, Davey, & Jones, 2017).

These Indigenous organisations deliver a range of clinical and allied health services and are also involved in community development and health promotion. ACCHSs provide approximately 50% of all primary health care to Aboriginal and Torres Strait Islander peoples (Panaretto, Wenitong, Button, & Ring, 2014, 649–50) and scholars have argued that ACCHSs are a practical embodiment of Indigenous self‐determination (Davis, 2013; Rowse, 2002).

This is because they are governed by Community‐based boards of directors, elected by members of the health service (Grant, Wronski, Murray, & Couzos, 2008, 8).

Aboriginal and Torres Strait Islander people own, run, and oversee their community‐controlled health services. ACCHSs are one significant example of Aboriginal self‐determination in practice, giving Aboriginal people a say on what their health services do and how.


Primary Health Networks take a commissioning approach to the funding and management of Indigenous health services. Commissioning is an umbrella concept that covers a range of public‐service activities.

These include needs assessment, procurement, purchasing, contracting, service delivery and performance management, all of which are interrelated yet disinct processes (Dickinson, 2014, 15). Sturgess (2018, 165) expresses commissioning’s primary function as: ‘to design and manage the interface between policy/funding and delivery’.

Tasked with improving the efficiency, effectiveness and coordination of services, commissioning organisations, such as PHNs, act as intermediaries between policymakers/funders and service providers.

Commissioners are responsible for the strategic design and ‘stewardship’ of service‐provision systems (Sturgess, 2018, 163), gearing their overall functioning towards the efficient achievement of government’s strategic objectives. In theory, commissioning improves on previous attempts to improve the purchaser‐provider relationship because it acknowledges some of the complexities encountered at the service delivery coalface (Sturgess, 2018, 156).

However, as Dickinson notes (2015), commissioning’s definitional ‘fuzziness’ has meant that in practice the concept has been used ‘as a synonym for more contracting out or privatisation’. Theoretically providers are accorded a stakeholder role in commissioning, but commissioners actually follow the familiar governance approach that privileges the demand (‘purchaser’) side of the purchaser‐provider relationship.

The evidence on commissioning’s effectiveness is mixed. A recent report written for the Department of Health laments the ‘limited evidence that links commissioning with quality improvement or cost containment’ (King’s Fund et al. 2016, 4).

However, some observers are hopeful that commissioning can deliver broad benefits if commissioners’ ‘softer skills’ can be strengthened (Dickinson, 2014, 17). Robinson and colleagues (2016, 10) have argued that the crux of the commissioning task is to accommodate multiple and sometimes divergent values, goals, and practices.

In this way, successful commissioners are those who achieve ‘a meeting of the minds’ amongst diverse stakeholders (Sturgess, 2018, 164). Booth and Boxall (2016, 3–4) contend that fostering reciprocal and trusting relationships between commissioners (e.g. the PHNs) and providers (e.g. ACCHSs) is an indispensable component of successful commissioning.

Research on the policies and funding arrangements that apply to ACCHSs also highlights the importance of close and trusting relationships between purchaser and provider. This literature (e.g. Dwyer, Lavoie, O’Donnell, Marlina, & Sullivan, 2011, 43; Lavoie, Boulton, & Dwyer, 2010, 675–6) promotes relational contracting as the best way of funding ACCHSs to maximise Indigenous health gains.

Relational contracting involves purchasers and providers working closely together, under flexible long‐term contracts, towards the achievement of shared goals.

Governments have long known4 that, when commissioning for complex social services (of which Indigenous‐specific comprehensive primary healthcare are a clear example), commissioners should assess how well providers ‘understand the human dimensions’ of the service contracts for which they are tendering (Sturgess, Argyrous and Rahman 2018, 466). Providers need time to develop this expertise and relational contracting allows for this.

However, based on the testimony of ACCHS representatives, PHN contracting and decision‐making processes are more hierarchical than relational.

PHNs control both the needs‐assessment and funding processes, inevitably compromising the space available for Indigenous self‐determination. Under the PHN commissioning model it is ultimately government who ‘calls the shots’, to use Gingrich’s expression (2011).

This seems to follow from the Department of Health’s vision of commissioning as ‘proactive and strategic’, where commissioners (i.e. the PHNs), decide what services should be offered, how, and by whom (Smith et al. cited in DoH 2015a, 2).

The PHN’s power structure and contracting arrangements bind Aboriginal service‐providers to the demands of the PHN as purchaser. The PHN is in turn bound to the government which has the final say when determining who and what gets funded in Indigenous health.

The PHN’s commissioning hierarchy, and the conflicts (discussed below) that it engenders, supports Dickinson’s (2014, 17) contention that ‘commissioning is an inherently political (with a small ‘p’) process’. The PHN’s power dynamics also fundamentally undermine the principle of Indigenous self‐determination.


Some ACCHS CEOs and managers are frustrated because PHNs have excluded them from key decision‐making forums on Indigenous health. PHN CEOs have the power to control who participates in key discussions around Aboriginal health services.

This runs contrary to the Government’s own PHN Grant Programme Guidelines, which state: ‘PHNs must have broad engagement across their region including with … Aboriginal Medical Services’ (DoH 2016a, 7, emphasis added).

It also contradicts the principle of ‘Aboriginal and Torres Strait Islander Community Control and Engagement’ that informs the National Aboriginal and Torres Strait Islander Health Plan 2013–20235 (Australian Government 2013, 10), and the associated Implementation Plan (DoH 2015c, 5).

Nevertheless, some PHNs have disregarded these nationally established guidelines and strategies, as this informant’s statement indicates:

The Commonwealth actually put out a guideline on how PHNs and AMSs should interact… We had a meeting with the CEO of the PHN and all the AMSs in the region. And I’m quoting the guidelines to him. And he said: ‘we didn’t have anything to do with putting them together, we don’t have to abide by them’. We’ve asked for Aboriginal representation on the board [of the PHN]. Nup. We asked for an Aboriginal Advisory Committee. Nup. (CEO, outer‐regional ACCHS, November 2017)

One way forward would be to institutionalise the principle of Aboriginal community control in all PHN actions and policies related to Indigenous health but this would be to seriously constrain the purchaser‐provider model and suggest it should cede place to a relational contracting approach.

Mandating agreements between ACCHSs and PHNs, as the Closing the Gap Steering Committee suggests (Wright & Lewis, 2017, 36), would give ACCHSs more say in how Indigenous health issues are approached by PHNs in their local areas.

In another example of PHNs ignoring Indigenous organisations, an ACCHS CEO alleges that her organisation was not consulted during the needs assessment stage of the commissioning process, and that the PHN’s picture of Indigenous communities’ healthcare needs is therefore based on incomplete information:

Well a good example is the current ITC program – so the Integrated Team Care arrangements. [The PHN] gave two thirds of the money to non‐Aboriginal organisations and one third to AMSs…It’s an Aboriginal‐specific program. And we said: ‘look, we should be getting more because we see more Aboriginal clients’. [The PHN replied]: ‘No you don’t’. I said: ‘well, where are you getting your stats from? Your stats aren’t accurate.’ Our stats’d be accurate because we know how many Aboriginal people live in our communities. No sense in using ABS because it’s not accurate. You know, our ABS, I think’s 823, or something like that, for [our town] … only. We know there’s more than 1000 Aboriginal people that live just in [our town]. (CEO, outer‐regional ACCHS, December 2017)

ACCHSs are frustrated because PHNs decide the level and nature of Aboriginal healthcare need without consulting Aboriginal Community organisations that have access to valuable sources of knowledge and information. This is a clear example of how the PHN, with a mandate from the Commonwealth, is able to dictate terms to Aboriginal organisations, a clear derogation of the principle of Indigenous self‐determination.

The non‐binding nature of the PHN and ACCHO Guiding Principles (DoH 2016b) has led to inconsistent PHN engagement with ACCHSs, as the following statement from an ACCHS CEO illustrates:

PHNs are regularly telling us, well, no they’re just guidelines from the Commonwealth and they’re right… They’re not policy direction that ensures that PHNs are making consistent decisions right across the 31 [PHN] regions in this country. You know, there’s some examples where PHNs are working incredibly respectfully and efficiently with Aboriginal organisations and there’s many that are not. (CEO, inner‐regional ACCHS, July 2017)

Some ACCHS CEOs have concluded that PHNs have too much flexibility when determining how best to work with ACCHSs.

The PHN Grant Programme Guidelines state that PHNs must use Community Advisory Committees but only minimally define their function as: to ‘provide community perspective to PHN boards’ (DoH 2016a, 8).

The lack of clear policy direction is one reason behind the varying levels of respect for Indigenous self‐determination across PHN regions.


ACCHS‐sector advocates and Indigenous health policy experts have argued that the PHN’s ability to improve Indigenous health outcomes is dependent on how well it engages ACCHSs’ skills and knowledge (e.g. Couzos, Delaney Thiele, & Page, 2016).

It is not clear that the PHN has a coherent strategy for engaging with ACCHSs and concerns have been raised over Indigenous cultural safety.

This is because the PHN’s competitive tendering processes clear the way for non‐Indigenous service providers to enter Indigenous healthcare settings (Russell, 2015, 77). The following excerpt emphasises this concern:

Who is PHN to say that an organisation is culturally safe or culturally appropriate? … And who says they’re culturally appropriate? And what happened to Aboriginal people’s freedom of choice? You know, they’re just being ignored, they’re not consulted about this… putting a dot art painting on the wall doesn’t mean you’re culturally appropriate, it’s just tokenistic… I just feel that Aboriginal people don’t get given… they don’t have a say and yet it’s their health that we’re talking about, you know. At least with us we give them a choice. (CEO, inner‐regional ACCHS, July 2017)

Some ACCHSs feel that the PHNs are not attuned to the culturally‐specific health needs and expectations of Aboriginal and Torres Strait Islander peoples. Moreover, this ACCHS CEO feels that Aboriginal peoples’ right to self‐determination was not respected in the top‐down decision‐making process that led to the creation of the PHN.

There is a feeling amongst some within the ACCHS sector that PHNs are not familiar with and have not sufficiently engaged with the ACCHS model of care or the Aboriginal definition of health (Cooke quoted in NACCHO 2017; Wright & Lewis, 2017, 33).

In response to a question about the differences and similarities between ACCHSs and non‐Indigenous health services, a very experienced CEO from an urban ACCHS had this to say:

No, they don’t even… they don’t even touch the surface of what we do. I’m on the PHN board. [The] PHN is mainly all doctors and they’re fascinated. I did a presentation to them and did a video. They couldn’t believe it, what we do. (CEO, urban ACCHS, March 2018)

This response suggests that PHN board members have limited knowledge of ACCHSs’ ways of working, and, that because the majority of PHN board members come from a conventional clinical health background, they do not understand ACCHSs’ holistic conceptualisation of Aboriginal Community wellbeing (see AH&MRC 2008, 32).

That said, these PHN board members being ‘fascinated’ by the CEO’s presentation indicates that there is potential for these organisations to learn from and work more closely with this ACCHS in the future.


A number of ACCHS managers and CEOs commented on the PHN’s lack of investment in their sector. The government’s under‐funding of the ACCHS sector has attracted persistent criticism from Indigenous health and policy scholars for many years (Alford, 2014; Grant et al., 2008, 19).

The following comment came in response to a question about the Indigenous Advancement Strategy (IAS), another recent policy initiative that has been similarly criticised for not engaging with Indigenous Community organisations, underscoring how ACCHSs feel ignored by funding and policy bodies:

It’s the same as the PHN stuff, there was no – they didn’t come and talk to us and say ‘how many patients you got? What are your occasions of service like? What’s your health‐outcomes data like?’ None of that, so they don’t know what we could do, what we could deliver. (CEO, urban ACCHS, January 2018)

This ACCHS CEO sees value in a process where governments, or intermediaries such as PHNs, could directly approach Aboriginal services with long‐standing relationships with their Communities in order to assess the possibility of building upon what is already in place. This did not occur with the PHN in her region.

The following statement from the manager of an urban‐based ACCHS eloquently articulates the strongly held view that funding and policy bodies should work with and build on the work of Indigenous Community organisations:

We’ve already told them: ‘have more dialogue with us’… it’s about relationships, it’s about understanding the [Indigenous health] space. It’s not just contract management … It’s really about making sure that the funding isn’t piecemeal. … We don’t want to be set up for failure… So this is the issue: I think the reporting is important and I think the dialogue with our funders is really, really important. It’s about having healthy relationships and discussions with our funders around what the challenges are both at an organisational level and at a Community level… It’s stepping back and actually sharing the problem rather than administering a contract. (Operations Manager, urban ACCHS, January 2018, emphasis added)

This manager is urging PHNs to embrace a partnership approach to Indigenous community‐controlled organisations. He believes that PHNs need to invest more in the ACCHS sector and that they should share responsibility for Indigenous health outcomes. He also sees a need for PHNs and governments to better understand the challenges faced by ACCHSs and their Communities. However, this would require not just the PHNs but the Australian Government to give up its doctrinaire commitment to contestable funding, an approach that is based on the idea that there should be a competitive service market.


From the perspective of senior managers in Aboriginal Community Controlled Health Services, the creation of Primary Health Networks has had a negative impact on the delivery of health services to Indigenous communities.

ACCHSs now have a new administrative body to which they must appeal for funds. The PHNs do not appear to give substantial weighting to Indigenous self‐determination when making decisions about Indigenous health services.

The Department of Health’s PHN guidelines acknowledge that ACCHSs, as Indigenous Community representatives, make vital and unique contributions to Indigenous healthcare.

However, the Department has not institutionalised Aboriginal community control into the PHN funding system. This leaves the level of Indigenous Community engagement to the discretion of PHN boards.

As a result, ACCHSs have not received significant investment from PHNs, nor have they been consulted in key Indigenous health decision‐making processes. Moreover, PHNs do not appear to possess high levels of Indigenous primary health care knowledge or expertise and would do well to engage with and learn from ACCHSs. Relational contracting is suggested as a way to approach this.

This paper has argued that PHNs have had a negative impact on Indigenous self‐determination and health services. PHNs offer ACCHSs very few avenues through which to enact self‐determination.

If, as I would argue, this unequal power dynamic is indicative of the broader relationship between Indigenous Communities and the Australian state, then Indigenous peoples’ recent call for substantive institutional reform becomes all the more comprehensible and urgent.


  • A note on style: in this paper ‘Community’, when capitalised, refers to the relevant local Aboriginal community or the broader Aboriginal and Torres Strait Islander community in Australia, depending on the context. This is in line with the definition set out by the Aboriginal Health and Medical Research Council (AHMRC 2008, 6), the state‐level peak body that represents the interests of ACCHSs in New South Wales.
  • The AH&MRC Ethics Committee has provided ethics approval for the project, allocating it reference number 1225/16.
  • The categories ‘urban’, ‘inner‐regional’ and ‘outer regional’ used in this paper are based on the Australian Statistical Geography Standard Remoteness Structure used by the Australian Bureau of Statistics <>.
  • Sturgess, Argyrous and Rahman (2018), in their fascinating study of the contracting modes that governed the transportation of convicts from England to Australia in the 18th and 19th centuries, found evidence that a relational mode of commissioning, which considered potential service providers’ reputation, expertise, and motivation, delivered better human outcomes than transactional commissioning, where the primary consideration was price.
  • Thank you to Associate Professor Janet Hunt for reminding me of the contradictions between PHNs’ actions and the Commonwealth Government’s commitments under the National Aboriginal and Torres Strait Islander Health Plan.

NACCHO Aboriginal Health and #RHD : Download the @END_RHD_CRE report :  Urgent action needed to stop 500 rheumatic heart disease (RHD) preventable deaths

” Aboriginal and Torres Strait Islander children are 55 times more likely to die of rheumatic heart disease than other Australian children.

We’re seeking a commitment from all political parties to stop this preventable disease from ever taking the life of another child in Australia.”

Ms Pat Turner, CEO NACCHO Founding Member of END RHD speaking at #Laborconf18 this week on the need for urgent action to reduce the burden of rheumatic heart disease among Aboriginal and Torres Strait Islander people. Together we can

 ” A new report predicts rheumatic heart disease (RHD) will lead to over 500 preventable deaths and cost the Australian health system $317 million by 2031 if no further action to tackle the disease is taken.

The Cost of Inaction on Rheumatic Heart Disease – published by the END RHD Centre of Research Excellence (END RHD CRE), based at the Telethon Kids Institute – puts the number of people affected by RHD or its precursor, acute rheumatic fever, at over 4,500.”

Download RHD report HERE


By 2031, the report estimates that number will triple to nearly 15,000 people.

Key findings:

  • There are currently 4,539 people living with rheumatic heart disease
  •  If no further action is taken to address rheumatic heart disease, a further 10,212 Aboriginal and Torres Strait Islander people are projected to develop the disease or its precursor – acute rheumatic fever – by 2031. Of these people: o 1,370 will need heart surgery
  •  563 with RHD will die
  • $317 million will be spent on medical care

Lead author Dr Rosemary Wyber said almost all of those predicted to develop acute rheumatic fever would be Aboriginal or Torres Strait Islander children and teenagers.

“Make no mistake about it – when we talk about the cost of inaction on rheumatic heart disease, we’re talking about the burden of disease for another generation of Aboriginal and Torres Strait Islander children and their communities,” Dr Wyber said.

The report also predicted that 1,370 people with the disease will need heart surgery and 563 will die with RHD.

“As a GP working in remote communities, I have seen first-hand the toll of RHD and the devastating impact it has on families and communities,” Dr Wyber said.

“This suffering is preventable. Deaths can be avoided, financial costs can be reduced, and new cases of disease prevented.”

RHD is caused by an abnormal reaction to the common Strep A infection. There is no cure for the disease, and people require an injection of long-acting penicillin every 21-28 days for at least a decade to stop it worsening. If people do not receive these injections, the disease can lead to heart failure or stroke.

“RHD should no longer exist in a country like Australia, yet our research predicts the human and economic toll will only continue to rise if we don’t see a significant increase in resourcing and investment in community-led models of care” Dr Wyber said.

“The social and environmental causes of RHD are linked to many other diseases of disparity, such as trachoma and otitis media. By addressing the causes, not only can we end RHD – we’ll significantly help close the gap.”

World renowned RHD expert and Director of the Telethon Kids Institute, Professor Jonathan Carapetis AM, said that in the past year there have been significant steps towards tackling RHD in Australia.

“In February, Minister Wyatt committed to the development of a roadmap; in May, Australia supported a World Health Assembly resolution to eliminate the disease globally; and in October, Minister Wyatt and Shadow Assistant Minister Snowdon made a bipartisan commitment to end RHD in this country” Professor Carapetis said.

This morning I moved a resolution at #ALPConf18 to make Rheumatic heart disease a federal health priority. The motion was seconded by Senator Malarndirri McCarthy – Northern Territory and was unanimously supported by delegates.

Rheumatic heart disease is a disease of poverty that disproportionately affects some of our youngest and most vulnerable First Australians.


“So with a growing political will, strong Aboriginal and Torres Strait Islander leadership, and a solid evidence-base backed by 25 years of research, I believe it’s possible to change the trajectory outlined by this report. We all need to work together and action is urgently needed.”

See Pat Turners full speech from October launch 

The report looked at the four jurisdictions with the highest recorded burden of disease: Western Australia, South Australia, the Northern Territory, and Queensland.

Researchers used linked hospital admissions and mortality data over the last two decades to project cases likely to occur between mid-2016 and 2031.

The findings will inform part of the RHD Endgame Strategy, currently being developed by the END RHD CRE and due for release in 2020.

The report was led by the END RHD CRE, with data collected and analysed through the NHMRC Project Grant ‘Burden of rheumatic heart disease (RHD) and impact of prevention strategies: comprehensive evidence to drive the RHD Endgame’.

NACCHO @RACGP Aboriginal Health Survey : 2 of 2 From now until February 2019, NACCHO and @RACGP  wants to hear from you about implementing the National Guide and supporting culturally responsive healthcare for Aboriginal and Torres Strait Islander people

In 2018–19, NACCHO and the RACGP are working on further initiatives and we want your input!

Download this post as PDF and share with your networks


What we are currently doing:

  • Conducting practice team surveys and focus groups to:
    • understand current system requirements and how they can improve identification rates of Aboriginal and Torres Strait Islander patients in mainstream practices and
    • integrate the key recommendations from the National Guide into clinical software
  • Establishing a Collaborative with the Improvement Foundation to conduct rapid quality improvement cycles leading to the provision of better healthcare for Aboriginal and Torres Strait Islander peoples
  • Engaging with medical software vendors to understand how we can improve identification rates and integrate the National Guide into clinical software
  • Developing resources for Aboriginal and Torres Strait Islander people regarding preventive health assessments and follow up care
  • Working with our Aboriginal and Torres Strait Islander-led Project Reference Group to carry out all project activities.

From now until February 2019, we want to hear from you!

Do you have ideas, solutions or examples of good practice relating to:

  • how health services can ensure that Aboriginal and Torres Strait Islander patients receive patient centred, quality health assessments (715) that meet their needs?
  • the resources that would support mainstream general practice teams to provide culturally responsive healthcare for Aboriginal and Torres Strait Islander people?
  • how guidelines, such as the National Guide, can be integrated into clinical software?
  • features of clinical software that will support improved identification of Aboriginal and Torres Strait Islander patients at your practice?
  • features of a 715 health assessment template that will support a comprehensive health assessment?

To participate in a short survey, please CLICK HERE

We also welcome your feedback and input at

With your feedback, we will:

  • understand the needs of our cohort
  • understand what works through our Collaborative model for improvement report
  • develop new resources to support you and your team with delivering better healthcare to Aboriginal and Torres Strait Islander peoples regardless of where care is sought
  • share the lessons with mainstream general practice and Aboriginal Community Controlled Health Services to improve the health and wellbeing of Aboriginal and Torres Strait Islander peoples.

National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people

Early detection, preventing disease and promoting health

The National Guide is a practical resource intended for all health professionals delivering primary healthcare to Aboriginal and/or Torres Strait Islander people.

Its purpose is to provide GPs and other health professionals with an accessible, user-friendly guide to best practice preventive healthcare for Aboriginal and Torres Strait Islander patients.

See Website

New to the third edition!

National Guide podcasts

Subscribe to the National Guide Podcast (listen to the third edition) to hear host Lauren Trask, NACCHO Implementation Officer and CQI expert, speak to GPs  and researchers on updates and changes in the third edition of the National Guide.


 National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people (PDF 9.8 MB)

 Evidence base to a preventive health assessment in Aboriginal and Torres Strait Islander people (PDF 9.4 MB)

 National Guide Lifecycle chart (child) (PDF 555 KB)

 National Guide Lifecycle chart (young) (PDF 1 MB)

 National Guide Lifecycle chart (adult) (PDF 1 MB)

NACCHO Aboriginal Health and the #Workforthedole Debate  #Election2019 Senator Nigel Scullion calls it returning to sit down money as Aboriginal leaders welcome Labor commitment to abolish discriminatory remote Work for the Dole Program

We welcome Labor’s focus on creating jobs and meeting the needs of remote communities, and its commitment to abolishing the existing program, which is harmful and discriminatory.

We are urging that the new program includes a firm funding commitment to support the creation of a substantial jobs package – this is vital for remote communities.

We welcome Labor’s commitment to work with First Nations people to co-design a new program and their recognition that our communities must be involved in decisions about policies that affect us.

Any scheme to replace CDP must be Aboriginal-led. We can’t have a continuation of the failed, top-down, bureaucratic approach that we have at the moment. We are looking to Labor to support the new program being delivered in an Aboriginal-led agency, not by the Canberra bureaucracy “

John Paterson, spokesperson for APO NT, said that it was critical that Labor follow through with a firm policy and funding commitment to ensure the creation of jobs and positive community development

Today’s revelations that the Labor Party will cut over $1 billion from the Indigenous Affairs portfolio and abolish the Community Development Program is an astonishing admission that Labor has no plans to improve life outcomes for Aboriginal and Torres Strait Islander Australia.

The Community Development Program is the continuation of almost 40 years of remote employment services and is a critical part of Government’s work in remote communities to engage adults in work and improve the circumstances of remote communities.”

Senator Nigel Scullion Indigenous Affairs Minister see full Press Release Part 2

Senator Dodson announced Labor would abolish the CDP, a program unions and welfare groups have argued is “blatantly discriminatory” because 83% of its 35,000 participants are Indigenous, and it imposes higher requirements than the work for the dole scheme does.

As a condition of income support, remote-area participants must engage in up to 25 hours of work activities a week.

Dodson said Labor would replace the CDP with a new program to be “co-designed” with First Nations people and restore the principle of “community control and direction”.

Aboriginal Peak Organisations NT (APO NT) has welcomed the Australian Labor Party’s commitment to abolish the Government’s discriminatory ‘work for the dole’ program in remote communities.

In announcing the Labor Party’s commitment to scrapping the Community Development Program (CDP), Senator Pat Dodson said that it would be replaced with a new program that ‘creates jobs, meets community needs and delivers meaningful training and economic development’.

Dr Josie Douglas, Policy Manager at the Central Land Council warned that income inequality between remote communities and urban cities is growing.

“Poverty is growing in remote communities, and young people, in particular, are giving up. They are losing hope. That’s why Labor must build on its commitment to abolish CDP and commit to a jobs package for remote communities, including training for young people.”

“Aboriginal people have the solutions. We have developed a new model – the Fair Work and Strong Communities model – which would immediately reduce poverty in remote communities by 2.6% and cut the gap in employment rates between remote Aboriginal people and the rest of Australia by one third,” said Dr Douglas.

“This approach has the broad support of key Aboriginal organisations and national bodies.

“By listening to us and adopting our proposal, Labor could make an immediate difference to thousands of people and provide a platform for economic, social and cultural development in remote communities,” said Dr Douglas.

The Fair Work & Strong Communities Proposal has been endorsed by over 30 organisations around Australia and includes:

The proposed scheme

1. Creating immediate paid work

 Funding packages for the creation of 10,500 jobs. Packages cover 20 hours at minimum wage plus on-costs, which may be topped up by an employer.

 1,500 paid, six-month work experience places for young people.

 Repurposing the existing $25m entrepreneurship fund to support social enterprise development.

2. Indigenous control

 Indigenous control is embedded at the national, regional and local level. The program is managed by a national, Indigenous led body.

 Within broad program goals (like increased employment rates) local communities have significant input into local targets and scope to vary ‘default’ policies in relation to level of obligations and penalties.

3. Focus on long term positive impacts

 Program orientation changes from short-term results to achieving net impact through, over time, the creation of sustainable new jobs and skilling local people to take up jobs already in communities.

 Financial incentives to penalise participants are removed.

 People with substantial long-term health issues and/or disabilities are assigned to a stream in which they are supported to participate voluntarily, but not compelled.

Costs and impact of the scheme:

The current CDP costs over $300m per year (excludes income support costs).

Net cost of the Fair Work Strong Communities jobs package (12,000 new jobs) = $195.8m per annum. However, this amount would be significantly decreased by potential offsets from current program costs.

National Centre for Social and Economic Modelling (NATSEM) has calculated the day one impacts of the proposed package as:

 poverty rate reduced from 22.7% to 20.1%

 Employment rate increases from 48.2% to 57.8% (employment rate gap reduces by one third)

Today’s revelations that the Labor Party will cut over $1 billion from the Indigenous Affairs portfolio and abolish the Community Development Program is an astonishing admission that Labor has no plans to improve life outcomes for Aboriginal and Torres Strait Islander Australia.

The Community Development Program is the continuation of almost 40 years of remote employment services and is a critical part of Government’s work in remote communities to engage adults in work and improve the circumstances of remote communities.

The Community Development Program has delivered great results:

The CDP has turned around community engagement and participation – from only 7 per cent at the end of Labor’s Remote Jobs and Communities Program to over 70 per cent today.

Over 28,000 jobs for remote job seekers

Over 9,600 long term employment outcomes

And the Government has already announced reforms to the Community Development Program to provide a fairer and simpler system, and move more people off welfare and into work. Changes include:

6,000 subsidised jobs across remote Australia

Ensuring communities are at the centre of CDP with increased local control and flexibility in the design and delivery of CDP

Support for remote business development

Changes to the provider payment model to focus on working closely with job seekers to improve engagement and address barriers to employment

Introduction of the Targeted Compliance Framework

Change hours of participation from a maximum of 25 hours per week to up to 20 hours per week.

Improved job seeker assessments, with local health workers able to provide the medical evidence required to review mutual obligation requirements.

Labor’s shocking lack of detail on this policy leaves a lot of uncertainty for residents of remote Australia.

Will the Labor Party introduce the mainstream jobactive program into remote Australia despite clear calls from Indigenous leaders and communities for the need for a program that is tailored to the needs of remote job seekers?

Will the Labor Party abandon the principle of mutual obligations and return communities to the misery of sit down money and passive welfare that fails children, women and families and causes dropping school attendance and community safety outcomes?

Who has the Labor Party consulted with in making this decision?

Has the Labor Party asked representative bodies and local Aboriginal CDP providers?  Has the Labor Party asked residents of remote communities?

Or has the Labor Party just made its decision based on the views of east coast academics and its union masters.

The Labor Party needs to come clean on its plans for remote Australia.

NACCHO Aboriginal Health #refreshtheCTGRefresh 2 of 2 : Download the #COAG 9 page statement on the #ClosingTheGap refresh

 ” One of the lessons governments have learned over the last ten years is that effective programs and services need to be designed, developed and implemented in partnership with Aboriginal and Torres Strait Islander peoples.

We must place collaboration, transparency, and accountability at the centre of the way we do business with Aboriginal and Torres Strait Islander Australia. Working in genuine partnership with Aboriginal and Torres Strait Islander peoples is fundamental to Closing the Gap.

All governments remain committed to engaging with Aboriginal and Torres Strait Islander Australians and other stakeholders to finalise and implement the Closing the Gap Refresh “

From the COAG Statement

1.Download CTG COAG 6 Page Statement

2.Download CTG  COAG 3 Page Draft Targets Outcomes

3. Download COAG Communique Dec 12

Where we actually let Aboriginal and Torres Strait Islander Australians lead the discussion, determine the outcome, own the outcome,”

The Victorian premier, Daniel Andrews, said the partnership provided a meaningful opportunity, the “likes of which we’ve not seen before”. From The Guardian 

“We can’t close the gap unless we do this in partnership with Aboriginal people,” he told reporters on Wednesday.

“I think the wording of what we’re doing so far on Closing the Gap is good but we have to talk funding at some stage.”

The Northern Territory chief minister, Michael Gunner, said on Wednesday it was a vital partnership and initiative could not afford to “go off the rails again”.

“ COAG’s commitment to a genuine formal partnership approach between the government and Aboriginal and Torres Strait Islander peoples on the Closing the Gap strategy is a welcome step in the right direction

This is something that we’ve long campaigned for – because involving Aboriginal and Torres Strait Islander people in decisions that affect their lives will lead to far better outcomes.

We as a sector are looking forward to working with the Prime Minister and COAG to negotiate and agree the refreshed framework, targets and action plans which will be finalised through the committee by mid-2019.

NACCHO Chief Executive Officer Pat Turner AM see NACCHO Press Release HERE

In December 2016, the Council of Australian Governments (COAG) agreed to refresh the Closing the Gap agenda ahead of the tenth anniversary of the agreement and four of the seven targets expiring in 2018.

In June 2017, COAG agreed to a strengths-based approach and to ensure Aboriginal and Torres Strait Islander peoples were at the heart of the development and implementation of the next phase of Closing the Gap.

In 2018, a Special Gathering of prominent Aboriginal and Torres Strait Islander Australians presented COAG with a statement setting out priorities for a new Closing the Gap agenda. The statement called for the next phase of Closing the Gap to be guided by the principles of empowerment and self-determination and deliver a community-led, strengths-based strategy that enables Aboriginal and Torres Strait Islander peoples to move beyond surviving to thriving.

Since the Special Gathering identified priorities, all governments have worked together to develop a set of outcomes and measures for inclusion in the Closing the Gap Refresh. COAG has now agreed draft targets for further consultation to ensure they align with Aboriginal and Torres Strait Islander peoples and communities’ priorities and ambition as a basis for developing action plans.


COAG recognises that in order to effect real change, governments must work collaboratively and in genuine, formal partnership with Aboriginal and Torres Strait Islander peoples as they are the essential agents of change.

This formal partnership must be based on mutual respect between parties and an acceptance that direct engagement and negotiation will be the preferred pathway to productive and effective agreements. Aboriginal and Torres Strait Islander peoples must play an integral part in the making of the decisions that affect their lives – this is critical to closing the gap.

COAG will ensure that the design and implementation of the next phase of Closing the Gap is a true partnership. Governments and Aboriginal and Torres Strait Islander people will share ownership of and responsibility for a jointly agreed framework and targets and ongoing monitoring of the Closing the Gap agenda.

The refreshed Closing the Gap agenda recognises and builds on the strength and resilience of Aboriginal and Torres Strait Islander peoples and communities.


Closing the Gap requires us to raise our sights from a focus on problems and deficits, to actively supporting and realising the full participation of Aboriginal and Torres Strait Islander peoples in the social and economic life of the nation. COAG recognises there is a need for a cohesive national agenda focussed on important priorities for enabling Aboriginal and Torres Strait Islander families, children and communities to thrive.

COAG has listened to Aboriginal and Torres Strait Islander communities and stakeholders. COAG has heard there is a need to focus on the long term and on future generations, to strengthen prevention and early intervention initiatives that help build strong families and communities, and to prioritise the most important events over the course of a person’s life and the surrounding environment.

COAG acknowledges Closing the Gap builds on the foundation of existing policies and commitments within the Commonwealth and each state and territory. Closing the Gap does not replace these policies, but provides a people and community centred approach to accelerate outcomes.


The Special Gathering Statement to COAG in February 2018 recommended the priority areas for the next phase of Closing the Gap:

 Families, children and youth

 Housing

 Justice, including youth justice

 Health

 Economic development

 Culture and language

 Education

 Healing

 Eliminating racism and systemic discrimination.

All priority areas are important and interconnected, and COAG is committed to achieving positive progress in all areas.

The Commonwealth, states and territories have consulted widely on these priorities. Aboriginal and Torres Strait Islander peoples and communities, peak bodies, service providers, technical experts and members of the public had the opportunity to provide their views on the future of Closing the Gap.

In considering where to set targets, there was a focus on the priority areas that lend themselves to the design of specific, measurable, achievable, relevant and time-bound targets. This focus on evidence and data enables COAG to effectively track progress over time.


Governments must deepen their relationships with Aboriginal and Torres Strait Islander peoples. This means understanding what matters to communities and continuing to build capability for genuine collaboration and partnership, acknowledging the differing priorities and challenges in different places across urban, regional and remote Australia.

All Australian governments are committed to working cooperatively in partnership with Aboriginal and Torres Strait Islander peoples, and their communities, to positively transform life outcomes for Aboriginal and Torres Strait Islander peoples.

COAG recognises that progress reports over the past decade confirm that closing the gap in remote Australia requires particular focus, recognising the rich cultural strengths as well as the need for targeted approaches to address disadvantage in these areas.

COAG acknowledges that culture is fundamental to Aboriginal and Torres Strait Islander peoples’ strength and identity. COAG further acknowledges the impacts of historical wrongs and trauma faced by Aboriginal and Torres Strait Islander peoples and families.

All Australian governments recognise the need to address intergenerational change, racism, discrimination and social inclusion (including in relation to disability, gender and LGBTIQ+), healing and trauma, and the promotion of culture and language for Aboriginal and Torres Strait Islander peoples. These will be taken into account as cross system priorities for all policy areas of the Closing the Gap agenda. Cross system priorities require action across multiple targets.


The Commonwealth, states and territories share accountability for the refreshed Closing the Gap agenda and are jointly accountable outcomes for Aboriginal and Torres Strait Islander peoples. COAG commits to working together to improve outcomes in every priority area of the Closing the Gap Refresh.

The refreshed Closing the Gap agenda will commit to targets that all governments will be accountable to the community for achieving. This approach reflects the roles and responsibilities as set out by the National Indigenous Reform Agreement (NIRA), and specified in respective National Agreements, National Partnerships and other relevant bilateral agreements.

While overall accountability for the framework is shared, different levels of government will have lead responsibility for specific targets. The lead jurisdiction is the level of government responsible for monitoring reports against progress and initiating further action if that target is not on track, including through relevant COAG bodies.

The refreshed framework recognises that one level of government may have a greater role in policy and program delivery in relation to a particular target while another level of government may play a greater role in funding, legislative or regulatory functions. Meeting specific targets will require the collaborative efforts of the Commonwealth, states and territories, regardless of which level of government has lead responsibility. Commonwealth, state and territory actions for each target will be set out in jurisdictional action plans, and may vary between jurisdictions. COAG acknowledges that all priority areas have interdependent social, economic and health determinants that impact the achievement of outcomes and targets.

Through a co-design approach, jurisdictional action plans will be developed in genuine partnership with Aboriginal and Torres Strait Islander communities, setting out the progress that needs to be made nationally and in each jurisdiction for the targets to be met. Action plans will clearly specify what actions each level of government is accountable for, inform jurisdictional trajectories for each target and establish how all levels of government will work together and with communities, organisations and other stakeholders to achieve the targets. Starting points, past trends and local circumstances differ, so jurisdictions’ trajectories will vary and may have different end-points.

COAG recognises that promoting opportunities for Aboriginal and Torres Strait Islander peoples to be involved in business activities contributes to economic and social outcomes for families and communities, and has committed to publishing jurisdiction specific procurement policies, and Aboriginal and Torres Strait Islander employment and business outcomes annually.


Closing the Gap is a whole-of-government agenda for the Commonwealth and each state and territory. To provide direct accountability to Aboriginal and Torres Strait Islander peoples and the Australian public as a whole, each jurisdiction will report publicly each year on its Closing the Gap strategy. The Prime Minister will make an annual statement to parliament.

Governments will engage with the community to develop a meaningful framework for transparently tracking and reporting progress with Aboriginal and Torres Strait Islander leaders.


The Productivity Commission’s Indigenous Commissioner will conduct an independent review of progress nationally and in each jurisdiction every three years. All governments will provide input into the Productivity Commission’s review, taking into account differences between urban, regional and remote areas.

The Closing the Gap targets may be subject to refinement, where appropriate, through the review of the NIRA and periodic Productivity Commission reviews.


A new formal partnership with Aboriginal and Torres Strait Islander peoples, through their representatives, will be established by the end of February 2019.

Building on the work undertaken to date, working through this new partnership, the Commonwealth, and states and territories, will by mid 2019:

 finalise all draft targets;

 review the NIRA; and

 work with the Productivity Commission’s Indigenous Commissioner to develop an independent, Aboriginal and Torres Strait Islander-led approach to the three-yearly comprehensive evaluation and review of progress nationally and in each jurisdiction.

One of the lessons governments have learned over the last ten years is that effective programs and services need to be designed, developed and implemented in partnership with Aboriginal and Torres Strait Islander peoples. We must place collaboration, transparency, and accountability at the centre of the way we do business with Aboriginal and Torres Strait Islander Australia. Working in genuine partnership with Aboriginal and Torres Strait Islander peoples is fundamental to Closing the Gap.

All governments are committed to broadening and deepening their partnerships with Aboriginal and Torres Strait Islander peoples and communities over the lifetime of the refreshed agenda. This includes strengthening mechanisms to ensure Aboriginal and Torres Strait Islander peoples have an integral role in decision making and accountability processes at the national, regional and local levels, building on existing arrangements and directions within different jurisdictions.

To guide the development of Commonwealth, state and territory action plans by mid-2019, COAG has endorsed a set of Implementation Principles informed by Aboriginal and Torres Strait Islander communities:

Shared Decision-Making – Implementation of the Closing the Gap framework, and the policy actions that fall out of it, must be undertaken in partnership with Aboriginal and Torres Strait Islander peoples. Governments and communities should build their capability to work in collaboration and form strong, genuine partnerships in which

Aboriginal and Torres Strait Islander peoples can be an integral part of the decisions that affect their communities.

Place-based Responses and Regional Decision Making – Programs and investments should be culturally responsive and tailored to place. Each community and region has its own unique history and circumstances. Community members, Elders and regional governance structures are critical partners and an essential source of knowledge and authority on the needs, opportunities, priorities and aspirations of their communities.

Evidence, Evaluation and Accountability – All policies and programs should be developed on evidence-based principles, be rigorously evaluated, and have clear accountabilities based on acknowledged roles and responsibilities. Governments and communities should have a shared understanding of evidence, evaluation and accountability.

Targeted investment – Government investments should contribute to achieving the Closing the Gap targets through strategic prioritisation of efforts based on rigorous evaluation and input from Aboriginal and Torres Strait Islander communities, especially as it relates to policy formation, outcomes and service commissioning.

Integrated Systems – There should be collaboration between and within Governments, communities and other stakeholders in a given place to effectively coordinate efforts, supported by improvements in transparency and accountability.


In 2008, COAG agreed to the NIRA to implement the Closing the Gap agenda. In signing the agreement, governments acknowledged that a concerted national effort was needed to address Aboriginal and Torres Strait Islander disadvantage in key areas.

At the time, Closing the Gap was the most ambitious commitment ever made by governments to improve outcomes for Aboriginal and Torres Strait Islander peoples. However, the agreement was negotiated with little to no input from Aboriginal and Torres Strait Islander peoples, and without an adequate understanding of the mechanisms and timeframes needed to deliver lasting change. It also perpetuated a deficit-based view that framed Aboriginal and Torres Strait Islander policy as a series of responses to disadvantage and inequality, and under-emphasised the strength and agency of Aboriginal and Torres Strait Islander peoples.

While some progress has been made to improve outcomes for Aboriginal and Torres Strait Islander peoples with respect to life expectancy, child mortality, educational achievement, employment and early childhood education, only three of the seven current targets were on track at the agreement’s ten-year anniversary in 2018. There is a shared view among Aboriginal and Torres Strait Islander peoples, the broader Australian community and Australian governments that we must do better.


Public engagement on the Refresh has been led by the Commonwealth at the national level, and by states and territories at the local and regional levels.

COAG Public Discussion Paper and Consultation Website:

In December 2017 the COAG public discussion paper and Closing the Gap Refresh consultation website were launched, with the website open for feedback and submissions from the public until the end of April

  1. Feedback from the website, including over 170 major submissions, was collated and used to inform the technical workshop process and COAG’s consideration of target areas for the next phase of the agenda.

Special Gathering of Prominent Aboriginal and Torres Strait Islander Australians:

In February 2018, COAG leaders agreed that the priority areas identified in the statement of the Special Gathering would form the basis for remaining community consultations on the Refresh. The Special Gathering priority areas were tested in the national roundtables and other engagement processes led by the Commonwealth from February 2018 and have been strongly supported by stakeholders.

Consultations: The Commonwealth held 18 national roundtables in state capitals and regional centres across the country, ending with a national peaks workshop in Canberra in April. Roundtables sought feedback from participants on the priorities identified in the Special Gathering statement. Over 1,000 people were directly engaged through the meetings and roundtables hosted by the Commonwealth in this first phase of public engagement.

In May and June 2018 the Commonwealth hosted a series of technical workshops to develop potential targets and indicators for the refreshed agenda. The workshops brought together academics, business and Aboriginal and Torres Strait Islander community experts and data custodians with Commonwealth and state officials in a co-design process structured around the Special Gathering priority areas. The first technical workshop in May was attended by officials from all jurisdictions and over 70 subject matter experts, including representatives from Aboriginal and Torres Strait Islander organisations and communities, academics and practitioners. A similar number attended the second technical workshop in June, which had a stronger emphasis on data issues and technical design.

A second series of national roundtables were conducted to test the analysis arising from the initial consultations, submissions and technical workshops. This phase of consultation sought to return to stakeholders who had previously been engaged in the process or lodged submissions to the public consultation website, including members of the Redfern Alliance, national peak bodies, national service providers, and other individuals and organisations. The outcomes of this phase of consultations were fed into discussions between governments in the lead up to the COAG meeting in December 2018.

States and territories held consultations over the same period to ensure views from across the country were heard and incorporated into the Refresh.

All governments remain committed to engaging with Aboriginal and Torres Strait Islander Australians and other stakeholders to finalise and implement the Closing the Gap Refresh

National Aboriginal Community Controlled Health Organisation (NACCHO) and peak bodies welcome #COAG announcement to a formal partnership approach to the #ClosingtheGap Refresh #RefreshtheCTGRefresh

“ COAG’s commitment to a genuine formal partnership approach between the government and Aboriginal and Torres Strait Islander peoples on the Closing the Gap strategy is a welcome step in the right direction

This is something that we’ve long campaigned for – because involving Aboriginal and Torres Strait Islander people in decisions that affect their lives will lead to far better outcomes.

We as a sector are looking forward to working with the Prime Minister and COAG to negotiate and agree the refreshed framework, targets and action plans which will be finalised through the committee by mid-2019.

We are pleased that the Prime Minister and COAG have finally recognised that Aboriginal and Torres Strait Islander people must play an integral part in the making of the decisions that affect their lives – and it’s the only way forward to closing the gap.”

NACCHO Chief Executive Officer Pat Turner AM see COAG full communique Part 1 below

Pictures above and below taken in PM office last Thursday 6 December meeting the peaks

Download full COAG communique HERE

COAG Communique 5 Pages 12 December

The National Aboriginal Community Controlled Health Organisation (NACCHO) has today welcomed COAG’s announcement to a formal partnership approach to the Closing the Gap Refresh.

Following the tireless campaigning from NACCHO and other Aboriginal and Torres Strait Islander peak bodies across Australia, Prime Minister Scott Morrison last week agreed to a full partnership approach between Indigenous people and governments to agree the Closing the Gap framework and targets and to put it to COAG for their consideration.

Before the Aboriginal and Torres Strait Islander peak bodies intervened, COAG was due to settle a new Closing the Gap framework and targets without the full involvement and agreement of Aboriginal and Torres Strait Islander people through their representatives.

The details of formal partnership between COAG and Aboriginal and Torres Strait Islander peoples will be settled in February 2019. It will include a Ministerial Council on Closing the Gap with expanded membership to include representation from COAG and Aboriginal and Torres Strait Islander peoples through their peak bodies.

Part 1 Closing the Gap COAG Communique

Press Conference at close of COAG today

COAG is listening to Aboriginal and Torres Strait Islander peoples, communities and their peak and governing bodies. Leaders are committed to ensuring that the finalisation of targets and implementation of the Closing the Gap framework occurs through a genuine, formal partnership between the Commonwealth, state and territory governments and Aboriginal and Torres Strait Islander people through their representatives.

This formal partnership must be based on mutual respect between parties and an acceptance that direct engagement and negotiation is the preferred pathway to productive and effective outcomes. Aboriginal and Torres Strait Islander peoples must play an integral part in the making of the decisions that affect their lives – this is critical to closing the gap.

Today, COAG issued a statement outlining a strengths based framework, which prioritises intergenerational change and the aspirations and priorities of Aboriginal and Torres Strait Islander peoples across all Australian communities.

The finalisation of this framework and associated draft targets will be agreed through a formal partnership.

Governments and Aboriginal and Torres Strait Islander representatives will share ownership of, and responsibility for, a jointly agreed framework and targets and ongoing monitoring of the Closing the Gap agenda. This will include an Aboriginal and Torres Strait Islander-led three yearly comprehensive evaluation of the framework and progress.

The arrangements of the formal partnership between COAG and Aboriginal and Torres Strait Islander representation will be settled by the end of February 2019, and will include a Ministerial Council on Closing the Gap, with Ministers nominated by jurisdictions and representation from Aboriginal and Torres Strait Islander peoples.

The framework and draft targets will be finalised through this Council by mid-2019, ahead of endorsement by COAG. A review of the National Indigenous Reform Agreement will be informed by the framework.

Joint Select Committee on Constitutional Recognition

COAG acknowledged the release of the Report of the Joint Select Committee on Constitutional Recognition and endorsed the concept of co-design recommended by the Committee.  COAG looks forward to discussing the work on co-design at its next meeting.